The Bed.—The best kind of bed for the sick is a small iron bedstead, about 3½ ft. wide and not too high, with firm, level, spring mattress, and light warm covering, avoiding large heavy linen counterpanes, which, though oppressively weighty, give but little heat. It should be placed in such a position as will be most out of draughts, and at the same time convenient for the nurse in performing personal services for the patient. It must never have either side against a wall, nor be between the door and the fire. It is a point of some importance, especially in cases of long illness, to arrange the position of the bed so that the sick person can see the fire or look out of window. A second bed, or hammock, or stretcher on wheels, is often very useful for shifting the patient on to while airing and making the other bed.
Good bed-making is imperative in sickness, and nothing is a better test of a nurse’s capacity than the way she keeps her patient’s bed. Some nurses are eternally fidgeting till they work the unhappy invalid into a frenzy. Others, again, in their dread of disturbing him, let the patient toss everything to the wildest confusion, trusting to one grand and general clearing up to set matters right. A good nurse keeps things straight almost unconsciously, taking advantage of any chance the patient gives to smooth out the crumpled sheet, or tossed bed-clothes, with a strong even pull, or to replace a heated, crushed pillow with a fresh cool one (though careful that, if cool, it is not chilly). Remember when smoothing a sickbed never to jerk or twitch the clothes, and be always sure your attempts do not endanger anything that may be lying on the bed, and whose downfall would most certainly disturb and flurry the invalid. A wide bed in a measure is a substitute for having 2 beds, as considerable relief may be obtained by using alternate sides of the bed; moreover, you can cool one side when the patient is on the opposite side, by turning back the clothes so as to let the air reach the lower sheet. Bed linen should always, if possible, be exposed to the open air, in the sun and wind, beforeusing, as this freshens it most effectually, whilst a drop or two of good lavender or rose water sprinkled on sheet and pillow-case add greatly to the pleasantness. The best way of making a bed so as to give the least possible disturbance to the sick person, and prevent bed sores, is laid down in these rules:—(1) Keep the sheet below the patient perfectly smooth; (2) wash the parts where the bone is prominent daily with soap and warm water, dry them well, rub them over with a little spirits of wine or whisky to harden the skin; (3) change the patient’s position frequently; (4) never let him lie on a blanket; a freshly-made bed, a good sponge over with vinegar and water, would often, after a restless, sleepless night, have the good effect of making the patient fall into a sound sleep. It is best to make a good lather with the soap, and not to use much water. Zinc-powder and boracic acid powder are often used to powder the back after the washing.
A very common torment of invalids is the weight of the bed clothes. They are heavy, but not warm. For the rich, blankets and eiderdown quilts are easily obtained; but for the poor, paper is far better than many more costly coverlids. It is by no means necessary to spend money on a paper blanket, though these are excellent; a few sheets of brown paper, or even newspapers, pasted together to the size of the bed, add greatly to the warmth and practically nothing to the weight. If it is not the beat possible covering, it is very good, and absolutely costless.
It is often necessary to change the sheets without disturbing the patient. This can be done either from side to side or from head to foot. The former method consists in loosely rolling up the soiled sheet sideways, from the side of the bed where there is most unoccupied space, until the roll can be pressed against the patient’s side. The clean sheet, previously loosely rolled up from side to side, is then unrolled over the uncovered part of the bed, until the clean roll lies by the side of the soiled one. The patient is now lifted over on to the clean sheet, the soiled sheet is taken away, and the spreading of the clean sheet is completed. The second plan is to roll up a clean sheet loosely from end to end. Beginning at the head of the bed, the soiled sheet is rolled down from underneath the bolster, and the clean sheet unrolled after it, and arranged in its place. The shoulders of the patient should then be raised a little, and the soiled sheet rolled down from under them, while the clean sheet is unrolled to follow it. The hips, and lastly the legs and feet, are to be gently raised one after another in a similar manner, the soiled sheet taken away at the foot of the bed, and the unrolling of the clean sheet completed.
With paralysed and other helpless patients, frequent washing or sponging is more necessary, and the draw-sheet becomes useful. This consists of a small sheet folded lengthwise 2 or 3 times, so that when placed beneath the patient it may reach from the middle of the back to the knees. One end of the folded sheet should be the part first used, the rest being loosely rolled up to within a few inches of the patient’s side. As the sheet becomes soiled, the unused portion is unrolled sufficiently for the soiled part to be drawn from under the sick person, and a clean part substituted. The soiled portion is rolled up as it is withdrawn, and secured by a safety-pin. A piece of waterproof sheeting or a strip of thin oil-cloth passed beneath the draw-sheet still further protects the bed.
Bedding and pillows should not be too soft, otherwise the patient is continually sinking into hollows, and becoming hot and restless in consequence. When a patient needs to be propped up, the greatest mistakes are made. Pillows are jammed and wedged in at the patient’s back till he is completely built in. A cheap and simple pillow which doctors strongly recommend as a support in such cases is made of chaff, or chopped straw, and stuffed hard. It is covered with any cheap material, and is shaped like a writing desk—that is to say, it is made to slope. It should be a little longer than an ordinary pillow, and should be 8-12 in. deep behind and 3-4 in. in front. Ordinary pillows (1 or 2) placed upon this as a basement make a capital back-rest for personssuffering, say, from bronchitis. Such a rest has many advantages: it does not give way, hence the patient no longer finds himself from time to time in a deep hole; it allows the arms and shoulders free movement; it is also cooler, and permits more frequent change of posture. In propping a patient up it should always be remembered that the back needs support as well as the head and shoulders.
A very great comfort to sick people, especially to those who have to be left much alone, is to be furnished with some simple arrangement by which they can raise themselves into the sitting posture and so maintain themselves with slight effort. This can be attained by fixing a length of strong webbing to the foot of the bed, and placing knots upon it at intervals, so as to enable it to be more readily and firmly grasped. A netted bed-rest, 3 yd. in length, is a very simple and useful contrivance; its main use is the same as that of the knotted webbing, but by allowing it to pass round the back of the invalid, and spreading it out, it makes an exceedingly pleasant bed-rest, fashioned on the principle of the hammock. A swing bed-rest has several advantages. It is very cool, and allows a free play of air on all sides of the patient, which is a very important advantage. It permits, moreover, considerable movement, and does away with the fatiguing restraint of keeping the body in one position. If the ventilation through the network be too great, or the weather be cold, a pillow can be placed against the patient’s back, within the rest. Instead of the rest being netted, it may be made of strong towelling, which will bear rougher usage. Its strength and serviceability will be increased by stitching here and there bands of webbing; and at each of its narrower ends strong broad tapes must be fastened, by which it can be secured to the foot of the bed. Such netted bed-rests can be had (5s.6d.each) at the Depot for Ladies’ Work, 16, King Street, Manchester.
Bedridden patients, and those who are paralysed or otherwise reduced to a condition of great weakness, often complain that they are continually slipping down in the bed. Often a box or footstool is slipped in at the foot of the bed, that the patient’s feet may be pressed firmly against it to prevent slipping. But this cannot be long continued where the legs are weak, for the muscles become exhausted, the knees give way, and then the slipping goes on just as badly as ever. This can be prevented, if a little round pillow, 3-4 in. only in diameter, be fixed so that the patient, though lying down, as it were sits upon it. Such a pillow, to answer its purpose, must be tied in its position very securely, and this may be done by a piece of webbing attached to each end, and tied either to the head or sides of the bedstead.
Following is a way to make pillows with paper stuffing. Use any sort of paper, and tear all into small square or oblong pieces. Then roll each piece between the finger and thumb into a tiny spiral, exactly as if beginning to make round spills. It is very little trouble to do. It is a most suitable occupation for blindman’s holiday, or for people with weak eyesight; and the pillows, as may be supposed, are far more elastic than if made of the same paper, flat. Of course, it is most suitable for an under pillow, if one has a choice; but so long as there are so many unfortunate invalids without any pillows at all, the plan is worthy of remembrance.
