Fig. 19.—Adjustable Bed Rest.
Adjustable tables are convenient for patients who are able to sit up in bed. These tables are supported on one side only so that they may extend over the bed. Another kind of bedside table has short legs and stands directly on the bed. Such a table can easily be made at home from a wide board with supports six or eightinches high nailed to each end. A lap board supported by heavy books may serve for temporary use. Indeed, home-made substitutes are often as good as expensive apparatus or even better. If sick-room appliances must be bought, it is well to remember that simple standard designs are best. Complicated apparatus is soon out of order, and is generally a trial both to the patient and to those who must adjust it. Persons taking care of chronic patients may often obtain valuable suggestions in regard to appliances by consulting a visiting nurse or the superintendent of the local hospital.
Fig. 20.—Adjustable Table.
Bedpansare utensils to receive bowel and bladder discharges of patients lying in bed. Enamelbedpans are better than porcelain, although more expensive. The shape known as the "Perfection" is best for general use. A "slipper" bedpan, although harder to clean and ordinarily less comfortable, may be preferable if it is especially difficult or undesirable to raise the patient. The square or douche pan is preferred by some people, and is especially useful when the quantity of discharge is large, as after an injection.
are utensils to receive bowel and bladder discharges of patients lying in bed. Enamelbedpans are better than porcelain, although more expensive. The shape known as the "Perfection" is best for general use. A "slipper" bedpan, although harder to clean and ordinarily less comfortable, may be preferable if it is especially difficult or undesirable to raise the patient. The square or douche pan is preferred by some people, and is especially useful when the quantity of discharge is large, as after an injection.
When a patient asks for the bedpan it should be brought if possible without a moment's delay, not only because no other form of neglect makes a patient realize her helplessness more acutely, but also because the desire to use it often passes quickly and delay may encourage the habit of constipation. If the patient does not ask for the bedpan, the attendant should offer it at suitable times. Bedpans should be warmed before use. An easy way to warm one is to let hot water run over it; the outside should afterward be dried.
To place the bedpan, first flex the patient's knees and push the night gown up; place one hand under the patient's hips, raise them slightly, and with the other hand slip the pan into place. If the patient is entirely helpless two persons are needed to lift her. Place a pad or folded cloth between the patient's back and the pan;then lower the patient gently. Before removing the pan, bring toilet paper, water and two pieces of soft old muslin or gauze. A patient, if able, prefers to use the toilet paper without assistance; her hands should afterward be thoroughly washed. If she is unable, the attendant must do everything needed. After the patient has been cleaned as thoroughly as possible with paper raise her hips with one hand and then remove the pan; it is important to raise her first because the skin often adheres and may be injured if the pan is suddenly pulled away; carelessness in managing the bedpan has caused more than one bed sore. Then remove the pan with one hand and cover at once. Turn the patient, if helpless, on her side, wash the parts with one piece of old muslin, thoroughly dry them with the other, and either burn or thoroughly wash both pieces afterward.
Empty the bedpan and clean it at once; ordinarily one can clean it without wetting or soiling the hands. Use cold water first, removing all adhering solid particles with a tightly rolled piece of toilet paper. Do not use a brush for this purpose. After using cold water, rinse the pan thoroughly in hot water, and at least once a day wash it well in hot soapsuds. Directions for disinfecting the pan will be given later, but remember that a properly kept pan needs no deodorantsolution. Glass urinals should be provided for men, and kept clean in the same way. Contents of both bedpan and urinal should always be carefully inspected; neither should be emptied in the dark.
Obviously the routine of a patient's day must vary according to her condition, her preferences, and the amount of time the attendant has to give her. The temperature, pulse, and respiration must be taken and all medicine, nourishment, and treatment given at the exact times ordered, but the attendant should learn whether or not the doctor wishes her to wake the patient for food or treatment. Good management in the sick-room depends upon foresight and planning, and therefore it is well to keep in mind the following suggestions:
Vitality is lowest in the early morning, hence baths and treatments, especially if they are fatiguing or painful, should if possible be left until after breakfast. Patients often wake early and wait, weak and miserable, for the day to begin. A hot drink at this time may give relief and enable the patient to sleep again. Even though breakfast time is near, nourishment should be given as soon as the patient wakes. She may not admit thatshe is hungry, but her nourishment should not be delayed until the family breakfast is ready, or still worse, finished.
