barley-water, mixed in equal quantities with the milk, will make
it agree, by lessening and softening the curd; sometimes the whey
of the milk, separated from the curd by rennet, and made richer by
adding 1 part cream, which contains no curd, to 4 of the whey, makes
a digestible food. Sometimes it is necessary to feed for a day or two
on rice water, with the boiled rice pounded and mixed in it; but such
cases are serious, and demand medical advice.
When a child has cut most of its front teeth--that is to say, towards
the end of the first year, it may be given once a day a meal of a
meat broth with barley in it, or of gravy and bread crumbs. The broth
should be made by cutting up the meat finely and letting it stand
for 2-3 hours in cold water and then boiling it. At about the same
time, or a little later, a lightly-boiled (much better raw) egg may
be used instead of the broth, once or twice a week; or a well-boiled
mealy potato, carefully mashed and mixed with good meat gravy. No
solid meat food should be given to a child under 2 years of age, nor
until it has cut all its teeth, for the simple reason that until
its back teeth are ready for use, it is unable to masticate such
food so as to prepare it to be digested in the stomach. After this
a little meat well-cooked may be given to a child occasionally; but
it should not form part of its every-day food. It is a great mistake
to give weakly and delicate children much animal food; for the first
3 years, the less they have the better. The best food is not that
which contains most nourishment, but which is best adapted to the
digestive organs. Whenever animal food is given, it should be minced
very fine, or bruised in a mortar, to make up for non-mastication.
Bread-and-butter, oatmeal porridge, milk, rice, and light puddings
should form the staple diet. Avoid stimulants, tea, cakes, and
pastry. The plainer and simpler the food, the stronger and healthier
will be the child. Compel children to eat slowly; and only allow them
to eat at meal times.
_Teething._--The number of first or milk teeth which a child gets is
20; they come in regular order, and at definite intervals; 8 front
teeth, 4 above and 4 below, called “incisors”; eye teeth, 2 above
and 2 below, called “canines”; and 8 back teeth, 2 above and 2 below
on each side, called “molars.” The order in which they ought to come
is:--the two lower middle incisors at about the seventh month, seldom
earlier; followed in a few weeks by the 2 upper middle incisors;
almost immediately afterwards, the other 2 upper incisors, one on
each side of the middle ones; a week or two later, the two other
incisors in the lower jaw come through, so that all the incisors
generally appear before any of the other teeth, and, being smaller
than the others, are generally cut without much trouble; by the end
of the tenth or eleventh month, after an interval of about 2 months,
the first 4 molars appear, and occupy 2 months, more or less, in
making their way through the gums; after another interval of 2-3
months, the eye teeth begin, and are fully cut by the end of the
eighteenth or twentieth month; this is followed by another period
of rest, after which the 4 back molars come, and soon after the end
of the second year the first dentition is complete. Teething is a
natural process; but the period in which it is going on is a time
of change from one mode of living to another, so that when a child
is teething, it requires more than ordinary care. Its bowels must
be kept in good order, rather too loose than too confined; give it
abundance of fresh air, and avoid changes of diet just when the teeth
are coming through; cooling drinks of milk and water, or barley
water, are useful to allay the thirst, and cool the hot mouth;
warm baths at night relieve feverishness which is often present;
if the gums are swollen and inflamed, a touch of the lance will be
productive of great relief. While the teeth are “breeding” in the
gums, the irritation may be reduced by gently rubbing them, or by
giving the child a crust or indiarubber pad to bite; but shortly
before they break through the gum the mouth is so tender that the
child will allow nothing to go near it, and it is just at this time
that lancing is of most service.
