A sufferer instinctively takes THE POSIT_Mother, Nurse and Infant A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies.

one lung is affected the patient lies on that side, that the healthy one

may have the greater freedom of motion. When there is peritonitis

(inflammation of the bowels), he lies on his back with his knees drawn

up to relax the abdominal muscles. If there is colic alone he may lie on

the abdomen, as pressure may relieve his pain. When a patient has been

persistently on his back, if he turns onto his side it is a sign of

improvement.

Inability to breathe termed ORTHOPNŒA, occurs in affections of the

heart, and also in asthma. Lying quietly in bed is usually a favorable

sign. Restlessness and slipping to the foot of the bed, in low stages of

fever, are bad signs.

Of the uneasy, morbid symptoms, _pain_ is the most important, and most

common. Pain occurs in nearly all inflammations, and it may occur where

there is no inflammation at all.

Bones, muscles, tendons, ligaments, the bladder, the kidneys, the

uterus, all modify in a manner that is peculiar to themselves the pain

that is produced by injury or disease. Such terms as the following are

used to express a peculiar character of pain: It is said to be sharp,

shooting, growing, burning, dull, heavy, tearing, and so on.

If pain is felt in any part when pressure is made upon it the heightened

sensibility is called TENDERNESS, the part is said to be tender. A part

may be both painful and tender, as it usually is if the pain continue

for a time; it may be tender without being painful as it is usually, if

pain continued for a time and then ceased.

Itching is an uneasy sensation allied to pain. It often affects the

natural outlets of the body. It occurs about the rectum from the motions

of little worms that nestle there, and other causes; and this itching of

the rectum, and likewise of the pudendum, are distressing complaints,

harassing the patient continually, preventing sleep and requiring

medical treatment (F. 195). The tingling and pricking often felt in the

windpipe, and provoking coughing, has some analogy to itching.

NAUSEA is sometimes a direct symptom of gastric disorder, at other times

it is a very important indirect result of disease at some distance from

the stomach. The nausea which is so troublesome to pregnant women, is an

instance of a morbid sensation, sympathetic of irritation in a distant

organ.

DIZZINESS or vertigo results sometimes from disease within the head, and

sometimes it is the indirect result of disease of the stomach or of mere

debility.

A sensation of sinking, sensations of weight and lightness, of

drowsiness, tenesmus, strangury, heartburn, and various conditions of

the special senses are mostly SUBJECTIVE SYMPTOMS.

One of the first symptoms of diabetis is a preternatural keenness of

appetite, but in most diseases the appetite is lost or impaired or

perverted.

THIRST is generally great in diabetis, and there is commonly

considerable thirst in inflammatory complaints.

The above named symptoms are mostly subjective, but are accompanied by

others that are objective, that show that the functions of certain parts

are disturbed or suspended; and it is of especial importance to notice

the PULSE, as this is a valuable guide in treating disease.

Each contraction of the heart sends out a wave which distends the blood

vessels, and they by their contractility or elasticity carry it on

through the entire arterial system. This periodical distention is the

pulse.

The PULSE BEATS can be felt wherever an artery approaches the surface;

it is usually taken and counted at the wrist; in children it can be best

taken at the temporal artery during sleep.

To take the pulse accurately place two or three fingers on the artery

making moderate pressure, and note particularly its frequency, its

regularity, its forces and its fullness.

The RATE varies with varying circumstances. The average number of

pulsations in a healthy adult is from 70 to 75, but there are some

persons who, when they are quite well have a pulse of 80 or 90 to the

minute, and there are others in whom it seldom rises above 60. It is

usually more rapid in women than in men, is much more frequent in early

life than in old age, and the average rate in a healthy child is 120.

In disease, the pulse may acquire a great degree of frequency. It may

reach 150 or even 200, but in such cases it is generally feeble and can

hardly be counted. Besides observing the frequency of the pulse, its

character in other respects must be noted.

IRREGULARITY OF THE PULSE generally indicates disease, and there are two

varieties of it. In most instances of irregular pulse, succeeding beats

differ in length, force and character; in the other variety a pulsation

is from time to time left out; the pulse is said to intermit.

In the DICROTIC PULSE a secondary wave or undulation can be felt. It is

often met in typhoid fever, and an inexperienced person might be led to

count double the number of beats.

Another important quality of the pulse is its hardness or

compressibility. The hard pulse ordinarily, though not always, indicates

inflammation. This hard pulse may be known by pressing pretty hard with

one finger, while we observe with the others whether we arrest or

abolish the pulse.

A pulse is said to be full or large if it is felt to strike a large

portion of the finger; other departures from the normal standard are

spoken of as soft, quick, or sharp, throbbing, bounding, thready, wiry,

flickering, &c.

OF THE TEMPERATURE.

The normal standard of the temperature of a healthy person is 98.4°.

There is some variation, and indeed a daily cycle of variations, so that

in the morning it is 99 or at least 98½ and in the evening 97½, but the

range is small, and if the variation is more than that, it is indicative

of disease. There is only a deviation of about 15° within which life can

be sustained; a temperature of more than 107° or less than 93° will

almost certainly prove fatal.

Every mother who can, as well as every nurse, ought to own a clinical

thermometer, as thereby she may detect the beginning of a disorder

before there are other marked signs of indisposition. She should use it

upon the first suspicion of a departure from health and frequently

afterwards, until she knows that the temperature is normal. An increase,

especially if beginning each day a little earlier, is a bad indication;

a decrease from a high temperature each day is a sign of improvement. In

pneumonia and generally in such disorders as are initiated with a chill,

the rise is sudden and rapid.

In typhoid and some other fevers, the elevation is slight at first and

gradually rises. The exacerbations and remissions or other deviations

can only be recognized by taking the temperature frequently, and it

should be taken at the same hour each day to exhibit the cycle of

changes.

An irregularity of temperature in the course of a disease that has a

regular type may indicate a complication, or it may depend upon local

causes, such as constipation, bad air, &c. The decline of fever and of

temperature may be gradual, or it may drop to a steady normal within a

few hours.

Before using the thermometer the index must be thrown down to a point

below the normal. Hold it with the bulb down and shake till it falls

sufficiently.

The part (the axilla) should not have been exposed for washing for at

least half an hour before taking the temperature, and it is a good

precaution to keep the axilla (or mouth) closed for ten minutes before

putting the bulb of the thermometer into it, and a little time may be

saved by slightly warming the bulb in the hand before its introduction.

If we are careful and see that the axilla is first dried from

perspiration, and that the clothing is not in the way, and that the

thermometer is held firmly in position a sufficient time, we may get a

correct axillary temperature, unless in a very emaciated person. If

taken in the mouth the lips must be closed during the process.

The rectum gives the most reliable temperature, and this method is

employed for infants. The thermometer should be oiled and introduced for

about two inches. Unless the presence of feces prevent, the thermometer

will be half a degree higher than if taken in the axilla. It will

sometimes take ten minutes or more to obtain the temperature, but some

thermometers will do the work in less than five minutes.

THE RESPIRATION.

That respiration and circulation are intimately connected, and that

whatever modifies the pulse usually effects the breathing is a fact

generally known. That the proper performance of the function of every

organ in the body depends somewhat upon proper respiration, is a fact

not so generally known and recognized, and as this is an important topic

we may properly here enlarge upon it.

By the muscular action of the diaphragm and intercostal muscles, and the

consequent contractions and expansion of the lungs, the alternate

inspirations and expirations are produced which we call breathing. The

lungs are not completely filled and emptied by each respiration, and a

certain amount of air remains stationary in them. Were this air which

remains stationary constantly in a particular portion of the lungs, the

same without change, we would derive no benefit from that portion of the

lungs. Practically, however, it is believed that the additional supply

breathed in and out is diffused through and alters the character of the

whole.

A healthy adult ordinarily breathes about eighteen times per minute,

taking in each time about twenty inches of air. It is said that it takes

at this rate sixteen respirations to completely renovate the air. This

is probably true of our ordinary breathing, but the renovation of the

air depends upon our manner of breathing. It is possible for us to

breath so that at one expiration we almost displace the air from every

portion of our lungs, and then by a full, deep, prolonged inspiration,

(throwing forward the chest, throwing back the shoulder, and keeping the

body erect,) fill the lungs fully with air and thus not only change the

air in our lungs, but change in some degree the character of our blood

so as to increase its purity.

In order to test this let me ask anyone who is suffering from any slight

indisposition, if it be headache, nausea, pains in different parts of

the body, or any sickness, to try to breathe in this manner for half an

hour, and observe if they do not feel better, being careful at the same

time that the air breathed is good and pure. This point is of so much

importance that I will refer to it again hereafter.

The character of the respiration is an important diagnostic symptom and

should always be noted. The rate of respiration varies as does that of

the pulse, but the former is partly under the control of the will. The

respirations are more rapid in women than in men, in children than in

adults; it is modified also by position, exertion, excitement, and other

conditions. We may count the respirations by observing the rise and fall

of the chest, but it is well to put our hand on the stomach where the

motions may be felt.

Breathing is in man mostly abdominal, in woman mostly thoracic, but

inflammation in the chest or abdomen will affect its character.

DYSPNŒA, difficulty of breathing, arises when from any cause the amount

of air entering the lungs does not correspond to the amount of blood

sent by the heart for purification. The air may be unfit for its work,

or disease in the lungs, or air passages may shut it out. Asphyxia

results if the supply of air is in any way cut off.

OF THE AIR.

In this connection I will say to the nurse, give the patient pure air.

Learn how indispensable this is to life, or health, or comfort; how

indispensable to any person, and especially to the sick; how liable the

air in the room is to be contaminated by the air breathed or expired by

those in the room; by lights burning in the room; by exhalations from

the bodies of the sick; by excreta left for a time in the room; by the

inevitable floating dust from the floors and walls; from clothing,

bedding, and furniture; and from the presence of organic matter in

increased quantity, and of most deleterious quality in and around the

sick.

A thousand feet of air space where the air is constantly renewed, is

necessary for a healthy adult; a sick person should have two or three

times as much, because with them there is increased susceptibility to

draughts. Be very careful that the sick are not placed so that a direct

current of air can blow on any part of the body, but either by the use

of fans or in some other way the air must be renewed around their bed.

VENTILATION.

The problem to be solved is, how can fresh, pure air be best supplied?

The inequalities of temperature within and without the room produces

some natural ventilation, as this sets the air in motion and effects an

exchange of air, if there are some apertures around the doors and

windows.

This, however, is seldom sufficient, and artificial ventilation is often

necessary. An open fire is a good apparatus for this purpose. The

draught which it creates carries the air from the room up the chimney,

while a fresh supply is drawn in to take its place. This supply should

be from the outward air, or from an adjoining room in which the air is

not contaminated.

The inlets and outlets for air should be of equal capacity, on opposite

sides of the room, and of different heights to secure thorough

ventilation. They should be as far as possible from the patient and from

each other. In cold and damp weather great care is necessary to keep the

air fresh and wholesome and at the same time to avoid chilling the

patient. But even in cold weather the doors and windows may be thrown

open for a minute at a time, if the patient is at the time protected by

additional clothing.

However, during the night and in cold and wet weather, the principal

supply of air will be from an adjoining room, air that is warmed, but it

should be as pure as possible. When the weather is cold, and especially

the latter part of the night, have more heat in the room and not less

fresh air; if needed give your patient additional clothing and foot

warmers.

The windows may be thrown open once or twice a day in cold weather, if

the patient is protected by putting additional clothing on the bed, and

using some sort of a screen, (an umbrella may be used for a screen), as

a protection from the cold and direct draughts. But as the contamination

of the air continues, the purification of it should be equally so, and

some fresh air must constantly be admitted—some device used for the

purpose. The window may be raised two or three inches and the aperture

closed with a board, then the air will find admittance through the

opening between the two sash; or when the window is raised three inches,

a board six inches wide may be placed on the window sill a little inside

of it; thus there will be an aperture both at the top and bottom of the

lower sash. Or the upper sash may be lowered a little. The current of

air which comes in (this is usually the lower one) should be directed

upwards.

In the summer a lamp may be kept burning in the fireplace or grate;

flues must in some way be kept heated or they will not draw. Stoves

assist ventilation to some extent, but furnaces and radiators do not

assist at all to ventilate, and the air is thereby especially dry. A pan

of water may be kept boiling in the room, or perhaps merely setting on

the stove, or a towel or two may be hung near a radiator and kept

constantly wet; these will dampen the air by evaporation, and this is

often necessary when the rooms are kept warm by artificial heat. About

66° is a proper temperature for a sick room in most cases, but 60° to

65° is suitable for fever cases; feeble and emaciated persons require a

temperature of 70° to 75°.

Be careful to have the room warm when the patient is out of bed.

THE SYMPTOMS OF INFLAMMATION.

The ordinary symptoms which characterize inflammation may be known if we

observe what takes place when an external part is injured. Let us

suppose that a healthy man has a piece of glass stuck in his arm. He

soon has pain, then redness in that part of his arm, then swelling,

which is hard near the injury, and increases so that some swelling may

be observed, though not so hard at a little distance, and the part is

quite tender and hot.

These are the ordinary symptoms of inflammation: pain, redness, heat,

and swelling, with tenderness that is manifested when the part is

pressed.

If the inflammation increases there are signs of disorder in other parts

of the body; the patient may be first chilly and feeble, then the skin

may become hot and dry all over the body, the pulse fall hard and

frequent, lassitude comes on with headache, perhaps pain in different

parts of the body; he has also other symptoms of fever; is restless,

sleeps ill, loses his appetite, his tongue becomes white, his mouth is

dry, he is thirsty, the secretions of the body are diminished, has what

is called inflammatory fever, or sympathetic fever, or pyrexia, the last

term being now most generally used.

These phenomena, this inflammation, ends in two or three different ways.

If measures have been taken for subduing the inflammation—in the

supposed case of the arm—if the glass has been removed, it will probably

happen that the symptoms above named will disappear. This is to end in

what is called RESOLUTION.

When the inflammation goes on until pus is formed it is said to end in

SUPPURATION. The symptoms grow more severe for several days, the

swelling at length assumes a more pointed form, the skin in its centre

begins to look white, and the swelling there gets softer; there is

throbbing pain, perhaps the patient has chills or rigors; then when the

swelling is cut open or the cuticle breaks a yellow creamlike fluid is

poured out which is pus, and there is generally an abatement of the

symptoms. If, however, the suppuration or discharge of pus continues for

some time, other symptoms are manifested such as frequent shiverings,

followed by flashes of heat which end in perspiration; this is HECTIC

FEVER.

When the inflammation is still more intense it sometimes ends in

MORTIFICATION, the part dies by the violence of the disease, the red

color changing to a livid or purplish, or greenish black hue, the flesh

losing its sensation and having an offensive odor.

Of course inflammation may be in an organ or structure that is internal,

and we determine the seat of the disease, partly by the character of the

pain. Sometimes the pain is sharp and piercing; this is its character

generally in serous membranes such as the pleura or peritoneum

(membranes covering the lungs and intestines.) There is less pain when

the inflammation is in the mucous membrane, or in the parenchymatous

structure of organs, such as the lungs, liver, and spleen.

There is generally an aggravation of pain upon pressing a part that is

inflamed. Pain caused by air distending the bowels and stretching the

nerves may be relieved by pressure. Spasmodic contractions of the

muscles will cause pain without much tenderness.

OF HEAT AS A SYMPTOM OF INFLAMMATION.

The temperature of an inflamed part exceeds that which belongs to it in

health. In inflammation as in fever, it has been known to rise to 107°.

The increase of heat depends upon an influx of arterial blood, and

therefore of oxygen into the part. There is probably always some

increase of heat, though it may not always be noticed in every case of

inflammation.

There is more REDNESS than is natural in a part that is inflamed. There

is more blood than usual in the vessels that carry red blood, and the

red blood enters into the small vessels where the red particles cannot

commonly be seen. All the minute vessels seem to be enlarged. The

redness often remains sometime after the inflammation has ceased.

The degree of SWELLING in different cases depends partly on the nature

and structure of the part affected and partly on the intensity of the

inflammation; in some instances there is so little that it is not

appreciable.

Almost all the swelling results from the presence of matters thrown into

the inflamed part. In the central hard portion the hardness is to be

ascribed to an effusion into the areolar tissue of it, of a fluid which

is transparent at first, afterwards becoming opaque, called coagulable

lymph. Serum is effused into the areolar tissue of the softer swelling

at the circumference.

ŒDEMA, DROPSY, ANASARCA.

Even under moderate inflammation some amount of effusion takes place

into the texture or from the surface of a part. This effusive serous

fluid called also serosity, resembles and probably is the scrum of the

blood. When this passes into the areolar structure of a part it is

called œdema, (though this is not always by inflammation) and if the

serosity passes out extensively over the body, the disease is called

anasarca or general dropsy.

If a considerable amount of this serous fluid is poured out in a short

time from the peritoneum, it is a form of ascites or abdominal dropsy.

If it is thus poured into the pleura it causes apnœa, or difficulty of

breathing, and requires aspirating.

CHAPTER III.

DIAGNOSIS OF DISEASES IN CHILDREN, EARLY TREATMENT, &C.