A table to stand on the bed is very convenient for trays, &c. It can be bought ready made, and is not at all expensive, or a very little ingenuity is needed to make one. About 2 ft. long, hollowed out on one side, and 1 ft. broad, is a good size. The legs may be 6-7 in. high.
The bed can be refreshed and aired by raising and lowering the clothes so as to produce a fanning motion. To turn a pillow without fatiguing the patient, put the hollowed palm of one hand at the back of his head while with the other you quickly reverse the pillow and replace it. To lay a bed with a waterproof sheet for temporary use, first make the bed with a blanket beneath the under sheet, and then spread the waterproof, a blanket and another sheet, without tucking in. When done with, it is only necessary to draw out the waterproof with its blanket and sheet, leaving the patienton a fresh sheet. No amount of care will keep crumbs out of a sickbed; they catch in every fold and frill and pass up the sleeves, and demand a search after every meal in which bread figures. To avoid rucks in the under sheets, stretch it tight on the mattress and fasten it down with safety pins.
Sickroom accessories.—These are of a varied character, and will be described under separate headings.
Poultices.Linseed.—The great art of poultice-making consists in applying it to the patient sufficiently hot, and, therefore, it is advisable to warm all the materials before beginning. Put the linseed (crushed or meal) before the fire or in the oven for 20 minutes to heat. Use by preference a tin bowl, and scald it with boiling water; then pour in as much boiling water as will be needed for the poultice, sprinkle in the hot linseed with one hand, and stir vigorously with a knife to the required thickness. To judge of this requires some practice. A poultice should be somewhat moister, if applied to an open wound, than if it is intended to relieve some internal pain; but in no case ought it to be sufficiently moist to stick in patches to the skin of the patient. The next step is to take a square of rag or paper ½ in. larger all round than the poultice is intended to be; spread the linseed on this about ½ in. thick, leaving the edges clear; fold the rag over on each side, and apply at once, covering with a pad of cotton wool and a layer of indiarubber or oil silk to keep the heat in. It is a good plan to oil the face of the poultice with a feather, as this effectually keeps it from sticking to the skin, even if it is not well mixed, and it is better than to put the poultice into a muslin. If, however, the muslin is preferred, on no account should a bag be made, for the poultice cools while it is being put in. A large piece of old linen, folded over at the back, like a parcel, keeps the linseed in, and makes at the same time a pad to cover it. Failing linseed meal, you can use either oatmeal or bran; if oatmeal, then boil it with the water like porridge. A poultice should be larger than appears absolutely necessary. It is intended to allay pain and inflammation, and as the pain probably extends beyond the inflamed part, a large poultice should be made to cover the inflamed part. Dr. Atkinson says that meal deprived of its oil is far better than that from which the oil has not been extracted. The latter does not retain its heat as long, and, unless covered by some fabric, is not so easily removed as the poultice made from the former. The exhausted meal takes up more water, and retains its heat longer. In making a poultice, the meal should be thoroughly stirred with a spoon while boiling water is gradually added, and when of proper (rather soft) consistence, should be spread on linen. The ability to bear the heat on the back of the hand is a good test of the degree to be used. The poultice should be applied directly to the skin, without intervening fabric, and be covered on the outside with good oiled-silk. A teaspoonful of laudanum may be sprinkled on the surface to increase its anodyne effects, or in place of water may be used a boiling infusion of camomile or poppy-heads. When the skin is inflamed, 3 grs. sulphate zinc or alum may be added to each oz. of water. A solution of 1-40 of carbolic acid may be used instead of simple water in the case of sloughing wounds. Once in 4 hours is a good rule to follow in changing poultices on the chest, the front and back being covered by separate poultices, and only one should be removed at a time. A fresh one should be ready when the change is made. Frequent changes are most grateful in cases of abdominal pain.
To relieve spasm, as in colic—intestinal, biliary, or renal; to relieve inflammation of the pleura (lining membrane of the chest), the lungs, the liver, or other organs, it is essential to apply the poultice as hot as possible, while protecting the skin from being scalded. In order to do this, a flannel bag should be prepared, a convenient size being 12 in. by 8; this should be closed at 3 edges and open at the fourth; one side of it should be 1-1½ in. longer than the other, and it is convenient also to have 4 tapes attached at the points which form the corners when the bag is closed, in order to keep the poultice in position. Besides this, another strip of flannel should be prepared of thesame breadth as the length of the bag, and long enough to wrap round it once or oftener. Crushed linseed, bowl, and spoon should be got together, and the spoon and bowl thoroughly heated by means of boiling water; the poultice should then be made with perfectly boiling water, and rather soft. As soon as it is ready, it should be poured into the bag, previously warmed by holding it before the fire; the flap which is formed by the longest side of the bag should now be turned down and fastened in its place by a few long stitches with a needle and thread; it should then be quickly wrapped in the strip of flannel (also previously warmed), and fastenedin situ, if necessary, by means of the tapes. It may be covered outside with a sheet of cotton wool. In this way the poultice may be applied boiling hot to the skin without burning; the 2 layers of flannel which are at first dry allow the heat to pass very gradually indeed to the skin; as the moisture of the poultice soaks through them they become better conductors, and the heat passes more quickly, but the increase is so gradual as not to cause any painful sensations whatever, but only one of soothing and comfort. The poultice also naturally keeps much longer hot, and the necessity for changing it arises much less frequently. The difference between the effect of a poultice made in the ordinary way and in the manner just described is sometimes exceedingly striking. It is, perhaps, less marked in cases of inflammation than in those of spasm.
Bread.—In a small and perfectly clean saucepan have a teacupful of boiling water. Add breadcrumbs, or the crumb of a stale loaf: 1½-2 oz. will be sufficient for this quantity of water, and let it soak over the fire for about 5 minutes. Then turn it into a piece of rag, and spread it of suitable size and evenly. This plan ensures its being hot.
Mustard.—If a mustard poultice is wanted it can be made in the same way as linseed, save by adding a certain proportion of dry mustard to the linseed. Some persons prefer to boil a little mustard in the water that is to be used. Dr. Tyson, of Philadelphia, recommends the addition of molasses to mustard in making plasters. This furnishes a mild persistent counter-irritant which can be worn for hours. Leaves of so-called “mustard paper” may be made as follows: The mustard must be deprived of all fatty matters; the adhesive agent must contain neither alcohol, resin, nor fatty matter; nor must it be of the nature of a plaster. Submit the mustard farina to strong pressure, and wash with sulphide of carbon or petroleum essence. Spread on paper an adhesive liquid formed of a solution of 4-5 parts caoutchouc in 100 parts mixed carbon sulphide and petroleum essence. Sprinkle over the freshly coated paper by means of a sieve, the prepared mustard. Pass between two rollers, and afterwards gently warm to promote volatilisation of the liquid solvents used. Cut to pattern as required.
Court Plaster.—This is generally bought. To make it, soak isinglass in a little warm water for 74 hours, then evaporate nearly all the water by gentle heat, dissolve the residue in a little proof spirits of wine, and strain the whole through a piece of open linen. The strained mass should be a stiff jelly when cool. Now stretch a piece of silk or sarcenet on a wooden frame, and fix it tight with tacks or pack-thread. Melt the jelly and apply it to the silk thinly and evenly, with a badger-hair brush. A second coating must be applied when the first has dried. When both are dry, apply over the whole surface 2 or 3 coatings of the balsam of Peru. Plaster thus made is very pliable and never breaks.
To make it without silk, mix enough collodion with castor oil to render it elastic when dry, the oil having profusely been rubbed with some zinc oxide. Into this mixture dip glass plates, and, after drying, redip and redry 2 or 3 times, or until a film of suitable thickness is obtained. Upon this paint the usual solution of isinglass to give it adhesiveness, and, after again drying, separate it from the glass.
