Brush burnis a name given to injuries where the surface of the skin has been removed. They include the scraped arms and legs which are common accidents in childhood. In order to dress a brush burn, particles of dirt should first be removed preferably by means of forceps that have been boiled, and the surrounding skin should then be cleansed with soap and water. The injured part should next be flushed with sterile salt solution, made by boiling water five minutes and adding to it salt in the proportion of one teaspoonful to a pint of water. If the dirt is difficult to remove a soap compress should be applied. To prepare the compress several thicknesses of gauze or muslin should be boiled in a strong solution of castile or green soap for ten minutes. The compress should remain in place several hours, and may be repeated if necessary. After the wound has been thoroughly cleansed, it should be dressed with old muslin that has been saturated in castor oil or spread with boracic ointment.
is a name given to injuries where the surface of the skin has been removed. They include the scraped arms and legs which are common accidents in childhood. In order to dress a brush burn, particles of dirt should first be removed preferably by means of forceps that have been boiled, and the surrounding skin should then be cleansed with soap and water. The injured part should next be flushed with sterile salt solution, made by boiling water five minutes and adding to it salt in the proportion of one teaspoonful to a pint of water. If the dirt is difficult to remove a soap compress should be applied. To prepare the compress several thicknesses of gauze or muslin should be boiled in a strong solution of castile or green soap for ten minutes. The compress should remain in place several hours, and may be repeated if necessary. After the wound has been thoroughly cleansed, it should be dressed with old muslin that has been saturated in castor oil or spread with boracic ointment.
In many cases of sickness institutional care has marked advantages. It may be the only solution when adequate provision for the sick is impossible at home; and it is often a necessity when a patient requires special equipment or apparatus, expert nursing, and medical attention within reach both day and night.
On the other hand, it would not be desirable even if it were possible for all sick persons to be cared for in institutions. Care at home when it is adequate may be more successful than equally skillful care given elsewhere, since the sick quite as much as the well are injured by long separation from normal family life. Most children, because they need the attention of their own mothers, most convalescent and chronic patients, and most aged persons are cared for at home; and in the great majority of cases no better place for them could be found. Since patients of these four groups have needs peculiar to themselves, somespecial points in caring for them are considered in this chapter.
Ability to observe quickly and accurately is seldom more needed than it is by a woman who cares for children. No one expects babies to explain their troubles, but people forget that small children are unable to describe their physical sensations with any degree of accuracy, although discomfort or sickness may show itself in all degrees of ill temper and bad conduct. For these exhibitions many a suffering child has been punished, where an older and more articulate person would have received considerate attention.
Children, like babies, have a low resistance to disease. Moreover, they react quickly both to favorable and to unfavorable surroundings. Hence slight causes sometimes produce pronounced or even violent symptoms in children without giving cause for great anxiety, although the same symptoms if exhibited by adults, might indicate critical illness. On the other hand the recuperative power of children is high, and their recoveries are sometimes surprisingly rapid. It is a mistake, when a child has completely recovered from an acute but brief illness, to coddle him for weeks afterward merely because a grown person in similarcircumstances would have failed to regain his strength.
When a child is sick in bed, especial efforts should be made to insure adequate ventilation without chilling him. Children always lose heat rapidly because the body surface is proportionately large; when they are ill, therefore, it is especially necessary to keep them well covered, to see that their hands and feet are warm, and to avoid chilling them during their baths. But overheating must also be avoided, since all children, sick or well, who are too warmly dressed or who stay in rooms that are too warm, become weak and irritable and more susceptible than others to colds and other respiratory disorders. The child's skin should be kept clean and dry, but he should not be disturbed nor handled unnecessarily.
Sick children require very simple food at short intervals. Variety is not so necessary for a child as for an adult, unless the child has been allowed to form bad habits of eating. Sick children should not be indulged unnecessarily, either in regard to their food or in other ways. However, attempts made during an illness to change the habits of a badly trained child are unwise because usually unsuccessful; parents who sow the wind by neglecting to train their children when they are in good health may as well make up their minds toreap a veritable whirlwind when the children are ill. Even when children are well trained it is difficult and sometimes impossible to prevent them from forming bad habits during sickness. Yet the labor of training a child reaps perhaps at no other time a richer reward than it does when the child is ill, and his recovery might be seriously impeded by unwillingness to accept necessary food, medicine, or treatment.
Physical defectsare faults in the structure of the body; adenoid growths, imperfect eyes, abnormally curved spines, and defective teeth are examples. Most physical defects can be cured in childhood by treatment or by slight operations. If untreated they frequently lead to sickness or to serious impairment of the body, and if neglected until adult life their injurious consequences are generally beyond remedy, even when the defects themselves can be repaired.
are faults in the structure of the body; adenoid growths, imperfect eyes, abnormally curved spines, and defective teeth are examples. Most physical defects can be cured in childhood by treatment or by slight operations. If untreated they frequently lead to sickness or to serious impairment of the body, and if neglected until adult life their injurious consequences are generally beyond remedy, even when the defects themselves can be repaired.