It is not often that a correct diagnosis can be made of a disease by a

single symptom, but there are marked and characteristic symptoms which

indicate some diseases in children with considerable certainty.

A strongly marked nasal or palate sound in the child’s cry indicates an

abscess behind the pharynx. When this nasal tone is heard we should

palpate with the finger on the throat to ascertain the degree of

soreness.

A long drawn, ten times lengthened, loud sounding expiration with normal

inspiration, and no dyspnœa is sufficient for the diagnosis of CHOREA

MAJOR (St. Vitus dance.)

A high thoracic continually sighing inspiration, the upper part of the

thorax doing the work of breathing, and with a sighing or groaning

sound, shows the commencement of HEART WEAKNESS, CARDIAC PARALYSIS OR

FATTY DEGENERATION OF THE HEART, and will probably be followed by such

symptoms as cyanosis, coldness of the extremities, &c.

Strongly marked diaphragmatic expiration accompanied by a fine, high

whistling sound, points to BRONCHIAL ASTHMA. This sound, however,

resembles that made in croup. If there is a pause between the end of

expiration and the beginning of inspiration, croup may be excluded.

Sleepiness, lasting twenty-four to thirty-six hours, occurring without

fever or other disturbance to account for it, is an initial symptom of

MENINGITIS, though it might be caused by narcotics or uremia.

A prominent, firm fontanelle means increase in quantity of the contents

of the cranium-exudation of some sort. It cannot be caused by fullness

of the vessels alone if it is firm and resisting. We know that we have

cerebral disease with DROPSY or exudation (Hydrocephalus).

When the fontanelle is deeply sunken, it points to loss of blood or

other nutritive juices, as in cholera, &c.

A sharp, shrill cry, accompanied by an expression of fright or great

anxiety, and occurring about an hour after the child has fallen asleep,

is the only symptom of the “ALP”—night terrors, sudden awaking from bad

dreams.

Periodical crying, lasting from five to ten minutes, should always make

us think of spasm of the bladder or PAINFUL URINATIONS.

Violent crying at stool with fear of the act, and general avoidance of

it, points to FISSURE OF THE ANUS, and is usually accompanied with

constipation.

A violent cry full of pain and almost continuous, with the throwing

about of the head on the pillow and grasping it with the hands, means

OTITIS or EARACHE.

Weakness or immobility of the child, after a comparatively slight or

short illness, points to SPINAL PARALYSIS.

Delayed ossification of the cranial bones is an early sign of RICKETS,

as is crying continued for weeks (increased on touch of the

extremities), accompanied with fever and incessant sweating.

Vomiting of all kinds of food continued for weeks in children of closed

cranium but with large cranial measurements, when there is no fever,

pain, idiopathic disease, or a cerebral tumor, indicates chronic

HYDROCEPHALUS with an acute onset.

Congestion of the cheeks in children, excepting in cases of cachexia and

chronic disease, indicates an INFLAMMATION or a febrile condition.

Congestion of the face, ears and forehead of short duration, strabismus

with febrile reaction, oscillation of the iris, irregularity of the

pupil with falling of the upper lids, indicates a brain affection.

Enlargement of the spongy portions of the bones indicates RICKETS.

A thick and purulent secretion between the eyelids may indicate great

PROSTRATION of the general powers.

Passive congestion of the conjunctival vessels indicates approaching

DEATH.

Long continued lividity, as well as lividity produced by excitement or

exercise, the respirations continuing normal, are indices of FAULT IN

THE FORMATION OF THE HEART, or great blood vessels.

A temporary lividity indicates the existence of a grave acute disease,

especially of the respiratory organs.

Irregular muscular movements, which are partly under the control of the

will, indicates the existence of CHOREA (St. Vitus dance).

The contraction of the eyebrows, together with a turning of the head and

eyes to avert the light, is a sign of cephalalgia (headache).

When the child holds its hand upon its head, or strives to rest the head

upon the bosom of the mother or nurse, it may be suffering from ear

disease.

When the fingers are carried to the mouth, and there is besides great

agitation apparent, and when it turns its head from one side to another,

there is probably some obstruction or some abnormal condition of the

larynx.

A feeble and plaintive cry indicates a trouble in the abdominal regions.

If the respiration is intermittent but accelerated, there is capillary

bronchitis. In bronchitis the cough is clear and distinct.

A hoarse and rough cough is indicative of true CROUP. When the cough is

suppressed and painful, there is PNEUMONIA or PLEURISY.

In diseases of the stomach, liver or bowels we have usually a coated

tongue; a white tongue indicates FEBRILE disturbance or some THROAT

trouble; a brown moist tongue, INDIGESTION; a brown dry tongue,

DEPRESSION, BLOOD POISONING or TYPHOID FEVER; a red moist tongue,

INFLAMMATORY FEVER; a broad, pale flabby tongue accompanies a DROPSICAL

CONDITION of the system; a tremulous, moist and flabby tongue indicates

FEEBLENESS, NERVOUSNESS; a pale flabby tongue which shows the pressure

of the teeth, a generally relaxed condition of the system; the irritable

or strawberry tongue with its red papilla, points to an irritated

stomach, and is met with in SCARLET FEVER; a furred and dry tongue is

indicative of VIOLENT LOCAL INFLAMMATION; if afterwards clean, red and

dry, protracted INFLAMMATORY FEVER.

Wheezing cough and wheezing breathing indicates ASTHMA; dull, heavy

aching pain at the base of the chest, ACUTE BRONCHITIS; urgent desire to

go to stool, DYSENTERY; diminished secretion of urine, INFLAMMATORY and

FEBRILE DISORDERS; cold hands and feet, NERVOUS DISEASES and low states

of the blood.

In general, the diagnosis of diseases of children is easy if we simply

compare the objective symptoms with those which should obtain in a

healthy child of the same age. But we must remember that with children

symptoms which appear very grave are often evanescent, and on the other

hand the indications of very serious disease may be disregarded on

account of their natural vivacity and recuperative powers. In each case

each child should be studied by itself considering its antecedents, its

peculiarities, its surroundings, and its relations to them.

The mother has the best chance to know these; she sees the child when

awake and asleep, when dressed and undressed; she knows its history,

what has been its diet, what her own health has been, her own habits,

her surroundings and occupations, and whether there may or may not have

been anything to cause sickness of the child in her own toils or trials.

The nurse and the mother should note all the facts, for their own

guidance and for the guidance of the physician if he is called.

EARLY TREATMENT OF INFANTILE DISEASES.

Very few of the symptoms heretofore mentioned can be neglected with

impunity. While some cases of sickness may be left to the powers of

nature to restore health, others require judicious early treatment, and

a physician should be called. We should generally enjoin rest, but we

should act by our medicines to meet every positive indication.

We are the assistants of nature; we must act by removing the causes

where they can be reached; we must relieve pain, but we must not by

officious kindness do too much and interfere with the natural return to

health. Remember that drugs are not all powerful, that time, rest, diet

and numberless little things are the means by which we aid in the fight

against disease.

It is an excellent plan not to continue medicine too long. Place the

child on the road to health and see if it will not with a little

supervision improve—still, however, using proper rest, diet, &c.

But as the apparently trifling symptoms of to-day may become the full

fledged attack of to-morrow, we must pay attention to every untoward

symptom. Parents are liable to be unnecessarily scared, and afterwards

go to the other extreme and neglect calling a physician until serious

injury has occurred.

I will here give you a few aphorism and general rules: Treatment of the

sick should be according to the patient as well as according to the

disease. Adult males are not so sensitive as females; young children,

whether male or female, are sensitive, tender and excitable, and alive

to every irritation. But young children differ in their constitution,

and some have peculiarities or idiosyncracies so that medicines of

ordinary activity act very powerfully or even violently.

Small children are always sensitive to the action of medicine, and small

doses only are required for them. And in consequence of the activity of

the vital powers, and the quickness and force of the circulation, there

is a remarkable susceptibility to inflammatory action, disease sometimes

running on rapidly to organic and incurable mischief.

In treating children employ the mildest remedies at first, and aid their

action by regimen. When an emergency demands, use those articles which

experience has shown to have power to meet such an emergency. Exhibit

such medicine in the minimum dose and increase or repeat until the

desired effect is produced. Be very careful not to fill the child with

nostrums for some imaginary ill, lest you thereby make it ill. Always

remember that the first step in treatment is to change the conditions

which produced the disease—remove the cause and assist nature to repair

the injury.

CHAPTER IV.

TREATMENT OF INFLAMMATION IN ITS INCIPIENT STAGES.

Usually the nurse or the mother does not treat disease, or administer

medicine except under the direction of a physician, and it is not always

necessary for her to know the principles that guide in their

administration, or why particular medicines are given. But it is

sometimes necessary for the nurse or mother to decide what shall be

done, and to act before the doctor can be consulted. Accidents and

emergencies occur, distress and sickness may suddenly attack some member

of a family at any time, and little ailments are complained of every day

by some of them; the question arises, what shall be done?

It is not necessary every time to send for the physician, and he cannot

at a moment’s notice be obtained. For many ailments the mother

prescribes, and many times the early and judicious use of medicines or

regimen not only relieves present suffering, but also prevents the

developement of serious, and protracted and dangerous maladies. This is

especially true in regard to incipient inflammation, and I shall here

speak particularly of its treatment.

What has heretofore been said about inflammation gives us some guide to

enable us to know whether the case calling for our care is one of an

inflammatory character. If the pulse is full and hard and a little more

frequent than usual, and there is restlessness and some pain we may

conclude that there is IRRITATION that precedes inflammation at least,

before such symptoms as depression, chilliness followed by heat,

headache, a furred tongue, loss of appetite, and apparent weakness come

on. But if any of these symptoms are present we should search for the

cause. Perhaps if the inflammation is external we shall be able to

ascertain what produces the trouble. In every case we ought to know the

cause if possible, as we thus have more clear indications for treatment.

But we may use the sedative treatment in all cases where these symptoms

come on in a person who has previously been healthy. Of course you will

not bleed—that, if done at all, should be done by the doctor. But all

sources of irritation ought to be removed, so that the patient may enjoy

perfect quiet; the sick room should be ventilated, and kept at the

temperature of about 60°; let the diet be light; allow ice and cold

water freely, and if there is much febrile excitement use sedatives and

saline refrigerants. The best sedative is veratrum viride, and the

following is a convenient way of administering it: Drop 30 drops of the

fluid extract of veratrum in 30 teaspoonfuls of water and give 1

teaspoonful every two hours. To adult subjects if there is considerable

fever two drops of the extract, or two teaspoonfuls of the diluted

preparation may be given at first and the dose may be repeated in an

hour, but it will not be best to continue such large doses. Aperients

may be given if there are fecal accumulations in the bowels. Although

quinine is a tonic, six to ten grains of it are sometimes given with

good effect in a case of inflammation.

Opium is a good remedy judiciously given; one dose (1 grain for an

adult) is good in a case of catarrh or cold; successive doses are

necessary in a case of peritonitis or enteritis, but this should be

given on a physician’s advice. It acts probably by quieting the

nerves—by sustaining the faltering action of the heart, and by keeping

the inflamed part at rest. Sometimes cold, and sometimes hot

applications are made to inflamed parts, and it is said that the

sensations of the patient are the best criterion of their usefulness.

Except, however, in cases of inflammation of the brain, and perhaps even

then, I think that hot applications are the best. When we wish to

promote suppuration hot fomentations should be applied.

COUNTER IRRITANTS relieve inflammation of the deeper parts by drawing

the circulating fluid and the nervous energy to the surface. The milder

kinds called rubefacients, produce merely local warmth and redness;

these may often be used advantageously. Mustard applied so as to redden

the skin is generally useful.

VESICANTS, epispastics, or blistering agents are safe appliances but

they are distressing, and their use may be deferred until a physician

advises them.

I have said that the diet should be light while the pulse is hard and

full. Afterwards when the pulse is natural, or if it becomes irregular

or small, good broths or other nutrients are to be given, milk, cream,

and even raw eggs may be administered. In general food should not be

pressed upon a patient.

OF TOPICAL APPLICATIONS FOR INFLAMMATION.

I have mentioned counter irritants and I think it best at this time to

advert to all the various topical applications, irritating, soothing and

protective, and to give such instructions as I can in regard to them.

Counter irritants are frequently applied over or near the seat of the

disease, and often also at a remote part to obtain what is called

revulsive action. In both instances, however, their action may be

revulsive. If applied to the thorax or chest, for example in a case of

pneumonia, the cuticle to which it is applied is almost as remote from

the lung by the way of the circulation, as is the cuticle of the wrist

or ankle. But practically a sinapism may be very useful applied at

either place—possibly more useful if applied over the seat of the

inflammation, because there is a sympathy between the parts—they may be

used very beneficially in domestic medication.

In a few succeeding pages I give some directions to the nurse who acts

under the doctor’s orders.

AMMONIACAL LINIMENTS, and other washes and embrocations that are

sufficiently irritating to produce redness when rubbed on the skin,

should be rubbed on briskly so as to produce considerably increased

circulation in the capillaries, &c. One of the most commonly used

rubefacients is mustard. To make a mustard plaster, or sinapism, take

one part of powdered mustard, and about three times the quantity of

flour and mix into a paste with tepid water, and spread it evenly

between two pieces of thin muslin. As hot water or vinegar weakens the

active principle of mustard, tepid water is best, even if it seems cold

when applied to the patient. Good sinapisms are conveniently made also

by doubling brown paper several thicknesses, wetting it and sprinkling

on the mustard alone.

The mustard must not be left on long enough to vesicate; usually it

should be taken off within half an hour (or moved,) except when applied

to the soles of the feet, when they may commonly be left on for several

hours. Their action must be carefully watched upon an insensible or

delirious patient, or a little child. In mixing the plaster for children

glycerine may be used, and then the plaster may remain on longer.

Confine in place by a bandage. If the patient complain of the burning or

smarting after the plaster is removed, dust the part with starch or fine

flour, or dress with vaseline to exclude the air.

You may make a cayenne pepper plaster in the same way that a mustard

plaster is made, or you may sprinkle pepper upon a thin slice of pork.

This makes good draughts for children and may be useful sometimes for

sore throat if applied to the neck. But capsicum plasters, &c., can be

bought at the drug store. In the country it is generally convenient to

obtain and apply horse radish leaves; these are good rubefacients. In

order to produce immediate VESICATION I have known a doctor to heat an

iron spoon until it was sufficiently hot, and then rub it over a small

space of skin; and a small blister may be quickly made by saturating a

bit of cotton with hartshorn, putting it in a top thimble and applying

it to the skin to remain seven or eight minutes. But the agent most

commonly used to produce vesication is the CANTHARIDEAL PLASTER. If you

are to produce a blister with this, the part should first be washed and

dried, shaved if there is any hair upon it, then if you wish the blister

to rise soon wet the plaster and also the skin with vinegar; apply, and

secure the plaster in place by a bandage. Most commonly it will rise in

from four to eight hours, but without waiting for it to rise fully you

may remove the plaster and apply a poultice which will produce the

desired effect. Do not tear the skin in taking the plaster off. When the

blister is well raised make a slight incision or two for the escape of

serum, and dress with vaseline or tallow. This is the usual way, but in

some cases the physician may direct differently, perhaps may leave the

blister undisturbed and allow the fluid to be reabsorbed.

Strangury and congestion of the kidneys sometimes follow the prolonged

use of cantharides; to prevent this, it is sometimes recommended that

tissue paper be well oiled and interposed between the plaster and skin.

And as camphor corrects the action of cantharides upon the bladder, it

is recommended that in case of a child particularly, a solution of

camphor in ether be sprinkled upon the plaster. If a blister is applied

to a young child, it should be carefully watched and not allowed to

remain too long. In two or three hours the skin will be well reddened,

and the plaster may be removed and a poultice applied.

TINCTURE OF IODINE is sometimes applied as a counter irritant, but

several coats and repeated applications are necessary to produce a

blister.

Local stimulation can be obtained from bits of cantharideal plaster kept

on for an hour or two, and removed or changed before the point of

vesication is reached. The same effect follows the rapid passage of a

hot flat iron over a piece of brown paper or flannel laid upon the skin.

It is generally best that the flannel should be wet first; and should an

emergency arise when from hemorrhage or some other cause there is danger

of immediate collapse, the application of heat in this way may rouse the

sufferer and prevent immediate death. This or the actual cautery is

sometimes used to relieve lumbago, or rheumatism. If you have thereby a

slight burn, you may dress it in a solution of bicarbonate of soda and

cover from air with rubber tissue.

If a SETON is inserted in the skin, the silk should be moved daily and

the matter well cleared out.

WET CUPS are applied to relieve congestion and to abstract blood, the

skin being first scarified.

DRY CUPPING is most practiced for the relief of pain and to draw the

blood away from an inflamed organ. Small tumblers may be used in the

absence of cupping glasses, if the edges are smooth. When you apply the

cups have at hand also a lamp, a saucer of alcohol, a bit of sponge or a

wad of lint fastened to the end of a stick. Have the cups perfectly dry,

dip the sponge in the alcohol which you will ignite from the lamp, (they

being near the patient), and let it burn for an instant in the inverted

glass, then withdraw and extinguish it, and rapidly place the cup over

the intended spot. As the heated air in the glass condenses in cooling,

the skin will be forcibly sucked up, and the blood drawn towards the

surface. Each cup will remain on from three to five minutes. Do not

attempt to apply them to a bony and irregular surface, and be very

careful not to burn the patient by getting the edges of the glass too

hot. To remove the cup press with the finger close to the cup so that

air will be admitted.

