Suppositories.—Sometimes medicines are given through the rectum. For this purpose they are combined with cocoa butter or other material, and made into small cones called suppositories. They melt at a low temperature and should be kept onice until needed. A suppository should be lubricated with vaseline, and inserted very gently as far as the finger can be introduced, while the patient is lying on the back or left side.
—Sometimes medicines are given through the rectum. For this purpose they are combined with cocoa butter or other material, and made into small cones called suppositories. They melt at a low temperature and should be kept onice until needed. A suppository should be lubricated with vaseline, and inserted very gently as far as the finger can be introduced, while the patient is lying on the back or left side.
Enemata.—An injection of a fluid into the rectum is called an enema. (Plural, enemas, or enemata.) Enemas are generally used to cause evacuation of the bowels.
—An injection of a fluid into the rectum is called an enema. (Plural, enemas, or enemata.) Enemas are generally used to cause evacuation of the bowels.
For a simple purgative enema one of the following is generally used: plain water; or a solution of common salt in the proportion of one teaspoonful of salt to one pint of water; or soap suds made with a white soap such as castile or ivory. Unless otherwise ordered the temperature of the enema should be between 105° and 110° F.
To give an enema, one should proceed as follows: First protect the bed by placing under the patient's hips a rubber sheet, covered by a draw sheet or large towel. Let the patient lie on the back, with the knees flexed and head low. Bring to the bedside a commode or bedpan, and lastly the solution contained in a fountain syringe having a long rubber tube, stopcock and short hard rubber nozzle. The bag of the syringe may be hung on the bed post or elsewhere, but it should not be more than three feet at most above the patient's head. Lubricate the nozzle with vaseline either from a tube, or removed from a jar by means of apiece of toilet paper; never dip the nozzle itself into a vaseline jar. Let the solution flow into the bedpan until it runs warm and smoothly; a jerky flow means presence of air bubbles which cause pain if injected into the bowels. Unless the patient is able to do it herself, gently insert the nozzle, and at the same time start the flow. Force must not be used in inserting the nozzle, and the flow should be gentle; if the solution goes in rapidly the patient may be unable to retain it. If there is a desire to expel the enema as soon as the injection has begun, shut off the current and wait a minute, meanwhile making gentle pressure upon the patient's abdomen with one hand; then lower the bag a little and begin again. A grown person should take from two to four pints, and a child from one to two pints. After the enema is finished give the bedpan immediately; the enema will, however, be more effective if retained a few minutes. The bedpan should be given and removed according to the directions onpage 176. Sometimes an enema is expelled with such violence that it soils the upper sheet; to protect the covers a rubber sheet may be spread over the patient's knees and legs. Since an enema sometimes causes nausea or faintness, a patient should be watched constantly during the process.
To give an enema to a baby one may use a small syringe having a soft rubber bulb with a nozzle directly attached, or the ordinary fountain syringe with the small, hard rubber tip designed for infants. The enema should be given in a warm room free from draughts, and the baby must be warmly covered throughout the process. First cover the lap with a pad or folded blanket. Upon the blanket place a warmed rubber sheet, and over the rubber a warm diaper. Hold the baby on your lap, so that he lies on his back with his knees drawn up. Hold his feet or legs firmly in your left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that all the air is expelled from the syringe, and then proceed as already directed. A baby will take from two or three ounces up to half a pint or even more, according to the size of the child. After the injection is finished place a small vessel under the baby's hips, and hold it until the fluid has been expelled, keeping the child well covered all the time.
After being used, the nozzle of a fountain syringe should be washed with soap and water, boiled, dried and put away in a clean place. Inserting the nozzle into the bag of the syringe immediately after withdrawing it from the rectum is a filthy but not uncommon practice. The syringe should be kept clean inside and out; itshould be washed in hot soapsuds, rinsed in clean hot water, drained, and when thoroughly dry wrapped in a clean towel or tissue paper. The ordinary fountain syringe hanging for months by a dirty string on a hook in the bath room is an unpleasant and generally an unclean object.
Sprays and Gargles.—Several other methods of administering medicines are occasionally employed. Some remedies may be applied directly to the throat by gargles, and to the nose and throat by sprays. The throat may be cleansed by gargling with a solution of a teaspoonful of baking soda or common salt in a glass of warm water. Nose sprays should not be used except under medical advice, and it is well to remember that if the mouth washes, gargles, and sprays advertised to be disinfectants were really strong enough to kill germs, they would be too harsh for common or continued use. The nozzles of nose and throat sprays should be boiled immediately after use. A surprising number of families who have progressed far beyond common drinking cups and towels, continue to use a common nose spray without even washing the nozzle. Children while they are well should be taught to gargle the throat; a child with a sore throat and an aching head is in a poor condition to learn anything.
—Several other methods of administering medicines are occasionally employed. Some remedies may be applied directly to the throat by gargles, and to the nose and throat by sprays. The throat may be cleansed by gargling with a solution of a teaspoonful of baking soda or common salt in a glass of warm water. Nose sprays should not be used except under medical advice, and it is well to remember that if the mouth washes, gargles, and sprays advertised to be disinfectants were really strong enough to kill germs, they would be too harsh for common or continued use. The nozzles of nose and throat sprays should be boiled immediately after use. A surprising number of families who have progressed far beyond common drinking cups and towels, continue to use a common nose spray without even washing the nozzle. Children while they are well should be taught to gargle the throat; a child with a sore throat and an aching head is in a poor condition to learn anything.
