reference; in serious attacks it may give immediate warning that the
physician is required; and even while the doctor is in attendance
he often wishes observations regarding the temperature to be
taken several times a day, in his absence, for his guidance and
information. Following are a few illustrations of the uses to which
the clinical thermometer may be put by any intelligent person. The
natural temperature of the human body is 98·4°F. and the little arrow
on the thermometer indicates this normal degree of heat, so that when
the index rests at the arrow, the natural temperature is proved to be
present. It is the variations above or below the arrow that mark the
presence of disease.
The agony of colic is well known, but it is generally of little
danger in the absence of inflammation. In peritonitis (inflammation
of the bowels), the temperature runs quickly up to over 101° F.; in
colic it scarcely rises more than a degree, if even thus far, above
the natural temperature. A severe pain in the side causes pleurisy
to be suspected. If the temperature is normal, there is no pleurisy,
and the pain is probably neuralgic. Diarrhœa may continue for a few
days, and the patient feels so out of sorts that typhoid fever seems
to have set in; but all the specific forms, such as typhoid, typhus,
scarlet fever, diphtheria, or measles, are accompanied by such an
increase of body heat as will probably send up the record to 101°
F., or possibly 3-4° higher. A child with persistent vomiting, sore
throat, and high temperature will probably in a day or so show the
rash of scarlet fever. In any case, when a temperature remains above
100-101° F. for more than 1-2 days, without obvious cause, the doctor
should be consulted. If the child has disordered stomach or sustained
a chill, the thermometer will record fever; but, after a purgative
in the one case and a tepid or hot bath in the other, the increased
heat will be found to be gone, and with it any alarm which may have
been felt. In the course of an inflammation or fever, the friends
can be informed by the medical man what degree of heat he expects,
and should this be exceeded the doctor should be informed of the
fact. Indeed the clinical thermometer is invaluable, especially to
families at a distance from their medical adviser. It can be obtained
from any instrument maker for 7_s._ 6_d._-12_s._ 6_d._, or more. Its
application is a very easy matter. The bulb containing the mercury
should be placed in the mouth or arm-pit; care should be had in the
last case that clothes do not intervene between the instrument and
the arm, and that it is so placed in the arm-pit as to be completely
surrounded by skin. The patient must then press the arm gently to the
side so as to retain the instrument, and in 5 minutes the thermometer
will show the body’s temperature.
Dollond, 1 Ludgate Hill, London, E.C., sells an improved Lens
Clinical Thermometer. The importance of the “lens” front cannot be
over estimated, for with such a thermometer there is no difficulty in
reading off the temperature even in the dull light of a sickroom, for
the thin thread of mercury is magnified quite twenty times its size.
This thermometer is made with a contraction in the tube near the
bulb, which prevents the mercury returning, until shaken down. The
price of this thermometer is 7_s._ 6_d._
W. H. Harling, 47 Finsbury Pavement, London, E.C., is the maker of an
excellent clinical thermometer with lens front, which registers the
temperature in the space of a single minute. It is furnished with a
metal case having a bayonet fastening, and costs only 8_s._ 6_d._ The
same maker supplies also ordinary clinical thermometers, in cases, at
prices ranging from 3_s._ 6_d._ upwards. Other sickroom requisites
are noticed on p. 1007.
When used to take the temperature of patients suffering from
infectious disease, the thermometer should be disinfected by being
washed in “Sanitas” or carbolic acid solution after each time of
using. In taking the temperature under the tongue, the index should
be “set” as directed, and the bulb should be placed as far back under
the tongue as convenient and agreeable; the mouth should then be kept
shut, and the patient should breathe through the nose: 3 minutes are
sufficient for taking the tongue-temperature. In the arm-pit the
thermometer should be left for 5 minutes and the fore-arm should be
made to lie across the chest, so that the thermometer may thus be
made to rest in a sheltered position.
