Painis the most important subjective symptom and should never be disregarded. Bodily pain does not occur in persons who are in all regards physically and mentally well; hence pain is a sign that something, small or great, is out of order.
is the most important subjective symptom and should never be disregarded. Bodily pain does not occur in persons who are in all regards physically and mentally well; hence pain is a sign that something, small or great, is out of order.
"Of all symptoms pain is the one which interests patients the most. We here emphasize the truth, too little understood, that pain is an unpleasant sensation, nothing more, and isneverimagined. Imagination may be its cause, but the pain thus produced hurts just as truly as pain produced by a real disease. Pain is only a phenomenon of consciousness; it is always real, even that felt in a dream. If the patient is too unconscious to feel it, there simply is no pain, no matter how badly the person's body is injured." (Emerson: Essentials of Medicine, p. 356.)
"Of all symptoms pain is the one which interests patients the most. We here emphasize the truth, too little understood, that pain is an unpleasant sensation, nothing more, and isneverimagined. Imagination may be its cause, but the pain thus produced hurts just as truly as pain produced by a real disease. Pain is only a phenomenon of consciousness; it is always real, even that felt in a dream. If the patient is too unconscious to feel it, there simply is no pain, no matter how badly the person's body is injured." (Emerson: Essentials of Medicine, p. 356.)
One should remember that no possible method exists to measure the intensity of pain exactly, or to describe its quality accurately. Therefore in describing pain, it is best to use the patient's own language. Four points should especially be observed, (1) its location; (2) its character, which may be dull or sharp, stabbing, throbbing orcontinuous, slight or severe; (3) the time at which it is worst; certain diseases, for instance, are characterized by more severe pain at night; (4) it should be noticed whether the pain is relieved or increased by change of position, eating or drinking, heat or cold, or the like. Pain may be felt in a part far from the place where the trouble really lies; thus a dislocated shoulder causes pain in the elbow.
Pain is always a danger signal, although the significance is not always so great as the sufferer thinks. The more attention a patient gives to his pain, the more severe it always becomes, therefore his attention should not be called to it unnecessarily. A good observer, however, can get much information by noticing the patient's expression, position, motions, etc., without constantly asking him how he feels. Although many persons overestimate pain, others persistently disregard it, either because they are unwilling to take the necessary measures to remedy it, or because they wish to appear heroic. Both courses of action are mistaken; everyone should realize the folly and danger of bearing pain if it is possible to remove the cause.
Nausea, fatigue and malaise are other subjective symptoms; malaise is the name given to a general feeling of physical discomfort not restrictedto any one part of the body. All three are abnormal when there is not apparent or sufficient cause.
Records.—An accurate record should be kept of the patient's symptoms, medicine, diet, treatment, etc., so that the doctor may have a continuous record, and so that another person taking charge temporarily may know just what has been done for the patient. The record must be written; otherwise details cannot be remembered exactly. It should be as simple and concise as possible; it is the place for facts, not for opinions, and if inaccurate it is worse than none. It is better not to keep the record in the patient's room, for the patient should not see his own record, nor hear its contents discussed. The doctor usually writes his orders on the record sheet itself, or on a separate sheet to be attached to the record for reference. Blank record forms can be purchased, but a form that is made at home is entirely satisfactory. An example of a daily record sheet follows.
—An accurate record should be kept of the patient's symptoms, medicine, diet, treatment, etc., so that the doctor may have a continuous record, and so that another person taking charge temporarily may know just what has been done for the patient. The record must be written; otherwise details cannot be remembered exactly. It should be as simple and concise as possible; it is the place for facts, not for opinions, and if inaccurate it is worse than none. It is better not to keep the record in the patient's room, for the patient should not see his own record, nor hear its contents discussed. The doctor usually writes his orders on the record sheet itself, or on a separate sheet to be attached to the record for reference. Blank record forms can be purchased, but a form that is made at home is entirely satisfactory. An example of a daily record sheet follows.
Tuberculosis, Cancer, and Mental Illness.—As we have seen, early symptoms of sickness are always important; yet it seems worth while to mention particularly the early symptoms of tuberculosis, cancer, and mental disorders, because each of these diseases, though curable in manycases when taken in the early stages, is serious and often fatal if neglected. Certain facts relating to their cause and prevention should be known to everyone. Tuberculosis, long our greatest cause of death, is gradually growing less; but cancer and mental disease are now on the increase.
—As we have seen, early symptoms of sickness are always important; yet it seems worth while to mention particularly the early symptoms of tuberculosis, cancer, and mental disorders, because each of these diseases, though curable in manycases when taken in the early stages, is serious and often fatal if neglected. Certain facts relating to their cause and prevention should be known to everyone. Tuberculosis, long our greatest cause of death, is gradually growing less; but cancer and mental disease are now on the increase.