Inhalationor breathing in, is another methodused to introduce drugs into the membranes of the nose, throat, and lungs. Smelling salts are an example of substances used for inhalation; they are used to stimulate persons who are faint. They should not be placed close to the nostrils, nor used at all when the patient is totally unconscious.
or breathing in, is another methodused to introduce drugs into the membranes of the nose, throat, and lungs. Smelling salts are an example of substances used for inhalation; they are used to stimulate persons who are faint. They should not be placed close to the nostrils, nor used at all when the patient is totally unconscious.
Inhalations of steam are often used in asthma, croup, and bronchitis. Special croup kettles are made for the purpose, but an ordinary pitcher half full of boiling water may be used instead. The patient's head should be held closely over the pitcher, and a towel should be adjusted around the top covering the patient's nose and mouth, but admitting just enough air to make it possible for him to breathe. If a drug is ordered it should be added to the water.
Inunction, or rubbing a substance into the skin, is sometimes ordered for delicate babies and children. After the skin of the abdomen has been washed with warm soapy water and thoroughly dried, the substance ordered, generally olive oil or cod liver oil, should be applied by means of a circular movement of the palm of the hand. The oil should be warm and the rubbing continued until it is absorbed.
, or rubbing a substance into the skin, is sometimes ordered for delicate babies and children. After the skin of the abdomen has been washed with warm soapy water and thoroughly dried, the substance ordered, generally olive oil or cod liver oil, should be applied by means of a circular movement of the palm of the hand. The oil should be warm and the rubbing continued until it is absorbed.
Ointments are also applied by inunction. A small quantity at a time should be rubbed in, using a circular motion. If an ointment is orderedto be applied where the skin is broken, the ointment should be spread upon gauze and applied without friction. Liniments are rubbed in in the same way as ointments. In many cases rubbing accomplishes more than the ointment or liniment itself, so that this part of the treatment must not be slighted.
Household Medicine Cupboard.—In every household a small cupboard is needed for medical and surgical supplies. Glass shelves are desirable, because they show when dirty and are easily cleaned, but a wooden cupboard can easily be lined with clean paper or white enamel cloth held in place with thumb tacks. Dirty, stained shelves should not be tolerated. The cupboard should be kept locked and the key put well out of the reach of children. In the cupboard should be kept medicines in daily use; they should not be paraded on family dinner tables.
—In every household a small cupboard is needed for medical and surgical supplies. Glass shelves are desirable, because they show when dirty and are easily cleaned, but a wooden cupboard can easily be lined with clean paper or white enamel cloth held in place with thumb tacks. Dirty, stained shelves should not be tolerated. The cupboard should be kept locked and the key put well out of the reach of children. In the cupboard should be kept medicines in daily use; they should not be paraded on family dinner tables.
Poisonous drugs should have rough glass bottles and conspicuous labels. All medicine bottles should be kept well corked, since evaporation may take place and the remaining solution, by becoming stronger, may be dangerous to use in the ordinary amount. Pills and tablets sometimes deteriorate by standing, and may become so hard that they pass through the stomach and intestines without dissolving. It is best to buy drugs andsurgical supplies in small quantities; when it is cheaper to buy more at a time the druggist should be asked whether they will deteriorate or not.
Almost every family needs to keep on hand some cathartics, some disinfectants, some material for first aid, and a few simple appliances. Most families have certain other needs peculiar to themselves, and for those who live at a distance from drug stores a greater quantity and variety may be required. Elaborate equipment and extensive supplies of medicines are neither economical nor necessary for household use.
Castor oil, Rochelle or other laxative salts, and two grain cascara tablets ordinarily constitute a sufficient supply of cathartics. The dose of castor oil is one or two teaspoonfuls for a baby up to a tablespoonful for an adult. Rochelle salts and seltzer aperient are given dissolved in water; the ordinary dose is from one to four teaspoonfuls. Seidlitz powders come in two packets, one white and one blue. The contents of the packets should first be dissolved in separate glasses each filled about a quarter full of water. One solution should then be poured into the other and the mixture taken while it is effervescing. Cascara tablets are generally given in one to ten grain doses.
A small bottle of tincture of iodine and one of70% alcohol should be kept for disinfecting. Neither one is for internal use. The iodine is used to disinfect small wounds and abrasions of the skin. It is applied with cotton swabs and several swabs should be made and kept on hand in a box or envelope. Alcohol is used to disinfect thermometers and other instruments that cannot be boiled, for rubbing, and may also be used for disinfecting the skin. A 90% solution is sometimes used for rubbing; it need not be bought until needed. Denatured and wood alcohol are poisons and should be used in households only in spirit lamps; they are not safe for other purposes.
First aid materials may include two gauze bandages two and one-half inches wide and two bandages one inch wide, one American Red Cross First Aid Outfit, a small package of absorbent cotton, a roll of old muslin, a package of adhesive plaster one inch wide, boracic ointment, picric acid gauze or other application for burns, safety pins, and a pair of scissors.