Some indications of common physical defects are given below; they ought to be more generally known than they are. If a child exhibits one or more of the symptoms mentioned, he ought to be given a complete physical examination by a competent physician, and treatment, if needed, should begin without delay. The idea that children will outgrow these defects without treatment is erroneous. Better, however, than waiting untilsymptoms appear is the modern way of giving every child a physical examination at stated intervals, a practice already common in public schools where effective health work is carried on.
Eyestrainfrequently comes from imperfections in the shape of the eye; these imperfections can almost always be corrected by glasses. When a child is suffering from eyestrain, the eyes themselves may show indications of trouble; they may be blood-shot, the lids may itch or be crusted or inflamed, or styes may appear. In other cases the symptoms of eyestrain have no apparent connection with the eyes; such symptoms are headache, nausea, vomiting, indigestion, fatigue, irritability, poor scholarship, and nervous exhaustion. If a child shows any of these symptoms, or if he rubs his eyes, frowns, squints, wrinkles his forehead, sits bent over his book, or develops round shoulders, there is sufficient reason for having his eyes examined by an oculist. Examination by an optician should not be considered sufficient.
frequently comes from imperfections in the shape of the eye; these imperfections can almost always be corrected by glasses. When a child is suffering from eyestrain, the eyes themselves may show indications of trouble; they may be blood-shot, the lids may itch or be crusted or inflamed, or styes may appear. In other cases the symptoms of eyestrain have no apparent connection with the eyes; such symptoms are headache, nausea, vomiting, indigestion, fatigue, irritability, poor scholarship, and nervous exhaustion. If a child shows any of these symptoms, or if he rubs his eyes, frowns, squints, wrinkles his forehead, sits bent over his book, or develops round shoulders, there is sufficient reason for having his eyes examined by an oculist. Examination by an optician should not be considered sufficient.
Enlarged Tonsils and Adenoids.—The tonsils are masses of spongy tissue situated at the back of the mouth, on either side of the opening into the throat. If enlarged they may seriously interfere with breathing, and if diseased they frequently harbor the germs causing many acute infections, as well as germs of rheumatism and most of theheart disease originating in early life. Therefore the tonsils ought to be removed if they are diseased or greatly enlarged, but there is ordinarily no good reason for removing normal tonsils.
—The tonsils are masses of spongy tissue situated at the back of the mouth, on either side of the opening into the throat. If enlarged they may seriously interfere with breathing, and if diseased they frequently harbor the germs causing many acute infections, as well as germs of rheumatism and most of theheart disease originating in early life. Therefore the tonsils ought to be removed if they are diseased or greatly enlarged, but there is ordinarily no good reason for removing normal tonsils.
Adenoids are situated at the back of the nose, and like the tonsils are composed of spongy tissue. Adenoids sometimes become so enlarged that they interfere with the passage of air through the nose, thus predisposing to catarrh, colds, and other respiratory diseases, to high palate with irregular teeth, to inflammation of the middle ear leading to deafness, to diminished mental activity, and to general poor health.
If a child breathes through his mouth, if he snores at night, keeps his mouth open and has a dull, apathetic expression, his nose and throat should be examined, and if advisable his tonsils and adenoids should be removed.
Defective Hearing.—Permanent deafness among children in the great majority of cases comes from trouble in the throat or nose; hence the most effective measure to prevent deafness is to make sure that every child's nose, throat, and mouth are in a normal condition. Sensitive or timid children try to hide infirmities of any kind, but deaf children seem peculiarly unable to explain their difficulties. "No one," says Cornell, "has ever recorded that a small child complained ofinability to hear." A child's ears should be examined if he breathes through his mouth, if he stoops habitually, if he is persistently inattentive, or if he is vague or stupid in carrying out directions. A child who appears normal at times and inattentive or stupid at other times should also be examined, since he may be deaf in one ear.
—Permanent deafness among children in the great majority of cases comes from trouble in the throat or nose; hence the most effective measure to prevent deafness is to make sure that every child's nose, throat, and mouth are in a normal condition. Sensitive or timid children try to hide infirmities of any kind, but deaf children seem peculiarly unable to explain their difficulties. "No one," says Cornell, "has ever recorded that a small child complained ofinability to hear." A child's ears should be examined if he breathes through his mouth, if he stoops habitually, if he is persistently inattentive, or if he is vague or stupid in carrying out directions. A child who appears normal at times and inattentive or stupid at other times should also be examined, since he may be deaf in one ear.
Temporary deafness may come from accumulated wax in the ear. The wax should be removed by a doctor; inexpert attempts are likely to cause serious injury to the ear drum. Intermittent deafness may be caused by enlarged tonsils and adenoids. Children thus affected are not infrequently punished for seeming disobedience. Such children are especially liable to street accidents.