Tuberculosis.—Every year tuberculosis causes the death of about 150,000 people in the United States. It is caused by the bacillus tuberculosis, a germ which may attack any tissue of the body, although it most frequently affects the lungs of grown people, and the bones and glands of children. The disease is not inherited, but susceptibility to it appears to be; it is readily communicated from person to person. The germ of tuberculosis is so widely distributed that probably few persons over 30 years of age have not been infected with it at some time, although the infection may have been too slight to be noticed. Indeed, most people have probably been infected many times, though without serious results.
—Every year tuberculosis causes the death of about 150,000 people in the United States. It is caused by the bacillus tuberculosis, a germ which may attack any tissue of the body, although it most frequently affects the lungs of grown people, and the bones and glands of children. The disease is not inherited, but susceptibility to it appears to be; it is readily communicated from person to person. The germ of tuberculosis is so widely distributed that probably few persons over 30 years of age have not been infected with it at some time, although the infection may have been too slight to be noticed. Indeed, most people have probably been infected many times, though without serious results.
Tuberculosis is spread chiefly in two ways: (1) through any bodily discharges from infected persons, especially through the nose and mouth discharges; (2) through milk from infected cows. The ways by which the disease is spread indicate methods of prevention. Milk, especially for children, should either be pasteurized orshould come from cows that have been tested and proved to be free from the disease. Other methods of prevention include avoiding any and all bodily discharges of infected persons, and increasing bodily resistance as far as possible. Good food, sufficient rest and fresh air are not only important preventives, but also the most efficacious means of cure. Persons who suffer from insufficient food, exposure, bad housing, long hours, and bad conditions of work are especially susceptible to tuberculosis, and thus it is rightly called a disease of poverty.
Early symptoms of tuberculosis include cough, hoarseness, loss of appetite, pain in the side, loss of weight, getting tired easily, feeling run down, rise in temperature in the afternoon, night sweats, expectoration, and spitting blood. No one, nor even several, of these symptoms necessarily indicates the presence of tuberculosis; on the other hand, even the cough is not necessarily present when tuberculosis actually exists. When one or more of these symptoms appears and continues, a thorough examination should be made by a doctor; examination can do no harm, certainly, if tuberculosis is not found, and if it is, immediate treatment is of the greatest importance. No known drug or medicine is a cure for tuberculosis. Successful treatment depends on takingthe disease in time and in following the doctor's advice unremittingly.
Cancer.—The cause of cancer is not known. All the evidence, however, goes to show that it is neither communicable nor hereditary. Cancer may occur on the skin, stomach, or other organs; in women it most commonly occurs in the breast or uterus (womb). In both sexes it occurs most frequently after 40 years of age. No known medicine will cure cancer; salves and ointments have no effect. Radium andx-ray should not be relied upon if the cancer can be removed by operation. Safety consists in removing the growth entirely, and complete removal is possible only in the early stages.
—The cause of cancer is not known. All the evidence, however, goes to show that it is neither communicable nor hereditary. Cancer may occur on the skin, stomach, or other organs; in women it most commonly occurs in the breast or uterus (womb). In both sexes it occurs most frequently after 40 years of age. No known medicine will cure cancer; salves and ointments have no effect. Radium andx-ray should not be relied upon if the cancer can be removed by operation. Safety consists in removing the growth entirely, and complete removal is possible only in the early stages.
Early diagnosis is consequently of the greatest possible importance, and an examination can do no harm in any case. Warts and moles on the skin may develop into cancer, and should be removed if they show signs of irritation. Loss of appetite and weight, any disturbance of the stomach or intestines, and sores that refuse to heal should lead a person to consult a physician; the same is true of any lump in the breast, and of irregular or persistent bleeding from the uterus in women over forty. The fact that pain is not present in cancer until the late stages leads many persons to neglect the trouble until it istoo far advanced for operation. Time is all-important; hope depends on operation in the early stages when there is a very great probability of permanent cure.
Mental Illness.—Insanity, like cancer, is increasing. Like both cancer and tuberculosis, hope lies in prevention and early treatment; and like them both, in its early symptoms it is too often unrecognized or neglected.
—Insanity, like cancer, is increasing. Like both cancer and tuberculosis, hope lies in prevention and early treatment; and like them both, in its early symptoms it is too often unrecognized or neglected.
Many people are surprised to learn that known, avoidable causes are responsible for the condition of about 50% of the insane patients now under treatment. Chief among these known causes is a communicable germ disease called syphilis, to which is due the disease called paresis, or "softening of the brain." About 25% of patients admitted to hospitals for the insane are there from the effects of habitual use of alcohol, even in "moderate" quantities. Other cases of insanity result from diseases of the heart, arteries, and kidneys, and still others have been traced to the poisons of tuberculosis, typhoid, diphtheria, and other communicable diseases. Prevention of insanity caused by these diseases depends upon prevention or complete cure of the diseases themselves.