_Illness._--Infantile disorders within the range of domestic
medicine are chiefly diarrhœa and constipation. The former, in
a suckled child, will probably be due to the condition of the
mother, who should carefully regulate her own bowels, taking a
simple aperient, like castor oil or rhubarb if necessary. Diarrhœa,
with bottle feeding, may arise from sour food: boil the milk, mix
it with barley water instead of water, make it weaker, and add 2
tablespoonfuls lime-water or a few grains soda bicarbonate to every
½ pint food. See that cold to feet or body is not the cause. For
constipation, generally occurring in bottle-fed infants, reduce the
food, omit lime-water, and change one meal a day from milk to thin
oatmeal gruel. Avoid medicines, except perhaps 30 gr. manna in 1
tablespoonful distilled water, or 1 tablespoonful fluid magnesia in
the food of one meal for a day or two, or castor oil if a severe
case. Gentle injection of a little warm water is an excellent thing
in stubborn cases. Vaccination is a paramount duty hardly requiring
mention. Especially beware of chills during convalescence. Exposure
to cold after scarlet fever brings dropsy and kidney diseases, and
consumption and bronchitis follow whooping-cough and measles.
Medicines kept should be under lock and key, for obvious reasons. The
following may be found useful:--Ipecacuanha wine and powder, say of
the former 2 oz. and of the latter 1 dr.; grey powder, 1 dr.; castor
oil 6 oz.; antimonial wine, 1 oz.; sulphate of zinc, 1 dr.; fluid
magnesia, 6 oz.; lime-water, by the gallon, if the infant is brought
up by bottle; laudanum or solution of morphia, 1 oz.; Bow’s liniment,
or camphor liniment; spongio-piline, for application of fomentation
or as a poultice. Lint, oiled silk, and gutta-percha tissue, with 6
oz. carbolic lotion, strength 1 to 40. These are mostly for use by
the medical attendant; amateur doctors should restrict themselves to
giving a dose of castor oil or fluid magnesia.
_Moral Training._--Why do women intrust their young children to the
care of low-minded ignorant girls, when least able to take care
of themselves, yet exercise so much caution to prevent familiar
intercourse with servants and inferiors in later youth? With proper
treatment, plenty of well-bred and well-educated girls could be found
to take nursemaids’ places, to the great advantage of both children
and nurse. Obviously, no girl who is not fit to be a companion, an
intimate companion, of the mother, is fit to be the guardian and
guide of that mother’s children. The nursemaid should be a girl or
woman of culture, and not be expected to do anything menial. Early
training of children is of great importance. Be with them as gentle,
loving, and patient as you can be, but at the same time be firm.
Never deceive a child, and never let it weary you into granting a
request you have once refused as injudicious. Teach it from the
first to bear and to forbear, to obey at once, and to be courteous;
the little wretch who snatches anything he fancies, and howls like
a monkey if crossed is a pitiable little object, the victim to his
parents’ folly, who were too selfish to give themselves the trouble
and vexation of training him.
Never allow children to be rude and unceremonious to each other
because they are brothers and sisters. Be extra careful of your
language and manners before children. Never lose your temper with
them, never frighten them, and above all things do not strike a
child on the head; there is a certain portion of the body especially
intended by nature for receiving castigation. Never flatter nor pet a
child, nor allow self-admiration to grow upon it. Reduce children’s
parties to sensible hours--3-7 for the little ones, and not later
than 9 for the older ones--and provide more sensible amusements and
less empty show and finery. Dancing, magic-lanterns, shadows, and
scores of simple games will occur to every one. Avoid all toys which
are painted or gaudily coloured.
One word about foreign nurses. They are often engaged with the
object of early commencing the acquirement of a foreign language,
generally French. But it must not be forgotten that the class of girl
obtainable as a nurse is not likely to be capable of teaching the
refined language or accent. These nurses may be engaged through the
International Institution, 69 Berners Street, London, W.
_THE SICKROOM._
=The Room.=--The rules which apply to dwelling rooms generally have
a double importance in the case of the sickroom. The sanitation,
ventilation, warming, and lighting, all demand extra care and
attention. A southern aspect is preferable to any other; the
room should be cheerful, spacious, and lofty, and subject to the
invaluable effect of sunshine. It would be desirable for all houses,
even of moderate size, to have some one corner suitable for a
sickroom. If space admits of such a room being entirely isolated
from the rest of the house, so much the better; but much may be done
by securing two rooms opening into each other, with hot and cold
water supply within easy reach, and a closet properly placed. When
necessary, the room should be kept clean by dusting with a damp
cloth, rubbing the floors in the same way.