Temperatures should be taken in ordinary cases at 8 A.M. and 8 P.M.;
2 o’clock is a convenient hour for a third observation. Variations
in temperature occur in healthy persons, but such change does not
usually amount to more than 2° or 3° F. What is to be regarded as
deserving of attention under the ordinary circumstances of life
is a fall below 97°, or a rise above 99·5°. In fevers, as a rule,
the temperature does not rise above 106°; but in fever a heat of
108°, continuing even for a very short time, would be regarded as
a most dangerous symptom. A very high or very low temperature must
be looked upon as dangerous; should it be excessive either way, the
case will probably prove fatal. A very sudden change is suspicious,
and very frequently dangerous. In children, however, the presence
of indigestible food in the intestinal canal may suffice to cause
a rapid rise in the temperature. After the temperature has been
stationary for some time, or has commenced to fall, a fresh rise
may herald the advent of some complication, or the approach of a
new disease. An unexpected fall may denote hæmorrhage, exhausting
diarrhœa, or the perforation of the peritoneum or pleura (lining
membranes of the abdomen and chest). A considerable rise during the
course of a disease which is not generally regarded as febrile--viz.,
in tetanus, epilepsy, and cholera--usually precedes death.
_Making a Medical Coil._--Procure a well-seasoned walnut board about
21½ in. long, 3 in. wide, and ⅜ in. thick. From this cut one length
12 in. long for the base board _a_, and 3 pieces 3 in. square (like
_b_) for the coil heads; when cut, a fillet 8 in. long must be nailed
or screwed on the two sides of the base board (as shown in _a_);
these fillets should be ¼ in. square section. Corresponding square
nicks must be cut of two of the square heads (as shown at _x_ in
_c_). All the woodwork when thus squared and finished should be
soaked for ¼ hour in melted paraffin wax, and then rubbed dry while
still warm.
Obtain a thin brass tube (known in the trade as “triblet tubing”)
about ½ in. diameter, 4½ in. long; turn up a short plug and button to
fit one end of this tube and serve as a handle (see _d_). This may be
fastened to the tube by driving in 3 fine brass brads, and filing off
the heads flush with the tube.
[Illustration: 109. Home-made Medical Coil]
Cut up about 100 lengths of straight iron wire (best soft annealed)
No. 22 gauge, say, about 4½ in. in length; fill the brass tube with
them as tight as you can fit them; cut them all to the same length
(they must protrude a little beyond the tube). Now draw out about 2
in. of the iron bundle and wrap it tightly round with twine, leaving
about ½ in. free. Draw more out, and continue wrapping until you have
wrapped to within ½ in. at each end of the bundle. Tie the string,
and withdraw the bundle from the brass tube. Melt a little solder in
a ladle, dip the ends of the iron bundle into soldering fluid (zinc
dissolved in hydrochloric acid), and then at once into the melted
solder. Allow the bundle to cool; file off the superfluous solder,
so that the bundle will just enter freely into the tube. It should
appear like _e_ when the string has been removed.
The next operation is to make a good stout paper tube, also about 4½
in. in length, into which the brass tube _d_ can slide easily. To
make this, put a few turns soaped writing paper round the tube No.
1, then roll and glue seven turns of good stout brown paper, 4½ in.
in length, round this writing paper, or else it will be difficult
to draw out the tube. This paper tube _f_ must be allowed to dry
thoroughly while still on the brass tube _d_. When quite dry, it must
be slipped off, the writing paper lining drawn out, and then it must
be soaked for a few minutes in melted paraffin wax.
The iron bundle should also be allowed to stand in melted paraffin
wax for some time, and then stood up to drain in a warm place. This
will prevent rusting. When quite cold, all superfluous paraffin
having been removed, a strip of brown paper, ½ in. wide, is rolled
round one extremity of the iron bundle, until it is of such a
diameter as to fit tightly into the paper tube _f_. This paper strip
must be cut off at this point and glued tightly round the end of the
iron bundle. The brass tube _d_ is then slipped over the iron bundle
until it just reaches the little paper collar just made. The brass
tube and bundle together are pushed, button end first, into the paper
tube _f_; and when the paper collar round the iron bundle is just
about to enter the paper tube, it is to be well served with hot glue
and forced into the tube. The whole must now be allowed to dry and
set thoroughly.
Taking one of the 3 in. heads (the one which has not any nicks in
the sides), bore a centre hole with a brace and centre bit, just
large enough for the paper tube _f_, with its iron core, to fit
tightly (see _b_). Putting a little thin good hot glue round the
free extremity (the end opposite to that at which the brass enters),
push it into the hole in the square head, until it projects about ⅛
in. on the other side. This must be allowed to dry thoroughly before
proceeding to the next operation.