Applying cold to the Head.—Take one fold of cotton or linen rag, soak it in cold water, the colder the better, squeeze dry and apply it as rapidly as possible. Do not take a large piece of cloth folded several times, and keep squeezing it in your hand tillit is quite hot and then put on. One fold of cloth, the thinner the better, dipped often in the cold water and rapidly applied gives great relief in headaches, for example. If you can procure ice put a piece in the water. Ice is sometimes ordered to be kept constantly on the head; to keep it from melting, wrap it up in flannel, or put it in sawdust, and in a cool place. To break ice, use a large needle. Ice-bags can be bought for 3s.-4s., or it may be put in a bladder and applied to the part, or a bag may be made of guttapercha and chloroform. By putting a little chloroform along the edges and folding them over, you can make a very useful bag for ice; the ice should be broken in small pieces before being put in the bag, and be removed as soon as it melts.
Fomentations.—A very good, perhaps the best, plan is to put a piece of flannel, folded 4 or 5 times thick to the required size, into a potato-steamer over boiling water. In this way it soon becomes hot, and little or no wringing is necessary. Where a potato-steamer is not to be had, however, the following plan should be adopted. Take a strong towel or cloth, or a piece of ticking, and pin or tack a deep hem in each end. Into these run two short, strong sticks—anything will serve: a couple of iron spoons, and even a small poker, such as is called a “curate,” though this last is rather long for choice. Lay the towel, or “wringer,” as it is technically called, over a large basin, so that the sticks hang outside; place the folded flannel in the middle, and pour boiling water over. The flannel can easily be wrung dry by one pair of hands, and if it is not made by the bed side, it can be carried there without fear of cooling in the wringer. Sometimes opium or turpentine is to be added. The quantity of either to be used will be prescribed by the doctor, and it should be sprinkled on the side of the flannel that is to go next the skin, immediately before applying it to the patient. The flannel should be covered with wool and oil-silk, just as a poultice is covered. Fomentations are, in many cases, as efficacious as poultices, and they possess, besides, the advantage of being easier to make, and of costing practically nothing, since the flannels can be used repeatedly. For the very poor, the cost of linseed for poultices is often a serious item. There is no danger of scalding if the flannel is squeezed so dry that it cannot drip nor wet the palm of the hand.
Another plan is described as follows: Take your flannel folded to a required thickness and size, dampened quite perceptibly with water, but not enough to drip, and place it between the folds of a large newspaper, having the edges of the paper lap well over the cloth, so as to give no vent to the steam. Thus prepared, lay it on the stove or register, and in a moment steam is generated from the under surface, and has permeated the whole cloth, heating it to the required temperature.
Blisters.—Blisters and leeches should only be used under medical direction. Before the application of either, the part should be well washed with soap and warm water. Then, in the case of the blister, it has only to be slightly warmed before the fire and left on until “it rises,” and a good-sized vesicle has formed (which will usually be in about 8-10 hours), when the water must be let out by snipping the skin with the point of a sharp scissors—a perfectly painless operation—and the blistered surface dressed with spermaceti ointment spread on soft lint.
Leeches.—Leeches can generally be induced to bite by putting a few drops of milk or blood on the spots they are intended to take. They will usually fall off of themselves when filled, but if they remain on too long they must not be pulled off, but a little salt shaken on them, which will soon make them let go. Another simple and easy way of detaching leeches is to drop a few drops of camphor julep (mist. camph.) on the part, when they will soon relinquish their hold. The bleeding from their bites will also generally stop without interference. If it should continue to an undesirable degree, the nurse may nearly always stop it by making gentle pressure over the bite with her finger, or applying a little powdered alum or the muriated tincture of iron (tinctura ferri perchloridi). Never leave a patient for the night until all bleeding has completelyceased. The bleeding may be increased, when desired, by fomenting with warm water.
Enemas.—A nurse is often required to administer an enema or injection—which in many conditions of disease is a most valuable method of treatment. Be careful not to disturb or uncover the patient until quite certain that you have arranged ready to hand everything that will be required. Almost any variety of injection apparatus answers the purpose sufficiently well, but in using the rubber ones care must be taken to squeeze out all air from the bulb before commencing, else the air will be forced in by the first compression. The most convenient position for the patient is lying on the left side. Then the nozzle of the instrument, having been well greased and warmed, should be passed slowly and carefully into the bowel, the point being directed slightly backwards. On no account whatever must the least force be used. If there is any difficulty or pain in introducing the tube to the required distance, the nurse must wait for a minute or two, when, in all probability, the opposing muscle having become relaxed, it will pass in easily and without pain. The injection should then be given very slowly and quietly, and without any jerking or irregularity of motion, especially if it be desired that it should be long retained; it must be stopped immediately if the patient calls out that he can bear no more. Enemata are generally either nutrient or purgative; but occasionally other medicines are given in this way. The nutrient are of extreme value, as it sometimes happens that, when nourishment can be taken in no other way, sufficient may be supplied by this means to tide over the period of danger. A good nutritive enema may be made as follows: The yolks of 2 fresh eggs well battered in about ½ pint strong beef tea, or in 2 tablespoonfuls (half a canister) of Brand’s extract of beef, dissolved in warm milk. About ½ wineglassful port wine, or 1 tablespoonful brandy may be added in cases of extreme exhaustion. It should be given at about blood heat—100° F. An active purgative enema may be made with: 4 tablespoonfuls castor oil, 1 teaspoonful oil of turpentine, and about 1 pint well-strained gruel, or soap and water. An enema of plain soap and water often answers very well.
Clinical Thermometer.—In trifling ailments its use is for reference; in serious attacks it may give immediate warning that the physician is required; and even while the doctor is in attendance he often wishes observations regarding the temperature to be taken several times a day, in his absence, for his guidance and information. Following are a few illustrations of the uses to which the clinical thermometer may be put by any intelligent person. The natural temperature of the human body is 98·4°F. and the little arrow on the thermometer indicates this normal degree of heat, so that when the index rests at the arrow, the natural temperature is proved to be present. It is the variations above or below the arrow that mark the presence of disease.
The agony of colic is well known, but it is generally of little danger in the absence of inflammation. In peritonitis (inflammation of the bowels), the temperature runs quickly up to over 101° F.; in colic it scarcely rises more than a degree, if even thus far, above the natural temperature. A severe pain in the side causes pleurisy to be suspected. If the temperature is normal, there is no pleurisy, and the pain is probably neuralgic. Diarrhœa may continue for a few days, and the patient feels so out of sorts that typhoid fever seems to have set in; but all the specific forms, such as typhoid, typhus, scarlet fever, diphtheria, or measles, are accompanied by such an increase of body heat as will probably send up the record to 101° F., or possibly 3-4° higher. A child with persistent vomiting, sore throat, and high temperature will probably in a day or so show the rash of scarlet fever. In any case, when a temperature remains above 100-101° F. for more than 1-2 days, without obvious cause, the doctor should be consulted. If the child has disordered stomach or sustained a chill, the thermometer will record fever; but, after a purgative in the one case and a tepid or hot bath in the other, the increased heat will be found to be gone, and with it any alarm which may have been felt. In the course of an inflammation or fever, the friends can be informed bythe medical man what degree of heat he expects, and should this be exceeded the doctor should be informed of the fact. Indeed the clinical thermometer is invaluable, especially to families at a distance from their medical adviser. It can be obtained from any instrument maker for 7s.6d.-12s.6d., or more. Its application is a very easy matter. The bulb containing the mercury should be placed in the mouth or arm-pit; care should be had in the last case that clothes do not intervene between the instrument and the arm, and that it is so placed in the arm-pit as to be completely surrounded by skin. The patient must then press the arm gently to the side so as to retain the instrument, and in 5 minutes the thermometer will show the body’s temperature.