For use in cases of fainting or exhaustion it is well to keep aromatic spirits of ammonia on hand. Its bottle should have a rubber stopper. The dose is one-half to one teaspoonful, in a quarter to half a glass of water. Hot coffee and tea are also good stimulants, but the time necessary to prepare them makes it desirable to have aromaticammonia on hand. Household or ordinary ammonia must not be used as a substitute.
Olive oil, mustard, and baking soda may be brought from the kitchen when needed. It is assumed that vaseline, cold cream, hand lotion, talcum powder, and other toilet preparations will also be available.
Only a few appliances are necessary. Among them are a medicine glass, a teaspoon, clinical thermometer, hot water bag, fountain syringe, and an alcohol lamp in houses without gas or electric stoves. It is better not to buy other appliances until they are needed, particularly rubber goods since they deteriorate rapidly.
Footnotes:[2]See "Nostrums and Quackery," p. 445.
[2]See "Nostrums and Quackery," p. 445.
[2]See "Nostrums and Quackery," p. 445.
Inflammation.—A process called inflammation sometimes occurs in tissues that have been injured or invaded by bacteria. Although painful, it is nevertheless one of the reparative processes of the body, and therefore beneficial. Common examples of inflammation are boils, sore throat, and the swollen, painful condition resulting from sprains and fractures. Characteristic symptoms of inflammation are heat, redness, swelling, and pain.
—A process called inflammation sometimes occurs in tissues that have been injured or invaded by bacteria. Although painful, it is nevertheless one of the reparative processes of the body, and therefore beneficial. Common examples of inflammation are boils, sore throat, and the swollen, painful condition resulting from sprains and fractures. Characteristic symptoms of inflammation are heat, redness, swelling, and pain.
When a tissue has been invaded by bacteria, nearby blood vessels dilate, thus bringing an increased supply of blood to the affected part. This extra supply serves to wash away the offending substance, and at the same time it brings more white blood corpuscles, one function of which is to destroy bacteria. From the increased supply of blood the affected part becomes red and hot, and so much blood may come that the vessels further on are unable to carry it away fast enough. Some of the fluid part of the blood is then forced out into the tissues, and the partbecomes swollen. Distension of the tissues and pressure on the nerve endings cause pain, and the injured part now exhibits the characteristic symptoms of inflammation.
Fig. 21.—"The History of a Boil."This figure represents a cross-section of normal skin. Note the surface layer, or cuticle, and the "true skin," or cutis. In the cutis one sees that the blood capillaries are just wide enough for the blood-cells to pass through "in single file." The skin has just been pricked by a dirty pin. On the point of this pin were several poisonous germs which were deposited ata. (From Emerson's "Essentials of Medicine.")
Fig. 21.—"The History of a Boil."This figure represents a cross-section of normal skin. Note the surface layer, or cuticle, and the "true skin," or cutis. In the cutis one sees that the blood capillaries are just wide enough for the blood-cells to pass through "in single file." The skin has just been pricked by a dirty pin. On the point of this pin were several poisonous germs which were deposited ata. (From Emerson's "Essentials of Medicine.")
Fig. 22.—"The History of a Boil"(continued). The poison from these germs diffuses through the cutis. The capillaries dilate. The leucocytes force their way through the walls of the capillaries and travel towards these germs. Note the dumb-bell shape of the leucocytes as they pass through the minute holes in the capillary walls, and their pseudopods as they travel towards their common destination, attracted by the poison from the germs. The skin in this region is now swollen, red, hot, and painful. (From Emerson's "Essentials of Medicine.")
Fig. 22.—"The History of a Boil"(continued). The poison from these germs diffuses through the cutis. The capillaries dilate. The leucocytes force their way through the walls of the capillaries and travel towards these germs. Note the dumb-bell shape of the leucocytes as they pass through the minute holes in the capillary walls, and their pseudopods as they travel towards their common destination, attracted by the poison from the germs. The skin in this region is now swollen, red, hot, and painful. (From Emerson's "Essentials of Medicine.")
At this point, if the injury begins to heal or the bacterial infection to yield, the extra blood supply is gradually carried off, the blood vessels resume their normal size, and the tissues return to their usual condition. If, however, the infection does not yield so quickly, more and more white blood corpuscles assemble and pass throughthe walls of the tiny blood vessels into the tissues. Here the struggle continues. Some bacteria and some white blood corpuscles are killed, and substances are formed which liquify these dead cells and also some cells of the surrounding tissues. The resulting fluid is called pus or matter, and in the case of a boil we then say it has come to a head. If the infection occurs near a cavity or near the surface of the body, the pus may escape by breaking through at the point of least resistance, and may carry most of the poisons alongwith it. If the pus finds no outlet it may be gradually absorbed by the blood stream, and healing may result without discharging. On the other hand, the germs may make their way into the circulation, thus causing the serious condition known as blood poisoning.
Fig. 23.—"The History of a Boil"(continued). The migration of leucocytes has continued until now they form a dense mass surrounding the germs. The poison of the germs has killed all the leucocytes and also all the cutis immediately around them, and now digestive fluids from the dead leucocytes is turning the whole dead mass into liquid pus. The boil has "come to a head." There is a little lump on the skin and through its thin covering of cuticle can be seen the yellow pus. (From Emerson's "Essentials of Medicine.")