Before breakfast the bedpan should be offered, the patient's face and hands should be washed, her teeth brushed, her hair tidied, the bed straightened, and the room put in order. These services should require a few minutes only. The room if properly arranged at bed time needs only a little attention now unless untidy work has gone on during the night; disorder in a sick-room is as unnecessary in the early morning as at any other time.
After the patient has finished her breakfast she may rest, or if allowed, read her mail or the newspaper while the attendant prepares for her day's work; about an hour after breakfast the patient should be bathed, unless she prefers her bath in the evening. After the bath some form of light nourishment should be given, even to a patient who has regular meals. If a patient is able to sit up in a chair, the best time for her to do so is generally just after the bath and toilet have been completed; but if she feels tired she had better wait until afternoon. The bed room can be better aired and cleaned if it is possible to take her into another room; and she herself generally profits by a change of scene.
The doctor should definitely state when and for how long a patient may sit up for the first time after an illness, and an amateur who may be ignorant of the dangers involved should not assume the responsibility of deciding. When a patient is to sit up for the first time, put on her stockings, slippers, and wrapper before she leaves the bed. Arrange an arm chair with pillows in the seat and at the back, bring it close to the bedside and cover it with a large blanket unfolded. The chair may face either the head or the foot of the bed. Help the patient to a sitting position on the extreme edge of the bed, with her feet hanging down. Next, standing in front of her and supporting her well, let her slip down until she stands upon her feet, then let her turn, and gently lower her into the chair. See that the patient while sitting up is warmly covered, and that her foot-stool, pillows, etc., are adjusted comfortably. Move her chair so that the outlook may be as interesting as possible, and at least a little different from the view from the bed. Most patients like to look out of the window; children and old people enjoy it particularly.
If the patient shows signs of fatigue, she should go back to bed even before the appointed time. To help her back to bed, reverse the process of helping her out. A footstool may be neededif the bed is high, or two people to lift her if she is weak or heavy. When a patient is in bed no one should ever sit on the bed, lean against it, use it as a table for folding linen, making pads, etc., take hold of the bed posts in passing, or touch the bed unnecessarily in any way.
The best time for visitors is the last of the morning or the early afternoon. A judicious visitor may do an immense amount of good, especially to a chronic patient; indeed, she may be the only ray of light in a dark day. Subjects of conversation should be pleasant, but not too stimulating or exciting. The visitor should be prepared to carry the burden of the conversation, to drop topics skillfully that seem to involve fatigue or excitement, and either to go or to stop talking if the patient seems tired. Visitors should remember to talk naturally and cheerfully on ordinary topics, and to avoid excessive sympathy and labored attempts to cheer the patient. They should also remember that few patients bear well even the mildest forms of teasing. The patient's room is not the place to discuss personal or family troubles; yet it is only too often chosen for such purposes, probably because the complainer knows that in it an audience is always to be found.
Visitors not belonging to the family should not be present in the sick-room during treatment ofany kind, unless their help is required; neither, as a rule, should they stay during the patient's meals. A member of the family may stay with advantage if the patient tires of eating alone, but casual visitors almost invariably offend by undue urging if the patient's appetite is poor, or by facetious remarks if it is good.
Ordinarily only one visitor should be admitted at a time, since a weak patient may be tired merely by looking from one to another. If it is desirable to limit the call, the attendant should tell the visitor beforehand how long to stay, or arrange a signal for the visit to end. To announce baldly in the sick-room that the patient is tired and the visitor must go, will only elicit aggrieved protests from both. In illness lasting only a day or two all visitors should be discouraged; during colds, because they are communicable; during general fatigue, headaches, digestive upsets, and painful menstruation, because rest and quiet are highly desirable. Visitors at such times too frequently give injudicious sympathy, and may actually delay the recovery of patients who enjoy playing the rôle of interesting invalid.
The time when a trustworthy visitor is present may be the best time for the attendant to rest. The patient should be told when the attendant is going, and approximately when she will return.It is a mistake to slip away while the patient sleeps; she seldom fails to wake before the time scheduled and to resent the desertion. Surprises of any kind, pleasant or unpleasant, are seldom good for patients.
Toward the end of the afternoon the patient is probably tired, especially if she has not slept during the day. When fever is present her headache and restlessness increase as the day goes on, but it should be remembered that uncomfortable beds and too heavy covers cause much of the restlessness attributed to fever. Rubbing the back and legs with alcohol, giving a tepid sponge bath, remaking the bed or changing her position may help to soothe her.