Dollond, 1 Ludgate Hill, London, E.C., sells an improved Lens Clinical Thermometer. The importance of the “lens” front cannot be over estimated, for with such a thermometer there is no difficulty in reading off the temperature even in the dull light of a sickroom, for the thin thread of mercury is magnified quite twenty times its size. This thermometer is made with a contraction in the tube near the bulb, which prevents the mercury returning, until shaken down. The price of this thermometer is 7s.6d.
W. H. Harling, 47 Finsbury Pavement, London, E.C., is the maker of an excellent clinical thermometer with lens front, which registers the temperature in the space of a single minute. It is furnished with a metal case having a bayonet fastening, and costs only 8s.6d.The same maker supplies also ordinary clinical thermometers, in cases, at prices ranging from 3s.6d.upwards. Other sickroom requisites are noticed on p.1007.
When used to take the temperature of patients suffering from infectious disease, the thermometer should be disinfected by being washed in “Sanitas” or carbolic acid solution after each time of using. In taking the temperature under the tongue, the index should be “set” as directed, and the bulb should be placed as far back under the tongue as convenient and agreeable; the mouth should then be kept shut, and the patient should breathe through the nose: 3 minutes are sufficient for taking the tongue-temperature. In the arm-pit the thermometer should be left for 5 minutes and the fore-arm should be made to lie across the chest, so that the thermometer may thus be made to rest in a sheltered position.
Temperatures should be taken in ordinary cases at 8A.M.and 8P.M.; 2 o’clock is a convenient hour for a third observation. Variations in temperature occur in healthy persons, but such change does not usually amount to more than 2° or 3° F. What is to be regarded as deserving of attention under the ordinary circumstances of life is a fall below 97°, or a rise above 99·5°. In fevers, as a rule, the temperature does not rise above 106°; but in fever a heat of 108°, continuing even for a very short time, would be regarded as a most dangerous symptom. A very high or very low temperature must be looked upon as dangerous; should it be excessive either way, the case will probably prove fatal. A very sudden change is suspicious, and very frequently dangerous. In children, however, the presence of indigestible food in the intestinal canal may suffice to cause a rapid rise in the temperature. After the temperature has been stationary for some time, or has commenced to fall, a fresh rise may herald the advent of some complication, or the approach of a new disease. An unexpected fall may denote hæmorrhage, exhausting diarrhœa, or the perforation of the peritoneum or pleura (lining membranes of the abdomen and chest). A considerable rise during the course of a disease which is not generally regarded as febrile—viz., in tetanus, epilepsy, and cholera—usually precedes death.
Making a Medical Coil.—Procure a well-seasoned walnut board about 21½ in. long, 3 in. wide, and ⅜ in. thick. From this cut one length 12 in. long for the base boarda, and 3 pieces 3 in. square (likeb) for the coil heads; when cut, a fillet 8 in. long must be nailed or screwed on the two sides of the base board (as shown ina); these fillets should be ¼ in. square section. Corresponding square nicks must be cut of two of the square heads (as shown atxinc). All the woodwork when thus squared and finishedshould be soaked for ¼ hour in melted paraffin wax, and then rubbed dry while still warm.
Obtain a thin brass tube (known in the trade as “triblet tubing”) about ½ in. diameter, 4½ in. long; turn up a short plug and button to fit one end of this tube and serve as a handle (seed). This may be fastened to the tube by driving in 3 fine brass brads, and filing off the heads flush with the tube.
109. Home-made Medical Coil
109. Home-made Medical Coil
109. Home-made Medical Coil
Cut up about 100 lengths of straight iron wire (best soft annealed) No. 22 gauge, say, about 4½ in. in length; fill the brass tube with them as tight as you can fit them; cut them all to the same length (they must protrude a little beyond the tube). Now draw out about 2 in. of the iron bundle and wrap it tightly round with twine, leaving about ½ in. free. Draw more out, and continue wrapping until you have wrapped to within ½ in. at each end of the bundle. Tie the string, and withdraw the bundle from the brass tube. Melt a little solder in a ladle, dip the ends of the iron bundle into soldering fluid (zinc dissolved in hydrochloric acid), and then at once into the melted solder. Allow the bundle to cool; file off the superfluous solder, so that the bundle will just enter freely into the tube. It should appear likeewhen the string has been removed.
The next operation is to make a good stout paper tube, also about 4½ in. in length, into which the brass tubedcan slide easily. To make this, put a few turns soaped writing paper round the tube No. 1, then roll and glue seven turns of good stout brown paper, 4½ in. in length, round this writing paper, or else it will be difficult to draw out the tube. This paper tubefmust be allowed to dry thoroughly while still on the brass tubed. When quite dry, it must be slipped off, the writing paper lining drawn out, and then it must be soaked for a few minutes in melted paraffin wax.
The iron bundle should also be allowed to stand in melted paraffin wax for some time, and then stood up to drain in a warm place. This will prevent rusting. Whenquite cold, all superfluous paraffin having been removed, a strip of brown paper, ½ in. wide, is rolled round one extremity of the iron bundle, until it is of such a diameter as to fit tightly into the paper tubef. This paper strip must be cut off at this point and glued tightly round the end of the iron bundle. The brass tubedis then slipped over the iron bundle until it just reaches the little paper collar just made. The brass tube and bundle together are pushed, button end first, into the paper tubef; and when the paper collar round the iron bundle is just about to enter the paper tube, it is to be well served with hot glue and forced into the tube. The whole must now be allowed to dry and set thoroughly.
Taking one of the 3 in. heads (the one which has not any nicks in the sides), bore a centre hole with a brace and centre bit, just large enough for the paper tubef, with its iron core, to fit tightly (seeb). Putting a little thin good hot glue round the free extremity (the end opposite to that at which the brass enters), push it into the hole in the square head, until it projects about ⅛ in. on the other side. This must be allowed to dry thoroughly before proceeding to the next operation.
Now proceed to wind the primary coil. To this end, take about ½ lb. No. 24 silk-covered copper wire, and wind it round the tube, as shown atg, from end to end, in continuous layers, taking care to put a sheet of paraffined paper between each layer, and also to baste each layer with melted paraffin wax before winding on another. About 4 layers will thus be got on, and an even number of layers must be aimed at, so as to get the 2 ends of the wire at the same extremity, and able to fasten them under the binding screwy. To effect this, before screwing down the said screws, the ends of the copper wire are stripped of their covering and wound once round the screw of the binder. Free ends of wire, at least 6 in. in length, must be left for attachments, &c. This is shown ath.
This primary coil, with its iron core, sliding brass tube regulator, &c. may now be fastened to the base board by means of 2 screws from underneath, as shown ati, at 4 in. from one end, and therefore 8 in. from the other. One of the free ends of the primary wire is brought to one of the binding screwsv, while the other connects to the clapperz. A short piece of wire connects the platinum screw pillarw, to the other binding screw, which is not visible, as it is behind the platinum pillar. At this point it will be well to try the working of the primary coil. For this purpose, couple up the 2 binding screws on the base board with a good bichromate cell. Connect the two binding screwsuini, with the 2 brass handles intended for use. Screw up the platinum screwwtill the clapperzbegins to vibrate. Now hold the handles in your hand. As long as the brass tubejis entirely over the iron core, little or no sensation is perceptible. If an assistant pulls out the tube, little by little, the current will be found to increase in strength until the regulator tube is quite out.