WET CUPPING will be attended to by the physician, who will provide the

scarificator, and adhesive straps. See that plenty of soft towels are

provided.

There are two varieties of LEECHES used in this country, the American

and the foreign. The latter differs from the former in having five or

six stripes down its back instead of three, and it will draw from five

to six times its own weight of blood as it is larger and more voracious

than the American variety.

The domestic variety is sometimes preferred for children, as it will

draw a sufficient amount of blood usually. Leeches should not be applied

over any large vessel, and preferably should be over a bony surface

where pressure can be made to stop the blood if it continues to run. The

leech should not be handled, it may be washed and dried in the folds of

a towel.

To induce them to bite, the part to which they are to be applied must be

perfectly clean, and it may be best to pick or scratch the skin so that

the leech has first a taste of blood; or you may put the leech in a wine

glass, test tube, leech glass, or small bottle filled with water; cover

with a cord and invert over the place; hold it close and slip out the

paper. The leech will then probably take hold and the glass can be taken

off, and the water absorbed by a towel. If one is to be applied inside

the mouth or nostril, put a thread through its tail to prevent its being

swallowed. If such an accident should occur have the patient drink

freely of salt and water, and induce vomiting.

If the leech seems sluggish when applied stroke it gently with a dry

towel. When full it will drop off. If you wish to take them off sooner,

do not remove by force, but put a little salt on their heads. If the

bleeding from the orifice continues too long it may be checked by a

compress of lint, an application of ice, or by touching with nitrate of

silver, or carbolic acid. Leeches not used may be kept in a jar of water

with sand in the bottom, and a perforated cover, or it may be covered

with a linen cloth. The water in which they are kept should be changed

twice a week in winter and oftener in summer. Salt will make a leech

disgorge the blood with which it is filled, but if kept afterwards it is

liable to be diseased, and to cause disease in those that are with it.

By FOMENTATIONS or stupes is commonly meant the application of flannels

or towels wet with hot water or some medicinal decoction. If hot water

only is used, they are a convenient means of applying warmth and

moisture, but they require constant attention, needing to be changed

every ten or fifteen minutes. They are chiefly of use in relieving pain

and inflammation, and in promoting suppuration when that is desirable.

Two pieces of flannel should be at hand each doubled to the desired

size; they are to be saturated with boiling water and wrung out dry as

possible. To wring it out without scalding one’s fingers, put it inside

a towel, and this may be made with a hem at the end so that a stick can

be thrust through it. Wring the flannel so dry that it will not make the

bed or bed clothing wet. Cover with oiled muslin a little larger than

the fomentation, and over that lay some dry flannel or cotton. If the

stupe is put on hot, and frequently changed, it derives or draws blood

towards the skin, and is often useful in relieving spasm and pain; and

the continued use of them prevents suppuration. Medicaments are

sometimes added to make them more irritant or sedative; then they are

not changed so often, but they must not be allowed to get cold. After

the fomentations are discontinued, carefully wipe the parts dry to which

they have been applied, and cover with a warm, dry flannel.

I subjoin a few useful fomentations in which decoctions or medicines are

used.

1. Add one ounce muriate of ammonia and two ounces spirits of camphor to

1 quart of boiling water just before dipping the flannel into it.

2. For a fomentation to the bowels, chest, &c., of a child, take 1 oz.

paragoric, 1 oz. Jamaica ginger, and 4 ozs. hot water.

3. Twenty drops spirits turpentine may be sprinkled over each stupe, but

be careful about blistering the skin or making a sore.

4. A decoction of chamomile flowers, hops, or conium, may be used for

the fomentation instead of water.

5. Twenty drops or more of laudanum may be dropped over each stupe. This

might soothe pain without causing stupor.

POULTICES, like stupes, are means of applying warmth and moisture. If

applied early, it is believed they may prevent the formation of pus, as

they bring about a resolution of the inflammation. When suppuration has

commenced they facilitate the passage of matter to the surface, and

lessen the extent of the disease. When applied to an inflamed part or

swelling they should extend over considerable surrounding surface, but

for a suppurating wound they should be but little larger than the

opening.

Avoid putting them on very hot in a case of paralysis and also upon

children, though they should be applied quite hot usually.

To make BREAD POULTICES pour boiling water on slices of bread without

crust, simmer a few minutes, then beat up the bread quickly and spread

it upon a piece of muslin previously cut of the desired size, leaving

about two inches of margin upon each side. Then put on the poultice some

lard or oil or vaseline to keep it from getting dry and hard, and to

make it less likely to stick. It will be well to put on it a cover of

thin muslin or mosquito netting, or tulle, or illusion, and then fold

over like a broad hem the edges of both the covers. The poultice should

be evenly spread about a quarter of inch in thickness and may be carried

to the patient on a small tray or board, and if you are changing the

poultice you should also have a small basin to carry away the old ones.

After applying the poultice cover with some impervious material (oiled

muslin or rubber cloth) to keep in the heat. Such a poultice as this

will keep warm for five or six hours, but it should not be allowed to

become cold and hard. Milk should not be used in making poultices as it

quickly sours.

POULTICES ARE MADE OF VARIOUS MATERIALS. Flax seed meal, starch,

powdered slippery elm, Indian meal, and oat meal are used. They should

all be made of such a consistence that they will be tenacious as

possible, and should have at least a little oil on them to prevent their

getting dry.

For PUTRID SORES some disinfectant solution may be used instead of water

in making the poultice, such as a weak solution of chlorinated soda.

YEAST POULTICES are used to hasten the separation of gangrenous sloughs.

Mix six ounces of yeast with the same quantity of water at blood heat.

Stir in fourteen ounces of wheat flour and let it stand near the fire

until it rises. Apply while fermenting, or, “Take of wheat flour a

pound, yeast half a pint, mix, and expose the mixture to a gentle heat

until it begins to rise.”

The following are old officinal forms for poultices:

ALUM CATAPLASM. Take the whites of two eggs, of alum a drachm, shake

them together so as to form a coagulum. (A common mode of preparing the

alum poultices is to rub the whites of two eggs briskly in a saucer with

a lump of alum till the liquid coagulates.) The curd produced by

coagulated milk with alum is sometimes used as a substitute. The alum

cataplasm is sometimes employed in incipient or chronic opthalmia as an

astringent application. It is placed over the eye enveloped in folds of

cambric or soft linen.

CATAPLASM CARBONIS LIGNI. Take a sufficient quantity of wood charcoal

red hot from the fire, and having extinguished it by sprinkling dry sand

over it, reduce it to very fine powder and incorporate in the simple

cataplasm in a tepid state. Charcoal recently prepared has the property

of absorbing those principles upon which the offensive odor of

putrefying, animal substance depends. In the form of poultice it is an

excellent application to foul and gangrenous ulcers, correcting their

fetor and improving the condition of the sore. It should be frequently

renewed.

CONIUM CATAPLASM. Take of extract of poison hemlock (conium) two ounces,

water a pint. Mix and add of bruised flax seed sufficient to produce a

proper consistence. This cataplasm may be advantageously employed as an

anodyne in cancerous, scrofulous, and other painful ulcers, but its

liability to produce narcotic effects in consequence of the absorption

of the active principle of the hemlock must not be overlooked.

Sometimes a bag is made to contain a poultice, and such a bag should be

used if we desire to apply a large poultice to the chest or abdomen. One

can be made for the breast and for the back at the same time, and two

straps over the shoulder may unite them. A hop poultice is a thin bag

loosely filled with hops and wrung out of hot water.

DRY FOMENTATIONS are sometimes employed. Thin bags filled with heated

sand, ashes, salt, bran, or hops are used, to keep the heat applied to

the skin; and to warm the feet and quicken the circulation in the

extremities, hot bricks, bottles filled with water, &c., are applied.

These should be rolled in hot flannel or at least enveloped in

something.

OF THE APPLICATION OF COLD.

Cold applications are sometimes used to subdue inflammation in the early

stages. They are not good when matter is forming, or during sloughing.

When they are used they ought to be continuously applied so as to keep

up a constant cooling effect. Sometimes either water or some lotion is

used with the design of cooling by evaporation. If a part is wet with

water, alcohol, vinegar, a solution of muriate of ammonia, or other

fluid, and left uncovered, the effect will be to cool it. When you

design to cool by evaporation do not lay on more than one thickness of

muslin or lint, and this must be wet so often that it does not get

nearly dry. But a part may be cooled by several folds of muslin wet in

ice water, and changed for fresh ones before they get warm. It is

important that they do not become warm, and hence they should be

frequently changed; alternate cooling and reaction is hurtful rather

than beneficial. A steady cold stream of water is one means of cooling,

and another device is to carry across a part a long strip of muslin or

lamp wicking, having one end in a vessel of cold water higher than the

bed, and the other leading to a basin below it. Protect the bed well

with India rubber cloth so that both the patient’s clothing and the bed

are kept dry.

Rubber bags are made to contain ice, and these are made in different

shapes to be adapted to different parts of the body. They should not be

more than half filled, and as soon as the ice melts the supply must be

renewed. The ice used should be finely broken; this may be done by

wrapping it in a fine cloth and pounding it. If mixed with one-third saw

dust the ice will keep longer. A fold of muslin should be interposed

between the ice bag and the skin, and they should be kept in their place

by a bandage or some other means. An ice bladder for application to the

head can be kept from pressing on the head by being folded in a napkin,

which may be attached to the pillow by a pin. A cup shaped sponge may

answer in the place of the ice cap to contain the ice; this must be

wrung out before it is saturated, so that the pillow may not become wet.

COLLYRIA are best applied to the eye at the outer angle; a glass dropper

or a camel’s hair pencil may be used—this same one should be used for

nothing else. Draw down the lower lid, and tell the patient to look up

at the same time that the drop of eyewater is slid in. Do not leave

moist cloths bound upon the eye as they become hot and may do harm.

If you rub in liniment with your hand, wash the hand carefully before

touching a sensitive spot, as some of the ingredients may cause smarting

or other injury.

CHAPTER V.

DUTIES OF THE NURSE IN VARIOUS CIRCUMSTANCES, CONTAGION, DEATH, &C.

The fact that certain diseases are contagious is one that throws some

grave responsibilities upon the nurse, and on account of the importance

of the subject, I will here discuss it in the light of modern science.

Infectious diseases are supposed to be propagated by the agency of

minute living parasites given off from the body of the sick and

conveying the specific virus. The germ thereby includes this for the

cause of all the zymotic diseases—diseases that are contagious and

produced by some morbid principle or germs acting on the system like a

ferment. They are claimed to be a vegetable growth of a fungoid nature,

and the theory is that during the process or period of each—a period of

growth like mildew—the victim is a sufferer from a more or less violent

fever; that the period varies; in typhoid it is twenty-one days, in

other forms of fever perhaps a shorter time, till the microscopic

fungoid growth may be said to effloresce and shed its spores. Some

diseases also that are not contagious are believed to be caused by

organisms in the air. There are various kinds; monads, bacteria,

vibriones, &c., are among the substances found in the atmosphere of a

large city, and elsewhere.

A very great variety of these forms called fungoid growth have been seen

and distinguished, and it is demonstrated clearly that certain forms

cause certain diseases. For example, cholera or choleraic symptoms have

been induced in animals by the introduction of the cholera bacillus into

their intestines, and almost invariably the dead animals showed a great

abundance of the characteristic bacillus in the intestinal tract. The

diseases which are now known or believed to be caused by such virus are

very numerous, and directions for preventing a disease from spreading

are based upon this theory; epidemic and endemic diseases are generally

attributed to such a cause. The list of germ diseases is about as

extensive as the list of contagious diseases.

EPIDEMIC DISEASES are those that act upon numbers of people at the same

time. Probably there is generally, though not always, disease organisms

diffused through the air.

ENDEMIC DISEASES are confined to particular localities. Sporadic cases

of disease are those occurring singly, or scattered considerably.

DISINFECTANTS are such substances as act upon the specific germs or

minute living particles to destroy them. ANTISEPTICS are such as prevent

decomposition or putrefaction.

SEPTIC GERMS are generally destroyed when widely diffused in the air. It

is believed that oxygen acts as a disinfectant, at least dry air is not

favorable to their growth. A dry heat of 300 degrees will destroy them,

and they are generally killed by a freezing temperature. Against

communicable diseases the chlorine class of antiseptics including

iodine, iodoform, bromine, and sulphur are the most effectual, and

chlorine and sulphuric acid may without danger be used in the sick room

to a sufficient extent to do some good.

The most rapid and powerful of the disinfectants is the solution of the

bichloride of mercury (corrosive sublimate). The solution most commonly

used is of the strength of fifteen grains to the quart. It can be

applied directly to floors, beds, walls, sinks, drains, vessels, &c.

For clothing use a solution of common salt and sulphate of zinc, two

ounces of the salt and four ounces of the sulphate to a gallon of hot

water; soak the clothes in this and then boil them in water with borax,

or soap or soda.

When a disease is known to be very contagious and dangerous, especial

care is necessary to avoid contact on the part of patients and nurses

with outsiders. All superfluous things must be taken out of the room

before the patient is put into it, and care will be necessary

continually to make the quarantine effectual. Every article carried out

of the sick room must be disinfected; a set of dishes should be kept for

the patient’s exclusive use, washed only by the nurse; the bedding,

clothing, &c., must be washed by the nurses themselves, after being

soaked in a disinfecting solution; dressings and other cloths, such as

old cloths used for handkerchiefs, may be burned; all excrementitious

and vomited matter must be disinfected; the broom that is used to sweep

the room must not be used elsewhere; no current of air must be permitted

to pass from the sick room to the rest of the house; and it is well also

to hang about the room cloths wet with some disinfectant solution; hang

over the doorway a sheet similarly disinfected; and the nurse should

cover her head with a close cap.

Lest the confinement and isolation make the nurse sick she must take

care of her own health. Two nurses should be employed for every such

case, so that neither may be obliged to sleep in the same room with the

patient, and each should change her clothes and go out of doors for a

time every day and take a brisk walk in the open air.

The ventilation is of especial importance in contagious diseases, as no

disinfection can render the air entirely pure. To prevent the infectious

particles that are thrown off the skin in cases like small pox and

scarlet fever, from polluting the air of the room, the clothes should be

frequently changed, and the patient’s body be washed and anointed with

some ointment.

Charcoal placed about the room in shallow vessels does some good by

means of its property of absorbing gas; and solutions of carbolic acid,

chloride of lime, soda, and zinc are germicides, but the chief use of

the carbolic acid family is where suppuration is going on, to prevent

the spread of septic infection. It is also a means of disinfection

perhaps, if the spray is used in malarial disease. Condy’s fluid and

sulphate of iron are used as antiseptics, but these stain clothing.

Chlorine should not be used with sulphuric acid, or carbolic acid.

Either copperas or chloride of lime may be thrown dry into water

closets. A little disinfectant should be kept standing in all sputa

cups, urinals, and bedpans, and in cases of typhoid, and cholera, the

stools must be carefully disinfected. These diseases are not only

directly infectious, but the germs in the discharges may multiply and

spread the disease. Cover the bottom of receiving vessels for stools

with copperas or chloride of lime, and after use add crude hydrochloric

or sulphuric acids in quantity equal to half the bulk of the discharge.

Cover closely and carry from the room, and empty into a trench prepared

to receive them, at a distance from the water supply, and all clothing

and bedding soiled by the discharges must be disinfected and boiled.

After a case is ended the room must be subjected to a cleaning and

fumigation. Everything that can be so treated should be either boiled or

subjected to a heat of 220° in a disinfecting oven. Rubber sheets and

aprons may be cleaned with bichloride solution, and the floors,

woodwork, and perhaps the walls should also be washed with a solution of

bichloride of Mercury. While the room is being fumigated, drawers and

closets should be open and things not thoroughly disinfected should be

hung up in it. A good way to fumigate the room is to burn sulphur in it,

but you may evolve chlorine from common salt in the following way: Mix

an equal bulk of common salt and black oxide of manganese in a shallow

earthen dish, add two pints of sulphuric acid previously diluted with

two pints of water, and stir with a stick. It is best in using this to

have also steam in the room.

To fumigate a room have the doors, windows, and fireplace closed, and

paste paper carefully over the cracks. If sulphur is used put it in iron

pans, allowing two pounds to every thousand cubic feet of space; set the

pans on brick, so that they will not burn the floor; pour a little

alcohol on the sulphur and ignite, then leave the room quickly so that

you do not breathe the gas; paste up the door when you go out; keep it

closed for twenty-four hours, then open all the windows and let the room

air.

Those directing the disinfection should always remember the bleaching

and corroding power of chlorine and sulphurous acid gas.

When a patient has died from any infectious disease the body should be

washed in some disinfectant solution, or soap should be used containing

bichloride of mercury, and a sheet should be wrapped around the body wet

with the same. Saturate also a large wad of cotton with it and leave it

under the hips. The burial should be soon and private in these cases.

OF THE NURSE’S DUTIES IN CARING FOR THE DYING AND DEAD.