Defective teethhave been considered onpage 44.
have been considered onpage 44.
Posture.—In childhood the bones are soft and yield with comparative ease to continued strains; hence they often become deformed by bad positions assumed in sitting, standing, or in using the body in other ways. The postures habitually assumed by a child should be noticed and good postures should be insisted upon. But it is not enough to admonish him. The various causes tending to encourage bad positions should be corrected; among them are insufficient illuminationof books and work, defective eyesight or hearing, obstructions in breathing, muscular weakness, and low general vitality. Children should have their chairs and tables suited to their size for their work both at home and in school.
—In childhood the bones are soft and yield with comparative ease to continued strains; hence they often become deformed by bad positions assumed in sitting, standing, or in using the body in other ways. The postures habitually assumed by a child should be noticed and good postures should be insisted upon. But it is not enough to admonish him. The various causes tending to encourage bad positions should be corrected; among them are insufficient illuminationof books and work, defective eyesight or hearing, obstructions in breathing, muscular weakness, and low general vitality. Children should have their chairs and tables suited to their size for their work both at home and in school.
Fig. 28.—Incorrect Sitting Postures.(From Cornell, "Health and Medical Inspection of School Children." F. A. Davis Co., Philadelphia.)
Fig. 29.—Incorrect Sitting Postures.(From Cornell, "Health and Medical Inspection of School Children." F. A. Davis Co., Philadelphia.)
Fig. 30.—Incorrect Sitting Postures.(From Cornell, "Health and Medical Inspection of School Children." F. A. Davis Co., Philadelphia.)
Fig. 31.—Incorrect and Correct Standing Postures.(From Cornell, "Health and Medical Inspection of School Children," F. A. Davis Co., Philadelphia.)
Fig. 32.—Round Shoulders.(Goldthwait, from Pyle's "Personal Hygiene.")
The adjustable chairs and desks now used in schools are a marked improvement upon theschool furniture which has caused so many deformities in the past.
One of the serious deformities caused by habitual faulty posture is curvature of the spine. A curvature not only injures a child's appearance and thus handicaps him in later life, but it brings strains and pressure upon the organs of the chest and abdomen which may seriously impair his health. As curvatures often pass unnoticed in their early stages, every child should be inspected occasionally when all his clothing has been removed, to see whether the weight is borne evenly on both feet, whether the development of the two sides is uniform, and whether the head and shoulders are properly carried. It should be noticed when the child stands, whether one shoulder is higher than the other, whether one shoulder blade projects more than the other, whether one hip is higher than the other, and whether one hand is lower than the other whenthe arms are hanging at the sides. The child should walk both toward and away from the observer, who should notice whether the child uses the two sides of his body in the same way, and whether he drags or shuffles his feet or has other abnormalities of gait.
If abnormalities are found, a physician should be consulted. Often corrective exercises are all that is needed, and no one should put braces of any kind upon a child unless they have been prescribed by a physician. No attempt should be made to correct the common tendency of children to toe in or "walk pigeon-toed." Toeing-in is a natural manner of walking during theformative period and tends to strengthen the arch of the foot, while toeing-out tends to weaken the arch and to cause flat foot or broken arches.
Fig. 33.—Lateral Curvature.(From Bancroft's "Posture of School Children." The Macmillan Co., New York.)
Fig. 34.—"Wing Shoulder Blades in Forward Shoulders.(From Bancroft's "Posture of School Children." The Macmillan Co., New York.)
Predisposition to Nervousness.—Heredity plays an important rôle in the predisposition to nervousness, so that children of nervous parents are particularly likely to show nervous instability. It is, however, difficult to say in a given case how much of his nervousness a child inherits and how much he acquires by imitating the irritability, the out-breaks of temper, and the other evidences of imperfect emotional control displayed by his nervously disposed parents. On the other hand, even children of nervous predisposition sometimes overcome their defects to some extent by imitating parents who have acquired self-control.
—Heredity plays an important rôle in the predisposition to nervousness, so that children of nervous parents are particularly likely to show nervous instability. It is, however, difficult to say in a given case how much of his nervousness a child inherits and how much he acquires by imitating the irritability, the out-breaks of temper, and the other evidences of imperfect emotional control displayed by his nervously disposed parents. On the other hand, even children of nervous predisposition sometimes overcome their defects to some extent by imitating parents who have acquired self-control.
Children predisposed to nervousness should be watched with special care, but they should not be allowed to realize that they are the objects of unusual solicitude. They need the most favorable surroundings that can be obtained, and their general health should be maintained at the highest possible level. Any condition that lowers vitality tends to increase their troubles; nervousness may be caused among children of good inheritance, and increased among others, by poor nutrition, lack of exercise and play out-of-doors, fatigue, loss of sleep, eyestrain, adenoid growths, and the poisons of infectious diseases.