The secondary coil now demands attention. A paper tube, precisely similar tob, but of such a size as to slide easily over the primary coiliis prepared, and paraffined. This must be cut exactly the length of the coilk, leaving the knobjprojecting. The 2 square pieces of board in which the nicks were cut (c) must then have central holes cut in them to take this paper tube, and then glued, one at each end of the said tube, as shown. Two small binding screws are then to be inserted in the centre of the upper edge of each square. A bung is now placed in each end of the tube, and a ¼ in. iron rod pushed through both, to serve as an axle. This is then mounted on 2 standards, as shown atn; and beginning by attaching one end of the uncovered wire to the binding screwm, about ½ lb. No. 36 silk-covered copper wire is now carefully coiled on, being most diligent in avoiding kinks, breaks, or flaws of every description. Each layer must be paraffined and separated from its neighbour by paraffined paper. When the quantum of wire has been laid on, the finishing end is connected to the binding screw inn. The last coil should be covered with paraffined paper, and finally covered with a jacket of good silk velvet. The secondary coil is then complete, and may be slid inits place over the primary coilo. When it is quite over the primary, the secondary current will be at its strongest, if the metal tube regulator is drawn out; it will be weaker as the metal tube regulator is more and more inserted; or may be even more delicately regulated by sliding the secondary coil itself more or less over the primary. The secondary coil, while the primary is being excited with a freshly made pint bichromate, will give a ½ in. spark when the regulator is out and the secondary coil right over the primary. This will pass easily through a dozen persons. (S. R. Bottone.)
There are various other sickroom appliances demanded in special cases which do not require description here. Most may be had of such well-known firms as Salmon, Ody & Co., 292 Strand, and Savory and Moore, 143 New Bond Street.
Feeding patients.—A nurse should bear in mind these two leading facts; that while in sickness there is usually a greatly increased tissue-waste, and consequently an increased necessity for nutriment, there is almost always a decreased appetite, or no appetite at all—often such a repugnance to food that, if left to himself, the patient would prefer taking none at all. Hence, although the medical attendant may decide what is the most suitable form of nourishment, on her devolves the more difficult task of inducing the sick person to take it. With this view, she must exercise all her ingenuity to tempt and encourage him, by bringing everything in the neatest possible form. On no pretext whatever should there be any cooking in the sickroom; nor should she take her own meals there; nor should any food be left standing near the patient. On the contrary, though his nutriment must be brought to him frequently—more frequently, of course, the less he can take each time—and punctually, it should only be in such quantity as he is likely to consume; and immediately that is done, everything in connection with food should be removed from sight and smell until the next time.
The nurse must devote much of her attention to the subject of diet, observing carefully the patient’s appetite, and attending carefully to the quantity of food and the effect of it. The sense of taste of many people is very acute when they are ill, and you must take care that the spoon in the arrowroot, which looks perfectly clean, does not taste to the patient of the soup for which it was used last. Eatables should not be kept in a sickroom: if you are obliged to have anything within reach, put it under a cover; a tumbler turned over does very well for biscuits or jelly, and for larger things a bell glass is useful; tin boxes, the next best thing, generally make a noise when they are opened. The water given to a sick person should not only be boiled and allowed to cool, but ought always to be filtered. It should frequently be changed, as it quickly absorbs the impurities with which the air of a sickroom is charged, and becomes injurious, if not dangerous to drink. In cases of faintness, where stimulants are not ordered, the patient should be made to sip some liquid slowly; the mere effort of sipping accelerates the action of the heart.
When solid foods cannot be taken, the best kinds are those which contain the most nourishing properties in the smallest and most easily digested form. Prominent among these is well-made beef tea: not the greasy watery broth which so often goes by that name, but nearly pure beef juice which has been slowly extracted, with the addition of little or no water, from fresh lean beef. A good substitute may be found in Bovril, which has the great advantage in an emergency of being immediately procurable at a chemist’s or grocer’s. Home made beef tea takes a long time to prepare properly, and even then it is deficient in staminal properties, whereas Bovril contains the entire nutritious constituents of pure beef, of which it takes 40 lb. to make 1 lb. of Bovril extract. Of equal value is milk; which, especially when combined with bread and butter, is very nourishing, and forms a most valuable article of sick diet. If it seems to disagree, or curdle on the stomach, it can generally be prevented doing so by the addition of about ⅓-¼ its bulk of lime-water. These may be varied by mutton broth, chicken or rabbit jelly, eggs in any form—plain, in custard, or in pudding with arrowroot and sago—and real turtle soup; which latter is, however, so terribly expensive asto be outside the reach of most people. Jellies made with gelatine, which contains scarcely any nutriment, are almost useless; and tea should be given only as an indulgence when specially wished for, and then it should be very weak, and with plenty of milk. All food given to the sick should be very fresh, of the best quality, and most carefully cooked.
Boiled Flour Gruel.—Where the illness has been long and tedious, and the strength reduced, the following will be found very useful: To prepare the flour, put into a basin as much as it will hold, pressed tightly down. Then tie a cloth over it, and allow it to boil hard for 6 hours. Then take off the cloth, and let the flour stand in the basin till next day, when remove the crust which will have formed, and put the remainder away in a covered jar. For use, mix 4 tablespoonfuls flour smoothly into a paste, then pour on it ½ pint boiling milk or water, and boil for 10 minutes, constantly stirring to avoid lumps. Brandy, sherry, lemon juice or cream may be added, according to taste. Gruel may also be made from baked flour, but it is not so easy of digestion.
Rice Gruel.—1 oz. each rice, sago, and pearl barley boiled in 3 pints water, which, in 2 hours, generally reduces it to 1 qt. Strain and flavour to taste. This forms a good nourishing diet, especially with the addition of a little isinglass.
Onion Posset or Gruel.—This has been found very efficacious for colds, and is made with Robinson’s groats with the addition only of an onion, which should have been previously boiled for 6 hours. The yolk of an egg well beaten is an improvement.
Chicken Broth.—The younger and fatter the birds are for this the better. It is made by immersing the legs, neck, and trunk of a fowl into just as much water as will cover them, and boiling gently for an hour. The white meat makes a delicious entrée if cut up finely and treated as a veal mince. Potato flour is useful for thickening in cases where boiled flour is not handy; but home-made things are always the best, as the ingredients are known.
Oyster Fritters.—Remove the beards, and put each oyster into a tablespoon, and fill with a batter made as follows: 1 oz. rice flour mixed with 2 tablespoonfuls water, 1 teaspoonful vinegar, and 2 salad oil, the yolk of an egg, and a little salt and pepper. Allow the batter to stand, and just before using, beat the white of an egg to a stiff froth, and mix with it. Fry the oysters covered with the batter in boiling fat, turn them, place them on blotting paper to drain; serve on a hot dish, and garnish with slices of lemon, and thin rolls of brown bread and butter alternately.
Potato Chops.—Mash nicely with a little milk, butter, pepper, and salt, any potatoes left from the day before, spread evenly over a boned loin chop previously sprinkled with finely chopped fried mint. Fry to a golden brown in boiling fat, then place it on blotting paper to remove the superfluous grease. Garnish with fresh mint and watercress.
Jellies and Creams.—The following recipes were published by Mary Hooper, in theQueen:—
When jellies and creams are ordered for sick people in families where there is not a good cook, they are usually obtained from the confectioner; but this is not at all in the interest of the invalid, and efforts should be made to provide his diet from the home kitchen. An idea prevails that it is very troublesome to make jelly. It is not at all necessary to clear the jelly through a bag for invalids, nor indeed for ordinary domestic use. By a little care in the use of citric acid, which is perfectly wholesome, a jelly nearly as bright as that which has been cleared with eggs may be produced. In some cases, jelly without wine is required for invalids, when coffee, cocoa, or Seville orange jelly will probably be useful. It is difficult to make these jellies palatable without making them sweet, and they will only keep a short time. If the doctor does not object, or where it is desirable to give stimulants in a disguised form, a very small quantity of absolute alcohol may be used, and it will obviate the last-named disadvantages.
Milk jellies, or creams, whenever they can be taken, are an excellent form of diet,and are very easily prepared by the following recipes. For those who require a quickly-made cream, “Nelson’s Blanc mange” will be found very useful; it merely requires to be dissolved in milk or water, and in a very short time is ready for use. This blanc mange is made of very rich milk, and tastes equal to that prepared at home with cream. The unflavoured blanc mange should, as a rule, be selected for invalids, as any home-made flavour can be added to it. These flavourings—lemon, Seville orange, almond and vanilla—are very easily prepared by infusing any of the three first-named in gin, the latter in brandy. As these are more digestible than any which can be bought, it is well worth while to take a little trouble in the matter. It is sometimes necessary to tempt the appetite of an invalid by a pretty looking dish, which is also nice and nourishing. Such a dish can be easily made by the recipe for Alexandra Cream.