Certain duties devolve upon the nurse in cases of DEATH from any

disease, and I prefer to refer to those duties here.

Among the signs that indicate approaching dissolution are a peculiar

sharpness of the features; coldness of the toes, fingers and nose; a

dusky shade about the finger nails; cold perspiration, restlessness, and

muscular twitchings or stupor. When you are sure that the end is near it

is best that the friends should be informed. While there is slight

grounds for hope do not give up all efforts, but do not disturb the

dying by useless ministrations. Note the exact time at which death takes

place; this is usually, though not always, obvious.

There may be a rise of temperature, and the body be quite warm a short

time after death; this is produced by chemical changes, but after a

short time its temperature corresponds with that of the room in which it

is lying. Then the peculiar stiffening of the muscles called RIGOR

MORTIS sets in which lasts for a time and then disappears. Before rigor

mortis comes on prepare the body for burial by washing it (using a weak

solution of chlorinated soda or carbolic acid), closing the eyes,

arranging the lips naturally, and combing the hair. Bandage the jaws

closely, stuff all the orifices of the body with absorbent cotton to

prevent discharges, and bind a cloth around the hips. A clean night

dress or shroud or any other clothing desired can be over this, then

cover the face and all with a sheet.

The arrangements can be put in the hands of an undertaker, but it is

quite likely the friends will wish you to superintend them. If the body

is to be kept for several days it must be packed in ice, and after

twenty-four hours the face has a more natural appearance. The dark

discoloration of the skin observable a few hours after death on the neck

and sides and more dependent parts, is caused not by mortification, but

by the blood settling or gravitating downwards. Slight discolorations

about the face can be made less conspicuous by dusting them with toilet

powder.

After the body has been taken from the house, the bedding must be sent

out to be disinfected, all the appliances of sickness removed, the room

put in order, and the windows left wide open for several hours.

SOME GENERAL LESSONS IN NURSING.

Rule 1. Do not get out of temper, but try to make the sick chamber the

pleasantest and yet the quietest room in the house. Do not appear

anxious however great your anxiety.

2. Do not converse in whispers; invalids generally are suspicious and

will imagine all sorts of things if they see their friends conversing in

this manner.

3. Do not urge the invalid to eat and drink when she does not feel like

it.

4. Do not ask a convalescent if she would like this or that to eat and

drink, but prepare the delicacies and present them in a tempting way.

5. Do not allow the nauseating medicine bottles to stand in the sight of

the patient.

6. Study all the peculiarities of your patients, and instead of opposing

them by arguments or otherwise, humor them whenever they do not

interfere with the physician’s orders or instructions.

7. In all cases keep everything that is used by the patient perfectly

clean.

8. If the patient is not allowed to drink as much as she desires, give

her the limited quantity instead of a full glass. If she is allowed to

drain the glass she will probably be satisfied.

9. Do not allow flowers or plants to remain in the room over night, and

always remove flowers from the sick chamber as soon as they become

stale.

10. In all cases the patient should have baths so often that the skin is

kept clean, and the pores are not stopped up.

11. Take care not to chill or fatigue a patient while bathing. A sponge

bath can be given in bed, the bed being protected by an extra draw

sheet.

12. The mouth should be often washed and the teeth brushed or wiped off

with a soft cloth.

13. The hair should be combed at least once daily. The ladies’ hair is

braided or twisted on top of the head so that she will not have to lie

on a knot.

14. Do not light a sick room at night by means of a jet of gas burning

low.

15. Preferably use sperm candles.

16. Do not have the temperature of the sick room much above 60°.

17. Do not allow offensive matters to remain; but in a case of emergency

where these cannot be removed at once, you can wring a heavy cloth out

of cold water and use as a cover, placing over this ordinary paper.

18. Do not neglect during the day to attend to necessaries for the

night, that the rest of the patient and family be not disturbed.

19. To avoid making a noise by throwing coals on the fire, place it in

paper bags and lay them on the fire.

20. Do not lean or sit upon the bed, if this is disagreeable to the

patient.

21. Always remember that nothing which contributes to the welfare of

those who require the nurse’s care, is too trivial to demand her

attention.

22. The following may by some be called little matters, but attention to

them will add materially to the well being of the sick: Refrain from

constant enquiries of patients as to how they feel, for sick people are

easily annoyed; anticipate the wants of your patient if possible; never

tiptoe about the room; if the patient is very sick have the courage to

tell the friends who call that the invalid cannot see friends, if able

to see them their stay must not be prolonged; do not allow a patient to

sit up in bed without covering the shoulders with some light wrap;

support them properly with pillows, or a chair and pillows; when obliged

to leave the room take something with you which is no longer needed, and

bring back necessary articles, thus saving annoyance to the patient and

labor to yourself.

23. To AVOID MISTAKES IN GIVING MEDICINE it is a good rule to always

read the label before and after measuring the dose; no medicine should

ever be given in the dark; tie a ribbon on bottles that contain remedies

for external use; shake a bottle before opening it; do not leave a

bottle uncorked; generally keep medicines in a dark closet which is cool

as possible; have every medicine that is dangerous taken internally

labeled “poison”; keep them under lock and key.

24. The nurse should know the ordinary doses of medicines and the

symptoms of overdosing. Every unusual and inordinate action of a drug

may be a good reason for omitting a dose or two till the physician is

seen and new directions are given, otherwise be always regular and

prompt in the administration of medicines.

25. But in general the nurse can best display her knowledge and exercise

her skill by faithfully carrying out the instructions she has received

from the physician. If the directions are not what she would expect, it

may be an exceptional case; the doctor and not the nurse is the judge as

to what is exceptional; she must obey his orders. Do not receive orders

from the physician in silence, and when he is gone refuse to obey them.

The nurse should never hide anything from the doctor, even if she has

done wrong; it is a serious thing to think that life should be risked in

order to conceal wrong doing. Never be afraid of troubling the doctor;

he will always be glad to hear anything that will help in the diagnosis

or treatment of the case. The nurse has much to do with an art whose end

is the saving of human life; any neglect to act openly and intelligently

becomes a crime.

26. Remember that kindness and tenderness as well as faithfulness are

needful to successful nursing.

BEDSORES.

Every precaution should be taken by the nurse to avoid bedsores on her

patient. These appear most frequently upon the hips, but may develop

elsewhere in parts subjected to pressure. To harden the parts they must

be frequently washed with soap and water and thoroughly dried. A draw

sheet should be placed under the patient that can be changed as often as

it becomes wet and damp. Be careful to keep the sheet free from wrinkles

and inequalities, and the patient’s clothes must be kept smooth under

her. Occasionally rub on the skin oil or vaseline, and then dust on some

fine powder such as oxide of zinc, fine starch, or toilet powder.

Plasters that are entirely unirritating may be applied either before or

after there is an evident sore, and if change of position is not

possible, it may be necessary to obtain air cushions or a water bed.

An air mattrass or air cushions may be put on any bed, but a water bed

must be put in a trough or wooden frame made of just the right size. The

water in a bed of this kind should be of a temperature of 70° and

renewed every two weeks. To prevent a water bed from sticking to the

boards some old cloths must be interposed.

Reddening and roughening of the skin, and pain on pressure indicate an

approaching bedsore before there is an abrasion of the skin. Those

washes that cause smarting must be discontinued, and sulphate of zinc

ointment, and unirritating plasters used.

If a part is dead and likely to slough off, apply charcoal or yeast or

chlorinated poultices until the gangrenous parts can be removed. After

the separation of the slough you can apply lint smeared over with

carbolated cosmoline or whatever application the surgeon or doctor may

direct. The sore must be washed and applications renewed each day, and

at each time it may be covered with a piece of oiled silk or muslin, or

rubber tissue confined in place by adhesive straps.

BATHS.

The SPONGE BATH or washing can be done partly under the bed clothes, and

but a small part of the body need to be exposed at a time. Do not bathe

immediately after a meal.

Always have a bath of the temperature directed by the doctor. The

following terms are used to indicate different temperatures:

BATH. WATER. VAPOR. AIR.

Cold, 32° to 65° Fahr.

Cool, 65 to 75

Temperate, 75 to 85

Tepid, 85 to 92 90° to 100° 96° to 106°

Warm, 92 to 98 100 to 115 106 to 120

Hot, 98 to 112 115 to 140 120 to 180

To put a feeble patient in a bath wrap her in a sheet and lower her

gently down in it. When she is taken out wrap her in a warm dry sheet

and over this fold a blanket. After a few minutes’ rest and a little

wiping with a soft dry towel the clothes may be put on.

Do not give a cold bath when the patient feels chilly, when there is

perspiration, or there is inflammation or congestion of an internal

organ.

The temperature of the body may be lessened by means of the wet pack in

cold water, or by means of a sheet wrung out of cold water wrapped

around the patient, and changed every ten or fifteen minutes, or by

applying towels from the neck downwards, wrung out of cold water.

For the wet pack the sheet may be wrung out of either hot or cold water.

Spread a comforter and two blankets on the bed and over these a sheet

wrung out of the water. Remove all the patient’s clothing, lay her in

the middle of the sheet, then draw over one side after another of the

blankets and comforter, wrapping her from the neck to ankles; apply

something to the feet to keep them warm, give plenty of drink, and put a

wet compress on the forehead. If this is intended to induce perspiration

or repose, the patient may remain in the pack two or three hours.

A BLANKET BATH is used as a means of sweating. A blanket is wrung out of

hot water and wrapped around the patient. She is to be packed in three

or four dry blankets and allowed to rest quietly for thirty minutes.

Then the surface of the body must be well rubbed with warm towels, and

the patient made comfortable in bed.

COLD OR TEPID SPONGING is sometimes directed when there is a fever.

Commence at the head and sponge downwards, then wrap in a blanket and

leave her undisturbed for an hour or more.

The effect of the HOT BATH if long continued is to induce languor and

weakness. Watch by the patient while she is in the water, and take her

out if there is any sign of fainting. Do not give a hot bath during a

menstrual period.

A hot foot bath is one of the best means of revulsion to relieve the

head. Let the water come nearly to the knees, cover both the patient and

tub with a blanket, keep the feet in the hot water for about twenty

minutes.

If a HOT AIR BATH or a VAPOR BATH is given, some device should be used

to keep the blankets from pressing upon the patient. Two half hoops may

be tied together so that they answer the purpose. By the same means

steam may be diffused around her, if hot bricks wrapped in wet flannel

and put on dishes are placed in the bed beside her, or steam can be

conducted from a boiling teakettle under the blankets. Or place the

patient in a large cane seated chair, and surround both completely with

blankets, letting them extend to the floor and be secured about the

patient’s neck. Under the chair, place a basin of hot water with an

alcohol lamp beneath it; bring the water to boiling, and the patient

will soon be in a perspiration which may be carried to any extent.

For a BRAN BATH, boil two pounds of bran in a gallon of water and add to

the bath.

For a SALT BATH, add one pound rock salt to every four gallons of water.

For a SULPHUR BATH, add twenty grains sulphuret of potassium to a gallon

of water. Used for skin diseases and rheumatism.

In cases where there is a high fever, especially in children, the warm

water bath is given to reduce the temperature. If a child that has a

temperature of 104° is immersed in water heated only to 98° for fifteen

or twenty minutes, it will part with some of its heat.

BATHING OF INFANTS.

The bath for very young infants should be quite warm—about 97°. Some

nurses ascertain if it is an agreeable warmth by dipping an elbow in the

water. The temperature may from week to week be lowered gradually to 85°

or 80°. Two baths a day may be given. The evening bath should be warmer

than the morning. A brisk, gentle rubbing after the bath is beneficial.

If a child gets blue and shivers the bath is too cold. The warm bath

will often serve to put a restless and feverish child to sleep.

To bathe an infant support its head on your hand and arm, dip the baby

into the bath; then rub the whole surface of the skin rapidly with a

soft sponge or piece of flannel soaped; next again immerse the body in

the water, then quickly and thoroughly dry with a fine warm towel.

Before giving a bath have every thing likely to be needed at hand, and

the room warm.

CHANGING CLOTHING.

Before raising up a patient to put on a chemise or night dress, pull up

the soiled one towards the neck, and as soon as the head and shoulders

are raised, the soiled garment can be slipped off over the head and a

clean one put on; then pull this down smoothly under the back before

laying the patient down.

If two garments are worn one can be slipped inside the other, and they

can be slipped on as one.

CHAPTER VI.

SURGICAL NURSING.

Before I dwell particularly upon surgical cases and wounds of all kinds,

I will refer to some general duties of the nurse who attends during a

surgical operation.

Generally the patient to be operated on should have a bath the previous

night, and perhaps an enema on the morning of the operation; if the

operation is on the female genital organs a warm douche should be given.

Prepare the room by having it well cleaned and aired and of a

temperature of about 85°. Such things as are likely to be needed; for

example, vaseline, carbolic acid, basins, sponges, towels, scissors,

needles, pins, ice, hot and cold water, should be provided. If you have

to make bandages, an old cotton sheet is good material from which to

tear the strips. To join the strips lay two ends flat on each other

overlapping for an inch, and baste together all four sides. A roller

bandage may be from two to twelve yards long; it must be rolled as

tightly as possible; the selvage and all loose threads must be trimmed

off.

The proper cleaning and preparing of sponges is important. If one has

been used it should be well washed and left in a solution of sal soda,

and then kept for several days in a five per cent. solution of carbolic

acid. New sponges should be prepared with twice as much care.

In a case where there is to be an operation upon the female genitals, a

T bandage may be required; this should be put on before the ether is

given, at least the part above the hips, the other part may be left free

till after the operation, to be then brought between the thighs and

attached to the other in front.

Only a little light food should be taken for three or four hours before

etherization. Prepare the patient for going to the room by having her

hair combed and braided, artificial teeth must be taken out, and all

tight bands loosened. Arrange the clothing so that it will be protected,

and so that it can be changed afterwards easily. See that she passes the

urine the last thing before taking her place for the operation.

Have a bed ready that is properly made and protected, to which she can

be moved when the doctors allow it, and where she can be kept quiet. If

there is nausea and vomiting, the effects of the ether, you may quiet it

by letting her sip a little hot water or by putting a hot, dry cloth on

her neck and chest. During the operation you had simply to wait on the

surgeon, now the patient will be principally in your care.

You will receive instruction from the surgeon in regard to things

needing peculiar watchfulness and every point must be carefully noted.

As the wound may need to be watched during the first twenty-four hours

for hemorrhage, it must be so arranged that it can be looked at without

waking the patient.

The danger to which surgical cases are liable are, 1. Shock; 2.

Hemorrhage; 3. Erysipelas; 4. Pyemia; 5. Tetanus. If there is TRAUMATIC

ERYSIPELAS the edges of the wound are red and swollen, the secretion of

pus ceases, and by the next day the skin around the wound becomes of a

peculiar red color. There will be fever, headache, nausea, and a coated

tongue.

ERYSIPELAS can be generated by inattention to sanitary laws. It is

infectious and spread by fomites, and the virus of erysipelas may give

rise to puerperal fever. It is not proper for a nurse that has had the

care of a case of erysipelas, to soon be the nurse of a lying-in woman,

even if she is careful about using disinfectants on her hands and

changing her clothes.

Certain influences augment the susceptibility of the body to the agency

of the poison. Among the influences are intemperance, low spirits,

anxiety, insufficient nourishment, and foul air. There should be great

care in regard to ventilation, and clearing and cleaning the room where

it has been present.

The disease cannot be cut short by active remedies, but may be made to

terminate favorably by the use of the perchloride of iron, &c. (F. 177.)

TETANUS (lockjaw) may follow slight wounds. At first the muscles of the

jaw are rigid, but the rigidity or spasms may extend all over the body.

It may result from exposure of the wound to cold, and some cases of

tetanus in infants have been attributed to the funis, in instances where

as much as three or four inches were left attached to the umbilicus. In

a case of tetanus the patient should lie in a darkened room, and noise

should also be excluded.

INCISED WOUNDS, made in the flesh by sharp cutting instruments, of

course may be trivial cuts, or deep incisions, and may sometimes be

treated by the nurse, either because they are slight injuries or because

a surgeon cannot immediately be obtained.

If there is not much bleeding there will not be very much to do. It is

well to have a little carbolic acid in the water with which it is

washed. The bleeding will soon cease if only small vessels are divided.

If there is any extraneous matter on the surface of the wound it must be

removed. Then put the surface of the lips of the cuts together, and take

measures to keep them in this state till they have become firmly healed.

If sutures are necessary take one or more stitches. The most common

method of keeping the surface of divided parts in contact is by strips

of adhesive plaster. Apply them after having put the wounded parts in a

position favorable for bringing the edges of the wound together, then

while one holds the lips of the wound evenly together secure them in

this position by strips of adhesive plaster applied across the line of

the wound. Leave a little interspace between each two strips of plaster.

It is not best to bind it up so that there is no passage or exit for

blood. But slight wounds may become serious if some poison or virus gets

into it; you may need to put on lint or a compress over the strips of

plaster and then a roller or bandage.

But some incised wounds instead of being immediately dressed and bound

up, demand that immediate attention should be paid to the hemorrhage. We

may usually know whether the bleeding is arterial, venous or capillary.