It is characteristic of many nervous children that they are too easily stimulated; they may be excitable, restless, unnaturally quick in moving, over-sensitive to pain and discomfort, easily fatigued, irritable in temper, and unable to control the emotions. They frequently make involuntary motions like grimacing and winking the eyes. Children of low nervous tone, however, are not necessarily excitable. A nervous child may be muscularly weak, awkward in gait, listless, dull, clumsy, forgetful, and inattentive. Such children often suffer from cold hands and feet and from profuse perspiration.
Much can be done for these unfortunate children by removing the cause of their troubles if possible, by giving them simple and wholesome surroundings, by suiting their occupations to their strength, by eliminating mental strain, particularly during the adolescent period, and by training them to control their minds as well as their bodies.
"In addition to the hardening of the body, the education of the child should include measures which increase the resistance of the child against pain and discomforts of various sorts. Every child, therefore, should undergo a gradual process of 'psychic hardening' and be taught tobear with equanimity the pain and discomfort to which everyone sooner or later cannot help but be exposed. What I have said about clothing, cold baths, walking in all weather and at all temperatures, play and exercise in the open air, has a bearing on this point, for a child who has formed good habits in these various directions will have learned many lessons in the steeling of his mind to bear pain and to ignore small discomforts."—(Barker: "Principles of Mental Hygiene Applied to the Management of Children Predisposed to Nervousness.")
"In addition to the hardening of the body, the education of the child should include measures which increase the resistance of the child against pain and discomforts of various sorts. Every child, therefore, should undergo a gradual process of 'psychic hardening' and be taught tobear with equanimity the pain and discomfort to which everyone sooner or later cannot help but be exposed. What I have said about clothing, cold baths, walking in all weather and at all temperatures, play and exercise in the open air, has a bearing on this point, for a child who has formed good habits in these various directions will have learned many lessons in the steeling of his mind to bear pain and to ignore small discomforts."—(Barker: "Principles of Mental Hygiene Applied to the Management of Children Predisposed to Nervousness.")
After serious or prolonged illness the vitality is generally low and all bodily processes are likely to be depressed. During convalescence, therefore, the digestion is feeble, the muscles are weak so that fatigue follows slight exertion, and the sluggish condition of the circulation renders the patient especially sensitive to cold. Since the nervous system also becomes depressed and irritable, a convalescent patient is easily excited, easily discouraged, and quickly fatigued by mental effort. He finds the simplest decisions hard to make, and his emotions difficult to control; indeed, many a patient who has borne acute pain with unflinching courage becomes peevish at this stage, weeps easily, and expects more expression of sympathy than is good for him. Some persons naturally make quick recoveries, whileothers recuperate slowly. A long and tedious convalescence, it should be remembered, is the patient's misfortune rather than his fault.
In restoring a convalescent patient to normal living it is imperative to proceed slowly. Food should be increased gradually both in variety and in amount; but the patient's appetite is not always a safe guide, and it may need to be encouraged or to be restrained. Both mental and physical exertion should begin only under careful supervision, and should increase by slow degrees. The patient should sleep as much as possible, should take long intervals of rest, and should continue no occupation to the point of fatigue. A patient who has been ill in a hospital or who has had at home the exclusive services of a nurse or an attendant, often finds the period following his return or following the nurse's departure an exceedingly difficult transition. The family should not expect or allow him to resume too many duties at a time when the mere acts of bathing and dressing may demand all the strength he has. Many convalescents are obliged, or think they are obliged, to take up regular work again before their strength is fully restored. There is generally no economy in so doing; indeed, time is saved in the end by waiting until recovery is complete before undertaking full work.
Important as it is to build up the patient's physical strength, it is hardly less important to direct his thoughts away from himself and his sickness, and to help him renew his interest in normal living. During his illness he has of necessity relied upon the judgment and support of other persons, and his pain and discomfort have forced him to think constantly of himself and his many needs. The habit of sickness is readily broken by some persons, particularly by those whose nervous exhaustion has not been great and whose interests outside themselves are naturally keen. But the sick point of view has remarkable tenacity, and other patients, unless circumstances or deliberate efforts redirect their thoughts, will look upon themselves as invalids to the end of time.
Hopefulness promotes health, while discouragement, apprehension, and unhappiness lower the tone of the whole system. Hence set backs, failures, delays, and relapses should not be dwelt upon, but signs of progress should be mentioned; judiciously however, since overdone attempts to cheer a patient seldom fail to have the opposite effect. If objects or situations that suggest undesirable thoughts are eliminated, the less often those thoughts tend to recur. Therefore, in order to break the habit of sickness, old thoughts mustbe gradually banished and new ones must be substituted. Sick-room appliances should be put out of sight as soon as they are no longer needed, and the patient may profit by moving into a different bed room. A few days spent away from home as soon as his strength permits often prove effective in breaking up sickness associations; the patient is generally encouraged when he finds that he can sleep in a different bed, endure some fatigue, and exist without daily visits from the doctor. Even a day spent at a different house in the same town sometimes directs the patient's thoughts into fresh channels. Gradually, but as quickly as safety allows, he should take his place in the normal family life and cease to be treated as an exception.