Simple Jelly.—Soak 1 oz. gelatine in ½ pint cold water for 1 hour or more. It is an advantage to soak gelatine overnight when convenient, because it is then more easily dissolved. Boil 6 oz. lump sugar in 1 pint water, skimming it until clear; then throw in the soaked gelatine, let it boil slowly for 5 minutes, removing all scum as it rises. Dissolve in a basin ¼ oz. citric acid, in lump, in ½ gill boiling water, pour the jelly on to this, when more scum will rise, which should be carefully taken off. Now add 1 gill wine and a little lemon flavouring, and, when nearly cold, put the jelly into a mould. Lemon juice can be used instead of the citric acid, but the jelly will not then be so bright.
Cocoa Jelly.—Mix 1 dessertspoonful cocoa in ½ pint water, stir over the fire until it boils, sweeten it with ¼ lb. lump sugar, or according to the taste of the patient. Stir into it, whilst boiling, ½ oz. gelatine, soaked in ½ pint cold water for some hours, flavour with vanilla, and stir occasionally until the jelly begins to set.
Coffee Jelly.—Soak ½ oz. gelatine in ½ pint cold water, dissolve it in ½ pint very strong coffee, sweetened to taste. Extract of coffee can be used to flavour this jelly, and answers well.
Porter Jelly.—Procure a cow-heel (which should be thoroughly cleaned) and 2 calves’ feet; wash them in cold water, and put them into a pan with 5 pints water, and let them boil until the meat leaves the bones; strain the liquor through a hair sieve, and let it stand for one night in a cool place. Next morning put the stock into a pan with 1 lb. loaf sugar, ½ pint porter, the juice of 4 lemons with their rinds cut very thin, and the well-beaten whites of 8 eggs. Let all boil together till it rises to the top of the pan; then throw in a teacupful of cold water; then let it boil slowly about 20 minutes, at the expiration of which time add 1 wineglassful brandy. Boil 5 minutes longer, then lift the pan from the fire, and let it remain at the side of the fire, to keep hot. In about ½ hour the scum will collect in a lump, leaving the liquor quite clear. Run it into moulds.
Port Wine Jelly.—Take ½ pint port wine, 2 oz. isinglass, and ½ lb. white sugar candy. Let the ingredients be put together in a jar and stand for 6 hours; then put the jar into a saucepan of water, and as soon as it boils take it off the fire and strain through muslin; when cold it is fit for use.
Restorative Jelly.—Put into the jar in which the jelly is to be kept 2 oz. isinglass, 2 oz. white sugar candy, ½ oz. gum arabic, and ½ oz. nutmeg grated. Pour over them 1½ pint tent or port wine. Let it stand 12 hours, then set the jar in a saucepan of water, and let it simmer till all the ingredients are dissolved, stirring it occasionally. The jelly must not be strained. A piece the size of a nutmeg to be taken twice a day. If nutmeg is not liked, any other spice will do as well to flavour it.
Blanc Mange.—It is better, if possible, to soak the gelatine for this cream all night, because it will then dissolve in warm liquid, whereas if it is only lightly soaked, the milk must be boiling. Warm 3 gills milk or cream, and dissolve in it ½ oz. gelatine, previously soaked in ½ gill water. Sweeten to taste, and flavour with extract of vanilla. When nearly cold, stir into the blanc mange the whites of 2 or 3 eggs beaten to astrong froth. This blanc mange will be found light and nourishing in cases of great weakness.
Rice Cream.—(a) Boil 2 oz. fine rice in water for 5 minutes, strain it, and boil until tender in 1 qt. new milk. Rub the rice through a sieve to a pulp, and add to it any milk not absorbed in the boiling; ½ oz. gelatine to 1 pint rice and milk. The gelatine can be soaked and dissolved either in milk or water. Stir over the fire until mixed, sweeten and flavour to taste. Stir the cream occasionally until cold, then lightly mix in the whites of 2 eggs beaten to a strong froth; when on the point of setting put it into a mould.
(b) Make 1 pint milk or cream into custard with the yolk of an egg and 2 oz. sugar; then dissolve in it ½ oz. gelatine previously soaked. Mix with it 1 oz. rice which has been baked or boiled in milk until perfectly tender, flavour with vanilla, and add 1 teaspoonful brandy if liked. Rinse a mould with cold water, put the cream into it, and let it stand until firm enough to turn out.
Semolina Cream.—Soak 1 oz. semolina in 1 gill cold milk for an hour, boil it until soft in ½ pint milk. Dissolve ½ oz. gelatine, previously soaked in ½ gill water, in ½ pint boiling milk, sweeten it with 2 oz. lump sugar, flavour to taste, and when the cream is beginning to set, put it into a mould.
Alexandra Cream.—Make ½ pint rice cream (a) or blanc mange as directed in the foregoing recipes. Dissolve ½ pint Nelson’s port wine jelly (sherry can be used if preferred, but the colour is not so tempting), either adding water or claret, according to the directions given with the jelly. When both the cream and the jelly are on the point of setting, put first a layer of the latter into a mould, then of the former, and so on until all is used. (Mary Hooper.)
Beef Tea.—(a) Cut 1 lb. beefsteak into dice, rejecting all skin and fat. Put into a stewpan a bit of fresh butter the size of a bean, throw in the meat, and sprinkle over a small pinch of salt. Cover the stewpan closely, and set it on the range at a low heat to draw out the juices, which will take 20 minutes. Take care there is no approach to frying, as that would dry up the extract and destroy the character of the tea. About every 5 minutes during the process drain away the gravy as it comes; if the meat is fine and fresh there will be at least ⅓ pint, and when all is drawn set it aside, either to use as extract of beef or to be added to the tea when finished. Now put to the meat 1 pint water, and let it boil gently for ½ hour. Pour the tea off, but do not strain it, as such nourishment as it contains lies in the thick portion. Of course if a patient is unable to take any solid this rule will not apply, and the tea must then be strained either through a linen or flannel bag. Having drained off the tea whilst still boiling hot, put into it the juices at first extracted, and having taken off every particle of fat it will be ready to serve.
(b) Cut the meat into small pieces, cover with water, and simmer an hour. If it is allowed, 2 or 3 peppercorns and a minced shallot—it is milder than onion—will be a nice addition to the tea.
(c) Cut the meat into very small pieces, and put it in a jar having a closely fitting lid, with cold water. The jar can be placed in the oven for 1-2 hours, according to the heat, or in a saucepan of water to boil for 1½ hour.
In all cases where it can be taken, beef tea should be slightly thickened, and especially when bread is refused. Boiled flour is best for this purpose; genuine arrowroot may also be used. The yolk of an egg beaten up in the broth-cup, and the tea poured boiling on to it, is excellent.
The meat from which beef tea has been prepared will make good stock, or be excellent if properly treated for the dinner of the family, who, be it remembered, have the chief of the nourishment in the fibre.
It is important in the preparation of beef tea to preserve the fine flavour of the meat, and to use such scrupulously clean vessels that no foreign taste can be impartedto it. The shin of beef should not be chosen for this purpose, for it gives more gelatine than juice. The best part is beefsteak or the neck; the first will yield the most gravy, and does not cost above 2d.per lb. more than the coarser portion of the ox.
The idea that beef tea should be boiled a long time in order to extract all the goodness of the meat is a mistaken one, for the gelatinous matter thus gained is of comparatively little value, whilst the delicate aroma of the tea is lost by long boiling.