Now proceed to wind the primary coil. To this end, take about ½ lb.
No. 24 silk-covered copper wire, and wind it round the tube, as shown
at _g_, from end to end, in continuous layers, taking care to put
a sheet of paraffined paper between each layer, and also to baste
each layer with melted paraffin wax before winding on another. About
4 layers will thus be got on, and an even number of layers must be
aimed at, so as to get the 2 ends of the wire at the same extremity,
and able to fasten them under the binding screw _y_. To effect this,
before screwing down the said screws, the ends of the copper wire
are stripped of their covering and wound once round the screw of the
binder. Free ends of wire, at least 6 in. in length, must be left for
attachments, &c. This is shown at _h_.
This primary coil, with its iron core, sliding brass tube regulator,
&c. may now be fastened to the base board by means of 2 screws from
underneath, as shown at _i_, at 4 in. from one end, and therefore
8 in. from the other. One of the free ends of the primary wire is
brought to one of the binding screws _v_, while the other connects to
the clapper _z_. A short piece of wire connects the platinum screw
pillar _w_, to the other binding screw, which is not visible, as it
is behind the platinum pillar. At this point it will be well to try
the working of the primary coil. For this purpose, couple up the 2
binding screws on the base board with a good bichromate cell. Connect
the two binding screws _u_ in _i_, with the 2 brass handles intended
for use. Screw up the platinum screw _w_ till the clapper _z_ begins
to vibrate. Now hold the handles in your hand. As long as the brass
tube _j_ is entirely over the iron core, little or no sensation is
perceptible. If an assistant pulls out the tube, little by little,
the current will be found to increase in strength until the regulator
tube is quite out.
The secondary coil now demands attention. A paper tube, precisely
similar to _b_, but of such a size as to slide easily over the
primary coil _i_ is prepared, and paraffined. This must be cut
exactly the length of the coil _k_, leaving the knob _j_ projecting.
The 2 square pieces of board in which the nicks were cut (_c_) must
then have central holes cut in them to take this paper tube, and
then glued, one at each end of the said tube, as shown. Two small
binding screws are then to be inserted in the centre of the upper
edge of each square. A bung is now placed in each end of the tube,
and a ¼ in. iron rod pushed through both, to serve as an axle. This
is then mounted on 2 standards, as shown at _n_; and beginning by
attaching one end of the uncovered wire to the binding screw _m_,
about ½ lb. No. 36 silk-covered copper wire is now carefully coiled
on, being most diligent in avoiding kinks, breaks, or flaws of every
description. Each layer must be paraffined and separated from its
neighbour by paraffined paper. When the quantum of wire has been
laid on, the finishing end is connected to the binding screw in _n_.
The last coil should be covered with paraffined paper, and finally
covered with a jacket of good silk velvet. The secondary coil is
then complete, and may be slid in its place over the primary coil
_o_. When it is quite over the primary, the secondary current will
be at its strongest, if the metal tube regulator is drawn out; it
will be weaker as the metal tube regulator is more and more inserted;
or may be even more delicately regulated by sliding the secondary
coil itself more or less over the primary. The secondary coil, while
the primary is being excited with a freshly made pint bichromate,
will give a ½ in. spark when the regulator is out and the secondary
coil right over the primary. This will pass easily through a dozen
persons. (S. R. Bottone.)
There are various other sickroom appliances demanded in special
cases which do not require description here. Most may be had of such
well-known firms as Salmon, Ody & Co., 292 Strand, and Savory and
Moore, 143 New Bond Street.
=Feeding patients.=--A nurse should bear in mind these two leading
facts; that while in sickness there is usually a greatly increased
tissue-waste, and consequently an increased necessity for nutriment,
there is almost always a decreased appetite, or no appetite at
all--often such a repugnance to food that, if left to himself, the
patient would prefer taking none at all. Hence, although the medical
attendant may decide what is the most suitable form of nourishment,
on her devolves the more difficult task of inducing the sick person
to take it. With this view, she must exercise all her ingenuity
to tempt and encourage him, by bringing everything in the neatest
possible form. On no pretext whatever should there be any cooking in
the sickroom; nor should she take her own meals there; nor should
any food be left standing near the patient. On the contrary, though
his nutriment must be brought to him frequently--more frequently, of
course, the less he can take each time--and punctually, it should
only be in such quantity as he is likely to consume; and immediately
that is done, everything in connection with food should be removed
from sight and smell until the next time.