Merely eliminating associations with sickness, however, is not enough; and exhorting a patient to forget himself and to become interested in something seldom accomplishes anything, especially if he is so depleted by illness that the thought of everyday activities suggests only weariness and pain. A person so weak that he is thoroughly fatigued by dressing himself should not be expected to view with enthusiasm the prospect of a full day's work. Much, however, may be accomplished by providing something that the patient really likes to do, and deliberateefforts must be made to stimulate his interest in some occupation, however simple it may be.
Occupations for invalids are more than a means to pass away the time; they are also of distinct curative value. The patient's interest is not always easy to arouse, and some ingenuity may be needed in the beginning; sometimes interest is best aroused by working at some handicraft in his presence, and finally offering, as a favor, to teach him to do it also. His interest in any occupation is invariably increased if a well person not only directs but shares in the work.
Care should be taken to select occupations suited to the patient's physical condition, to his age, tastes, and mental development. Two or three occupations are better than one, so that he may change from one to another before any one becomes tedious. Work requiring fine motions, close attention, or concentrated thought should be used for short periods, only, and no work should be continued to the point of fatigue. The patient should not be allowed to feel that he must finish a certain amount in a certain time. Even poor work is better than none, and a patient should always be encouraged by judicious praise.
Games and puzzles are useful to some extent, but an aimless occupation is not so beneficial as one which has a tangible product, particularlya product that is useful as well as beautiful. Occupations frequently possible for invalids and convalescents include knitting, crocheting, many kinds of needle work, clay modeling, basketry, stenciling, weaving, book-binding, metal work, and photography. Manuals are now available giving directions for these and many other handicrafts. Sick children often enjoy collecting stamps, post marks, and other objects, making scrap books, sewing, weaving, knitting, paper folding, and various other kindergarten occupations.
The whole field of caring for the sick offers nowhere greater opportunity for fine and finished work than it offers in the case of chronic invalids. It is an achievement of which an artist might be proud to make a chronic patient comfortable in body, happy in mind, and agreeable to others. Moreover, since success can never be attained by one who wearies in well doing, the care given to a chronic invalid tests not only the attendant's skill but also her moral and spiritual quality.
Care of a chronic patient has for its aims maintaining the patient's health, rendering him as happy and comfortable in mind and body as it is possible for him to be, and providing whatever special treatment and attention his case requires.In order to maintain his health constant attention must be given to diet, to hygiene of the sick room, and indeed to all his surroundings. In many chronic illnesses, such as rheumatism and kidney disease, the diet is prescribed by the doctor; in every case care should be taken that the patient is not overfed or underfed, that the food is suited to his digestive powers, that foods causing flatulence are eliminated, particularly if the patient's trouble is heart disease, and not the least important requirement, that he derive as much pleasure from his food as possible.
The regular daily care of the patient and of his room, already described in this book, should be scrupulously carried out, and no less scrupulously during the tenth year than it was during the tenth day. Cleanliness in every detail is absolutely essential to the patient's welfare; no one is more unpleasant either to himself or to others than a chronic patient who is neglected. Patients who are constantly in bed, it should be remembered, and paralyzed patients in particular, are peculiarly susceptible to pressure sores. If a patient is able, it is extremely important for him to sit up in a chair part of the day. Sitting up should never be omitted because it involves the expenditure of time and trouble for the attendant.
It is often said that for most people some personalexperience of sickness is beneficial; it can safely be said, however, that no one benefits from spending any considerable portion of his life in a state of helplessness and suffering. Behavior and character itself are determined by influences constantly coming into the mind from daily surroundings and associations with other people: one who recalls this fact needs only a moment's reflection to realize how ill adapted to healthy development of mind and character are the limited lives of the sick. Especially unfortunate is the situation of chronic invalids, shut off as they are from the objective interests and activities of normal life, deprived of all practice in making the salutary small adjustments and sacrifices required in every day living with other people, and self-centered as they necessarily tend to become from the inevitable focusing of attention upon their own discomforts and pain.
On the whole, a surprisingly large number of invalids successfully resist the disintegrating effects of sickness upon character. But it is nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a few but debases many." A selfish invalid has more than once destroyed the happiness of an entire family, or spoiled the life of one member of it by monopolizing her whole time and attention. Families should remember thattheir injudicious sacrifices seldom bring enduring happiness or contentment to the patient himself; indeed, in the long run such sacrifices generally injure him even more than they injure his victims. Clearly much must and should be sacrificed by members of a family to the needs of an invalid; but in general it may be said that a sacrifice is injudicious if it relieves the patient of activity or responsibility that he can support without injury, if it makes him more dependent in mind or body, if it results in restricting his attention to himself and his affairs, or if it increases his tendency to make demands on others.