Fig. 23.—"The History of a Boil"(continued). The migration of leucocytes has continued until now they form a dense mass surrounding the germs. The poison of the germs has killed all the leucocytes and also all the cutis immediately around them, and now digestive fluids from the dead leucocytes is turning the whole dead mass into liquid pus. The boil has "come to a head." There is a little lump on the skin and through its thin covering of cuticle can be seen the yellow pus. (From Emerson's "Essentials of Medicine.")
Inflammation may be treated by means of hot applications, cold applications, or counter-irritants. The effect of heat is to dilate the vessels and hence to increase the flow of blood to the injured part. This increased blood supply makesthe reparative process go on more vigorously, and also makes it possible for the accumulated fluid to be more rapidly carried away. Moist heat softens the tissues so that pus, if formed, can escape more easily.
Fig. 24.—"The History of a Boil"(concluded). The boil has finally ruptured. The liquid pus has escaped carrying with it the germs and most of their poisons; the migration of leucocytes has stopped; the capillaries are returning to normal size and now new tissue will grow and fill up this hole. (From Emerson's "Essentials of Medicine.")
Fig. 24.—"The History of a Boil"(concluded). The boil has finally ruptured. The liquid pus has escaped carrying with it the germs and most of their poisons; the migration of leucocytes has stopped; the capillaries are returning to normal size and now new tissue will grow and fill up this hole. (From Emerson's "Essentials of Medicine.")
Cold acts in just the opposite way. It decreases the size of the blood vessels so that less blood comes to cause pain and swelling; at the same time it diminishes the number of white blood corpuscles and the nutritive substance brought by the blood. The nature and location of the infection determine whether heat or cold is to be preferred.
Counter-irritants, of which mustard is an example, have a complicated action. A counter-irritant affects the blood circulation of the place to which it is applied, and at the same time it irritates the superficial nerves, which in turn stimulate other more distant nerves. The latter nerves control the circulation in tissues not adjoining those to which the counter-irritant is applied, and thus it is possible for a mustard paste, for example, if applied at one point to bring about changes in the blood supply of another part of the body. The mechanism by which counter-irritation is brought about is an intricate nervous process called reflex action.
In applying either moist or dry heat the danger of burning or scalding a patient must be constantly kept in mind. This danger is always great, but it is especially great when the skin is tender like that of babies, children, and old people, or when the vitality is low as in cases of chronic or exhausting illness. Unfortunately accidents in applying heat are not uncommon; a moment's carelessness may cause serious injury and prolonged suffering.
Dry Heat.—Hot water bags are used to applydry heat. They should be filled not more than two-thirds full of hot water, but the water must not be so hot that there is the slightest possibility of scalding the patient if the bag should leak. Boiling water should never be used. Before the stopper is screwed on, expel the air by squeezing the bag or by resting it upon a flat surface until the water reaches the top. After closing the bag make sure that both bag and stopper are in order, by noting whether leakage occurs when the bag is inverted and pressed moderately. Before it is placed near the patient the bag should be dried and entirely covered with a towel or canton flannel bag.
—Hot water bags are used to applydry heat. They should be filled not more than two-thirds full of hot water, but the water must not be so hot that there is the slightest possibility of scalding the patient if the bag should leak. Boiling water should never be used. Before the stopper is screwed on, expel the air by squeezing the bag or by resting it upon a flat surface until the water reaches the top. After closing the bag make sure that both bag and stopper are in order, by noting whether leakage occurs when the bag is inverted and pressed moderately. Before it is placed near the patient the bag should be dried and entirely covered with a towel or canton flannel bag.
Strong bottles, jugs, and jars, if they can be securely stoppered, may be used sometimes instead of hot water bags. The same precautions are necessary. Bricks, flat irons, or thick flannel bags containing salt or sand may be heated in the oven and used in the same way. Salt and sand retain heat for a long time, but are correspondingly slow to heat; therefore one bag should be heating in the oven while the other is in use. Their effect on the skin must be no less carefully watched than the effects of other hot applications.
Hot dry flannel may be used without fear of burning a patient, and it sometimes yields sufficientwarmth to relieve pain, particularly abdominal pain of babies. After it has been heated on a radiator or in an oven, it should be applied quickly and covered closely with another flannel to prevent escape of heat.
Dry heat can be applied conveniently by an electric pad. The part to be heated may be wrapped in flannel or placed directly above or below the pad. The pad should be carefully watched to see that the switch is not accidentally turned, as it is possible for the pad to become hot enough to burn the patient or to set fire to the bed covers.
Moist Heat.—To apply moist heat poultices or fomentations (stupes) are used.
—To apply moist heat poultices or fomentations (stupes) are used.
Poulticesmay be made of various heat-retaining substances, but flaxseed meal is generally used. The poultices when ready should be applied without delay, therefore all preparations should be made in advance. To prepare a poultice, first provide a piece of gauze or thin old muslin about two inches wider than you wish the poultice to be when finished, and about two inches more than twice as long. In a shallow saucepan boil water, varying in amount according to the size of the poultice desired; about equal parts of water and meal will be needed. When the water is boiling briskly add the meal gradually, beating constantlywith a spatula or knife. The poultice is done when the mixture coheres and is thick enough to drop from the spatula leaving it clean. Quickly spread a layer of the hot flaxseed from a quarter to half an inch thick on one-half of the muslin, leaving a margin on three sides of about an inch (Fig. 25). Fold in the margins of the cloth (Fig. 26) and then bring the other half of the cloth over the flaxseed so that the top of the poultice is covered. Tuck the free end of the upper half of the cloth under the turned in edges of the long sides.