The evening should be kept free from excitement, and every possible effort should be made to encourage sleep. It is a mistake to think that a better night results from keeping a sleepy patient awake all the evening; sick people should sleep when they can. Just before bedtime the attendant should prepare her own cot, and then make the following preparations for the patient to sleep: wash the patient's face and hands or give a sponge bath if it is desired, brush the hair, change the night gown, brush crumbs from the bed, tighten the sheets or remake the bed if necessary, rub the back and other pressure pointswith alcohol, shake the pillows, give liquid nourishment, preferably hot, cleanse the mouth, and give the bedpan. See that the patient's feet are warm, the bed covers right, the room ventilated properly and in good order, and the light extinguished or arranged for the night. If the patient is inclined to be wakeful a hot foot bath may help her, or sponging the entire length of the spine for fifteen minutes, using very hot water and long downward quiet strokes. No conversation should be encouraged during preparations for the night. Patients in bed all day often lose the habit of sleeping at the regular time, and lie awake far into the night from a vague feeling that someone else is coming or something further is to be done for them. Consequently last of all ask the patient if she wants anything more; if not, say good-night, go out and stay out, at least until she has had a chance to go to sleep. She is thus helped to realize that nothing further is likely to happen, and that it is time to go to sleep.
Toward morning the patient grows weaker. More bed covers will probably be needed, and they may often be added without waking her. Night at the best is a dreary time for the sick. Pain and weariness and discouragement are less bearable in the darkness; nervous fears and morbid fancies defy control. Never is kindness moreneeded or more appreciated than it is by those who lie awake and watch for the morning.
Substances used for food are generally grouped into three classes, called the three nutrients. The nutrients are: first, the proteids or nitrogenous substances, which are found in meat, fish, eggs, milk, cheese, peas, beans, etc.; second, the carbohydrates, which include sugars and starch; and third, the fats, which are found in butter, oil, the fat of meat, etc. In addition to the nutrients, water and certain mineral salts are essential to life, while some indigestible material like the fibre of vegetables is needed to give bulk and to stimulate the action of the intestines.
The nutrients furnish the body with materials for growth, and for repair of tissues worn out by use; they also furnish fuel substances from which the body obtains its heat and its energy. All three nutrients can serve as fuel, but the proteids alone can furnish materials for growth and repair of tissues. In order to be used by the body for any purpose, nutrients must first go through a series of complicated changes known as digestion,which renders them soluble so that they can soak through the walls of the intestine.
Digestion begins in the mouth. There the food is crushed and its fibres separated by the teeth, it is moistened by the saliva, and substances in the saliva begin a chemical action upon the starch. Chewing should be sufficient to reduce the food to a soft mass well moistened with saliva. Slow eating is desirable, but the emphasis should be placed on thorough chewing. For instance, long intervals between bites are of no special benefit if mouthfuls of food are washed down by swallows of water.
After it has been swallowed, the food passes into the stomach and remains there for a variable length of time, while it undergoes further preparation for absorption. It is moved about by the contraction of the muscular walls of the stomach, so that it becomes mixed with the stomach juices and more thoroughly softened. Some digestion of proteids goes on in the stomach, and a little absorption through the walls.
Little by little the food is discharged from the stomach into the small intestine, and the most important part of digestion then begins. It is acted upon chemically by a fluid flowing into theintestine from an organ called the pancreas; this pancreatic juice acts upon all three nutrients and is of great importance in the digestive process. The bile and other juices that flow into the intestine perform important functions also.
The food masses are moved along by rhythmic contractions of the intestine, and absorption goes on when the food has been so changed that it can soak through the intestinal walls into the blood and lymph vessels. The small intestine is about 20 feet long, and consequently affords a large surface for absorption, as does also the large intestine, into which the small intestine opens. The blood and lymph carry the digested food substances to all parts of the body, and thus the different tissues are provided with the materials they need for growth, repair, and energy. Excess of food substances may be stored as fat or expelled from the body.
As the blood and lymph go through the tissues they take from the tissues the refuse, or the part that remains after the fuel substances have been consumed. This refuse from the tissues may be likened to the ashes from a furnace; it is finally eliminated from the body through the kidneys and lungs, and to some extent through the skin and bowels. The part of the food that is not digested of course never soaks through the intestinal walls;it merely passes through the small and large intestines and is finally expelled as feces or bowel movements. The characteristic odor of fecal matter results from the action of bacteria upon it while in the large intestine.