Purposeful activity of some sort and the necessity for contributing to the welfare of others are essential parts of a wholesome life. If these essentials are entirely eliminated from the life of an invalid, the patient's greatest needs are probably left unsatisfied, even though the physical care he receives may be perfect in every detail. All that was said in regard to occupations for invalids applies with particular force to occupations for chronic patients, since however valuable manual occupations may be as a means to bring about recovery, they are still more valuable in furnishing interest and purpose in a life whose only prospect is a succession of weary, useless years. Handicapped patients sometimes learnoccupations that yield a financial return, and ability to earn even a little stimulates self respect and mental health, whether the money is needed or not. The important point, however, is that the finished product should have a recognized use.
In addition to enabling the patient to make things with his hands, a way should be found if possible by which he may contribute to the group of people with whom he lives. If a way can be discovered for him to do so, the opportunity should not be denied him nor should his service fail to be noted and appreciated, even if it is nothing more than telling a story to a restless child.
At the end of life, as at its beginning, every individual especially needs the interest and protection of his own family. In ordinary circumstances neither a baby nor an aged person can be cared for so fittingly or so successfully in any other place as he can be in his own home.
With advancing years is to be expected a general slowing down of all the powers. In old age both body and mind show characteristic changes, and particularly changes causing lowered resistance and diminished vigor. If the manner of living is adapted to these changes, both happinessand usefulness may be prolonged. But so gradually do the changes often come that they may escape notice for a long time, and the younger generation in looking back sometimes realizes with regret how much earlier measures might have been taken to prolong the usefulness and to mitigate the discomforts of aged parents and friends.
Old people are keenly sensitive to cold, since the circulation gradually becomes less vigorous and they take little exercise. Keeping them warm both in bed and out adds more perhaps to their comfort than any other one measure. They should have warm underclothing and soft shawls and other extra wraps. A real service will be rendered by the person who invents a suitable and dignified wrap for old or feeble men, who dislike the informality of sweaters and feel disgraced by shawls. Old persons should and can be kept warm in bed, by providing them with hot water bags, with warm night clothes including stockings, by using woollen or outing flannel sheets if necessary, and by providing a sufficient number of light but warm bed covers. It is not always understood that many covers do not remedy the deficiencies of a thin mattress. If a thick mattress or two thin mattresses cannot be provided, a thick comforter or even many layers ofnewspaper should be placed between the mattress and the springs, and another thick comforter should be placed between the mattress and the lower sheet. Rubbing the body with warm olive oil often affords great comfort, by improving the circulation and thus increasing the sensation of warmth, and also by relieving the tendency of the skin to become dry and cracked. Poor circulation at night may cause cramps in the muscles of the legs; the cramps can usually be relieved by warmth and gentle rubbing.
Old people frequently wish their rooms to be very hot, both by day and by night, even as hot as 80° or 85°, but if it is possible to keep them warm in any other way the temperature of the room should be kept at 70°. Well ventilated rooms are highly important for old people as for all others of low resistance, and it is entirely possible for their rooms to be warm and yet well ventilated. Aged persons should be carefully guarded from chill, exposure, crowds, and infected persons. Like little children they are peculiarly susceptible to the respiratory diseases, which cause many of the deaths commonly attributed to old age.
Digestion usually becomes weaker than in earlier years, and less food is needed. It should be simple, hot, and divided into four or five mealsrather than three. Old people often wake at an early hour, and hot nourishment will prevent them from growing weak and faint while waiting for the family breakfast. Both constipation and looseness of the bowels are common ailments in old age. So far as possible the bowels should be regulated by means of diet; but muscular weakness resulting in inability to control the bowels should not be mistaken for and treated as diarrhœa.
It is unwise for old people to undertake unaccustomed or sudden muscular exertion, since the muscular system including the heart muscle grows weak and is generally unable to endure great strain. The bones, moreover, grow brittle and heal with difficulty if broken, so that persons of advanced years no matter how active should avoid walking on icy pavements, climbing on chairs to reach high shelves, and placing themselves in other insecure positions. Assistance must be tactfully given, however, as active old people are inclined to resent it. On the other hand, old people should be encouraged to continue moderate and safe activities, and to take regular exercises suited to their strength. Although increasing muscular weakness tends to make most old people indolent, it is far better for them both in mind and in body to remain as active as they can without danger of too great fatigue. At allevents, they should be prevented if possible from becoming bedridden.
Since in old age sight, hearing, and other special senses become less acute, one should remember that an old person may not notice the odor of escaping gas, the light of a smouldering match, or the sound of an approaching motor car, and that he must be specially guarded from such dangers of every day life. On account of their dulled perceptions old people are sometimes unjustly considered to be less intelligent than they really are. Young people moreover should be told, if an aged person is untidy and careless in personal habits, that the apparent negligence is caused by dulled perceptions and diminished muscular control for which old people are no more responsible than they are for failing eyesight or for inability to hear.