Fig. 25.Fig. 26.Fig. 25.—Turn the edges of the muslin over the flaxseed by folding first on the lineAA', and then on the linesBB'andCC'.Fig. 26.—Fold on the lineEE', bringingFF'up over the flaxseed and tucking it under atDandD'.
Fig. 25.Fig. 26.
Fig. 25.
Fig. 25.
Fig. 26.
Fig. 26.
Fig. 25.—Turn the edges of the muslin over the flaxseed by folding first on the lineAA', and then on the linesBB'andCC'.
Fig. 26.—Fold on the lineEE', bringingFF'up over the flaxseed and tucking it under atDandD'.
Carry the poultice on a hot plate, or rolled ina newspaper or hot towel. Test it carefully with the back of the hand, apply it to the skin gradually, cover it with cotton batting, oiled muslin, or several thicknesses of flannel, and keep it in place with a bandage or towel. Remove it as soon as it has become cold, and unless the skin is much reddened apply a fresh poultice. If the skin is much reddened, anoint it with vaseline or sweet oil, wrap it warmly, and apply the next poultice as soon as the appearance of the skin is normal.
Stupesorhot fomentationsare cloths, preferably of flannel or flannelette, wrung out of boiling water and applied to the skin. Each stupe should be three or four times as large as the area to be covered. Two are needed, so that one may be prepared before removing the other. To prevent escape of heat and moisture the stupe should be covered after it has been applied, first with a piece of rubber cloth or oiled silk or muslin, and next with several thicknesses of flannel, or cotton batting made into a pad. The whole should be kept in place with a bandage or towel used as a binder. The doctor will tell how often the stupes are to be applied, but if the skin becomes irritated they must be stopped until its appearance is again normal.
Fig. 27.—Wringing Stupe.(From "Elementary Nursing Procedures," California State Board of Health.)
Great care must be taken in applying fomentations. They do little good unless very hot, but if applied too hot the patient is likely to be scalded. They must be wrung as dry as possible;but it is difficult to wring them without scalding the hands unless stupe wringers are used. Stupe wringers are heavy pieces of cloth, like roller towels or pieces of ticking, long enough to extend over opposite sides of the basin in which the stupe is to be boiled, and wide enough to hold the stupe easily. The wringer should be placed in the basin with the stupe arranged upon it. Boiling water should then be added, or the water, stupe, and wringer may be boiled together in the basin. After the stupe is ready, the wringer with the stupe upon it should be removed from the water by grasping the dry ends of the wringer. Then the ends should be twisted in opposite directions until the stupe inside is as dry as possible. Wringing is made easier if the wringer has wide hems into which sticks such as pieces of broom handles are inserted. By twisting the sticks in opposite directions the stupe may be wrung out easily.
Dry Cold.—Cold, like heat, may be used either dry or moist. Bags of rubber or of Japanese paper filled with small pieces of ice are used to apply dry cold. When weight is to be avoided, the bag should not be completely filled. After the bag has been filled and the air has been expelled,it should be stoppered securely and wrapped in a towel or piece of flannel, since it is possible for an uncovered ice bag to freeze the skin. Ice bags are easily punctured, and care should be taken not to bring pressure upon them especially when filled with sharp pieces of ice. An ice bag not in use should be thoroughly dry inside and out; it should be put away with enough absorbent cotton inside to keep the surfaces from adhering. Bags of Japanese paper are less costly than rubber, but less durable. To close them one should roll the top over and then tie it tightly with string.
—Cold, like heat, may be used either dry or moist. Bags of rubber or of Japanese paper filled with small pieces of ice are used to apply dry cold. When weight is to be avoided, the bag should not be completely filled. After the bag has been filled and the air has been expelled,it should be stoppered securely and wrapped in a towel or piece of flannel, since it is possible for an uncovered ice bag to freeze the skin. Ice bags are easily punctured, and care should be taken not to bring pressure upon them especially when filled with sharp pieces of ice. An ice bag not in use should be thoroughly dry inside and out; it should be put away with enough absorbent cotton inside to keep the surfaces from adhering. Bags of Japanese paper are less costly than rubber, but less durable. To close them one should roll the top over and then tie it tightly with string.
Moist Cold.—Cold compresses for the head are often used for patients with fever or headache; they sometimes quiet a patient who is restless. An old handkerchief or piece of soft linen folded with the raw edges inside may be used as a compress. It should be large enough to cover the forehead. Two compresses at least should be provided, and a large piece of ice in a basin. One compress should be wrung so that it will not drip, and then applied to the head. The other meanwhile should be placed on the ice to cool. As soon as the first compress becomes warm, the second should be applied in its place.
—Cold compresses for the head are often used for patients with fever or headache; they sometimes quiet a patient who is restless. An old handkerchief or piece of soft linen folded with the raw edges inside may be used as a compress. It should be large enough to cover the forehead. Two compresses at least should be provided, and a large piece of ice in a basin. One compress should be wrung so that it will not drip, and then applied to the head. The other meanwhile should be placed on the ice to cool. As soon as the first compress becomes warm, the second should be applied in its place.