Ordinarily, the chimney is the best ventilator, especially when the
fire is burning, which increases the upward draught. Never stuff up
chimneys: and except in very warm weather, always keep a fire in
the sickroom. It is not always easy to maintain at the same time
proper warmth and ventilation. But as a person is not liable to take
cold when well covered up in bed, a little of the window may almost
always be kept open, without fear of its doing harm, especially if a
piece of fine gauze be gummed or tacked across the opening so as to
break the force of the entering air. In ordinary sickness the best
temperature is 62°-70° F. It should not be allowed to vary much,
and as feeling is often deceptive, it is always advisable to keep a
thermometer in the room.
For the removal of slops, the ordinary paraphernalia of the housemaid
should be completely excluded from the sickroom, as both noisy and
disgusting. All vessels when used, instead of being put under the
bed, must be immediately removed and emptied outside, and brought
back carefully rinsed, and, when necessary, deodorised with a little
Condy’s fluid. Allow no confusion of medicine bottles, soiled
glasses, spoons, and such matters about the room: those in immediate
use should be kept arranged ready to hand; all others should be
removed.
Even with the greatest care fires will burn down low, and it is
necessary to have some means of restoration at hand. Few people know
how valuable wine corks are for this purpose; they should always be
saved, and a few kept in a corner of the coal basket. Orange and
lemon peel likewise, when well dried, make capital fire revivers;
and rather than that the fire in a sickroom should be allowed to go
out, use a lump of white sugar or a sprinkling of brown, which will
create in a moment a bright flame and revive the dying embers. Employ
a pointed hard wooden stick instead of a poker; it makes so much less
noise. Let a basket take the place of the coal-scuttle, and let its
contents consist of fair-sized lumps, about as big as a French roll;
a housemaid’s glove should be at hand to put these on with. This is
the provision for the day. For the night small paper bags, such as
fruiterers use, should be filled with about 1 lb. of small coal. This
does not burn so fast or make so much flame as the lumps, whilst the
feeding of the fire by these means divests the process of noise.
As little furniture as possible should encumber the room. No
foot-stools, boxes, or baskets should be in the way, to be tripped
over; no knick-knacks crowded on tables or mantelpieces to harbour
dust, take up room, or tumble down with a crash. Various forms
of sickroom furniture, adapted for confirmed invalids and serious
surgical cases, are made by Alfred Carter, 97 Holborn Viaduct, and by
Robinson and Sons, Ilkley, Yorkshire, whose catalogues will be worth
getting.
Of carpets, the less the better; but if any are used, mere strips or
rugs are best, as they are easily taken up and shaken, or cleaned.
Curtains should be got rid of, especially if of woollen or stuff;
cotton and linen should be used for any sofa or chair coverings.
Windows should be made to open easily from both top and bottom,
whilst some contrivance is necessary to prevent any rattling noise
from either window-frames or outer blinds. Venetian blinds, imperfect
at the best, are quite unsuitable for a sickroom, being always noisy,
and sure to admit alternate rays of light. Nothing wakes many people
so quickly as light--a mere crevice unprotected is often enough. In
the evening, be sure that the light of the lamp or candle does not
fall in the patient’s eyes; there is nothing more distressing. Gas
in a sick room is not healthy; a Queen’s reading-lamp, with a green
shade, is pleasant for a stationary light, and a candle for moving
about.
Real quiet is of paramount importance. Even “noiseless” crockery can
now be obtained. The principle adopted is that of noiseless tyres to
wheels, made of rubber, such tyres being fitted to the bottoms of the
jugs, basins, &c.
One thing that would give great pleasure to many a bedridden sufferer
is a looking-glass--sometimes two may, from the position of the bed,
be necessary--fixed so as to reflect all the passers-by, or to show
a patch of bright flower garden, bringing some of the outside life
into the sickroom. Ferns growing beneath a bell glass, where they
need no care or attention after they are once planted, may also be
introduced. Plants in pots and cut flowers will occur to every one;
it only remains to observe that growing plants, for their own sake as
well as for the patient, should be moved out of the room at night,
and that cut flowers from the side of a fever patient must be burnt
in the room when they are dead, and not carried into any other part
of the house.