Still other causes of insanity are known. Hereditary nervous weakness may predispose to insanity,and for such persons, those whose nervous resistance is naturally not very great, the stress of living may prove too much. Mental breakdowns are rarely caused by overwork unless accompanied by worry or bad hygienic conditions, but they result not infrequently from bad mental habits.
"The average person, little realizes the danger of brooding over slights, injuries, disappointments, or misfortunes, or of an unnatural attitude towards his fellowmen, shown by unusual sensitiveness or marked suspicion. Yet all these unwholesome and painful trains of thought, may if persisted in and unrelieved by healthy interests and activities, tend towards insanity. Wholesome work relieved by periods of rest and simple pleasures and an interest in the affairs of others, are important preventives of unwholesome ways of thinking. We should train ourselves not to brood, but to honestly face personal difficulties."—(Why Should Anyone Go Insane?, by Folks and Ellwood.)
"The average person, little realizes the danger of brooding over slights, injuries, disappointments, or misfortunes, or of an unnatural attitude towards his fellowmen, shown by unusual sensitiveness or marked suspicion. Yet all these unwholesome and painful trains of thought, may if persisted in and unrelieved by healthy interests and activities, tend towards insanity. Wholesome work relieved by periods of rest and simple pleasures and an interest in the affairs of others, are important preventives of unwholesome ways of thinking. We should train ourselves not to brood, but to honestly face personal difficulties."—(Why Should Anyone Go Insane?, by Folks and Ellwood.)
Prevention of insanity consequently depends chiefly upon avoiding alcohol and communicable diseases, especially syphilis; upon good hygiene, self-control, and avoidance of bad mental habits; and upon adopting a program of living and working that will not overtax one's nervous strength. Sleeplessness, unusual nervous fatigue following slight exertion, and diminished power to control the emotions, are among the danger signals. Andwhen a person becomes unusually depressed or morose, excited or irritable, suspicious, unreasonable, or "queer," it is probable that expert medical advice should be obtained as quickly as possible.
"Yesterday, October 10th, Johnny came home from school about half past three, and said he was too cold to play outdoors. He lay down and slept till about five, when he vomited a large amount of undigested food. I took his temperature and found that it was 103.8°, pulse 126, and respiration 28. At 10 that night his temperature was 102.5°, pulse 116, and respiration the same as before. The next morning at 8 he had a temperature of 100.6°, pulse 114, respiration 24. At noon his temperature was 101°, pulse 118, respiration 24; and at 4 o'clock his temperature was 100.6°, pulse 122, respiration 22. The doctor came at 6 o'clock yesterday afternoon; according to his orders I put Johnny to bed, gave him half a tablespoonful of castor oil at 6.30, and a special gargle. His throat was red and sore and he seemed to feel very miserable. The doctor took a culture from the child's throat. At 8.15 and again at 8.50 he had fluid bowel movements. At 9.30 he had a glass of milk, after which he slept until 6 a.m. when his bowels moved again and urine was passed. He passed eight ounces of urine at noon and four ounces at 3.30. He drank a glass of water at 6 this morning, and at 6.30 I gave him a cup of hot broth. At 8 he had a glass of milk, but at 10 he refused everything but a glass of water. At 1.30 he had a large dish of ice cream. He had a cool sponge bath last night at 9, and a cleansing bath this morning at 8.45. This morning his throat was still sore but not so red, and I saw that he gargled every half hour when he was awake. This afternoon he seems brighter and asked for his harmonica, so his throat is probably more comfortable."
Adequate care of the sick consists to a large extent in rendering their physical and mental surroundings as favorable as possible. Obviously, a sick person, since his strength is already depleted, needs not only to have his resistance increased in all possible ways, but also to have all his remaining strength conserved by eliminating every unnecessary tax upon it. In sickness even slight fatigue, chill, or nervous strain, insufficient ventilation, or improper feeding, may become factors of immense importance. Nothing is trivial if it affects the welfare and comfort of a patient.
Even when perfect provision for the care of the sick is out of the question, every effort should be made to insure as satisfactory arrangements as possible. Ideal conditions are seldom found except in buildings originally planned for the sick; yet in many houses a few simple changes will produce excellent results. Of course, it is not necessaryin every case to adopt all the following suggestions. Common sense must be the guide. For instance, in illness that is slight and likely to be of short duration, a patient may be more distressed than benefited by radical changes in his surroundings. Except when certain essentials are concerned, great consideration should be given to a patient's preferences; yet on the other hand it is not reasonable to make an entire family miserable in order to gratify some slight whim.