Cold Compresses for the Eyes.—Soft material should be selected for eye compresses. Each one should be cut only a little larger than the eye andshould fit neatly over it. Several compresses should be placed on a block of ice while one is applied to the eye, and every few minutes the compress should be changed. If there is discharge from the eye, each compress should be used but once; when used, they should be collected in a paper and afterward burned. Separate compresses should be used if both eyes are being treated. Definite directions in regard to changing compresses and the length of time the applications should be continued are generally given by the physician.
To some extent all hot applications are counter-irritants, but mustard pastes, mustard leaves, and the mustard foot-bath already described are the counter-irritants most commonly used.
Mustard Paste.—To make a mustard paste, mix dry mustard with flour, using for adults one part of mustard and six of flour to make a weak paste; increase the proportion of mustard up to equal parts of mustard and flour, according to the strength required. Use a smaller proportion of mustard for children; one part of mustard with from 6 to 10 parts of flour is generally enough. Add to the mustard and flour enough tepid water to make a paste, which must be absolutely free from lumps. Do not use hot water for thispurpose, because it destroys some of the active properties of the mustard. Spread the paste on thin muslin, apply it to the skin, and remove it as soon as the skin is reddened so that its color resembles that of a strong sun-burn. If the skin is especially sensitive, mix a little sweet oil or vaseline with the paste.
Mustard leavesshould be dipped in tepid water and may then be applied to the skin directly, but if specially sensitive, the skin should be protected by thin muslin or gauze. The leaf should remain until the skin is well reddened; a few minutes are generally sufficient.
Care must be taken not to leave either a mustard leaf or a paste in place long enough to blister the skin. After the application has been removed; the part should be protected by a soft cloth until redness disappears. Vaseline or sweet oil should be applied to the skin if it is greatly irritated.
Other counter-irritants in common use are iodine, turpentine, ammonia, kerosene, camphorated oil, capsicum vaseline, and various liniments. Tincture of iodine may be diluted with alcohol for especially sensitive skins; it sometimes causes blisters, and should not be applied more than once a day at most. Ammonia and turpentine cause blisters; they should not be used as counter-irritants except by a doctor's order, and thenonly after exact directions have been obtained. Turpentine and kerosene are inflammable and hence dangerous to use. It should be remembered that the action of all counter-irritants is physiologically the same, so that no advantage is obtained from the use of dangerous substances like kerosene and turpentine.
The first chapter of this book described the ways in which communicable diseases are carried from person to person, and also some principles underlying methods of prevention. This chapter aims to show how these principles apply in the actual care of patients whose diseases are transmissible. In order to apply them intelligently, it is necessary to keep in mind certain facts in regard to the transmission of infections. A brief summary of these facts follows.
Disease germs are present in the bodies of persons suffering from communicable disease, but they may also exist in the bodies of persons in good health; if present in the body, they may leave it in any bodily discharge. While every kind of germ does not leave the body by all the different routes, it is nevertheless true that most germs expelled from the body are carried in discharges from the nose, throat, bladder or bowels. Germ-laden discharges of an infected person maybe distributed to other persons by water, milk and other foods, by certain insects, by unclean hands, by common drinking cups, towels, handkerchiefs, and similar articles, and directly by nose and throat spray. After they have been thus conveyed to other persons, the germs make their entrance into the body of their new victims through the digestive tract, through the nose, throat, and other mucous membranes, or through breaks in the skin. Prevention of communicable diseases, therefore, depends upon the measure of success attained in blocking the transit of germs from person to person; but methods of prevention, though easy to understand, are unfortunately sometimes difficult to carry out. In order to carry them out effectively one must devote to the problem great accuracy, unremitting care, considerable intelligence, and a highly developed conscience.
Care of a patient suffering from transmissible disease is adequate only when it accomplishes two definite results. One result, which concerns the patient primarily, is to bring about his recovery as rapidly and as surely as possible; the other result, which concerns the community rather than the individual, is to make it impossible for the patient to infect others with his disease. In every case of communicable disease, from aslight cold in the head up to serious cases of pneumonia or typhoid fever, both the patient and the community must be constantly safe-guarded.
Incubation Period.—The interval between the moment when pathogenic germs enter the body, and the time when symptoms first appear and the patient begins to feel ill, is called the incubation period. Incubation periods vary according to the disease from a few hours to two or three weeks. The length of the period also varies somewhat in different cases of the same disease.
—The interval between the moment when pathogenic germs enter the body, and the time when symptoms first appear and the patient begins to feel ill, is called the incubation period. Incubation periods vary according to the disease from a few hours to two or three weeks. The length of the period also varies somewhat in different cases of the same disease.
Care of Patients with Colds or Other Slight Infections.—The usual symptoms of infectious diseases include fever, chill, sore throat, nasal discharge, cough, headache, vomiting and other digestive disturbances, and a general feeling of being sick all over. When one or more of these symptoms appear, unless they are very slight, a doctor should be sent for. The patient, whether child or grown person, should go to bed in a room alone and should stay in bed at least as long as the fever and symptoms of cold in the head continue, in order to protect others as well as himself. Persons in active life, it is true, are not always able to go to bed during colds; but there is no doubt that ultimately they would save time by doing so. It is especially necessary for children to remain in bed when suffering fromcolds, not only to insure their own well-being but also to protect others, since children are notably careless in regard to coughing, sneezing, and borrowing handkerchiefs. The patient needs mental rest as well as physical, and should not be allowed to work in bed.