=The Nurse.=--The _Lancet_ insists that there is no more excuse for
a nurse making a “guy” of herself than for her being decked out in
vulgar finery, with her hair got up after an elaborate style which
it would take her half the day to arrange. Print dresses of pretty
pattern, or grey alpacas, according to season, with a light white
cap, linen cuffs and collars, scrupulously white and clean, and a
coloured neck ribbon, would be infinitely preferable to the black
costumes of the sisterhoods. The heavy woollen dresses worn by some
sisterhoods are not all that is desirable in a sanitary point of
view. They do not “show dirt,” it is true; but it would be better
if they did; and in their folds it is not impossible that germs of
disease may be carried about. It may be laid down as a rule that
nothing in a nurse’s dress that rustles, creaks, flaps, or catches
can be in place. It is evident that this rule forbids silk dresses,
stiff stays, trailing robes, and ornaments that are likely to throw
things down. High heels are, of course, quite out of the question,
as is any fashion which interferes with easy movement on the part of
the nurse. Quietness, softness, usefulness are the points to be aimed
at in the costume of a nurse; and if brightness can be given by a
ribbon, the brightness may well be superadded. A nurse should wear no
rings, and her nails should be kept cut very close. The sleeves of
her dress should admit of being turned or rolled up above the elbow.
Never think any change in the patient’s manner or appearance too
trifling to tell the doctor of it. Unimportant as you may deem it,
it may be the very symptom he is watching for. Tell the doctor
everything fully and truly, and above all, obey him implicitly. Never
act against his orders, or tamper with them in any way. If you think
any change in treatment judicious, ask his opinion first before
trying it, but do not do things unknown to him. In this watchfulness
and strict obedience lie the chief difference between professional
and amateur nursing, and also too often the great advantage gained
by employing the former over the latter. The several symptoms should
be written down by the nurse from time to time on a slip of paper,
always at hand, for the doctor.
Always save whatever has been vomited by a patient for the doctor to
see, and be able to give information as to when the vomiting took
place, whether directly after food or liquid had been taken, or not;
notice whether there was much straining or retching before actual
vomiting occurred, also if it was preceded by pain, and the situation
of the pain. Remove the vomit from the room immediately.
In the case of coughing, observe whether it comes on in paroxysms, or
is incessant; whether it is dry and hard, or moist and accompanied
with expectoration; whether it is worse at any particular time, and
is attended with pain. If there is expectoration, this should be kept
for the doctor’s inspection. If blood is brought up, note whether it
is coughed up, vomited, or brought up from the back of the throat or
mouth; remark whether the expectoration adheres to the side of the
spitting-cup, or flows easily.
The number of times the bowels are moved in the 24 hours must be
noted, and whether the motion is attended with pain, griping, or
straining; also the colour of the motion, and, if the patient
passes worms, whether they are round or flat, tape, or small and
thread-like. Note in what quantities urine is passed; also how often,
whether with any discomfort or pain either before or after, its
colour and consistence, and if there be any deposit, its colour also.
Do not forget to give messages of inquiry, as sick people think
much of such kindnesses. Do not read letters out without reading
them to yourself first; you may come upon some passage about the
patient that you do not care to repeat, and your hesitation will
make him anxious and uncomfortable. In convalescence books are often
a difficulty, and require most careful choosing. Something not
exciting, but thoroughly amusing, is generally the best thing--the
lightest novel you can find. In any case, be careful not to read too
long at a time; the strain of listening and attending is very tiring.
In extreme weakness, when there is nothing to be done, say something
from time to time to take off the sense of loneliness, but do not ask
unnecessary questions or touch your patient--it is very tiring; and
never at any time lean against the bed and shake it, and do not put
anything heavy over the patient’s feet; the weight tires, and a hot
bottle warms much more effectually.