If the wound is open, blood from an _artery_ will _spurt out in jets_

and is of a bright red color. Unless the artery is very small a surgeon

will be needed, but you may be required to act very promptly to suppress

for a time a dangerous flow of blood. If a large artery is cut or

punctured the hemorrhage may be fatal in a short time. The application

of heat or cold, and the elevation of the part injured, may suffice in

slight cases, but in these severe cases other means are necessary.

First endeavor to arrest the rapid flow of blood by pressure upon the

wounded artery with your thumb. Then if the wound is in a limb let some

one tie a handkerchief loosely around the limb, and if you know the

course of the artery have the knot directly over it and between the

heart and the wound. Then put a stick in under and twist the

handkerchief so that it is tight enough to compress the artery. The

hemorrhage can thus be checked until the surgeon arrives. If the wound

is over a bone in the head or body, the bleeding may probably be checked

by binding on a hard compress where the artery is cut, thus making

direct pressure upon it. A ligature upon a limb ought not to remain very

tight more than an hour.

If the hemorrhage is from a leg below the knee it may be checked by

putting a firm roll of cotton in the flexed joint, and pressing the

lower part of the leg against the thigh; this will compress the artery.

CONTUSED WOUNDS are not often attended with serious hemorrhage. If there

is in the bruised part only slight subcutaneous laceration, nature may

soon repair the injury. But if there is considerable contusion indicated

by the ecchymosis where small blood vessels have been lacerated and the

blood extravasated into celular tissue, causing the dark discolored

spots and other evidences of severe injury, there will be subsequent

inflammation, perhaps suppuration, demanding treatment. A proper mode of

dressing at first is to bind on a compress saturated with a four per

cent. solution of carbolic acid, and for the fever and inflammation one

drop doses of ext. veratrum may be given.

But in all cases where wounds are severe the services of a physician

will be required.

A PUNCTURED WOUND signifies one made with a sharp pointed instrument,

the external opening being small compared to its depth. It is a good

rule in these cases to leave a free vent for any discharge that may be

set up. The danger in these cases is from serious injury to the deep

seated parts, and from suppuration which may burrow and extend still

deeper if there is not free exit for the pus.

One mode of treating POISONED punctural wounds (serpent bites, &c.),

which of course are peculiarly dangerous, is by applying cups over the

wound.

Any wound that suppurates much or sloughs causes a cavity to be filled

up, and the process by which the wounds and sores heal is called

granulation, and cicitrization. The wound is gradually filled up to the

surrounding level by new tissue appearing in the form of small red

granules bathed in pus. Healthy granulations on an exposed or flat

surface rise nearly even with the surrounding skin, and often a little

higher, but when they are much higher, and take on a growing action,

they are what is called proud flesh. Their growth may be checked by the

application of active astringents; nitrate of silver or burnt alum may

be used, or adhesive straps may be applied. The skin with which it is

covered when healed is formed from the surrounding skin, and the process

which is called CICITRIZATION does not go on well except when the

granulations are nearly level with the adjacent skin. The centre of a

sore has power to form new skin when there is a particle of live skin

there, and for this reason skin is sometimes grafted in.

A patient suffering from a suppurating wound becomes enfeebled from the

discharge of pus, and should have his strength kept up by nourishing

food. A surgeon will always endeavor to prevent the retention and

decomposition of discharges, and to protect from external contamination.

He will direct the time and means of dressing the wounds, but the nurse

must remember that decomposed animal matter acts as a virulent poison

introduced into the system as it may be through any abrasion of the

skin. All instruments used about a wound must be thoroughly cleansed

before being put away. Dressings which have been next the wound should

be burned; those which are to be washed should be disinfected. Avoid

soiling your own hands with discharges; protect with a bit of plaster

every place where there is any cut, or scratch, or sore. If you fear

that any virus has got in where there is any sore, or where the skin is

broken, touch it with carbolic acid.

FRACTURES AND DISLOCATIONS.

One of the signs of a FRACTURE is crepitus, the sound made by the

rubbing of the ends of broken bones together. This sound cannot always

be obtained, even when the bone can be moved so that the ends rub each

other, and as such motion causes considerable pain the nurse should not

seek for it, except as she harkens when the limb is accidentally or

necessarily moved. The separation and inequalities of the ends of the

fracture (when the bones are superficial), the change in the form of the

limb, and the shortening of it, are circumstances communicating

information in very many cases, and the diagnosis is made pretty certain

if there is unnatural mobility of the limb. In other cases there is loss

of motion or immobility, swelling and pain in the injured part, &c., but

it will possibly require the services of the skillful surgeon to detect

the existence and character of a fracture; and generally the coaptation

or setting of the bone, can be deferred until he arrives. The nurse can

do something in the meantime—can have the patient and fractured limb put

in as easy a position as possible; perhaps have something ready for

bandages and splints. A splint may be made of anything that will hold

the bone securely in place; it should be longer than the bone that is

broken. Sole leather is sometimes used; cut the required size, softened

in hot water, moulded to fit the part and left on until dry, when it

will be of the desired shape. Plaster of Paris bandages are sometimes

used. These are prepared by rubbing into the ordinary muslin rollers dry

plaster. They are then rolled. When they are applied, soft flannel

bandages are first put on the broken limb, then the one containing

plaster is (after being dipped in water, and some of the water squeezed

out), applied over the flannel. It takes ten or twelve hours for this to

set and become hard, and the broken limb must be kept still during the

time. Dust the part over with toilet powder before the bandage is

applied. The success of the surgeon depends very much on the good

constant care of the nurse. If it is necessary to move the limb keep up

some extension on it and do not twist it. Be very careful that the

directions of the surgeon are carried out, and it will probably be

necessary to keep up extension all the time, otherwise the deformity may

return and the limb be shortened.

DISLOCATIONS are not so easily reduced as fractures, but after the

setting and reduction of a dislocated joint the action of the muscles

tends to keep it in place. There is always some laceration of the

ligaments and sufficient injury to the soft parts to excite a little

inflammation, but the pain is relieved as soon as the bones are

replaced.

In general recent dislocations are easily reduced, but when the head of

a bone has been out of its place for several days the reduction becomes

exceedingly difficult, and as a rule the difficulty of reduction arising

from the muscles is proportioned to the length of time that has elapsed

from the period of the accident. For this reason a person who has a

little general knowledge on the subject of dislocations, should

sometimes make an attempt at reduction immediately after the accident.

The signs of dislocations are pain, incapacity of motion in the limb,

change in the length of the limb and in the direction of its axis.

Sometimes the dislocated limb is nearly incapable of any motion, and

sometimes the destruction of the means of union, allows the limb to obey

any extraneous influence.

The replacing of the dislocation would require very little effort or

force were it not for the resistance of the muscles and tendons attached

to them. In reducing a luxated bone the main point is to apply force

until the head of the bone dislocated can be slipped into its place,

which is generally when it is nearly to a level with its socket. This is

easily effected immediately after the accident, because at that time the

resistance of the muscles is not great; it may be best to attempt it,

but there should be no delay in sending for a surgeon.

I recommend that an attempt be made to set a DISLOCATED THUMB or FINGER

by making extension on the lower member and at the same time pressing

the head of the bone towards its natural situation. If the reduction is

effected, the thumb or finger should be rolled with tape and surrounded

and supported with pasteboard; and the hand and forearm put in a sling.

A surgeon may be necessary even in a case of dislocated thumb or finger,

but bones out of joint are so much more easily set at first, that it is

best to attempt to set them then, and the same may be said of some

larger bones.

For instance, if there is a DISLOCATION OF THE ELBOW, the patient being

settled, let one man take hold of his arm near the shoulder, to make

counter extension while another makes extension at the wrist. You

yourself being seated grasp the elbow with your two hands by applying

your fingers to the anterior part and your thumbs to the posterior,

press on the projecting point of bone downwards and forwards. You will

generally be successful, but I do not advise five minutes’ delay in

sending for a surgeon. I only advise that an effort be made immediately.

After thus reducing a dislocation of the forearm backwards at the elbow,

apply a bandage in the form of a figure of eight; apply some lotion or

liniment, and keep the arm in a sling. At the end of seven or eight days

when the inflammation has subsided, the articulation can be gently

moved, and the motion may be increased every day.

The figure of eight bandage is a roller applied alternately above and

below a joint, the roll being carried obliquely over a central point.

The art of putting on a roller bandage is an important one for a nurse

to acquire, and I may here give a few general principles though no exact

directions can be given. In applying a bandage care must be taken that

it is put on tight enough to fulfil the object in view, without running

any risk of stopping the circulation. A bandage must lie smoothly,

without wrinkles, and making an even pressure. For bandaging an arm or

leg a roller from two to three inches wide may be used; a few turns may

first be given on the hand or foot, and after this every circle is to be

applied so as to ascend up the limb in a gradual spiral form and cover

about one-third of the turn of the roller immediately below it. To

accommodate it to the shape of the limb reverses are made. The bandage

is doubled back by placing a finger on the lower edge to hold it firmly,

and turning the bandage downward over itself, at such an angle as

properly shapes its direction, and these turns can be made as often as

is necessary.

PART VI.

REMEDIES AND REGIMEN.

CHAPTER I.

HINTS IN REGARD TO THE TREATMENT OF COMMON DISEASES.

It is my design in a subsequent part of this work, under the head of

emergencies, to refer to those exceptional cases in which there is

peculiar danger, where some prompt action, something done immediately

may either save life or save from protracted disease. In such cases the

well instructed nurse may often do something without assuming undue

responsibility.

But I now intend to give such instruction in regard to the treatment of

minor ailments and complaints which are liable to arise in every family

daily, as will enable the mother or nurse to often relieve present

distress, and prevent future sickness and suffering. But I hope it is

fully understood that while I give such instruction as is founded upon

many years of study, and experience, and observation, I do not expect

that any one can become a doctor by the perusal of this small treatise,

or that the student of this book will ever set herself in opposition to

those who have devoted years to the study of the healing art. With the

understanding, then, that the mother is to prescribe medicine only in

such cases as mothers usually do prescribe, I will now give some

directions that will enable the nurse or mother to act with promptness

and assurance and efficiency.

Some medicine should be kept in every house, and I suggest the following

as a good list: Aconite, veratrum, paregoric, aromatic ammonia, spirits

camphor, essence peppermint, spirits nitre, syrup ipecac, witch hazel,

adhesive plaster, chlorate of potash, gum arabic, compound licorice

powder, carbolic acid, and the sanguinaria powder.

The last, which is the medicine that I always use in diphtheria, may be

prepared according to the following formula: Take of pulverized blood

root ½ ounce, Ferri sulphas Exsiccata ½ ounce. Triturate together. Dose,

1 grain put on the tongue dry every four hours. The medicine should be

kept dry and is best kept in a phial corked.

All the medicines should be labeled with the name and ordinary dose.

A small quantity of medicine will suffice to keep in the house. I

suggest the following amounts and labels: ½ oz. tinct. aconite. Dose,

1/20 of a drop (or less) every hour. Poison. ½ oz. veratrum viride.

Dose, ½ drop every two hours. 1 oz. paregoric. Dose, 1 drop to a

teaspoonful. 1 oz. aromatic ammonia. Dose, 20 drops diluted in water. 1

oz. ess. peppermint. Dose, 10 drops. 1 oz. spirits camphor. Dose, 1 to 5

drops. 1 oz. syrup ipecac. Dose, 5 drops to a teaspoonful. 1 oz. spirits

nitre. Dose, ¼ teaspoonful in water. ½ oz. fld. ex. witch hazel. Dose, 1

drop every hour. ½ oz. chlorate potash. ¼ lb. compound licorice powder.

Dose, 1 teaspoonful. 1 oz. gum Arabic. ¼ yd. adhesive plaster. 1 oz.

carbolic acid and glycerine. Poison. 1 oz. sanguinaria powder. Dose, 1

grain.

I will now give my treatment of diphtheria which is mostly by the use of

the Sanguinaria powder, as this very well illustrates the benefit of

having some mild safe medicine in the house, and using it early in the

disease. Nearly thirty years ago I was so well satisfied of the efficacy

of this medicine, that I advised all the families with which I was

acquainted and where I was their physician, to keep the powder in the

house and use it whenever any of them had sore throat; very many of them

did so, and it has happened that so far as I know, there has not been a

fatal case of diphtheria among them.

I advise that it be given in all cases of sore throat, for although it

is not so important a remedy in all these cases, it will very generally

be useful in a greater or less degree, and as the sore throat is usually

the first thing complained of in diphtheria, its early application is

thereby assured.

A very small dose will suffice, but there is no objection to taking two

or three grains for a dose every 4 hours, except the disagreeable taste.

I advise that it be taken alone, and not covered up, as I believe that

it acts locally perhaps directly upon the organism or germ that is the

cause of the disease. I have not, however, relied exclusively upon the

one medicine, but have always directed that they should give about a

teaspoonful of the saturated solution of chlorate of potash every hour,

and that they keep kerosene applied on the outside of the throat or

neck. Give plenty of milk and other nourishing diet, and but little

other medicine is usually required.

The SANGUINARIA (bloodroot) POWDER is properly given in other cases

besides diphtheria. A small dose given three times a day is not only a

good worm medicine, but will prevent the subsequent developement and

growth and multiplication of worms for some time. It is also a cure for

a cough that is dependent on an irritated state of the fauces.

Three grains taken after each meal is a good remedy in chlorosis or

suppression of the menses. In these cases it can be taken covered up in

wafers or in rice paper, thereby avoiding the bitter taste.

ACONITE should be kept in the house, and very small doses given in cases

where there is a little feverishness, and no marked symptoms of disease.

It is useful when there is an ordinary cold, and may be given two drops

of the tincture in half a glass of water, one teaspoonful every hour.

These small doses may be given to a little child, and yet they have some

effect upon older persons.

ORDINARY COLDS, however, require more efficient treatment, and I often

direct the following: A teaspoonful ginger, a teaspoonful cream of

tartar, and three large teaspoonfuls of sugar in a small glass of water,

to be drank as one draught after being stirred. Heat the feet and keep

them warm especially at night. The combination of ginger, cream of

tartar, &c., opens all the secretions so that the lungs, liver, bowels,

skin, and kidneys act in a natural manner, and there is immediate

benefit.

VERATRUM has already been mentioned as a remedy in inflammation. If good

extract or tincture is used it can always be relied on to reduce the

force and frequency of the pulse. It is frequently applicable because in

most of our diseases the force and frequency of the pulse is increased.

The pulse should be counted when it is first given, and counted

occasionally afterwards, and when the pulse becomes less frequent the

dose must be diminished or omitted. If an overdose is given it is

commonly vomited, otherwise it might be dangerous. Ordinarily half a

drop every two hours of the fluid extract is sufficient, but for adults

two drops may sometimes be given and repeated in an hour. We have so

many maladies that are inflammatory, where the pulse is full and hard,

that the indications for its use are frequent. Even in the commencement

of fevers, when the pulse is full and quick—where it was formerly the

practice of physicians to bleed, veratrum should be given till it has a

decided effect upon the pulse. In intermittent fever the effect of this

sedative upon it, given at the commencement of the fever or hot stage,

is as salutary as is the effect of quinine given during the

intermission.

Moderate doses are not liable to do harm except to those who have become

quite weak and low. A convenient way of administering it is to prepare

twenty drops of the extract in twenty teaspoonfuls of water, and the

dose can be easily regulated.

Croup may generally be cured if veratrum is given early and in efficient

doses. It is of no avail to administer it at an advanced stage when

there is apnœa; the pulse becoming feeble and intermitting, the lips

blue, the skin losing its heat; and when drowsiness, coma or other fatal

symptoms are coming on. When cough, hoarseness, catarrh, and loss of

voice are noticed in a young child, it should be narrowly watched and

protected against all circumstances likely to aggravate inflammation; it

should be kept in the house, and a warm, moist air should be kept in the

room (about 65°), its diet should be milk or farinaceous food; the

functions of the bowels and skin should be attended to; some aconite

should be given; if there is a slight, ringing cough, place the patient

in a warm bath for ten minutes, then confine it to bed; keep the air of

the room moist by the evaporation of boiling water; give castor oil or

other physic, and small doses of syrup ipecac, and spirits nitre. If the

respiration becomes sonorous and difficult, the voice hoarse and gruff,

the cough croupy and brassy as it is called, you have the characteristic

symptoms of croup. But the peculiar breathing, making a sort of crowing

sound with each inspiration, will always distinguish it, and there will

always be some fever attending it. Croup sometimes commences with sore

throat, and I believe that the sanguinaria powder will usually be

efficacious in its cure; but prompt doses of veratrum are still more

effectual. At the early stages you may give two drops of the extract,

and the dose may be repeated in half an hour, and perhaps repeated

afterwards. If there is not evident improvement an ounce of syrup of

ipecac or a teaspoonful of sugar and alum pulverized together, may be

given if necessary to make the child vomit.

In the meantime hot fomentations should have been applied to the throat.

A sponge the size of a large fist, dipped in water as hot as can be

borne, should be squeezed half dry and applied under the child’s chin so

as to cover the larynx, and the temperature maintained by resoaking it

every two or three minutes.

Baths may be used during the second stage of the croup; if the child has

a temperature of 104°, a warm bath ought to be administered, and the

child immersed in it up to its chin for fifteen or twenty minutes.