It must be remembered that the body is not nourished merely by swallowing food: in order to nourish the body food must also be digested, absorbed, and made use of by the tissues. Many factors may operate both in health and in sickness to render food indigestible. It may be originally unsuited to the human digestive apparatus, or spoiled, or poor in quality, or badly cooked. But even when wholesome in itself it may be ill-adapted to a particular person at a particular time; thus it may be too great in amount, or eaten at improper hours. Moreover a person's own idiosyncrasy or manner of living or fatigue or illness may render it especially indigestible for him.
Experiments have shown that pain, fear, worry, and other unpleasant emotions actually stop the action of the digestive juices and check muscular contractions of the small intestine. Furthermore, even the absence of pleasant anticipation of food has been shown to delay digestion for hours. Thus scientific knowledge confirms our common experience that such mental states seriously interfere with digestion. The converse is alsotrue. Agreeable taste and odor of food, or even pleasurable thought of it, start the secretion of digestive fluids. It is a common saying that the mouth waters at the prospect of inviting food, but it is less well known that appetizing food does actually start the stomach juices also. A person who understands the physiological effect that the emotions have upon digestion is in a far better frame of mind to cope successfully with the difficulties of feeding the sick than one who considers sick persons' likes and dislikes entirely irrational.
Nourishing the sick is not always an easy problem, but its importance can hardly be overestimated. Indeed, proper feeding in many illnesses makes the difference between life and death. The actual amount of nourishment needed in sickness is often less than in health, but it may be just as great, or even greater if the illness causes increased tissue waste. Yet the digestive process of a sick person must be rendered as little laborious as possible, all foods ordinarily difficult to digest must be eliminated, certain others must be withheld or restricted according to the nature of the sickness, and in addition one may have to deal with an appetite that is capricious, diminished, or totally absent.
Diet for the sick is often a part of medical treatment; in such cases the doctor will prescribe special diets and his orders must be carefully carried out. Except for special diets, food for the sick is generally divided into four classes: first, liquid or fluid diet; second, semi-solid diet; third, light or convalescent diet; and lastly, full diet. These diets are not very sharply distinguished.
Liquid dietgenerally includes milk, eggnog, albumen water, broths, soup, beef juice, thin gruel, and beverages. Liquid diet makes least demand upon the digestive powers, because it consists of food already dissolved and therefore nearer the condition in which it can be absorbed. Moreover, it is less likely than other foods to contain excess of fat, improperly cooked starches, and other indigestible material. Liquids must be given at regular intervals and at shorter intervals than solid foods; 6 to 8 ounces every two or three hours is not too much if the patient can take it. The doctor usually specifies the amount and the interval. Some patients will take more nourishment at one time if the interval is slightly increased.
generally includes milk, eggnog, albumen water, broths, soup, beef juice, thin gruel, and beverages. Liquid diet makes least demand upon the digestive powers, because it consists of food already dissolved and therefore nearer the condition in which it can be absorbed. Moreover, it is less likely than other foods to contain excess of fat, improperly cooked starches, and other indigestible material. Liquids must be given at regular intervals and at shorter intervals than solid foods; 6 to 8 ounces every two or three hours is not too much if the patient can take it. The doctor usually specifies the amount and the interval. Some patients will take more nourishment at one time if the interval is slightly increased.
Semi-solid dietincludes all fluids and in addition soft milk toast, soft cooked eggs, well cooked cereal, custards, ice cream and ices, junket, and gelatine jellies. Liquid or semi-solid diet is commonly given in acute fevers because digestivejuices and other fluids of the body are then diminished, and also because their digestion places a minimum of work upon a system already burdened with bacterial poisons.
includes all fluids and in addition soft milk toast, soft cooked eggs, well cooked cereal, custards, ice cream and ices, junket, and gelatine jellies. Liquid or semi-solid diet is commonly given in acute fevers because digestivejuices and other fluids of the body are then diminished, and also because their digestion places a minimum of work upon a system already burdened with bacterial poisons.
Light or convalescent dietgenerally means a simple mixed diet. In addition to the articles in the two preceding diets it includes oysters, chicken, baked potatoes, most fruits except bananas, simple desserts, white fish, and other meats and vegetables added judiciously until full diet is reached. Fried foods should not be included.
generally means a simple mixed diet. In addition to the articles in the two preceding diets it includes oysters, chicken, baked potatoes, most fruits except bananas, simple desserts, white fish, and other meats and vegetables added judiciously until full diet is reached. Fried foods should not be included.