Gruel.—Made as it should be, gruel is rarely disliked, and is more nourishing, and in many cases to be preferred to arrowroot—a thing most difficult to procure genuine, and very expensive. Made thin, as is customary, it is a comfort in sickness, is soothing to the stomach, and gives warmth to the body; made thick as a porridge it is the most nourishing of cereal foods. Robinson’s Embden groats, and Robinson’s patent groats, prepared by Keen, Robinson, and Bellville, are the only kinds of which gruel can be properly made. They are entirely free from the acrid flavour which is so disagreeable in inferior preparations of oatmeal, make a most nourishing and digestible gruel, with the advantage of being easily and rapidly served up—if made from the patent groats, the Embden takes longer—ten minutes only being required in the process of cooking. Robinson’s Embden groats were introduced about the year 1764 by Mr. Martin Robinson as an improvement upon the “whole gritts” then in use. In 1823 letters patent were taken out for a greater improvement known as Robinson’s Patent groats, now in use in all parts of the world. Take of the patent groats one tablespoonful, mix into a smooth paste of the consistence of cream with a wineglassful of cold water, pour this into a stewpan containing nearly a pint of boiling water or milk, stir the gruel on the fire while it boils for ten minutes; pour into a basin, add a pinch of salt and a little butter, or if more agreeable some sugar, and a small quantity of spirits if allowed. If made with water, milk or cream can be added afterwards.
A delicious substitute for gruel is made as follows: 1 oz. each rice, sago, and pearl barley; put 3 pints water, and boil gently for 3 hours, when the liquor should be reduced to 1 qt. Strain it in exactly the same manner as groat gruel, and flavour with wine, brandy, or anything else that may be suitable. If made a little thicker, say with 1½ oz. each ingredient to 3 pints water, a jelly will be produced, which may be eaten cold with sugar, fruit, syrups, or preserve.
Arrowroot.—(a) To make plain water arrowroot, with an Etna, put on ½ pint water to boil in the saucepan; mix, in a cup, 1 dessertspoonful arrowroot with a little water; pour the mixture into the boiling water, and cook it for 2-3 minutes, stirring all the time.
(b) Milk arrowroot is prepared exactly in the same manner. Some persons affirm that arrowroot should never be boiled, or it will lose its astringent qualities. In some particular cases, when strong astringents are needed, it should not be boiled, and should only have boiling water or milk poured upon it; but when the digestion is weak, it is better for the patient to take arrowroot cooked. Sifted sugar may be added according to taste; and in water arrowroot a little wine or brandy is generally given.
Pastry and Bread.—Any fat that is greatly heated decomposes, and gives rise to certain fatty acids that are sure to disagree with delicate persons. That is the reason why pastry and fried food are unfitted for invalids. Very plain pastry, made light with baking powder, is sometimes admissible; but a small egg or milk loaf with the inside taken out, and baked crisp and hot, is a much better substitute. Sponge cake is best of all cakes, because it is made without any butter. Bread should not be new, but may be baked crisp in the oven. Crust is often more digestible than crumb. A change in bread is easy to arrange; if it is only a change of shape, it is better than monotony. A French roll, loaves of baking powder bread, brown and white pulled bread, crisp biscuits, are easy to get in most places.
Puddings.—(a) Boil ½ pint milk with cinnamon, lemon, and bay leaves; add 2 oz. sugar, 1 oz. flour, a little salt, and 3 eggs; beat all together, and steam this custard in a plain mould or basin, previously spread inside with butter; when done firm and quite cold cut into square pieces and dip in frying batter; drop separately in boiling fat, and fry a light brown colour, and dish them up on a napkin. (b) 6 oz. finely-grated bread, 6 oz. currants, 6 oz. sugar, 6 eggs, 6 apples, some lemon peel and nutmeg; let it boil 3 hours. (c) Weight of 2 eggs in butter, which beat to a cream, same weight of flour, same of pounded white sugar, the grated rind and juice of 2 lemons; bake ½ hour in a small flat pie-dish, with a rim of paste round the edge, serve with sifted sugar on the top, and send up very hot. (d) ½ lb. best beef suet, ½ lb. grated breadcrumbs, ½ lb. beaten white sugar, 3 eggs, well beaten and strained; the grated rind and juice of a large lemon, stick a mould with raisins, pour in the mixture, boil 2 hours.
Treacle Posset.—Heat ½ pint milk in the saucepan, and when in the act of boiling, pour in 1 gill (¼ pint) treacle. The milk instantly curdles. It must be taken off the spirit lamp and allowed to stand for 10 minutes, and then strained through a piece of muslin to separate the curds. This must be drunk hot. White wine, whey, and lemon whey, are prepared in a similar manner, only substituting a glass of sherry in one case, and a glass of lemon juice in the other, for the treacle. All wheys must be strained before they are taken.
Restorative Soup.—Take 1 lb. newly-killed beef or fowl, mince it very fine, add 8 fl. oz. soft or distilled water, 4-6 drops pure hydrochloric acid, 30-60 gr. common salt, and stir well together. After 3 hours the whole is to be thrown on a common hair sieve, and the fluid allowed to pass through with slight pressure. On the flesh residue in the sieve pour slowly 2 oz. distilled water, and let it run through while squeezing the meat; there will be 10 oz. extract of meat, of which a wineglassful may be taken at pleasure. It must not be warmed to a greater extent than putting a bottle filled partially with it to stand in hot water. If the flavour be disagreeable, 1 wineglassful claret may be added to 1 teacupful.
Milk Toast.—Take 2 slices bread and toast well—that is, crisp. Take new milk or cream, also a bit of butter (varying according to toast required), and melt in a saucepan together. Then dip in the slices of toast, let them soak for a moment or two, lift on to a deep plate, and pour the remains of milk and butter on top. Serve very hot; add salt as required.
Hot Milk.—Milk that is heated to much above 100° F. loses, for a time, a degree of its sweetness and density; but no one fatigued by over-exertion of body or mind who has ever experienced the reviving influence of a tumbler of this beverage as hot as it can be sipped, will willingly forego a resort to it because of its having been rendered somewhat less acceptable to the palate. The promptness with which its cordial influence is felt is indeed surprising. Some portions seem to be digested and appropriated almost immediately; and many who fancy that they need alcoholic stimulants when exhausted by labour of brain or body will find in this simple draught an equivalent that will be as abundantly satisfying and more enduring in its effects.
Caudles.—The basis of all caudles is flour gruel, made either with water or milk, that made with milk being the most nutritious, while both are equally digestible. In cool weather a quantity of gruel may be made and kept in a cool place, and portions of it heated and used as required. When gruel enters largely into the diet, its acceptability to the patient will be augmented by varying the flavouring or spice used in its preparation. If, therefore, a quantity is made plain, it can be sweetened and variously flavoured as it is heated for immediate use.
Cold Wine Caudle (a nutritious, digestible, and slightly stimulating food, useful in all sickness where starch and wine are not objectionable).—Make a good gruel by mixing smoothly 1 tablespoonful flour with ½ pint cold milk or water, and stirring it into ½ pint boiling milk or water; add a level teaspoonful of salt, and let the gruelboil for 5 minutes, stirring it to prevent burning. To ½ pint cold gruel add 1 egg beaten to a froth, 1 glass of good wine, and sugar and nutmeg to suit the palate of the patient.
Hot Wine Caudle (preferably to cold caudle generally, and useful in the same physical condition indicated in the preceding recipe). Heat ½ pint gruel; beat the yolk of a raw egg to a cream with 2 tablespoonfuls pulverised sugar; beat the white of the egg to a stiff froth; when the gruel is boiling hot, quickly beat a glass of good sherry or Madeira wine into the egg yolk and sugar, stir the hot gruel into it, and then add the beaten white of the egg. Work very quickly, and serve the caudle hot.
Cream Caudle (an equally valuable food with the two preceding caudles, useful under similar physical conditions). To 1 pint gruel add 1 glass good wine, 1 gill sweet cream, 1 tablespoonful noyeau or any good cordial, and sugar to suit the patient’s taste. Use hot or cold, but preferably hot.