Choice of a Sick Room.—A south or east exposure is generally best for a sick room. A south room may be undesirable in very hot weather, but sunshine during a part of the day is essential. The room should be quiet, near the bath room, and well removed from odors from the kitchen. It should be situated so that good ventilation is possible. It is desirable though not necessary for it to have more than one window; in summer the windows must be thoroughly screened. It should be possible to open the window without exposing the patient to a direct current of air, and to open the door without placing him in full view of all who pass through the hall.
—A south or east exposure is generally best for a sick room. A south room may be undesirable in very hot weather, but sunshine during a part of the day is essential. The room should be quiet, near the bath room, and well removed from odors from the kitchen. It should be situated so that good ventilation is possible. It is desirable though not necessary for it to have more than one window; in summer the windows must be thoroughly screened. It should be possible to open the window without exposing the patient to a direct current of air, and to open the door without placing him in full view of all who pass through the hall.
It is essential for the patient to have a room to himself. Unless he needs care or help or watching at night, not even the person caring for him should sleep in the room. Neither should therest of the family keep their possessions in the sick room. Closets opening into the room, bureaus, and chiffoniers should be emptied of the belongings of other members of the family, to prevent people from tiptoeing into the sick room at all hours to remove garments. The sick room should for the time belong exclusively to the patient, and resulting inconvenience should be borne by well members of the family.
Every possible precaution should be taken to exclude from a sick room unnecessary noises of all kinds; flapping curtains, squeaky doors and rocking chairs, heels without rubber, creaking corsets, noisy petticoats, ticking clocks, refractory bureau drawers, and rustling newspapers are among the everyday sounds that irritate the nerves of sick and well alike. Ordinary out-of-door noises do not usually disturb the sick, except when the country patient is brought to the city, or the reverse; but nearby and generally avoidable noise is the kind that distracts and harasses nervous patients.
Whispering is an annoying sound and should not be allowed, either in the patient's room or just outside the door. Whatever the subject of conversation may be, the patient thinks that he is under discussion. Anything undesirable for him to hear should be settled well out of his hearing,and in speaking to him there is no possible objection to an ordinary well modulated voice.
Usually a person's own room is more restful and less disturbing than a strange place, but if it serves as a work room as well as a bed room, it may easily be the worst place during sickness. The sight of a desk piled high with papers or a basket overflowing with accumulations of family mending may actually delay recovery; even the room itself may constantly suggest work, and work necessarily left undone. The essential thing to remember is that mental rest is no less important than physical, and every effort should be made to secure them both.
Furnishing.—Superfluous articles add to the care of a sick room, and in consequence they should be removed at the outset. All the furnishings that remain should be easy to clean, but it is not necessary for a sick room to look bare and desolate.
—Superfluous articles add to the care of a sick room, and in consequence they should be removed at the outset. All the furnishings that remain should be easy to clean, but it is not necessary for a sick room to look bare and desolate.
The woodwork as in any other room should have a hard finish, and angles and corners that harbor dust should be as few as possible. Hard wood floors without cracks are best from the point of view of cleanliness and convenience. A few light, washable rugs make the best floor covering, but very small rugs on highly polished floors slide easily and are decidedly dangerous. Carpetsdiminish noise, but are objectionable from every other point of view.
In furnishing houses people ought to realize more frequently than they do how greatly nervous fatigue may be increased by ill chosen wall coverings. Plain papers or tinted walls are best for bed rooms and the color should not be harsh or striking; soft gray, green, or buff is good. The design is no less important than the color; a design that on casual inspection appears quite harmless may become an instrument of torture to a person unable to escape from it for a single hour. Weak or nervous patients sometimes become quite exhausted from attempting to follow an intricate pattern, or from counting over and over a design that is frequently repeated on the wall. If the patient sees grotesque faces and figures in the design the paper is more objectionable still.
Necessary furniture includes the bed, which will be discussed in detail later, a small table to stand by the head of the bed, a dresser, two chairs, and a wall thermometer. If the patient is able to sit up three chairs are needed, of which one should be an armchair with a high back. No rocking chair should be allowed in the room unless the patient himself prefers to sit in one; no one else should be allowed to rock in the room, since the motion is almost always annoying to patients. Elaborate,carved, or upholstered furniture is unsuitable in a sick room, but if it must be used it should have washable covers.
Other desirable articles of furniture are a couch, screen, foot-stool and a second, larger table. In few cases, if any, is anything further really necessary, although patients frequently desire special articles to which there can be no objection.
Most ornaments add much work and little beauty, and have no place in a sick-room. No heavy unwashable curtains or hangings should be allowed, but simple washable curtains and clean white covers for the tables and dresser are desirable. Pictures, if suitable, give much pleasure, but must be used with discretion. It goes without saying that the subjects should be pleasant, but not everyone realizes that complicated subjects are undesirable and that pictures of people or things in motion should be avoided; patients are sometimes worried to see motion that is forever incomplete.