Full dietmeans an unrestricted menu, but even from full diets especially indigestible foods should be excluded. The principles of feeding sedentary persons as described in manuals of dietetics apply to patients who are obliged to be inactive although not really ill, as for example, a patient suffering from a broken leg. Ordinarily in such cases, as in other kinds of illness, the appetite is greatly diminished, but a word of warning should be given against overfeeding patients whose meals are their chief interest. Such patients are only too likely to interpret full diet as anything they desire in any quantity at any time of day or night, and then to attribute their discomfort and irritability to their illness rather than to overeating.
means an unrestricted menu, but even from full diets especially indigestible foods should be excluded. The principles of feeding sedentary persons as described in manuals of dietetics apply to patients who are obliged to be inactive although not really ill, as for example, a patient suffering from a broken leg. Ordinarily in such cases, as in other kinds of illness, the appetite is greatly diminished, but a word of warning should be given against overfeeding patients whose meals are their chief interest. Such patients are only too likely to interpret full diet as anything they desire in any quantity at any time of day or night, and then to attribute their discomfort and irritability to their illness rather than to overeating.
Constipation is especially stubborn in sickness, since the patient is deprived of his usual exerciseand variety of food. So far as possible the bowels should be regulated by diet. Laxative foods include most vegetables with a large amount of fibre, coarse cereals and flour, oils and fats, and most fruits and fruit juices. Unfortunately many laxative foods are difficult for sick persons to digest and must therefore be used with caution. A glass of hot or cold water or orange juice an hour before breakfast may be helpful, and at bed time hot lemonade, oranges, prunes, figs, or other fruit if allowed.
It is essential for patients to drink water freely, and it should be given between meals and also between liquid nourishments. Persons inexperienced in the care of the sick frequently make the mistake of bringing water only when a patient asks for it.
Many acute illnesses begin with fever, headache, sore throat, and especially among children with vomiting, diarrhœa, and other digestive disturbances. In such cases all food should be withheld until the doctor comes, but boiled water, hot or cold, should be given freely. Efforts to tempt the appetite are then mistaken; few people are injured and many are benefited by omitting food even for 24 hours at the beginning of an acute illness, and with few exceptions a doctor can be found in a shorter time.
Serving Food for the Sick.—Food for the sick should always be most carefully prepared and of the best quality, and in addition it should be as inviting, as varied, and as well served as possible. Neglect in these respects is inexcusable. Even slight carelessness in preparing or serving food may arouse disgust and thus banish permanently some valuable article from the dietary.
—Food for the sick should always be most carefully prepared and of the best quality, and in addition it should be as inviting, as varied, and as well served as possible. Neglect in these respects is inexcusable. Even slight carelessness in preparing or serving food may arouse disgust and thus banish permanently some valuable article from the dietary.
Trays, dishes, tray cloths, and napkins for the patient must be absolutely clean and as attractive as possible. Cracked or chipped dishes should not be used. Individual sets of dishes for the sick may be purchased, and their convenience makes them well worth their price. Paper napkins may be used in many cases to save laundry work; clean white paper is always superior to soiled linen.
Before the tray is brought to the bedside, everything should be arranged so that the patient can eat in comfort. It is bad management to let the soup cool while the patient's pillows and table are being adjusted. In setting the tray great care should be devoted to placing the articles conveniently, and to the appearance and garnishing of the food. Careful serving requires more thought, but little if any more actual time than slovenly serving. Dishes should not be so full that food is spilled in transit; hot dishesshould be covered; hot dishes should reach the patient hot, and cold dishes cold. Liquid nourishment in a glass or cup should be served on a small tray or plate covered with a doily. Neither glass nor cup should be held by the rim.
It is not uncommon to overload trays and to serve everything at once in order to save steps, but a patient is ordinarily more interested in a meal that is served in courses unless very long intervals elapse between. Moreover, if the meal is served in courses he is not tempted to eat dessert first and then to refuse the rest of the meal. If food is given sufficiently often it is safer to err on the side of serving too little at a time rather than too much, since the sight of large amounts of food is often disgusting.