Families should also realize that changes in mind and character are beyond an aged person's control and that they should not be made the cause for remonstrance or arguing. Just as the arteries harden with advancing years, as the bones become brittle and as other tissues become less flexible, so changes are likely to occur in the nervous system. It is not surprising when the brain substance like other tissues is becoming less flexible, that the powers of attention shouldweaken, that memory for recent events should diminish, or that other mental powers should fail. Changes in disposition are not uncommon: previously controlled persons sometimes become querulous and exacting, while excitable and irritable persons become more placid. With most old people emotions become less intense; feeble old people hardly realize great joy or great sorrow, and seldom look forward to death with apprehension.
Among the most important changes that occur in the nervous system is its gradual loss in power to respond to new demands. New habits are difficult or impossible to form, and old habits are hard to break. Attempts to break the habits of a life time are therefore dangerous, and radical changes in old people's ways of living are attended by risk as well as by unhappiness. Such loss of adaptability in the nervous system makes it increasingly difficult for old people to assimilate new ideas and to understand new points of view. The feeling that the world is strange and that the next generation has gone on without them accounts for the tragic loneliness of many old people. Clearly it is for those who are younger and more flexible to bridge the gulf between the generations by their understanding and their sympathy.
Physical care to whatever extent it is needed should be given to all old people as soon as theyare unable to care for themselves, and thought should be given to adapting their surroundings and ways of living to their strength and needs, just as they should be adapted to the strength and needs of chronic patients. But a warning should be given against managing old people too much. It is hard for people who have managed their own lives successfully for many years to be managed, even for their own good. Indeed, it is questionable kindness to deprive old people of all freedom of action, even if following their own inclinations occasionally has disastrous results. Few persons would wish to prolong their lives if long life involved being thwarted in every desire, and sometimes real kindness consists in allowing old people to do certain things that are not good for them. Keeping them warm and letting them do as they please will go far to make old people happy.
Many of the changes in old age reverse the developing process of childhood. In youth and age extremes meet, and the care of the aged presents certain marked similarities to the care of little children. Both require simple food, occupations suited to their strength, and protection from infections, from fatigue, and from nervous strain; both are dependent, more or less helpless, and for their happiness both need the affectionate care of their own families. But in one respecttheir needs are fundamentally different. In childhood formation of proper habits is all important, and in caring for children the future effect of every word and act must be taken into consideration. Old people, on the other hand, since they live largely in the past and their habits are irrevocably formed, may be indulged without harm in ways that would demoralize a child; with a clear conscience one may make them happy in ways both great and small. This difference makes possible one of the greatest pleasures that come to one who cares for the helpless and the sick, for of all enduring satisfactions few are greater than the power to fill with comfort and happiness the closing days of life.
I. Show how you would:
II. Show how you would:
III. Show how you would:
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XI. (Answers to the following questions can generally be obtained from local health officers.)
XII. Explain why the following common beliefs are erroneous or unfounded:
The New York City Department of Health has kindly permitted us to include the following circulars of information issued by the Division of Child Hygiene.
The physical examination of school children shows that in many instances the teeth are in a decayed and unhealthy condition.
Decayed teeth cause an unclean mouth. Toothache and disease of the gums may result.
Neglect of the first teeth is a frequent cause of decay of the second teeth.
If a child has decayed teeth, it cannot properly chew its food. Improperly chewed food and an unclean mouth cause bad digestion, and consequently poor general health.
If a child is not in good health, it cannot keep up with its studies in school. It is more likely to contract any contagious disease, and it has not the proper chance to grow into a robust, healthy adult.
If the child's teeth are decayed, it should be taken to a dentist at once.
The teeth should be brushed after each meal, using a tooth brush and tooth powder.
The following tooth powder is recommended:
This prescription can be filled by any druggist at a cost not to exceed fifteen cents.
The physical examination of school children shows that in many instances they breathe through the mouth because they cannot breathe properly or sufficiently through the nose.
This may be due to bad habits in regard to keeping the nose clean, or, in a majority of instances, to a growth which is known as "adenoids" and which stops up the back of the nose. In either case, the air is not breathed through the nose, and the child becomes what is known as a "mouth breather."
Constant breathing through the mouth causes the child to become pale, restless in its sleep and dull in its actions. The child often speaks as though it had a cold in the head. Frequently there is an almost constant discharge from the nose.
Mouth breathing renders a child especially liable to contract tuberculosis and other infectious diseases; in fact, the child has very little resistance to disease of any kind.
Every child should be given a handkerchief, and be taught to thoroughly blow the nose several times each day. If, after doing this regularly, the child is still unable to breathe properly through the nose, it is probable that an adenoid growth is present. Such children should be taken to the family physician or to a dispensary for further advice and treatment.
Do not wait too long in the hope that the child will outgrow the condition, for the effect of adenoid growths persisting throughout childhood may injure the person for life.