Digestive Foods.—Where the digestion is weak, as is generally the case in sickness, much benefit may be derived from partially digested foods. Maltose is a sugar which does not readily undergo acetous fermentation, and therefore will not give rise to acidity and dyspepsia. This is a great matter, as cane sugar added to stewed fruit and milk puddings readily undergoes acetous fermentation in many stomachs. The lævulose sugar of fruit, like maltose, readily undergoes alcoholic but not acetous fermentation. Maltose being less powerfully sweet than cane sugar, a greater quantity is necessary to sweeten the pudding. If the raw starch, semolina, sago, or tapioca be first put in the dish by itself, and placed in the oven for an hour (taking care not to have it burnt by the oven being too hot), not only are the starch cells cracked, but a certain conversion of the starch into dextrine takes place. If to this be then added an equal quantity of ground malt and some hot milk poured on, and the dish be allowed to stand a few minutes before being put into the oven again, the diastase of the malt acts upon the farina and converts it into dextrine and maltose. Dextrine and maltose being soluble, the pudding is very thin. Such a pudding is admirably adapted for invalids and dyspeptics, as requiring scarcely any digestion in the body. For those with whom ordinary milk puddings produce acidity, such a pudding is specially suitable. Ground malt may be added to fresh milk, and forms an admirable food in cases of acute disease. Baked flour perhaps goes better with meat broths, to which it gives a high food value. (Well-baked flour requires but a touch of saliva to render it soluble, and, added to meat broths and gravy soups, renders them very nutritive.) Malt, being sweet, goes better with milk, or apple-water, or tamarind-water, or lemonade, and gives us a food which being all but independent of the digestive act, can be most usefully employed in the sickroom. Beef-tea (which alone is scarcely a food) and milk-and-seltzerwater pall upon the palate of the sick person, who craves variety just as do healthy persons. The adoption of ground malt as a food will solve for us one or two knotty questions connected with feeding people when the digestive power is feeble. Drinks like lemonade, made with malt instead of cane sugar, would not only not go sour in the mouth and stomach, but would contain some phosphates and soluble albuminoids, and so form admirable beverages in feverish states. The many malt extracts now in the market are well adapted for such end. (Lancet.)
An excellent peptonising apparatus, for the predigestion of foods for the sickroom, is sold by Savory and Moore.
Drinks.—Orange-whey.—The juice of 1 orange to 1 pint of sweet milk. Heat slowly until curds form, strain and cool.
Egg-Lemonade.—White of 1 egg, 1 tablespoonful pulverised sugar, juice of 1 lemon, 1 goblet water. Beat together.
Sago-Milk.—3 tablespoons sago soaked in a cup of cold water one hour; add 3 cups boiling milk; sweeten and flavour to taste. Simmer slowly ½ hour. Eat warm.
Baked Milk.—Put ½ gal. milk in a jar, and tie it down with writing-paper. Let it stand in a moderate oven 8-10 hours. It will be like cream, and is very nutritious.
Punch without Liquor.—Take the juice of 6 oranges and 6 lemons, adding sugar to suit the taste. Put to this a quantity of pounded ice and some sliced pine-apple, pouring over it 2 qt. water. This is an agreeable summer beverage for anybody, sick or well.
Rice Water.—Wash 2 oz. best rice and boil it fast for ½ hour in 1 qt. water. Any flavouring may be added, or a small piece of stick cinnamon or shred lemon peel may be boiled with the rice, and sugar used according to circumstances. Lemonade made with rice water when cold is very nice and refreshing.
Gum Arabic Water.—Put into an earthenware jar 1 oz. finest picked gum with 2 oz. sugar candy and 1 pint water; set it in a saucepan of water, and stir occasionally until dissolved. This is very useful as a night drink for hectic cough, and will allay the tickling in the throat. It should be kept as hot as possible. The little French porcelain veilleuse is best adapted for this purpose.
Lemon Juice.—Few people know the value of lemon juice. A free use of lemon juice and sugar will always relieve a cough. Most people feel poorly in the spring, but if they would eat a lemon before breakfast every day for a week—with or without sugar, as they like—they would find it better than any medicine. Lemon juice, used according to this recipe, would sometimes cure consumption:—Put 1 doz. lemons into cold water and slowly bring to a boil; boil slowly until the lemons are soft, then squeeze until all the juice is extracted; add sugar to taste, and drink. In this way use 1 doz. lemons a day. If they cause pain, lessen the quantity and use only 5 or 6 a day until you are better, and then begin again with 1 doz. a day. After using 5 or 6 doz., the patient will begin to gain flesh and enjoy food. Hold on to the lemons, and still use them very freely for several weeks more. Another use for lemons is for a refreshing drink in summer, or in sickness at any time. Prepare as directed above and add water and sugar. But in order to have this keep well, after boiling the lemons, squeeze and strain carefully; then to every ½ pint juice add 1 lb. loaf or crushed sugar, boil and stir a few minutes more until the sugar is dissolved, skim carefully and bottle. You will get more juice from the lemons by boiling them, and the preparation keeps better.—Lancet.
Linseed Tea.—Take 3 tablespoonfuls linseed, about 1 pint water, and boil for 10 minutes. Strain off the water, put in a jug with 2 lemons, cut in thin slices; put also some brown sugar. A wineglassful of wine is an improvement. This has been found most nourishing for invalids.
Barley Water.—Barley water is an important article in the invalid’s dietary. Dr. Pye Chavasse, in his work entitled ‘Advice to a Mother,’ strongly recommends Robinson’s patent barley, prepared by Keen, Robinson, and Bellville, of London. Take of the patent barley one ounce mixed with a wineglass of cold water, pour this into a stewpan containing nearly one quart of boiling water, stir this over the fire while boiling for five minutes, then flavour with a small bit of lemon peel or cinnamon and sweeten according to taste. Equal quantities of milk and barley water make a very nourishing drink, especially useful in feverish cases. Barley water should not be mixed with milk or syrup before required for use, as in a warm atmosphere it undergoes changes, and sometimes slightly ferments.
Almond Milk (an exceedingly nutritious beverage, useful in most conditions of illness).—Pour 1 qt. boiling water upon ¼ lb. shelled almonds, and when the skins soften rub them off the kernels with a clean towel; pound the almonds thus blanched in a mortar, putting in 3 or 4 at a time, and adding 4 or 5 drops milk, as the almonds are being pounded, to prevent oiling—about 1 tablespoonful milk will be required for the ¼ lb. almonds; when the almonds are finely pounded, mix them with 1 pint milk, 2 tablespoonfuls sugar, a level teaspoonful salt, and the yellow rind of a lemon, and place the milk over the fire to boil; meantime, beat 3 eggs smoothly, and strain the almond milk into them, stirring the mixture as the milk is strained in; return it to the saucepan, and place it in another pan of hot water, over the fire, stirring itconstantly until it begins to thicken; then remove it at once from the fire, strain it, and use it.
Barley Milk (a demulcent, refreshing, and nutritious beverage, useful in fevers and gastric inflammation).—Wash 4 oz. pearl barley in cold water until the water is clear; put it over the fire in a double kettle with 1 qt. milk and a level teaspoonful of salt, and boil it until the milk is reduced one half; then strain off the milk and sweeten to suit the taste of the patient. The barley may be used as food by adding to it a glass of wine and a little sugar.
Irish Moss Water (a bland, nutritious drink, excellent in feverish conditions and in colds).—Wash ½ oz. moss in plenty of cold water; then soak it for 10 minutes in 1 pint cold water; then add 2 pints cold water, 1 tablespoonful sugar, and 1 in. stick cinnamon to it, and boil it until it is about as thick as cream; strain it, add more sugar if it is desired, and use while warm. The yellow rind of a lemon may replace the cinnamon as flavouring.