After the breathing is relieved, still give small doses of syrup of

ipecac, or alum, or veratrum, sufficient to keep up nausea for a time.

After there is a decided amelioration of the symptoms, give the

following: To a teacupful of ginger tea add a teaspoonful of aromatic

ammonia, and a teaspoonful syrup of ipecac, and give a teaspoonful every

hour.

VERATRUM is the medicine upon which you must rely in croupy cases; this

disease requires vigorous treatment, but vigorous measures in the start

will generally save the life of the patient.

PAREGORIC is a useful medicine for pain, diarrhœa, cough and

restlessness, and may generally be given advantageously when two of

these symptoms are present. Opium has some beneficial effect in

inflammation, and very generally paregoric can be given where there is

febrile excitement. I would never give it when the child is only cross

and irritable, as a bad habit may thereby be engendered. There is always

danger of giving an overdose of any opiate; and although an adult may

sometimes take as much as two ounces of paregoric when he is suffering

severe pain, I do not advise that it be given to children often in doses

that exceed five drops.

DIARRHŒA may be treated in the following manner: To four ounces of

ginger tea add one teaspoonful paregoric, one teaspoonful aromatic

ammonia, one teaspoonful ess. peppermint, one half teaspoonful spirits

camphor, and two ounces of mucilage of gum arabic, and shake the whole

together. This is good medicine for all forms of summer complaint,

diarrhœa, dysentery, or cholera morbus. One-half teaspoonful of this is

a dose, but it can be given efficiently in a larger or smaller dose. It

acts by correcting the disordered state of the stomach, and it is upon

this usually that these diseases depend.

If the diarrhœa continues for a day or two, some mild astringent may be

given; perhaps three drops every two hours of the extract of witch

hazel. The diet is important, and it is well in these cases to have some

wheat flour boiled. (F. 47.) The flour grated from it and sifted, and

made into a gruel, may be profitably used with milk.

A thin solution of GUM ARABIC with milk affords both food and drink, and

is one of the most useful, and safe, and efficient remedies.

Such medicines as F. 74, 77, 79, 80, may be given in almost every case

with benefit. The alkalies neutralize the acids in the stomach, and the

aromatics have a grateful action. If the pain continues, a warm bath may

be given. Should the gums be swollen, they should be cut down to the

teeth.

But there are many cases of diarrhœa where my prescription would be the

following: Give no kind of food save that of the milk of the mother, and

that only once in four hours. Should the thirst require more fluid to

satisfy it, give from time to time a teaspoonful of cold water; put

flannel on its body, and woolen stockings on its legs; rub the abdomen

three or four times a day with the bare warm hand; do not ever wake the

child when asleep; when awake give it five drops paregoric every two

hours.

In the preliminary stage of CHOLERA INFANTUM, besides giving the

diarrhœa mixture with ar. ammonia, I would enjoin absolute rest in the

recumbent position, with warmth to the surface and extremities; perhaps

total abstention from mother’s and cow’s milk, and would order either

condensed milk or arrow root prepared with water. I would also make

counter irritation over the abdomen by poultices and sinapisms.

DYSENTERY when first coming on is attended with more fever than diarrhœa

is. It will be distinguished by the character of the pain and the

discharges. The patient is tormented by a sensation as if there was some

excrement to be dislodged; he goes often to the night chair, and strains

to get rid of the irritation; he discharges but little, and what is

voided is either a jelly like or bloody mucus; perhaps mixed with films

and membranous shreds. The pulse is hard and frequent, the skin hot, the

face flushed, and the patient complains of headache and thirst.

You may give some veratrum at first; one-half drop of the extract every

two hours for one day; and to allay the thirst, give cold water in which

some wheat flour has been stirred.

My principal remedies if the diarrhœa mixture does not cure, is to give

the sour drops (elixir vitriol), and either large or small doses of

ipecac. I also use injections of starch and laudanum, and rectal

suppositories. (F. 155, 160.)

You may find much benefit from some domestic remedies. Give either

occasional doses of strong table tea, or spoonful doses of vinegar and

table salt, or freshly prepared melted mutton suet.

AROMATIC SPIRIT OF AMMONIA is useful in hysteria, flatulent colic and

nervous debility. It is not a powerful medicine to overcome disease, but

it is a medicine that ought to be at hand to relieve many little

ailments that are liable to occur, when much medicine cannot be given. I

advise those that are suffering from sick headache to take 30 or 40

drops of it as a stimulant antacid. It may be well also to take a

teaspoonful of paregoric, and to lie down till sleep gives relief.

FAINTING FITS or FAINTING may demand a remedy, and 15 drops ar. spts.

ammonia may give the desired relief, if the sufferer lie down and a

little cold water be sprinkled in her face also.

This medicine is a grateful antacid in cases of SOUR STOMACH, and it

will usually give some relief in the flatulence and distress of

DYSPEPSIA.

It may often be used as a slight stimulant, but as it is an alkaline

remedy it should not be given conjoined with acids.

ESSENCE PEPPERMINT and SPIRITS CAMPHOR are often used in ailments

similar to those in which I use aromatic ammonia, and this may be given

in combination with them. Some persons have a decided preference for

essence cinnamon, or wintergreen, and these may be substituted for

peppermint; aromatics also, such as sweet flag, will have a similar

effect.

Spirits nitre is often a grateful stimulant to the stomach, but it is

also used in febrile affections, and inflammatory complaints. Four parts

of spirits nitre to one of ar. ammonia is diuretic, diaphoretic, and is

well suited to certain states of febrile disease.

When given to promote the action of the kidneys, a half teaspoonful or

more may be given every two hours in a spoonful of water. Scanty and

high colored urine, especially when it is acrid and burning, is an

indication for its use.

SYRUP OF IPECAC is used as an expectorant and emetic in colds and

coughs. If given to a child, one teaspoonful is an emetic dose, to be

repeated every fifteen minutes till it operates. If given to loosen a

cough, five or six drops repeated every half hour will suffice; but it

may be given in much larger doses. It is often given in combination. (F.

137, 139.)

WITCH HAZEL. Pond’s Extract Hamamelis is kept by many people in the

house, and as it is usually accompanied with directions, I shall refer

to it very briefly. The ordinary fluid extract is perhaps five times as

strong as Pond’s extract, and when used may be diluted accordingly. It

is astringent, and a medicine of that kind is often useful both

internally and externally. A few drops taken each day may prevent

bleeding, when there is a tendency to hemorrhage, although ergot would

be a more efficient remedy if given for immediate effect.

CHLORATE OF POTASH is very generally given in diphtheria, and is

generally safe; no harm can come from the advice to keep it constantly

in the house; it is not very soluble, and the saturated solution is not

too strong for use. It is a good way to put a half teaspoonful of it in

a glass, and keep a little water on it all the time, and give ten or

twelve teaspoonful doses of the solution a day for any kind of sore

throat or mouth.

COMPOUND LICORICE POWDER (F. 108) is a mild laxative, and may be given

to a young child in half teaspoonful doses. In larger doses it will

serve well for older persons for physic. While I think it well to keep

this in the house and to occasionally administer it, some other sort of

cathartic may at times properly be preferred. A great variety of this

sort of medicine is attainable, no one kind is always the best; this

powder is however a good laxative, in doses of a teaspoonful repeated in

eight hours if necessary.

GUM ARABIC is not often kept in the house as a medicine, but I think it

eminently proper to keep it; scarcely any other medicine is so safe and

harmless either in large or small doses, and few are more decidedly

useful than this in some cases. Made into an emulsion and taken either

alone or in combination with other medicine, or used as food, it is good

in every variety of bowel complaint. A teaspoonful of the mucilage

stirred into a cup of cold water and drank by the patient, may serve as

medicine and drink and sustenance when he can take no other food. It may

properly be added to expectorant and diuretic medicines; but the

beneficial effects are most obvious when it is administered for

inflammatory affections of the gastric and intestinal mucous membrane.

Slippery elm and flaxseed tea have a similar effect, but are not so

decidedly beneficial.

CARBOLIC ACID nine parts and GLYCERINE one part may be kept mixed

together; not because the glycerine assists or modifies the action of

the carbolic acid, but because it renders the acid soluble in the water,

so that the solution may be of any strength desired. CARBOLIC ACID is

not much used internally; it is so powerful that it ought to be regarded

as a poison; its effect is good, however, if given in small doses very

much diluted. It is believed to be destructive to disease germs, and may

very properly be given in bad cases of diarrhœa and dysentery. Two drops

of the acid in a glass of water is a weak solution, and may be given

without harm; a half teaspoonful every two hours.

There is not space in this work to describe particularly the various

cases in which it may be used externally. A solution one part in 100 of

water, may be applied advantageously to any inflamed part or to any

CUTANEOUS ERUPTION, or may be used as a wash or gargle in any SORE MOUTH

or SORE THROAT. To cure sores or eruptions, however, it is often

necessary to apply it much stronger. I apply a 1 to 5 solution to the

sores once or twice, and to burns a solution 1 to 30 for a few days.

I will give more particular directions for its use in HEMORRHOIDS or

PILES. Apply the acid and glycerine (9 to 1) to the piles by dropping 3

drops upon a bit of tissue paper and pressing it against the tumors, and

into the anus. Repeat this each day for three days, then use a mild

ointment or suppositories. (F. 206.)

A few doses of the compound licorice powder will be useful for piles if

the bowels are not regular.

I have already given some specific directions in regard to some diseases

in very young children; what further instructions I give will be of a

general character.

HOME REMEDIES AND APPLIANCES FOR SICK CHILDREN.

DENTITION predisposes to sickness, if it does not cause it, and it may

call into activity latent tendencies to disease. It may cause such

symptoms as the following: redness, heat, and tenderness of the gums; an

increase of saliva; starting as if in fright; restlessness, or

interrupted sleep; eruptions on the head or body; derangement of the

digestive organs, and sometimes convulsions. During the period of

dentition, be especially careful that the child has its food and sleep

regularly, and that it is restricted to suitable quantities of food at a

time. Keep the head cool and the feet warm; wash the child daily in cold

water, and allow it to be much in the open air. If a child is worrisome

and irritable it will be necessary to cut the gums. Lance them at the

elevated points, cutting them down to the teeth. At the same time,

aconite can be given, and perhaps a warm bath; and if there is

considerable fever give ordinary doses of veratrum. These remedies are

so generally useful where there is fever, that I will venture to

recommend them when either THRUSH, MEASLES, GERMAN MEASLES, MUMPS,

SCARLET FEVER, CHICKEN POX, or WHOOPING COUGH is coming on or suspected.

Each of these diseases have a natural course which they must run before

they terminate, and it is best, as in diphtheria, not to give medicines

powerful enough to interfere with the natural course of the disease. Do

not give physic. (F. 121, 122.)

So in OPTHALMIA it is better to have nothing but a little salt in the

water than it is to use harsh things to bathe the child’s eyes. Do not

rub the eyes; let a small stream of tepid water trickle onto them, and

wipe the discharges away with a soft rag. Burn the rag, wash your own

hands, and keep them away from your own eyes, on account of the danger

from contagion. (F. 210, 211.)

CONSTIPATION cannot be treated in all cases without giving some aperient

medicine. (F. 108, 109.) Oat meal gruel as a diet may be helpful; and

fresh vegetables—cabbages, turnips, onions, ripe fruit; oatmeal porridge

with molasses, and brown bread may be taken freely. Infants may be

partly fed on corn starch, and older children may have cracked wheat (F.

35), or peas, beans, squashes, and other fresh vegetables and fruits in

their season. A good draught of water on rising and retiring is

advisable; and a teaspoonful of soda and molasses mixed together and

taken daily for a week may cure a costive habit. A suppository of

castile soap may induce a movement in a child, or it may be best to give

an injection of tepid water, or soap and water.

For CHAFINGS bathe the parts well in tepid water, dry with soft cloths,

and apply by means of a soft sponge, F. 212.

The following diseases are inflammatory, and demand at first mild

treatment with aconite, veratrum, and warm baths:

In TONSILITIS (quinsy), use the blood root powder and bicarbonate of

soda. The patient can apply the bicarbonate of soda to the inflamed

tonsil with his finger, or it can be blown into his throat through a

quill, or through a hollow roll of stiff paper that contains a few

grains. For the chronic form of tonsilar enlargement use F. 213.

CORYZA or snivels is an inflammatory affection of the mucous lining of

the nose, attended with an abnormal secretion. Sometimes the child can

only breathe through its mouth; in such cases you may draw the breast

milk, and feed the child by means of a spoon. Give aconite, and as a

local application the inside of the nose may be often smeared with

vaseline, or cold cream, or carbolated cosmoline.

Bronchitis, pneumonia, pleurisy, and other inflammatory diseases, may

not show their distinctive character in their incipient stage, but there

will be at first sufficient fever to indicate the need of aconite,

veratrum, and perhaps the warm bath. Accessary means may be used, such

as the following: the patient should be placed in a warm room (about

65°) and have only light bed clothing; if the child is taken out of bed

he must have on a warm wrapper, or be otherwise well covered; he should

not lie flat in bed, but he should be somewhat propped up with pillows;

and it may be best to keep on a continuous poultice to the chest in

front and back. The patient should be kept very quiet, have mucilaginous

drinks and farinaceous diet; and the air of the room should be moistened

by steam or the evaporation of wafer; and the ventilation of the

apartment must not be neglected. They must have frequent sips of cold

water to allay thirst, besides marshmallow, slippery elm, or flaxseed

tea, and revulsives must be used as well as poultices and fomentations.

By the aid of a CLINICAL THERMOMETER many diseases may be distinguished

even in the incipient stage.

If a person without any premonitory symptoms is seized with a chill,

followed by rapid breathing, a dull pain in the chest, cough, high

fever, and comparatively slow pulse; if the thermometer indicates a

temperature of 104° or 105°, and the pulse does not beat over 110 a

minute, the case is one of ACUTE PNEUMONIA. Sometimes the temperature is

below 90°; if it exceed 120° it is almost certain to be fatal.

AGUE. CHILLS recurring regularly for a few days indicate the

intermittent nature of a disease. But during the first chill if the

thermometer is applied, we may know that a case is one of fever and

ague, if while the skin is yet cold the thermometer rises to 105°, and

later to 107°, and during the stage of sweating the instrument shows a

decline of 2° every fifteen minutes till it has reached 98½°. This rapid

rise and decline is due only to malaria, and quinine is indicated. (F.

182.)

TUBERCULAR PHTHISIS. If a patient has been losing flesh of late and been

troubled with a short, dry cough, take his temperature at about six P.

M. for a few evenings. If the thermometer records 99° to 100°, and no

other cause exists for this regular nightly increase of temperature, the

case can be put down as one of incipient consumption, especially if

tuberculosis has been in the family. Endeavor to improve the general

nutrition by attention to the quantity and quality of the food (as

generous diet as can be taken without disturbing the stomach or

increasing the feverish symptoms); by enjoining a residence in a healthy

climate; by exercise in the open air; by warm clothing; by daily tepid

sponging, with friction of the skin; and by cod-liver oil or petroleum

emulsion with hypophosphites. An animal diet is generally necessary. If

digestion fails and there is acidity of the stomach, give pepsin. (F.

72.) Add a teaspoonful of sweetened lime water to a tumbler full of

milk, and if this agrees with his stomach, he can take that amount four

times a day.

In TYPHOID FEVER the patient may complain of lassitude, headache, pain

in the back, etc., for several days before he is feverish. Then his

temperature is 99°, and it may be one degree higher each night, until on

the sixth and seventh evening it is 104°; it being each morning one

degree less than at night. Even if there is no diarrhœa, tympanitis, or

eruption, we may by observing the temperature, feel sure that we have a

case of typhoid fever. If it is a moderate case the temperature will be

104° at night, and 103½° in the morning, till the fourteenth day, when

it may decline one degree in the morning, and half a degree or one

degree in the evening. After that it may decline regularly till on the

21st day it may be 98½°. Relapse or chest difficulty may modify this

regular decline, and the nurse must carefully note and report to the

physician the temperature each morning and night.

In TYPHUS FEVER the temperature reaches its height, 104° or 105°, within

thirty-six hours. It continues at that height, with morning remissions

of one-half degree, till the eleventh or thirteenth day, when it rapidly

falls to the normal; a sweat or a long sleep ushering in the favorable

termination.

SCARLET FEVER. If a child is suddenly taken ill with a chill, vomitings,

very rapid pulse, and the thermometer records 105° or more, very early

in the disease, it denotes scarlet fever; and from this sign alone, even

without any sore throat or eruption, a diagnosis may be made. This

disease may very frequently go on well without any danger till the

eruption subsides, but danger arises from exposure of the child to cold

any time during the subsequent four weeks.

HYSTERIA. There may be pain perhaps in the bowels, abdominal tenderness,

and vomiting; or there may be symptoms of inflammation in some other

part; if the thermometer does not register more than 98½° it is probably

hysteria. Assafœtida, valerian, and such remedies will probably cure.

APOPLEXY. In this disease the thermometer soon after the attack shows a

temperature of only 97°, and lower still if there should be a second

effusion to still more compress the brain. On the contrary, in a fully

developed case of sunstroke, the thermometer will not record less than

107°.