—The usual symptoms of infectious diseases include fever, chill, sore throat, nasal discharge, cough, headache, vomiting and other digestive disturbances, and a general feeling of being sick all over. When one or more of these symptoms appear, unless they are very slight, a doctor should be sent for. The patient, whether child or grown person, should go to bed in a room alone and should stay in bed at least as long as the fever and symptoms of cold in the head continue, in order to protect others as well as himself. Persons in active life, it is true, are not always able to go to bed during colds; but there is no doubt that ultimately they would save time by doing so. It is especially necessary for children to remain in bed when suffering fromcolds, not only to insure their own well-being but also to protect others, since children are notably careless in regard to coughing, sneezing, and borrowing handkerchiefs. The patient needs mental rest as well as physical, and should not be allowed to work in bed.
The patient's nose and throat discharges should be received only in material that can be burned, like old linen or muslin, gauze, or paper napkins. As soon as they are soiled these handkerchief substitutes should be placed in strong paper bags and afterward burned. Soiled handkerchiefs lurking under pillows or in other parts of the bed may infect other people or re-infect the patient. Handkerchiefs that may not be burned should be placed as soon as soiled in a covered receptacle filled with cold water containing a little washing soda; when several have been collected they should be boiled in the same covered receptacle for 20 minutes. After boiling they may go to the regular laundry.
The patient's diet at first should be liquid or semi-solid. Large amounts of nourishment are not necessary during the first day or two, especially if the illness is likely to be short, but water should be taken as freely as possible. Cold drinks are generally acceptable during the feverish stage, but lemonade and other acidsshould be used with caution, since they sometimes irritate a sore throat. When the active symptoms have subsided the patient will need more food than usual, and a liberal, nourishing diet for a few days will do much to prevent the weakness and depressed vitality that often follow colds, tonsilitis, and other comparatively slight infections.
The bowels should be carefully regulated, and a mild cathartic is often beneficial at the outset.
Even during slight illness a patient should receive the daily care already described, and should be made as comfortable as possible. As in any illness, sponging and alcohol rubs are refreshing. An ice bag or cold compress may relieve headache, and hot applications or a cold compress on the throat are often soothing. The throat may be gargled with a solution of one teaspoonful of common salt dissolved in a pint of boiled water. If the patient perspires profusely he should be rubbed with a towel until dry, and provided with fresh warm, night clothes. An alcohol rub may well follow. It is most unwise for a patient who is perspiring freely to get up in a cold room and attend to himself.
Common colds are far more serious than they are usually supposed to be.
"More people suffer from common colds than from any other single ailment.... Could the sum total of suffering, inconvenience, sequelæ, and economic loss resulting from common colds be obtained, it would at once promote these infections from the trivial into the rank of the serious diseases.... Colds are contracted from other persons having colds, just as diphtheria is contracted from diphtheria. Arctic explorers exposed to all the conditions ordinarily supposed to produce colds do not suffer from these ailments until they return to civilization and become infected by contact with their fellowmen.... While common colds are never fatal, the complications and sequelæ are serious. These are rheumatic fever, pneumonia, sinusitis, nephritis, and a depressed vitality which favors other infections and hastens the progress of organic diseases."Common colds are perhaps most contagious during the early stages. If persons isolate themselves by remaining in bed during the first three days of a cold, they would not only benefit themselves, but would largely prevent the spread of the infection. The contagiousness and severity of colds differ in different epidemics and in different seasons of the year, depending upon the particular micro-organism involved and other factors not well understood."Prevention.—The prevention of colds consists, first in avoiding the infection, and, secondly, in guarding against the predisposing causes. Contact should be avoided with persons who have colds, especially in street cars, offices, and other poorly ventilated spaces where the risk of persons coughing or sneezing directly in one's face is imminent. Contact with the infection may further be guarded against by a careful self-education in sanitaryhabits and cleanliness, based upon the modern conception of contact infection."Colds, like other diseases conveyed in the secretions from the nose and mouth, are often conveyed by direct and indirect contact through lack of hygienic cleanliness and a disregard of sanitary habits. Kissing, the common drinking cup, the roller towel, pipes, toys, pencils, fingers, food, and other objects contaminated with the fresh secretions will transmit the disease."—("Preventive Medicine and Hygiene," Rosenau.)
"More people suffer from common colds than from any other single ailment.... Could the sum total of suffering, inconvenience, sequelæ, and economic loss resulting from common colds be obtained, it would at once promote these infections from the trivial into the rank of the serious diseases.... Colds are contracted from other persons having colds, just as diphtheria is contracted from diphtheria. Arctic explorers exposed to all the conditions ordinarily supposed to produce colds do not suffer from these ailments until they return to civilization and become infected by contact with their fellowmen.... While common colds are never fatal, the complications and sequelæ are serious. These are rheumatic fever, pneumonia, sinusitis, nephritis, and a depressed vitality which favors other infections and hastens the progress of organic diseases.