Flowers give great pleasure to the sick by adding color and variety and interest to their surroundings. They should be carefully tended and given fresh water daily. Fading flowers and forlorn plants should be removed from the sick room, and those having strong, heavy odors should not even be admitted. They do not need to be very manyor very expensive; indeed, a potted plant or a few cut flowers are often more acceptable than the great masses of costly flowers that are daily brought to the private wards of hospitals.
Ventilation.—A patient needs fresh air certainly as much as a well person, and probably even more. His room should be thoroughly ventilated night and day. A fireplace makes the problem easier, but in most cases an open window is the main dependence. It should be possible to open windows at the top as well as at the bottom, and the patient may be protected from a direct draught by a screen, or by a sheet stretched along the side of the bed and fastened at the head and foot by tying it around the posts.
—A patient needs fresh air certainly as much as a well person, and probably even more. His room should be thoroughly ventilated night and day. A fireplace makes the problem easier, but in most cases an open window is the main dependence. It should be possible to open windows at the top as well as at the bottom, and the patient may be protected from a direct draught by a screen, or by a sheet stretched along the side of the bed and fastened at the head and foot by tying it around the posts.
Ventilating a room without subjecting the patient to draughts is not always easy. One method is to insert a board three or four inches high under the lower sash so that air is admitted between the two sashes. Another way to ventilate without causing a draught is to remove one or two panes of glass and tack cheese cloth over the opening; or to tack cheese cloth to the lower edge of the upper window casing and to the upper edge of the upper sash, after the sash has been lowered about a foot. Once or twice a day the room should be thoroughly aired by opening windows and doors until the air has been completely changed. The patient,including his head, must be well-covered during the process. An electric fan is useful in summer, but it should not be close enough to the bed for the patient to feel air blowing upon him.
Heating.—Great care should be taken to maintain a suitable temperature in the sick-room, and for this purpose a thermometer in the room is a necessity. Between 65° and 68° is generally the best temperature, and hot water bags and extra covers may be given if the patient is chilly. During a bath or other treatment in which the patient is more or less exposed the temperature should be 70°. The temperature at night may be lower; how low will depend largely on the patient's condition and on what must be done for him during the night. Hot water, steam heat, or electricity is best for the sick room. Gas or oil stoves should never be used except in emergencies, and then for a short time only.
—Great care should be taken to maintain a suitable temperature in the sick-room, and for this purpose a thermometer in the room is a necessity. Between 65° and 68° is generally the best temperature, and hot water bags and extra covers may be given if the patient is chilly. During a bath or other treatment in which the patient is more or less exposed the temperature should be 70°. The temperature at night may be lower; how low will depend largely on the patient's condition and on what must be done for him during the night. Hot water, steam heat, or electricity is best for the sick room. Gas or oil stoves should never be used except in emergencies, and then for a short time only.
Lighting.—Sunlight is one of the most powerful disinfectants, and for this reason if for no other it is needed in every sick room. Sunless rooms, moreover, even if they were wholesome, are too depressing to a patient's spirits for use except perhaps in hot summer days. Ordinary well-regulated light is best in a sick room, and except in a few diseases, especially those in which the eyes are affected, it is undesirable to darken the room or toencourage in any way an appearance of gloom. The patient's eyes, however, should be protected from bright lights shining directly upon them; in this connection it is well to remember that lights and their reflections strike differently upon the eyes of a person lying down from the way in which they strike the eyes of persons sitting or standing, and a light that seems agreeable to the attendant may therefore be painful to the patient.
—Sunlight is one of the most powerful disinfectants, and for this reason if for no other it is needed in every sick room. Sunless rooms, moreover, even if they were wholesome, are too depressing to a patient's spirits for use except perhaps in hot summer days. Ordinary well-regulated light is best in a sick room, and except in a few diseases, especially those in which the eyes are affected, it is undesirable to darken the room or toencourage in any way an appearance of gloom. The patient's eyes, however, should be protected from bright lights shining directly upon them; in this connection it is well to remember that lights and their reflections strike differently upon the eyes of a person lying down from the way in which they strike the eyes of persons sitting or standing, and a light that seems agreeable to the attendant may therefore be painful to the patient.
Almost all persons sleep best in dark rooms, and in most cases it is undesirable for a sick room to be lighted at night. The attendant, however, must be able to see what she is doing and generally needs a shaded candle, small night light, or electric flash. It should be possible to see the patient clearly in case of need, otherwise serious changes in his condition occurring in the night may pass unnoticed.