The nurse must devote much of her attention to the subject of diet,
observing carefully the patient’s appetite, and attending carefully
to the quantity of food and the effect of it. The sense of taste of
many people is very acute when they are ill, and you must take care
that the spoon in the arrowroot, which looks perfectly clean, does
not taste to the patient of the soup for which it was used last.
Eatables should not be kept in a sickroom: if you are obliged to
have anything within reach, put it under a cover; a tumbler turned
over does very well for biscuits or jelly, and for larger things
a bell glass is useful; tin boxes, the next best thing, generally
make a noise when they are opened. The water given to a sick person
should not only be boiled and allowed to cool, but ought always to be
filtered. It should frequently be changed, as it quickly absorbs the
impurities with which the air of a sickroom is charged, and becomes
injurious, if not dangerous to drink. In cases of faintness, where
stimulants are not ordered, the patient should be made to sip some
liquid slowly; the mere effort of sipping accelerates the action of
the heart.
When solid foods cannot be taken, the best kinds are those which
contain the most nourishing properties in the smallest and most
easily digested form. Prominent among these is well-made beef tea:
not the greasy watery broth which so often goes by that name,
but nearly pure beef juice which has been slowly extracted, with
the addition of little or no water, from fresh lean beef. A good
substitute may be found in Bovril, which has the great advantage
in an emergency of being immediately procurable at a chemist’s or
grocer’s. Home made beef tea takes a long time to prepare properly,
and even then it is deficient in staminal properties, whereas Bovril
contains the entire nutritious constituents of pure beef, of which
it takes 40 lb. to make 1 lb. of Bovril extract. Of equal value is
milk; which, especially when combined with bread and butter, is
very nourishing, and forms a most valuable article of sick diet. If
it seems to disagree, or curdle on the stomach, it can generally
be prevented doing so by the addition of about ⅓-¼ its bulk of
lime-water. These may be varied by mutton broth, chicken or rabbit
jelly, eggs in any form--plain, in custard, or in pudding with
arrowroot and sago--and real turtle soup; which latter is, however,
so terribly expensive as to be outside the reach of most people.
Jellies made with gelatine, which contains scarcely any nutriment,
are almost useless; and tea should be given only as an indulgence
when specially wished for, and then it should be very weak, and with
plenty of milk. All food given to the sick should be very fresh, of
the best quality, and most carefully cooked.
_Boiled Flour Gruel._--Where the illness has been long and tedious,
and the strength reduced, the following will be found very useful:
To prepare the flour, put into a basin as much as it will hold,
pressed tightly down. Then tie a cloth over it, and allow it to boil
hard for 6 hours. Then take off the cloth, and let the flour stand
in the basin till next day, when remove the crust which will have
formed, and put the remainder away in a covered jar. For use, mix 4
tablespoonfuls flour smoothly into a paste, then pour on it ½ pint
boiling milk or water, and boil for 10 minutes, constantly stirring
to avoid lumps. Brandy, sherry, lemon juice or cream may be added,
according to taste. Gruel may also be made from baked flour, but it
is not so easy of digestion.
_Rice Gruel._--1 oz. each rice, sago, and pearl barley boiled in 3
pints water, which, in 2 hours, generally reduces it to 1 qt. Strain
and flavour to taste. This forms a good nourishing diet, especially
with the addition of a little isinglass.
_Onion Posset or Gruel._--This has been found very efficacious for
colds, and is made with Robinson’s groats with the addition only of
an onion, which should have been previously boiled for 6 hours. The
yolk of an egg well beaten is an improvement.
_Chicken Broth._--The younger and fatter the birds are for this the
better. It is made by immersing the legs, neck, and trunk of a fowl
into just as much water as will cover them, and boiling gently for
an hour. The white meat makes a delicious entrée if cut up finely
and treated as a veal mince. Potato flour is useful for thickening
in cases where boiled flour is not handy; but home-made things are
always the best, as the ingredients are known.