It would be a good thing if every nurse and every mother kept a clinical

thermometer.

CHAPTER II.

EMERGENCIES, ACCIDENTS, SUDDEN SICKNESS.

The diseases last named were there mentioned because their distinctive

character could be determined by the thermometer. They are, however,

examples of the kind of cases that I design now to speak of

particularly; where there is apparent cause for alarm, and where there

is apparent necessity that something should be done immediately.

These cases demand the services of a physician, and my design is only to

instruct you what to do before the doctor arrives; or rather I should

say, the instructions that I give are not intended to supercede medical

advice, though some cases may be of a kind in which little or nothing

can be done. These emergencies are of every variety, and I shall bring

the different kinds before you as fully as I can. Ordinarily it is not

at first apparent what the real malady is.

We will suppose that during the heat of summer a man drops down

unconscious. At first no one knows whether it is apoplexy or SUNSTROKE.

Do not get excited and do things that are rash; if you do not know what

ought to be done, do nothing; if you are not excited you may at least

use what knowledge you have acquired.

Send a message to the doctor, giving a description as far as you can of

the case, so that he may come prepared to treat it. Secure plenty of

fresh air and room, and get rid of those who are around, who cannot be

useful; if respiration is suspended, and there is immediate danger,

something may be done at once; at least to know if the man has merely

fainted. Have him laid in a horizontal position; you may soon have him

carried to the nearest house. For this something should be provided on

which he can lie horizontally; instruct the bearers to avoid unnecessary

jolting; have a bed ready to put him on; if the case is supposed to be

fainting give aromatic ammonia or a little stimulant of some kind; do

not raise the head, but keep it low as the feet. If it is a severe case

of sunstroke, the skin is hot and the pulse weak and fluttering; there

may be convulsions, but probably there will be no movement; remove the

clothing with as little disturbance as possible; do not cut anything

that can be ripped; throw cold water on the head and chest, or put the

patient in a cold bath of about 70° at first, and gradually reduce the

degree of cold; give a cup of good table tea; do not give alcoholic

stimulants without medical advice. If consciousness returns and the

temperature again rises, repeat the cold applications to the head, neck,

and chest; give ice water or ice tea; it may be best to rub the head and

body an hour longer, and to give stimulant enemata.

APOPLEXY can be distinguished from syncope by the pulse, which beats

perhaps with unnatural force; the face instead of being pale is

generally flushed, and turgid, and the respiration goes on though it may

be labored and stertorous. The condition of the sensorial functions is

much the same as it is in narcotic poisoning, or when a man is dead

drunk. The nurse should make all necessary enquiries so that she can

furnish the physician with a full history of the case to help him in his

diagnosis. In apoplexy the pulse is rather slow though full, and the

pupils of the eyes, one or both, dilated. There may be paralysis of one

side.

Loosen the clothes, elevate the head and chest, apply cold water to the

head, and heat to the extremities, and perhaps sinapisms also. Giving

physic may be deferred until the doctor arrives; and in general you may

pursue a similar course whether the case is one of CONCUSSION OF THE

BRAIN, or COMPRESSION or narcotic poisoning; cold may be applied to the

head by means of pounded ice in a bladder; keep the head cool and the

feet warm.

Many of this class of cases require still very careful nursing after the

dangerous symptoms are relieved. The skin should be kept healthy by

daily friction and bathing. The bowels must not be permitted to become

costive; the diet should be light, the food well chewed, the mind kept

cheerful and free from excitement.

POISONS.

In cases of poisoning no time is to be lost in administering relief, and

it is important that the nurse should be familiar with all the usual

antidotes.

Most commonly in a case of poisoning, speedy free vomiting should be

induced by those articles that are at hand, and that are quick and

prompt in their effects.

Even if the poison has been taken hypodermically, emetics may be given;

these will do no harm: Sulphate of zinc (white vitriol), is very prompt

in its action, and may be used when it can be procured (F. 134); and if

vomiting be present, we may aid it by giving warm water, or perhaps

pulv. ipecac, or some other vegetable emetic.

But either common salt or mustard is nearly always at hand and may be

given. Stir up a tablespoonful of salt or a teaspoonful of mustard in a

cup of warm water, and give immediately, and repeat until a pint is

swallowed; do not stop to stir them very much, but give as quickly as

possible. You may tickle the throat with a finger or a feather to induce

immediate vomiting. Do not give tartar emetic; do not give fluids so as

to distend the stomach too much; some bland fluid may be given with or

immediately after giving mustard and salt; either milk, lime water,

white of egg, flour and water, gruel, drinks sweetened with honey or

sugar. Oil should not be given unless ordered.

Before naming the antidotes for particular poisons I wish to instruct

the nurse to not only note the symptoms, but also to examine every

article of a suspicious nature, (such as phials, boxes, or papers

containing powders), and preserve them. Preserve also all vomited matter

and everything that may afford a clue to the poison for after

inspection, if the nature of the poison is likely to be a subject of

after inquiry.

In regard to the symptoms it may be well to know that Prussic acid,

cyanide of potassium, strong ammonia, pure carbonic acid gas, or pure

carbonic oxide may KILL almost at once, as indeed almost every poison

may if taken in a very large dose; strong acids, alkalies, aconite,

antimony, arsenic, tobacco, or lobelia may cause SPEEDY COLLAPSE.

Belladonna, hyoscyamus, strammonium, canabis indica, alcohol or camphor,

may cause DELIRIUM.

Nux vomica, strychnine, antimony, or arsenic may cause TETANUS or tonic

contraction of the muscles.

Antimony, arsenic, carbonic oxide, aconite, strong acids or alkalies may

cause CONVULSIONS.

Gelsemium, conium, aconite, arsenic, or lead may cause PARALYSIS.

Belladonna, atropine, hyoscyamus, or strammonium causes DRY SKIN; and

opium, aconite, antimony, alcohol or lobelia causes MOIST SKIN. The skin

is almost always moist in collapse.

Belladonna, atropine, hyoscyamus, stammonium, aconite, alcohol,

chloroform or conium may cause DILATED PUPILS.

Opium or chloral may cause CONTRACTED PUPILS, especially during sleep.

Prussic acid, laudanum, alcohol, carbolic acid, acetic acid, ammonia,

chloroform, creosote, iodine, phosphorus, camphor, or nitro benzole can

often be smelled in the BREATH.

Belladonna, atropine, hyoscyamus, strammonium or opium cause the MOUTH

and TONGUE to be DRY.

Arsenic, ammonia, cantharides, jaborandi or mercury cause SALIVATION.

Arsenic, antimony, corrosive sublimate, cantharides, digitalis,

colchicum or colycinth causes VOMITING and PURGING.

Lead, colycinth, copper, or arsenic causes COLIC. Arsenic, antimony and

lead cause CROUP.

ACIDS OF AN IRRITATING CHARACTER.

These include ACETIC, CITRIC, MURIATIC, NITRIC, OXALIC, SULPHURIC, and

ARSENIOUS acids. Their irritating and corrosive character depend upon

their strength and concentration, or the amount taken, some or all of

them being salutary in small diluted doses. Their injurious effects are

severe the moment they are swallowed, as they excoriate the throat and

gullet at the time of swallowing. But antidotes will lessen their power

on the stomach and bowels if given soon, and if given with the emetic

will render the vomited matter less irritating. Their corrosive

character causes severe pain, which may be followed by symptoms of

shock.

Alkalies are the antidotes. Give some one that is at hand, either

calcined magnesia, a solution of soda or soap, lime water or whiting. At

the same time the emetics and alkalies are taken, give demulcents, such

as milk, mucilage, gruel, flaxseed tea, etc. Of course the inflammation

consequent on the poison must be treated.

Carbolic acid might be included among those above named; the same

treatment would be proper, except that strong alkalies are ineffectual

as antidotes. Besides emetics give milk, demulcent drinks, and carbonate

of magnesia, with a little paregoric in water. Secure rest and warmth to

the body, use counter irritants externally.

ARSENIOUS ACID is included in the above list. The antidote for this is

hydrated peroxide of iron, recently prepared, and given in large doses.

It is prepared by the addition of liq. ammonia to muriated tinct. of

iron, or liq. ferri sulph., which yields the hydrated peroxide of iron

as a dense precipitate; and this should be given in tablespoonful doses

every five minutes until the symptoms are relieved. The nurse and

attendant’s duty, however, is to give emetics and demulcents freely.

ALKALIES are like the acids, irritating; if strong they excoriate the

fauces and esophagus. CAUSTIC POTASH, LYE, SODA AND HARTSHORN are

examples. In these cases give acids such as vinegar and lemon juice as

antidotes, and oils also to unite with the alkali and render it less

irritating. Demulcent drinks must be given with the emetics, and acids

must be continued afterwards.

For LUNAR CAUSTIC (nitrate of silver) give two teaspoonfuls of salt in a

pint of water, also the white of egg with other demulcents.

CORROSIVE SUBLIMATE. For this poison the antidote is white of egg and

milk, or a mixture of wheat flour and water and soap, which may be given

with emetics, or after them; before if no emetic is at hand. The

attendant nervous symptoms may be alleviated with paregoric.

TARTAR EMETIC of itself produces vomiting, but this may be kept up by

giving mucilage and such astringent infusions as common tea, &c.

COPPER. The sulphate or acetate of copper might act as an emetic, but

small quantities remaining in the stomach might act as irritant poisons.

Give large doses of simple syrup as warm as can be swallowed; give also

the whites of eggs and large quantities of milk; and as an antidote the

hydrated peroxide of iron.

For BISMUTH, IODINE, or COPPERAS taken in an overdose, give the same

emetics and demulcents as for copper.

ZINC and TIN. The sulphate of zinc and the salts of tin when not vomited

entirely, produce severe irritating effects on the stomach. Besides milk

and albumen give carbonate of soda in solution.

COLYCINTH, CROTON OIL, and SAVINE OIL may produce like the above,

vomiting, diarrhœa, and also constriction of the throat. Give copious

doses of barley water, etc.; give opium and perhaps stimulants. These

cases and all the rest of the above may be benefitted by taking freely

of gum Arabic mucilage, and may demand treatment for inflammation.

CANTHARIDES may produce severe pain in the bowels, bloody evacuations,

strangury, burning thirst and fever. Give emollient drinks with enemata,

to which some laudanum may be added, and also camphor; oil must not be

given in cases of poisoning by cantharides or phosphorus.

TOADSTOOLS, AGARIC, ACONITE, BELLADONNA, CONIUM, COLCHICUM, HELLEBORE,

and ALCOHOL, are acro-narcotics which may cause severe irritation of the

throat and stomach, and such symptoms as burning heat of the esophagus

and stomach, thirst, violent nausea, purging, dryness and constriction

of the mouth and throat; and be followed by such symptoms as are

produced by narcotic poisons: vertigo, headache, perversion of vision,

sense of suffocation, disposition to sleep, numbness or paralysis of the

limbs, prostration of the strength, cold extremities, feeble pulse, and

stupor.

STRAMMONIUM, CAMPHOR, CHLORAL, DIGITALIS, BITTER-SWEET and HYOSCYAMUS

may be called narcotic poisons. Give prompt emetics, demulcents, witch

hazel, active purgatives, strong coffee; keep the patient roused, use

electro-magnetism, cold douche, and employ friction.

For PHOSPHORUS, which a child sometimes obtains from the ends of

matches, give emetics, and administer big doses of magnesia in water and

mucilage. There are a few other poisons which might be classed as

irritant, such as nitrate potash (salt petre) which need the same class

of remedies as those already named. For nitre give also stimulants

freely.

OPIUM and BELLADONNA are antidotes to each other, and if a person has

taken an overdose of one, the other should be given if it is at hand.

Evacuate the stomach perhaps by tickling the fauces; give also strong

coffee, active stimulants, witch hazel; employ friction, perhaps electro

magnetism, and keep the patient moving. Morphine of course demands the

same.

For NUX VOMICA and STRYCHNINE, besides giving an emetic give aromatic

spirits ammonia, and also chloroform internally in ½ drachm doses

diluted. Give tannin and also animal charcoal, milk and spirits camphor

in large doses.

CARBONATE and ACETATE of LEAD sometimes act as poisons. Give sulphate of

zinc as an emetic, and epsom or glauber salts as a cathartic. A mixture

of syrup and persulphuret of iron may be given as an antidote to any

mineral poison.

HYDROCYANIC or PRUSSIC ACID, LAUREL WATER, and CYANIDE OF POTASH cause

immediately extreme prostration, nausea, giddiness, pale countenance,

slow breathing, and paralysis. Dash cold water on the face to produce a

shock, taking care not to soak the clothes of the patient; we may

produce a more decided effect if we alternate cold and hot effusions.

Have the patient inhale steam containing liquor ammonia or hartshorn;

give internally aromatic ammonia and chloroform; use friction,

especially along the spine and feet; artificial respiration may be

necessary. Give chlorine water of the strength of two drachms to the

ounce.

ANIMAL POISONS. For BITES OF SERPENTS apply a ligature above the wounded

part; use carbolic acid or any active caustic; apply cupping glass (or

mouth, when there is no sore in the mouth). Bisulphite of soda in large

doses is said to be an antidote. Give stimulants in large quantities.

MAD DOG BITES. A person having been bitten by a mad dog, or one

suspected of rabies, the wound must first be made to bleed, then washed,

and finally cauterized. Enlarge the wound so that the blood may flow out

freely; press out still more blood, and you may safely suck out some if

you do not have any sore on your mouth or lips. After tying a bandage

above the wound it must be washed until cauterization can be effected.

This can be made either with Vienna paste, butter of antimony, chloride

of zinc, or a red hot iron. If the dog can be secured and shut up it is

better than that he should be immediately killed. If the dog does not

prove to be mad, the person bitten should know the fact, as this may

prevent the alarming fears that of themselves sometimes prove

disastrous. The bitten person should have his mind diverted as much as

possible.

CARBONIC ACID GAS. A person having been poisoned by inhaling choke damp

or the fumes of burning charcoal, loosen the clothing, dash cold water

on the head and face, give plenty of fresh air, stimulants, and

inhalations of ammonia. Employ artificial respiration if necessary. If

the body is cold employ hot applications.

OTHER EMERGENCIES, PERSONS ASPHYXIATED FROM DROWNING, HANGING, &C.

When a person is asphyxiated treat him instantly. Give all the fresh air

possible; remove all light clothing from the chest and neck and face;

try to restore respiration first; clear the throat by placing the

patient on the face with one arm under the forehead; the tongue falls

forward and leaves the windpipe free; then wipe and cleanse the mouth.

TO EXCITE RESPIRATION turn the patient on his side and apply some

stimulating agent (as camphor or ammonia) near the nostrils, and dash

cold water, or hot and cold water alternately on the chest, which may

have been previously rubbed briskly. (The effort to promote warmth and

circulation by rubbing should be kept up continuously as far as

possible.) Should there be no respiration immediately you can use

MARSHALL HALL’S METHOD to imitate respiration. “Turn the patient again

on his face, raising and supporting the chest well on a folded coat or

other article of dress; make gentle pressure on the back, after which

turn him over on his side; then again on his face, and again press a

little; repeat these motions at the rate of fifteen a minute. During the

operation let one person attend to the movements of the head and the arm

placed under it.” If there is respiration and consequent life, dry the

hands, in cases of drowning; and as soon as you can, strip the body and

gradually reclothe or cover it; but if the breathing is not

satisfactory, after continuing these same efforts to restore respiration

for about fifteen minutes, you may use

SYLVESTER’S METHOD. “Place the patient on the back on a flat surface,

inclined a little upward from the feet; raise and support the shoulders

and head on a cushion or a folded article of dress; draw forward the

patient’s tongue, and keep it projecting beyond the lips, by having a

band or string around the tongue and chin, or by raising the lower jaw

so that the teeth retain it; standing at the patient’s head, grasp the

arms near the elbows and draw them steadily upward above the head, and

keep them stretched upwards for two seconds; then turn down the

patient’s arms and press them gently and firmly against the chest for

two seconds; repeat the movement alternately about fifteen times every

minute until a spontaneous effort to inspire is perceived; then proceed

TO INDUCE CIRCULATION AND WARMTH.” Rub the limbs upward with energy, and

continue the friction under the blanket and over the dry clothing;

promote the warmth of the body by applying flannels, bottles of hot

water to the pit of the stomach, the armpit, the thighs, and the sole of

the feet; then if the power of swallowing has returned, stimulants and

coffee should be administered.

A STROKE OF LIGHTNING may cause immediate death by its effects on the

nervous system. Sometimes it produces unconsciousness without being

fatal. In attempting resuscitation employ artificial respiration, and if

there are any signs of life treat as directed for shock. If there are

burns complicating the case, of course the burns must be treated. When

there is SHOCK the patient lies in an apoplectic state, the surface

pale; there is faintness, trembling, cold perspiration, low temperature,

feeble pulse, and probably nausea and vomiting. Keep the patient’s head

low, give aromatic ammonia, and apply heat to the extremities and to the

stomach. Strong beef tea should be given, and hot tea and coffee.