Remember that the process of settling for the night takes a long
time, and be sure to begin early. Some people sleep better in the
first part of the night, and you should notice the hour at which the
patient gets sleepy, and arrange accordingly; if kept awake long past
that hour, a restless night will be the consequence. It is never wise
to wake the patient, even to give medicine, except by the doctor’s
orders. You should have a small tray arranged with all the things you
are likely to want in the night, except medicines. By means of the
judiciously-placed screen, anything that has to be brought in can be
quietly handed over the top without a sound. Door-hinges and handles
should be carefully eased and oiled.
Real quietude means the absence of all excitement, and it must be
remembered that anything out of the common will tend to excite the
mind of a sufferer. Do not, therefore, walk on tip toe, for this, in
addition to its unusual elaboration of the gait, invariably causes a
certain amount of creaking. Speak in low tones, but do not whisper.
A whisper will often awake a sleeper who would not be disturbed by
an ordinary conversation; and never say “hush!” Let your clothes
and foot covering be of as noiseless and unobtrusive a character as
possible, and instead of gliding and tottering about like a rickety
ghost, do not hesitate to walk. If you have occasion to say anything
in the room, say it so that the patient can hear it if he wishes, and
do not let him be aware of your conspiring privately with the others,
especially at the door. The door has much to answer for. If it be
visible from the bed, people open it cautiously, put their heads in
and slowly withdraw again. If, as is more frequently the case, it is
screened by the bed curtains, mysterious openings and shuttings are
heard, unattended with any apparent ingress or egress, and _sotto
voce_ colloquies going on outside. When you enter, do so honestly
and at once. Do not spend 5 minutes in turning the handle, thereby
producing a series of irritating little clicks, finally terminating
in a big snap, with which the door flies open. If the latch be at
all rusty, a handle that is slowly wound back in this way will often
stick, and either require to be rattled back in position, or, if left
as it is, may start back suddenly, after a time, of its own accord,
with a report like a pistol shot.
A bracket or table on the landing or in an adjoining room, where
one can keep a basin, water, and a cloth for washing cups, &c., can
nearly always be managed; and even if one has to carry everything up
and down stairs, the comfort to the patient of systematic, dainty
cleanliness more than repays the trouble. Some nurses seem to think
it enough to place anything used outside the sickroom door, trusting
to a chance maid seeing it and carrying it off. But this proceeding
often worries the patient most exceedingly. He or she lies there and
fidgets over the chance of that stray cup being whisked over by a
passing skirt, with an ominous clatter and smash; and though this
probably does not happen, the expectation of it keeps the mind on
tenter-hooks, and prevents needful rest.
Let visitors sit between the door and the patient, getting the
benefit of the air and not between him and the fire, thus getting
in the direct current of foul air rushing towards the fireplace;
they should be well in sight of the patient, and never admitted at
meal times. While talking to the patient it is better to sit by the
side of the bed and as near the pillow as possible, so that you
may converse easily, while your face and body are turned in the
same direction as his. By this means you can make all necessary
observation of his features without enforcing the arrest of his eyes
on your own, which is so embarrassing and disagreeable to one lying
in bed, and is almost unavoidable when facing him. Keep him in as
comfortable a position as possible, by all means, but do not be too
demonstrative in smoothing the pillows and little offices of that
sort. Fidgety attentions will worry and do more harm than downright
neglect.
=The Bed.=--The best kind of bed for the sick is a small iron
bedstead, about 3½ ft. wide and not too high, with firm, level,
spring mattress, and light warm covering, avoiding large heavy linen
counterpanes, which, though oppressively weighty, give but little
heat. It should be placed in such a position as will be most out of
draughts, and at the same time convenient for the nurse in performing
personal services for the patient. It must never have either side
against a wall, nor be between the door and the fire. It is a point
of some importance, especially in cases of long illness, to arrange
the position of the bed so that the sick person can see the fire or
look out of window. A second bed, or hammock, or stretcher on wheels,
is often very useful for shifting the patient on to while airing and
making the other bed.