The patient's likes and dislikes should be considered as far as possible, but most patients should not be consulted about their menus beforehand. Great variety in one meal is not necessary; it should be introduced by varying successive meals. An article that has been especially disliked should not be served a second time, unless it can be disguised beyond a possibility of detection. An article of food to which a patient objects should be removed at once; one may appear disappointed if it seems wise, but should never argue. When patients persistentlyrefuse necessary nourishment a difficult situation is presented; persuasion and every form of ingenuity must be used, and the doctor's coöperation enlisted. When, for example, a strict milk diet is ordered for a patient who announces that he never takes milk in any circumstances the situation may seem hopeless but it is not necessarily so.
To Feed a Helpless Patient.—Helpless and weak patients must be assisted to eat or drink. A napkin should first be placed under the patient's chin. The attendant should place her hand under the pillow, raise the head slightly, and hold the glass to his lips with her other hand. An ordinary tumbler can be used by a patient lying down if it is not more than a quarter full, or a special feeding cup may be purchased. Bent glass tubes may be used for cool liquids; they should be washed immediately after use. A child who can sit up sometimes takes more nourishment if it is given through a soda water straw.
—Helpless and weak patients must be assisted to eat or drink. A napkin should first be placed under the patient's chin. The attendant should place her hand under the pillow, raise the head slightly, and hold the glass to his lips with her other hand. An ordinary tumbler can be used by a patient lying down if it is not more than a quarter full, or a special feeding cup may be purchased. Bent glass tubes may be used for cool liquids; they should be washed immediately after use. A child who can sit up sometimes takes more nourishment if it is given through a soda water straw.
If the patient must be fed with a spoon care should be taken that the liquid is not too hot, but the attendant should not blow upon it to cool it. It should be given from the point of a spoon placed at right angles to the lips, and plenty of time between mouthfuls should be allowed. A swallow should not be given at the moment when the patient is drawing the breath in. Greatpatience is required if a helpless person is to be fed acceptably. The attendant should sit by the bedside rather than stand, should present at least the appearance of having unlimited time, and should endeavor not to deprive the patient in any way of the satisfaction he may derive from his nourishment.
Action of Drugs.—Modern medical practice increasingly emphasizes diet, baths, exercises, and other hygienic measures in the treatment of sickness. Drugs are given far less than they were a generation ago; yet medicines are still the most familiar of all remedies, and the most abused by those who persist in treating themselves. Misuse of medicine even by intelligent people is astonishingly common.
—Modern medical practice increasingly emphasizes diet, baths, exercises, and other hygienic measures in the treatment of sickness. Drugs are given far less than they were a generation ago; yet medicines are still the most familiar of all remedies, and the most abused by those who persist in treating themselves. Misuse of medicine even by intelligent people is astonishingly common.
Problems of sickness and health would be enormously clarified if the uses and limitations of drugs were more generally understood. Many people still believe that every disease can be cured by a drug if only the doctor is clever or lucky enough to think of the right one to give. Such beliefs result naturally enough from centuries of faith in charms and magic, and occasionally are confirmed by remarkable cures apparently brought about by drugs, but really pure coincidence or the result of suggestion.
It is a fact that a few medicines are knownwhich if rightly used actually do cure certain diseases. An example of their action is the curative effect of quinine in malaria. Such medicines, unfortunately, are few. In the great majority of cases medicines do not cure disease; their beneficial action is ordinarily indirect and is due to their power either to increase or to check certain processes within the body.
It is here that the abuse of drugs comes in. Disordered bodily processes give rise to symptoms of disease; and it is the symptoms of disease, not the disease itself, that trouble the patient. A patient with typhoid, for example, is not conscious of the toxins in his blood, but of headache, weakness, and fever; the man with eyestrain is not aware of an imperfectly shaped lens, but of headache and indigestion. What the patient wants is to have his symptoms relieved; in some cases they can be controlled by drugs, and the sufferer then considers himself cured. But the original condition persists: it may in the meantime be improving, but it may on the other hand be growing worse.
Not infrequently it is best to check symptoms, and to check them by means of drugs. When they should be checked, only a thoroughly trained physician is qualified to decide. The question is not one for amateurs, since the whole practiceof medicine, including the prescription of drugs, constantly becomes more nearly an exact science. People should obtain and follow expert advice in regard to health as they would in regard to other affairs of life. The constant self-dosing practised by thousands of people is harmful and unintelligent; it is, however, no less irrational to go to the other extreme and refuse to take medicine prescribed by a competent doctor.