There are but few exigencies that generally occasion more alarm than

CONVULSIONS. Fits may come on without premonitory symptoms; there is

sudden loss of consciousness, accompanied by irregular and powerful

contractions of the muscles. All the voluntary muscles may be affected,

or there may be only spasm of the features, or of one side, or of a

single limb. During a general paroxysm the countenance is distorted, and

the face pallid or livid; generally there is stertorous breathing, and

as the attack subsides a disposition to sleep. It is seldom fatal in

adults, unless caused by brain or kidney disease.

Do not attempt too much treatment, but you may put the patient in such a

condition as to help his recovery. His dress is to be loosened, and all

clothing about his neck removed; place him where he can breathe pure and

cool air, and you may prevent his falling out of bed; if the face is

flushed, cold may be applied to the head and warmth and sinapisms to the

extremities. If occurring in a young child you may give a warm bath, or

a warm hip bath. If there is ability to swallow, give bromide of

potassium, either alone or simultaneously with the administration of

chloroform and ether.

GIVING ANESTHETICS.

If you give chloroform you may pour a few drops on a handkerchief and

hold it an inch from the patient’s nose and lips. Ether and chloroform

together may be poured, a teaspoonful at a time on a little cotton

inside a cone of paper made large enough to fit over the mouth and nose,

the air being nearly shut out. The head of the patient must be kept low

while he is under the influence of it. Observe the pulse while giving

it; a feeble pulse is a sign of danger, and if the pulse is growing

weak, or the face is growing livid or pale, stop giving the chloroform;

if the symptoms continue, and there is no natural respiration, draw the

tongue forward so that it will not obstruct the trachea; have plenty of

fresh air; apply friction by rubbing the limbs, and if necessary

artificial respiration.

CLOTHES ON FIRE.

Accidents from fire are very likely to cause a panic, but possibly you

may by effort so cultivate coolness and presence of mind, as to act

wisely and deliberately even then, even if your own clothes are on fire.

If you are able to think at all, the question will be if there is water

within reach that can be used to extinguish it immediately; if there is

not, how can it be smothered? Possibly the burning portion can be

enveloped in that part of the dress that is not burned; or a rug may be

within reach, or some woolen thing that may be used to stifle it,

without pressing it against the person’s flesh. But very probably the

best that the person can do is to lie down on the floor and roll on the

carpet. If you see another woman on fire, do not scream or run away;

grasp her clothes all together, if you can without pressing the fire

against her person; or if you can immediately put out the fire by

catching up a rug or some heavy woolen thing and enveloping her in it,

do so. Remember at the same time to avoid inhaling much of the flames or

setting fire to your own clothes.

BURNS AND SCALDS. There are various modes of treating burns, but one

good general rule is that the dressings should be so applied as to

exclude the air. If the skin is not destroyed or removed, either the

bicarbonate of soda may be applied dry, or in a strong solution; or

wheat flour may be applied dry, and the burn covered with a thick layer

of cotton batting; or the white of egg may be spread over it, and

another layer put on as soon as one dries, until some six or eight

layers are applied. If the skin is abraded either olive oil or vaseline

or carbolated cosmoline applied and covered with cotton or wool is a

good dressing. (F. 187, 214.)

BURNS PRODUCED BY STRONG ACIDS should be first bathed with some alkaline

solution such as soda or ammonia; on the contrary if lime or caustic

potash cause the injury, neutralize the alkali by applying acid diluted;

a teaspoonful of vinegar or lemon juice in a teacupful of water would

suffice.

If a BAD SCALD is occasioned by a child falling backward in the water,

carefully undress the child; lay it on a bed on its breast if the burn

is on its back; then dust over the parts with bicarbonate of soda; lay

muslin or cotton wool over it, and so arrange the bed by means of two

boxes and a board that the covering cannot press on the scald.

If a FRAGMENT OF LIME GETS INTO THE EYE, bathe it immediately with a

weak solution of vinegar or lemon juice.

If something like dust or dirt gets in the eye, it may be cleaned out by

taking hold of the eye lash and pulling the upper lid down, and forcibly

blowing the nose. You may sometimes wipe the dirt from the eye with a

soft handkerchief. Always wipe the eye towards the nose.

When something like a PEA or CHERRY PIT IS IN THE NOSTRIL direct the

patient to draw in a full breath, then close the mouth and the other

nostril and try to blow the offending object out. If he fails you can

probably remove it by means of a hair-pin; or while the other nostril is

closed, blow forcibly into the mouth and dislodge the object.

Remove insects from the ear by oil or tepid water. A little oil or

glycerine may first be dropped into the ear; and then it may be syringed

with warm or tepid water, taking care not to close the opening with the

nozzle of the syringe. This may be tried if the substance in the ear is

hard.

If a child is choked let it get on all fours and cough. Anything stuck

or lodged in the throat may sometimes be worked out with a hair-pin or

bent wire.

If a CROCHET NEEDLE’S HOOKED POINT IS IN THE FLESH make certain on which

side the hook is, then put an ivory bodkin or any similar article down

to the hook, and draw both out together.

If a FINGER OR THUMB IS CUT in two, without any crushing of the parts,

the severed portion should be immediately applied to its place; if the

cut is clean, the hewn off part may be made to unite, possibly if it has

been off for two hours. The wound should be washed with carbolic

solution if that is immediately procurable, and the severed parts should

be accurately fixed by sutures (stitches) in their normal position, and

a splint applied.

Life is sometimes destroyed suddenly by persons drinking a large

quantity of cold water when greatly fatigued. To avoid all danger in

these cases, a small quantity should be sipped at a time; and washing

the face, hands and temples before drinking is a good precaution. But if

by drinking cold water the system is severely chilled so that

prostration takes place, endeavor to secure warmth by giving a

teaspoonful paregoric, and rubbing the hands and body briskly; and if

the patient can be brought sufficiently to his senses he should be made

to drink enough warm water to induce vomiting; this excites circulation

and perspiration, and determines towards the surface. Warm applications

should be made to the feet and to the region of the stomach, and the

body should be warmed as soon as possible.

CHAPTER III.

SLIGHT HURTS AND AILMENTS.

There are a hundred little accidents liable to occur in a household

which a very little surgical skill would suffice to set right.

Besides medicines, there are several handy articles which should be

always kept ready in a clean drawer, should an emergency arise that

demands their use. Have a little case containing a lancet, scissors,

pins, needles and thread; have also one or two bandages, some lint and

oiled silk, a bit of lunar caustic (nitrate silver), and some strips of

adhesive plaster, a stimulant lotion, an eye lotion, a liniment, and one

or two kinds of ointment.

Use the lancet to open small abscesses or gum boils; the pins are handy

for fastening bandages, &c., and should be of different sizes; the

thread should be strong and white; the needles of fair size, with good

large eyes; charpie may take the place of lint; it is made by scraping

old linen; it is often useful; for instance, to heal old sores, dip LINT

or CHARPIE in clean, cold water, to which a few drops of carbolic acid

has been added; then apply it to the sore, which it must more than

cover; then apply oiled silk and a retaining bandage. The lint may be

used for water dressings to wounds, and these may take the place of

poultices in treating swellings which we wish to reduce or soothe.

Keep the best ADHESIVE PLASTER procurable; and it ought to be cut up

into different breadths. When it is necessary to use this plaster, see

that the wound is perfectly clean, and apply long narrow slips. Warm the

plaster by holding it against a can of boiling water for a few seconds,

then apply it across the wound. In case of scalp wounds the hair must be

cut off before the plaster is applied.

In a case of fractured ribs, strapping should be applied to the injured

side.

LUNAR CAUSTIC is used to cauterize dog, or cat, or skunk bites that are

supposed to be POISONOUS.

An excellent LOTION for HEADACHE and other pain is made of a quart of

water, a teacupful of common salt, one ounce of hartshorn, and a half

ounce of spirits of camphor; mix and keep in a bottle tightly corked;

saturate a cloth and apply to seat of pain.

That form of conjunctivitis (sore eyes), which occurs in new-born

infants, is in the vast majority of cases, easily removed by lukewarm

water, or by such simple astringents as alum and borax. (F. 193, 215,

may be properly kept in the house for ordinary sore eyes.) Of course

severe cases require skilled treatment, but in all ordinary cases

careful wiping away of the secretion, the use of the alum solution, and

the greasing of the skin to avoid excoriations, are in order. For

œdematous inflammation with little purulent or mucous secretion, but

with the tissues loaded with serum, a dilute wash of the witch hazel

extract acts very beneficially.

The teeth of children when they are pressing on the gums and trying to

make their way out, should sometimes be lanced by cutting the gums. Cut

down to the new tooth until it is felt under the lancet; for incisors

and cuspids a straight line; for molars a cross cut.

The best way to do it is—let the operator and nurse sit opposite each

other, close together; the child is laid down face upwards, its head in

the operator’s lap, and its feet in the nurse’s lap; the nurse holds the

limbs of the child quietly; with his left hand the operator takes the

jaw between his fingers, and then slowly and firmly does the cutting. As

the child is still, there is no false cut.

SPRAINS caused by a twisting of the ankle cause very much pain, although

there is no displacement of bone. When it first occurs, put the foot and

ankle in hot water and let it remain for an hour in water as hot as can

be borne; then wrap the part in several folds of flannel which have been

wrung out of hot water, and cover it with a dry bandage, and let it rest

for several days, keeping it elevated as high as may be comfortable.

When first used again, support the joint by strapping. Strips of

adhesive plaster cut an inch wide, may be applied both above and below

the joint. It may be best to renew the straps every day,—the hair should

be shaved off before the plaster is applied.

There are many LITTLE AILMENTS that may be cured or relieved by regimen;

or by such articles as are in every house.

WATER.

A glass of HOT WATER taken in the morning before breakfast washes off a

coating which is sometimes adhering to the lining membrane of the

stomach, and affecting the digestion.

HOT WATER after continuous application renders great service to the

WEARY EYE and cures the slighter maladies of the eye. If an eye is

contused and blackened, foment the parts continually with hot water

until the pain ceases, then keep the eye wet with a lotion, or bind on a

bit of lean, fresh beef, to remove the dark discolored spot.

The itching of pruritis may be much relieved by the application of a

cloth wet in hot water.

The HOT FOOT BATH is especially efficacious for some HEADACHES. If the

head is filled with blood and the temples throb, soak the feet in very

HOT WATER in which a spoonful of ground mustard or of salt has been

stirred. The blood will be drawn from the head and relief obtained.

For those who are troubled with EXCESSIVE SWEATING, tepid sponging of

the neck, face, chest and hands with equal parts of vinegar and water at

bedtime is useful and agreeable.

CONVULSIONS may frequently be cut short by turning the patient on the

left side; but as soon as possible put the feet in a basin of warm water

in which is a little mustard, and apply a cloth saturated with cold

water to the forehead.

A woman who suffers acute pain in the pelvic region a few days

antecedent to the menstrual flux, should take a WARM SITZ BATH of

fifteen minutes’ duration before retiring at night.

The ENEMA OF TEPID WATER may be useful in constipation, and in looseness

of bowels, in spasmodic colic, and in painful menstruation; also for

piles. The temperature of the enema should be agreeable to the patient.

The itching that accompanies many skin diseases is much reduced by a

warm bath containing a handful of borax, and a handful of bicarbonate of

soda, in about thirty gallons of water.

Those who practice daily bathing, and indulge freely in COLD WATER, are

seldom troubled with a cold. Frequent bathing, the head being well

dipped, will brace the system and render a person proof against

draughts.

There are many obstinate affections of the head that have been known to

give way to affusion of COLD WATER upon the part. For inflammation of

the brain, headache, earache, drunkenness, delirium tremens, the

delirium of fever, epilepsy, rheumatism of the head, diseases of the

eye, deafness, loss of smell and taste, and in nose bleed this remedy

may be brought to bear. One mode of taking the HEAD BATH is for the

patient to lie down, placing the back of his head in a shallow dish

filled only an inch or two with water.

The WET GIRDLE is a useful medical appliance to give tone and strength

to certain parts. Two and a half or three yards of good toweling with

tapes arranged at one end, the corners of which have been turned over so

as to form a point, is a good girdle. It should pass about three times

around the body; one-half having been wet and put on so as to have two

thicknesses of the wet part upon the abdomen and one upon the back. The

girdle may be worn every day, but the folded wet sheet is used for a

time in febrile diseases, such as inflammation of the lungs, or of the

bowels, colic, cholera morbus, &c. Fold a common coarse sheet four

double; wet two thicknesses of this in cold water to come next the body;

have the patient lie in bed with the four thicknesses around her, using

warm bricks, bottles, &c., for the feet.

A table spoonful of CHARCOAL powdered, stirred into a glass of water and

drank at once, is excellent in many cases of headache from SOUR STOMACH,

FLATULENCE, &c.

Children who complain of choking sensations in the throat (caused by

worms), may find relief from swallowing salt and water.

Those who are suffering from DYSENTERY should have a little WHEAT FLOUR

stirred into the water that they drink.

TAR WATER.

Every body ought to have TAR WATER in the house. It is made by adding

one pint of wood tar to four pints of cold water, mixing thoroughly and

shaking frequently during twenty-four hours, and then filtering the

water which may be poured from the tar. Given internally it is

stimulative in its action, and acts somewhat upon the kidneys; is useful

for cough and hoarseness, and for incipient urinary difficulty; locally

applied it is slightly astringent, antiseptic and disinfectant; and by

destroying the putrefactive germs, it prevents or restrains the process

of suppuration. It is especially useful in puerperal septic diseases, as

it is antiseptic and disinfectant; the resinous principle which it

contains, exerts a healing action upon the genital lesions, and

suppuration is prevented. It may be used three times a day as a vaginal

wash during the lying-in period, and cloths used to protect the vulva

and receive the discharges should be moistened with it. It is a useful

local application in the treatment of various diseases of the vulva and

vagina, especially for the horrible itching of pruritis. Its use renders

innocuous the irritating discharges, and its sedative and alterative

action restrains and stops the morbid process. It has a curative value

in skin diseases, and in general it may be used in the various cases

where carbolic acid is usually prescribed. Other medicine may be

dissolved in it.

SALT WATER.

Salt is a promoter of health and longevity, and people generally who

like salt, vinegar, &c., should be allowed to gratify their taste. If

the blood is too rich, salt may restore it to a normal condition; and

may restore to it the needed elements if the blood is impoverished. One

of the best remedies for SPITTING OF BLOOD is to drink a little salt

water.

For persistent bleeding from the nose, cut a piece of raw fat salt pork,

about four inches long, and near half an inch thick and over half an

inch wide, wedge shaped at the ends, and force it through the nostril

clear back to the pharynx.

A teaspoonful of salt taken just before a fit of the ague may

effectually break up an intermittent fever, and prevent a recurrence of

the chills.

A spoonful of vinegar with salt in it is an excellent remedy for

dysentery.

CARBONATE OF SODA AND WATER.

Probably the anesthetic, antiseptic, and disinfectant property of

bicarbonate of soda is due to the ready disengagement of carbonic acid

from it. For BURNS AND SCALDS where the skin is not broken, powdered

bicarbonate of soda may be strewn over the burned parts. If the burns

are deep and attended with much suppuration, linen rags sprinkled with a

solution of the soda (1 to 50) should be laid on, and as soon as these

rags become dry, they should be replaced by others, or be moistened

again in the solution. But for most burns the rags should be kept on

constantly, and moistened by pouring the solution over them, as changing

the compresses would cause more suppuration and delay the healing

process.

If a hand or foot is burned, and soda, &c., is not obtainable, it may be

kept immersed for a considerable time in cold water with a salutary

effect.

A teaspoonful of baking soda taken each day, dissolved in a pint of

water, is a good remedy for habitual constipation.

HONEY AND TAR.

“For the BITES OF REPTILES (rattlesnakes, moccasins, &c.), give the

patient about a gill of strained honey every ten or fifteen minutes

until vomiting is produced.”

A table spoonful of powdered charcoal mixed with honey, milk, or cold

water, and taken every morning will tend to cure any one who is troubled

with either constipation or diarrhœa.

OIL.

The application of OIL to the whole surface of the body is a simple

method of treatment of such infantile complaints as ATROPHY, BRONCHITIS,

CONVULSIONS, DIARRHŒA, and FEBRILE DISTURBANCE generally. Smear SALAD

OIL all over, from the crown of the head to the toes, three or four

times a day.

For PRURITIS ANI rub on linseed oil freely at bedtime each night.

SPIRITS NITRE.

For RHUS POISONING (poison oak) apply sweet SPIRITS OF NITRE. Where the

discharge of urine is attended with heat and pain, pound a handful of

melon or pumpkin seed with a lump of white sugar, add a quart of boiling

water, then add half an ounce of spirits of nitre and rub them together.

A teacupful may be taken every two hours by adults.

OTHER REMEDIES, REGIMEN, &C.

For STRANGURY use bee tea made by pouring a pint of boiling water on

fifteen or twenty honey bees.

For ERYSIPELAS apply cranberries locally, either cooked or uncooked.

Another good local application for erysipelas is ELDERFLOWER TEA. Linen

cloths wet with the cold infusion should be applied, and before they are

dry should be wrung out of clean water, then dipped in the infusion and

reapplied. The patient should also drink some of the elder flower tea.

(F. 177.)

Mother, Nurse and Infant A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies. · 第 9 / 11 章

A sufferer instinctively takes THE POSITION most conducive to ease. When