A reading lamp on the bedside table is desirable for patients allowed to read, but reading in bed even with a well-regulated light is fatiguing, and should not be continued for long uninterrupted periods. A pocket flash light is safer than matches and a candle for patients who wish to consult their watches in the night; indeed, matches in the hands of patients always involve risk. Some patients find twilight a time of great depression. In such a case it had best be shortened by drawing theshades early, turning on the lights, and remembering not to leave him alone.
Cleaning.—The sick-room should be kept thoroughly clean at all times, and the less dust stirred up in doing so the better. Dry sweeping or dusting should not be allowed. Ordinary brooms should be dampened or covered with damp cloths, and dust cloths should be dampened also; but dustless mops and dusters are still better. Vacuum cleaning is very desirable; the noise, which is its only disadvantage, is not a serious objection in most cases. The cleaning of rooms after a communicable disease will be considered later.
—The sick-room should be kept thoroughly clean at all times, and the less dust stirred up in doing so the better. Dry sweeping or dusting should not be allowed. Ordinary brooms should be dampened or covered with damp cloths, and dust cloths should be dampened also; but dustless mops and dusters are still better. Vacuum cleaning is very desirable; the noise, which is its only disadvantage, is not a serious objection in most cases. The cleaning of rooms after a communicable disease will be considered later.
A sick room must be kept tidy as well as clean. The effect of order is quieting, but it should be maintained whether the effect upon the patient is apparent or not. Food and medicine should not be kept in the sick-room, and all used dishes, tumblers, soiled linen, etc., should be removed at once. Unnecessary articles should not be found in the room at any time; every necessary article should be kept in its place, and its place should be a good one.
Maintaining order in the room does not mean that patients should be made uncomfortable. All patients, especially old people, want certain possessions within reach, and their wishes should be considered in spite of the fact that the æstheticeffect is generally far from good. For instance, a perfectly smooth bed is undesirable if in order to make it smooth the patient must be tucked in so tightly that he is uncomfortable. And it would be a mistake to remove an old man's newspapers before he has read them, even if he persists in strewing them all over the floor.
The Attendant.—One person and one person only should carry the entire responsibility for the patient. She should plan for him as well as care for him, should see the doctor and take the doctor's orders. Confusion and innumerable mistakes result when several members of the family attempt to do the talking and directing.
—One person and one person only should carry the entire responsibility for the patient. She should plan for him as well as care for him, should see the doctor and take the doctor's orders. Confusion and innumerable mistakes result when several members of the family attempt to do the talking and directing.
The attendant should wear washable dresses with sleeves that can be rolled up, washable aprons, and shoes with rubber heels. All her clothing should be comfortable. She should be neat in appearance, scrupulously clean in person, and should keep her finger nails short and smooth. Jewelry, especially rings and chains that rattle, and finery of any sort are all out of place in a sick-room.
The attendant must learn that her own sleep, her diet, and her out-of-door exercise are essential to the patient's well-being hardly less than to her own. An amateur nurse often considers that going without food and sleep is a proof of her devotion.In a passion of self-sacrifice she neglects herself utterly for the first few days, and as a consequence is quite useless at a later period when her services may be most needed. An exhausted, sleepy nurse, trained or untrained, is wholly unfit to be trusted with medicines and doctor's orders, to note changes in the patient's condition, or to give him kindly attention. Efficiency and fatigue have never pulled together since the world began, and no one can do good work when suffering from lack of sleep and rest.
The person, then, who genuinely wishes to give her patient the best possible care should not make a martyr of herself. She should go out of doors daily; both fresh air and occasional absence from the patient are essential to her physical and mental well-being. Moreover, she will be showing her patient the greatest kindness in the long run if during her recreation time she thinks of him as little as possible. Indeed, she need not consider herself inhuman if she has a thoroughly good time.
On the other hand, a person who is responsible for the care of a patient must be made to realize that she and she only is ultimately responsible during the entire 24 hours of every day. Being responsible for a patient does not mean that she should be with him every minute, or do everything herself: it does mean that she should plan so effectivelythat everything necessary is done, either by herself or by another competent person. When she goes away for even half an hour, she should appoint someone else to be responsible in her place and to her when she comes back. She must consequently make very clear just what she wants done. If there is medicine, nourishment, or treatment to be given, she can easily make a list, with the time for each, and ask that each item be crossed off the list as soon as the work has been done. She should not forget to ask for the list when she returns.
What is really needed is a little executive ability. As Florence Nightingale said:
"It is impossible in a book to teach a person in charge of the sick how tomanage, as it is to teach her how to nurse. Circumstances must vary with each different case. But it is possible to press upon her to think for herself. Now what does happen during my absence? I am obliged to be away on Tuesday. But fresh air, or punctuality is not less important to my patient on Tuesday than it was on Monday. Or: At 10 p.m. I am never with my patient; but quiet is of no less consequence to him at 10 than it was at 5 minutes to 10. Curious as it may seem, this very obvious consideration occurs comparatively to few, or, if it does occur, it is only to cause the devoted friend or nurse to be absent fewer hours, or even fewer minutes from her patient—not to arrange so as that no minute and no hour shall be for her patient without the essentials of her nursing."—(Notes on Nursing.)