Amateur Dosing.—Amateur dosing either of oneself or of others is dangerous in more ways than one. In the first place, time is lost. Moreover, symptoms are characteristic; checking or altering them increases the difficulty of finding the real trouble. The man with eyestrain who takes one drug to stop his headache and another to "cure" his stomach, is simply delaying the time when properly adjusted glasses will relieve both. In this case the result may not be serious; but such a loss of time in finding the trouble and beginning proper treatment might prove fatal in the case of tuberculosis.
—Amateur dosing either of oneself or of others is dangerous in more ways than one. In the first place, time is lost. Moreover, symptoms are characteristic; checking or altering them increases the difficulty of finding the real trouble. The man with eyestrain who takes one drug to stop his headache and another to "cure" his stomach, is simply delaying the time when properly adjusted glasses will relieve both. In this case the result may not be serious; but such a loss of time in finding the trouble and beginning proper treatment might prove fatal in the case of tuberculosis.
Another objection to amateur prescription of medicine is the fact that most drugs have more than one effect. In addition to their main action they have others, subordinate or ordinarily less marked. These minor effects may be serious in some cases. Many headache remedies, for example,affect the heart; a dose that is harmless for a normal person may be strong enough to injure seriously a person with a weak heart. A doctor, and a doctor only, is competent to decide when and in what quantity medicines will be beneficial, because he alone understands both the condition of the patient and all the possible effects of the drug.
In no circumstances should medicine prescribed for one person be taken by another. This rule seems obvious enough; yet every day people pass on their pet remedies to friends. Some medicines deteriorate after standing, and others grow stronger; nevertheless, medicine supposed to have cured a cough or a tonic supposed to have strengthened some member of the family after an attack of grippe is cheerfully administered months later to another member of the family, who, to make matters worse, may differ in age, strength, and probably in the nature of his sickness. Drugs are expensive, and it is considered economical to use them up; measured by lost time and impaired health such practices may be anything but thrifty.
Cathartics, tonics, and various drugs to relieve pain and sleeplessness are among the remedies most commonly taken without medical advice. Enough has already been said about constipation to indicate proper hygienic treatment, but anotherwarning should be given against habitual use of cathartics. Many of these drugs are irritating; even when not irritating, they are harmful, since the body depends more and more upon the drug to do for it what it should be enabled to do for itself, by remedying the original cause of the trouble. Licorice powder, cascara, saline cathartics such as Seidlitz powders and Rochelle Salts and some others are harmless for occasional use, if occasional is not too liberally interpreted.
Tonics are poor substitutes for proper diet, rest, and fresh air. Using them may be likened to beating a tired horse; the horse goes faster, but he is not really stronger. In some emergencies the horse must go faster and there is nothing to do but beat him, and in some cases the tonic should be given; these, however, are cases for a doctor to decide. People persist in taking tonics because they are unwilling or unable to rest, or otherwise to change their ways of living.
Medicines to stop pain or to induce sleep are probably the most pernicious of all self-prescribed remedies, for they add to other dangers the possibility of forming drug habits. These habits are so insidious and so powerful that it is not safe to take habit-forming drugs even once except by a doctor's direction. In short periods of time strong people, apparently firm in will and character,have acquired habits from supposedly moderate use of drugs like morphine, cocaine, and alcohol. No one, no matter how sure of his own self-control, can afford to run so grave a risk.
Patent Remedies.—Objections to self dosing in general apply even more strongly to using patent medicines. The ingredients of patent medicines are ordinarily unknown, so that using them is unintelligent at best. Sometimes they contain habit-forming or other harmful drugs. In other cases the ingredients are innocent enough, but totally unable to bring about the results claimed for them. The old story about a powerful remedy discovered by accident and thus unknown to the medical profession deceives only the ignorant or credulous; with our present knowledge of chemistry and physiology powerful remedies are not discovered in that way.
—Objections to self dosing in general apply even more strongly to using patent medicines. The ingredients of patent medicines are ordinarily unknown, so that using them is unintelligent at best. Sometimes they contain habit-forming or other harmful drugs. In other cases the ingredients are innocent enough, but totally unable to bring about the results claimed for them. The old story about a powerful remedy discovered by accident and thus unknown to the medical profession deceives only the ignorant or credulous; with our present knowledge of chemistry and physiology powerful remedies are not discovered in that way.