Have your child's throat and nose examined one month after measles, scarlet fever, or diphtheria.
Children affected with vermin of the head are excluded from school. The following directions will cure the condition:
Mix one-half pint of sweet oil and one-half pint of kerosene oil. Shake the mixture well and saturate the hair with the mixture. Then wrap the head in a large bath towel or rubber cap so that the head is entirely covered; the head must remain covered from six to eight hours.
(Tincture of larkspur may be used instead of oil mixture. The directions for use are the same.)
After removing the towel, the head should be shampooed as follows:
To two quarts of warm water add one teaspoonful of sodium carbonate (washing soda). Wet the hair with this solution and then apply Castile soap and rub the head thoroughly about ten minutes. Wash the soap out of the hair with repeated washings of clear warm water. Dry the hair thoroughly.
Nits: If the head is shampooed regularly each week as above described, it will cure and prevent the condition of "nits."
(1) 1 to 2 ounces juice of a sweet orangeorPulp of 6 stewed prunesor1 ounce pineapple juice.
(2) 8 ounces milk with either zwieback, or toasted biscuits or stale toasted bread.
Note: Fruit must be given either ½ hour before or ½ hour after milk.
Milk alone or with zwieback.
(1) 6 ounces soupor3 ounces beef juice.
Note: Soup may be made of chicken, beef or mutton.
(2) Stale bread may be added to the above.
Milk or toasted bread and milk.
(1) 4 ounces thick gruel mixed with 4 ounces top half milk. Taken with zwieback.
Note: Gruel may be made of oatmeal, farina, barley, hominy, wheatena, or rice.
(2) Apple sauceorPrune jelly.
Total milk in 24 hours, 1 to 1¼quarts.
Note: 8 ounces is equal to a half pint.
(1) Juice of one sweet orangeorPulp of six stewed prunesorPineapple juice (fresh or bottled) 1 ounce.
(2) A cereal such as cream of wheat, oatmeal, farina, or hominy preparations with top milk (top 16 ounces) sweetened or salted. A glass of milk, bread and butter.
Note: If constipated give the fruit ½ hour before breakfast with water; if not, they may be given during the forenoon.
Raw fruit juice must be given either ½ hour before or ½ hour after milk.
A glass of milk with two toasted biscuits or zwieback or graham crackers.
(1) Broth or soup made of beef, mutton, or chicken, and thickened with peas, farina, sago or riceorBeef juice with stale bread crumbs; or clear vegetable soup with yolk of eggorEgg soft boiled, with bread crumbs, or the egg poached, with a glass of milk.
(2) Dessert: apple sauce, prune pulp, with stale lady-fingers or graham wafersorPlain puddings: rice, bread, tapioca, blanc-mange, junket or baked custard.
Glass of milk, warm or cold; zwieback and custard or stewed fruit.
Total milk in 24 hours, 1½ quarts.
(1) Juice of 1 sweet orangeorPulp of 6 stewed prunesor1 ounce pineapple juice (fresh or bottled)orApple sauce.
(2) A cereal such as oatmeal, farina, cream of wheat, hominy or rice, slightly sweetened or salted as preferred, with the addition of top milk (top 16 ounces)orA soft boiled or poached egg with stale bread or toast.
(3) A glass of milk.
Note: If constipated give the fruit ½ hour before breakfast with water; if not, they may be given during the forenoon.
Milk and raw fruit juice must not be given at same meal.
(1) Broth or soup made of chicken, mutton or beef, thickened with arrowroot, split peas, rice, or with addition of the yolk of an egg or toast squares.
(2) Scraped beef or white meat of chicken, or broiled fish (small amount)orMashed or baked potatoes with fresh peas or spinach or carrots.
(3) Dessert: apple sauce, baked apple, rice pudding, junket or custard.
(1) A cereal or egg (if egg is not taken with breakfast) with stale bread or toastorBread and milk or bread and cocoa or bread and custard.
(2) Stewed fruit.
(1) Fruits: an orange, apple, pear or stewed prunes.
(2) Cereal: oatmeal, hominy, rice or wheat preparations, well cooked and salted, with thin cream and sugarorEgg: soft boiled, poached, omelet or scrambled.
(3) Milk or cocoa.
(1) Soup: beef, chicken or mutton.
(2) Meat: chicken or beefsteak or roast beef or lamb chops or fish.
(3) Vegetables: spinach or carrots or string beans, peas, cauliflower tops, mashed or baked potatoes, beets or lettuce (without vinegar)
Macaroni, spaghetti.
Bread and butter—not fresh bread or rolls.
(4) Dessert: custard, rice or bread or tapioca pudding, ice cream (once a week) cornstarch pudding (chocolate or other flavor) stewed prunes or baked apple.
(1) Milk toast or graham crackers and milkorA thick soup, as pea, or cream of celery with bread and butterorA cereal and thin cream with bread and butter.
(2) Stewed fruit; custard or plain pudding; jam or jelly.