"It is impossible in a book to teach a person in charge of the sick how tomanage, as it is to teach her how to nurse. Circumstances must vary with each different case. But it is possible to press upon her to think for herself. Now what does happen during my absence? I am obliged to be away on Tuesday. But fresh air, or punctuality is not less important to my patient on Tuesday than it was on Monday. Or: At 10 p.m. I am never with my patient; but quiet is of no less consequence to him at 10 than it was at 5 minutes to 10. Curious as it may seem, this very obvious consideration occurs comparatively to few, or, if it does occur, it is only to cause the devoted friend or nurse to be absent fewer hours, or even fewer minutes from her patient—not to arrange so as that no minute and no hour shall be for her patient without the essentials of her nursing."—(Notes on Nursing.)
It is exceedingly difficult to care for members of one's own family or to be cared for by them. Too much or too little is almost invariably expected by one person or the other, and where great affection is involved not only is the strain increased on both sides, but often harm results from too great unselfishness on either side or both. But sometimes the reverse is true, and then one should remember that normal behavior may be impossible for the sick. During weakness and pain, irritability and unreasonableness are as characteristic as other symptoms, and it is as foolish to demand a normal mental state from a sick person as it would be to demand a normal temperature. For a cheerful, reasonable, and unselfish patient—and there are surprisingly many—one should be devoutly thankful, but patience and pity should be given no less to those whose tortured nerves cause suffering to others as well as to themselves.
Every woman who cares for the sick should remember that she is the patient's chief if not his only link with the normal world, and that his plight is pitiful indeed if she is complaining or irritable or unwilling. Anyone who cares for the sick should remember also that she is necessarily in a most intimate relation with the patient, and that such enforced intimacy calls forextra consideration on her part, and for the most scrupulous respect for confidential matters. It is inexcusable even for members of the patient's family to discuss with one another the patient's private concerns, or his queer or unreasonable or annoying ways. During sickness the skeletons in most people's mental closets walk forth, and anyone who misuses special opportunities to know intimate affairs can only be classed with eavesdroppers and village gossips.
The common saying that the best bed for an invalid is his own bed contains an element of truth. Taking from a patient his own accustomed bed, even when a better is substituted, sometimes disturbs him greatly and makes him feel that he is indeed very ill. Nevertheless, a suitable bed is essential to the proper care of a helpless person, and no patient should continue to use an unsuitable one, unless his illness is slight and also likely to be of very short duration.
Besides being comfortable, a bed suitable for the sick must be clean and easy to keep in a sanitary condition. The springs should be firm, and the mattress should be elastic and should give an even support without lumps and hollows. The bed covers should be clean, light, and warm; the pillows should be sufficient in number not only to make the head and shoulders comfortable, but also any other part of the body in need of support. Moreover, the bed should be so placed and of such a kind that the work of caring forthe patient may be rendered as easy for the attendant as possible. In every household at least one bed suitable for a sick person should be available in case of need.
Bedsteads.—Beds of white enameled iron, brass, or brass and iron combined are most easily kept clean, and are the best in every way. The frame should be strong enough to stand firmly, yet not so heavy that it is hard to move. It should have as few angles as possible, and all its joints should be smooth and well finished. The springs should be made of wire stretched tightly on a metal frame that fits smoothly into the head and foot pieces. Large castors should be used; they may be removed from the foot if the bed moves too easily.
—Beds of white enameled iron, brass, or brass and iron combined are most easily kept clean, and are the best in every way. The frame should be strong enough to stand firmly, yet not so heavy that it is hard to move. It should have as few angles as possible, and all its joints should be smooth and well finished. The springs should be made of wire stretched tightly on a metal frame that fits smoothly into the head and foot pieces. Large castors should be used; they may be removed from the foot if the bed moves too easily.
A bed to be used in sickness should have the following dimensions—length, 6 ft. 6 in., height 24 to 26 inches, width, 36 inches. If a bed is either too high or too low the labor of lifting and moving the patient is greatly increased. If the bed is too narrow the patient is insecure. If the bed is too wide, its center is difficult or impossible to reach without leaning or kneeling upon it; and if too short, it will prove uncomfortable for a tall person. A bed that is too low may be raised on four heavy boxes of the same height; or still better, upon heavy wooden blocks whichany carpenter can easily make, and which are well worth a little trouble to obtain. In the top of each block a hollow should be made into which the leg of the bed will fit after the castor has been removed. A broad firm stool or a low chair may be provided for a patient who has difficulty in getting in and out of a high bed.