Even to these comparatively harmless patent preparations there are two serious objections. One is the loss of time, during which the patient may grow worse. The other is that money is obtained under false pretenses; fraud is a common element in the success of patent remedies. One of the least harmful, a substance called "Murine" may be taken as an example[2]. This substance was widely advertised at one time as a "positive cure for sore eyes." Analysis showed it to be a solutionof borax, which cost about five cents a gallon to prepare. It sold for one dollar an ounce, or at the rate of $128.00 a gallon. Although it could not bring about the wonderful cures advertised, it was practically harmless, and buyers of "Murine" must have been injured chiefly in pocket. But with "cancer cures" and "consumption cures" it is a different story. Early treatment of these diseases is essential to recovery; delay in many cases means robbing the sufferer of his only chance of life. No drugs are now known that will cure these diseases, and it seems incredible that anyone should be willing to practise such cruel deception upon ignorant people merely for the sake of making money.
Administration of Medicine.—Medicines may be introduced into the body in a number of ways. In the majority of cases they are swallowed and finally carried to the tissues by the blood just as digested food is carried.
—Medicines may be introduced into the body in a number of ways. In the majority of cases they are swallowed and finally carried to the tissues by the blood just as digested food is carried.
Except in rare emergencies no medicine should be given to a sick person without the doctor's order. The prescribed dose should be accurately measured in a medicine glass having a scale to show the number of teaspoonfuls. When measuring medicine, think only of what you are doing; neither talk nor listen to conversation. First read the label on the bottle. Next, shake thebottle, if the medicine is liquid, in order to mix the contents thoroughly. Then remove the cork with the second and third fingers, and hold it between them while pouring, thus keeping the cork clean and protecting the contents of the bottle. Hold the medicine glass on a level with the eyes, and in the other hand hold the bottle, with the side bearing the label uppermost to avoid soiling it; pour out the dose, measuring exactly, wipe the bottle, replace the cork, and again read the label on the bottle.
Most medicines should be diluted with a little water. Pills and capsules should not be presented to patients in the attendant's fingers, but on a saucer or teaspoon. Acids and medicines containing iron should be taken through a glass tube kept for medicine exclusively. Tubes and glasses should be washed at once after use, and neither they nor the bottles should stay in the patient's room. If a dose is omitted for any reason, do not increase the next dose; give the regular dose at the next regular time.
Serious mistakes in giving or taking drugs are far too common, and no precautions are too great to guard against them. Never use medicine from a box or bottle that has no label. Never take or give another person a medicine selected in the dark, even though you have positive knowledgethat there is no other bottle or box of medicine in the whole house; in just such circumstances the fatal mistakes occur.
A few things can be done to make medicines more palatable. The water used to dilute the dose and to be taken after it should be very cold. Holding the nose is helpful. A piece of cracker, a peppermint, or a slice of lemon or orange, if allowed, may be taken afterward. Giving disagreeable medicine in ordinary food, as lemon juice, orange juice, or milk, and giving bitter powders in jam or jelly, is unwise because it sometimes results in life long dislike for a useful article of diet. Where food is given directly after the dose to take away its taste, the association of dislike seems to be formed less frequently.
The taste of castor oil is so disgusting that it often causes vomiting, but if skillfully given the oil need not be tasted by a patient who is willing to coöperate. Its way of sticking to the tongue and teeth constitutes the chief difficulty; the object therefore is to prevent it from sticking by swallowing the dose all at once. To administer the oil, wet the inside of a medicine glass or large spoon with very cold water, and leave a little water in the bottom. Pour the required dose in slowly and cover it with more cold water. Let the patient hold in his hand something to take away thetaste,—cracker, bread, peppermint, or whatever is allowed; for castor oil water is not very effectual. Then direct him to hold his nose, open his mouth, and hold his breath; caution him to let the oil run down without swallowing until all has been taken, and afterward to chew the cracker, continuing to hold his nose until he has swallowed the cracker. When the patient understands and is ready, pour the dose in quickly as far back as possible, taking care not to spill the last drop on the lips. This process may seem unduly troublesome, but when castor oil is needed it is badly needed and efforts to make it stay down are worth while. The following method also effectually disguises the taste of castor oil: place in a glass a teaspoonful of baking soda, add the prescribed dose of oil and then the juice of half a lemon. Mix all together thoroughly and let the patient take the mixture while it is effervescing. This method may be used unless the patient is not allowed soda and lemon juice. Castor oil may be bought in capsules, but on account of their size many people find the capsules impossible to swallow.