_Oyster Fritters._--Remove the beards, and put each oyster into a
tablespoon, and fill with a batter made as follows: 1 oz. rice flour
mixed with 2 tablespoonfuls water, 1 teaspoonful vinegar, and 2 salad
oil, the yolk of an egg, and a little salt and pepper. Allow the
batter to stand, and just before using, beat the white of an egg to a
stiff froth, and mix with it. Fry the oysters covered with the batter
in boiling fat, turn them, place them on blotting paper to drain;
serve on a hot dish, and garnish with slices of lemon, and thin rolls
of brown bread and butter alternately.
_Potato Chops._--Mash nicely with a little milk, butter, pepper, and
salt, any potatoes left from the day before, spread evenly over a
boned loin chop previously sprinkled with finely chopped fried mint.
Fry to a golden brown in boiling fat, then place it on blotting
paper to remove the superfluous grease. Garnish with fresh mint and
watercress.
_Jellies and Creams._--The following recipes were published by Mary
Hooper, in the _Queen_:--
When jellies and creams are ordered for sick people in families
where there is not a good cook, they are usually obtained from the
confectioner; but this is not at all in the interest of the invalid,
and efforts should be made to provide his diet from the home kitchen.
An idea prevails that it is very troublesome to make jelly. It is
not at all necessary to clear the jelly through a bag for invalids,
nor indeed for ordinary domestic use. By a little care in the use
of citric acid, which is perfectly wholesome, a jelly nearly as
bright as that which has been cleared with eggs may be produced.
In some cases, jelly without wine is required for invalids, when
coffee, cocoa, or Seville orange jelly will probably be useful. It is
difficult to make these jellies palatable without making them sweet,
and they will only keep a short time. If the doctor does not object,
or where it is desirable to give stimulants in a disguised form, a
very small quantity of absolute alcohol may be used, and it will
obviate the last-named disadvantages.
Milk jellies, or creams, whenever they can be taken, are an excellent
form of diet, and are very easily prepared by the following recipes.
For those who require a quickly-made cream, “Nelson’s Blanc mange”
will be found very useful; it merely requires to be dissolved in
milk or water, and in a very short time is ready for use. This blanc
mange is made of very rich milk, and tastes equal to that prepared
at home with cream. The unflavoured blanc mange should, as a rule,
be selected for invalids, as any home-made flavour can be added to
it. These flavourings--lemon, Seville orange, almond and vanilla--are
very easily prepared by infusing any of the three first-named in gin,
the latter in brandy. As these are more digestible than any which can
be bought, it is well worth while to take a little trouble in the
matter. It is sometimes necessary to tempt the appetite of an invalid
by a pretty looking dish, which is also nice and nourishing. Such a
dish can be easily made by the recipe for Alexandra Cream.
Simple Jelly.--Soak 1 oz. gelatine in ½ pint cold water for 1 hour or
more. It is an advantage to soak gelatine overnight when convenient,
because it is then more easily dissolved. Boil 6 oz. lump sugar in
1 pint water, skimming it until clear; then throw in the soaked
gelatine, let it boil slowly for 5 minutes, removing all scum as it
rises. Dissolve in a basin ¼ oz. citric acid, in lump, in ½ gill
boiling water, pour the jelly on to this, when more scum will rise,
which should be carefully taken off. Now add 1 gill wine and a little
lemon flavouring, and, when nearly cold, put the jelly into a mould.
Lemon juice can be used instead of the citric acid, but the jelly
will not then be so bright.
Cocoa Jelly.--Mix 1 dessertspoonful cocoa in ½ pint water, stir
over the fire until it boils, sweeten it with ¼ lb. lump sugar, or
according to the taste of the patient. Stir into it, whilst boiling,
½ oz. gelatine, soaked in ½ pint cold water for some hours, flavour
with vanilla, and stir occasionally until the jelly begins to set.
Coffee Jelly.--Soak ½ oz. gelatine in ½ pint cold water, dissolve it
in ½ pint very strong coffee, sweetened to taste. Extract of coffee
can be used to flavour this jelly, and answers well.