Beds with complicated attachments for moving patients are not recommended for family use. They are expensive, likely to get out of order, seldom needed, and generally unsatisfactory. In some surgical cases a bed with a firm, flat surface is necessary. Such a surface may be secured by placing between the mattress and springs two boards slightly separated, or one wide board with holes bored in it to afford ventilation.
Wooden beds are undesirable: they are difficult to keep clean, they readily absorb moisture and odors, they cannot well be disinfected, and their solid frames prevent a free circulation of air. Moreover, it is almost impossible to render fit for use again a wooden bed into which vermin have once made their way. Folding beds and lounges even of the best type are unhygienic, usually too low for the patient's comfort, and often insecure.
A bedstead should be wiped frequently with a damp cloth; if it is of enameled iron it may be washed with soap and water. The springs maybe cleansed with a stiff brush dipped in kerosene oil. Excessive use of water upon the springs is likely to make them rust.
Mattresses.—Various substances are used in the manufacture of mattresses, but nothing has yet been found that is as satisfactory as curled hair. It is light and clean and elastic, it does not readily absorb odors, and it is easily renovated. Although hair is more costly than other materials, a hair mattress may be used almost indefinitely if it is occasionally made over.
—Various substances are used in the manufacture of mattresses, but nothing has yet been found that is as satisfactory as curled hair. It is light and clean and elastic, it does not readily absorb odors, and it is easily renovated. Although hair is more costly than other materials, a hair mattress may be used almost indefinitely if it is occasionally made over.
Felt or cotton mattresses are firm, but heavy, difficult to keep clean, and likely to absorb odors. A useful mattress made from straw is sometimes found in country districts. Such a bed is thoroughly hygienic, for the worn straw may be burned and the tick washed and refilled with clean straw; but straw beds are generally hard and lumpy. The least desirable of all mattresses is the old fashioned feather bed, and it should never be used if a better can by any possibility be obtained; but a feather bed should not be arbitrarily taken away from an old person accustomed to its use, unless his welfare is really at stake.
A mattress made in two sections is unnecessary for a single bed; indeed, a mattress made in onepiece is more easily kept in place if the patient is restless. A good quality of blue and white ticking makes a serviceable cover for both mattress and pillows since its color is not likely to run.
Care of the Mattress.—A mattress should be brushed frequently with a whisk broom, especially around the tufts and edges. If a patient is long confined to bed, a fresh one should occasionally be substituted so that the regular mattress may be removed, well brushed, beaten with a carpet beater, and left exposed to the sun and air for a day or two. A mattress that is badly soiled should be sent to a cleaner and made over; it cannot be cleaned properly at home. It is generally possible to remove blood stains, if they have not soaked through the ticking, by applying a thick cream made from raw starch and cold water. When the starch becomes dry it should be brushed away, and the application should be repeated until the stain has disappeared. For the best results the starch should be applied before the stain is dry.
—A mattress should be brushed frequently with a whisk broom, especially around the tufts and edges. If a patient is long confined to bed, a fresh one should occasionally be substituted so that the regular mattress may be removed, well brushed, beaten with a carpet beater, and left exposed to the sun and air for a day or two. A mattress that is badly soiled should be sent to a cleaner and made over; it cannot be cleaned properly at home. It is generally possible to remove blood stains, if they have not soaked through the ticking, by applying a thick cream made from raw starch and cold water. When the starch becomes dry it should be brushed away, and the application should be repeated until the stain has disappeared. For the best results the starch should be applied before the stain is dry.
Pillows.—One patient can use an almost unlimited number of feather pillows. Some should be soft and others firm, some large and some small; but pillows that are very large and thick are less useful than a greater number of smaller ones. It is well to have several small pillows of varyingsize and thickness to support different parts of the body.
—One patient can use an almost unlimited number of feather pillows. Some should be soft and others firm, some large and some small; but pillows that are very large and thick are less useful than a greater number of smaller ones. It is well to have several small pillows of varyingsize and thickness to support different parts of the body.
Hair pillows are often acceptable in warm weather, and they are also desirable for patients with high fever or excessive perspiration. Rubber air pillows are a convenience in traveling and add much to the comfort of a patient when he first goes out in a carriage or motor car, but air pillows are not sufficiently durable for general use.
If a pillow tick becomes soiled, the feathers may be transferred to a clean tick by making an opening about six inches long in the end of each pillow, sewing the ticks together, and then shaking the feathers from one tick to the other. The soiled tick can then be washed. If the feathers themselves have become soiled they should be renovated by a cleaner. Pillows, like mattresses, should be frequently brushed, sunned, and aired. They should not be held in the mouth while a clean pillow-case is adjusted.