"Common colds are perhaps most contagious during the early stages. If persons isolate themselves by remaining in bed during the first three days of a cold, they would not only benefit themselves, but would largely prevent the spread of the infection. The contagiousness and severity of colds differ in different epidemics and in different seasons of the year, depending upon the particular micro-organism involved and other factors not well understood.
"Prevention.—The prevention of colds consists, first in avoiding the infection, and, secondly, in guarding against the predisposing causes. Contact should be avoided with persons who have colds, especially in street cars, offices, and other poorly ventilated spaces where the risk of persons coughing or sneezing directly in one's face is imminent. Contact with the infection may further be guarded against by a careful self-education in sanitaryhabits and cleanliness, based upon the modern conception of contact infection.
"Colds, like other diseases conveyed in the secretions from the nose and mouth, are often conveyed by direct and indirect contact through lack of hygienic cleanliness and a disregard of sanitary habits. Kissing, the common drinking cup, the roller towel, pipes, toys, pencils, fingers, food, and other objects contaminated with the fresh secretions will transmit the disease."—("Preventive Medicine and Hygiene," Rosenau.)
Care During More Serious Infections.—When a patient is suffering from serious transmissible disease, he needs the most skillful care available, and for the sake of others he must be strictly isolated or quarantined. By isolating or quarantining a patient is meant making such arrangements that germs expelled by the patient are necessarily destroyed before they can enter the body of another person. Isolation, therefore, includes disinfection, and while methods vary according to the nature of the particular disease, yet the principles given below are applicable in most cases.
—When a patient is suffering from serious transmissible disease, he needs the most skillful care available, and for the sake of others he must be strictly isolated or quarantined. By isolating or quarantining a patient is meant making such arrangements that germs expelled by the patient are necessarily destroyed before they can enter the body of another person. Isolation, therefore, includes disinfection, and while methods vary according to the nature of the particular disease, yet the principles given below are applicable in most cases.
The first essential is that the patient should have a room to himself. No one except those caring for him should enter the sick-room for any purpose whatever; visitors should be rigidly excluded. At the outset all unnecessary articles should be removed from the sick-room, and itshould be possible to boil, burn, scrub, or otherwise thoroughly clean everything allowed to remain. The windows should be screened in summer, and flies must be excluded. Fresh air is especially needed by patients with communicable diseases, and ventilation of the room must be adequate both day and night. Foul odors plainly indicate that the patient or something in the room is not clean. The remedy is obvious and deodorants are quite unnecessary if the patient and the room are properly cared for. It is highly desirable to reserve a bath room for the exclusive use of the patient and his attendant and also to reserve a room adjoining the patient's room for the exclusive use of the attendant. When it is impossible, as it often is, to give up so much space, each family must make the best arrangement it can to separate the patient and his attendant from the rest of the family.
The attendant must remember that her ten fingers are the ten most active agents in distributing the communicable diseases. After handling the patient or anything that the patient has touched, and whenever she leaves the patient's room, she must scrub her hands thoroughly with warm water, soap, and a nail brush. She should not soil her hands unnecessarily, even though she intends to scrub them later. She must remember for herown protection to keep her hands away from her mouth and face, and to cleanse them with special care just before eating. If disinfection is needed in addition to the scrubbing, she must use conscientiously whatever solution the doctor orders.
At the same time that she is caring for a patient with a communicable disease, the attendant ought not to care for children or other members of the family, she ought not to prepare food, and she ought not to handle dishes or utensils used by other persons. Every day, however, many women are doing just these things, and it is true that in many instances no bad results are observed. Yet if any arrangement to insure safety can possibly be made, it is inexcusable to run the risk of spreading diseases which kill thousands of persons every year and injure many more for life.
When home conditions render adequate care and strict isolation of the patient impossible, hospital care should be seriously considered. No personal or sentimental objections should be allowed to influence the decision, if removing the patient to a hospital is necessary to safeguard his welfare or the welfare of the family. Hospital care should be considered especially for patients with typhoid fever, because untrained persons cannot safely care for patients so seriously ill. Since a patient with typhoid needs skilled care,and since he greatly endangers other persons, most authorities consider hospital care essential unless the patient can have the continuous services of a trained nurse and almost ideal home conditions. Many cases of typhoid, it is true, are successfully nursed at home in extremely adverse conditions by visiting nurses; yet in few kinds of sickness is continuous care by a graduate nurse more necessary to protect the community as well as to safeguard the patient himself.
Members of a family in which there is typhoid should be immunized if the doctor advises it. This process, which is performed by the doctor, in the majority of cases renders a person immune to typhoid fever for three or four years.
The question of home or institutional care for persons with tuberculosis must also be carefully considered. In some cases tuberculosis may be cared for at home with comparative safety, and in some other cases the risk is not very great if the patient is intelligent, careful, and well supervised. But everyone should face the fact that all cases of tuberculosis of the lungs involve some risk to others in the family, and most cases involve great risk. The danger to children is greater than to adults. Most tuberculosis infections, it is now believed, are acquired in childhood. The bad results of an infection acquiredin childhood may not show themselves for years, since the germs may remain inactive until the person's resistance is lowered by some unfavorable condition.