'"SSi 
 
Jltljaca, S^eta ^atk 
 
 BOUGHT WITH THE INCOME OF THE 
 
 SAGE ENDOWMENT FUND 
 
 THE GIFT OF 
 
 HENRY W. SAGE 
 
 1691 
 
rne aate snows when this volume was taken. 
 To leneW this book copy the call No. iuid give to 
 \ tbeubnriuk. 
 
 % 
 
 wi^-^l^- 
 
 HOME USE RULES 
 
 \ 
 
 All Book! wtiject to Kecall 
 All boRowera moat i 
 
 'tm- 
 
 •i'^rttT ' All Bonowers moat regie- 
 
 "2 19ilffl--fi-*^- ter in the librur to bomnr 
 
 ' nf 5^< hnolo tar homa tue. 
 
 ..,.i»^J,i... 
 
 books for home nie. 
 
 All books must be re- 
 tarned st end of college 
 rear for insiwction and 
 lepaiis. , , 
 
 Limited books most be te- 
 tumed within the four week 
 limit and not renewed. 
 
 Students must return all 
 books before leaving town. 
 Officers should arrange for 
 the return of books wanted 
 during their absence from 
 town. 
 
 Volumes of periodicals 
 and of pamphlets are held 
 ia the hbrary as much as 
 possible. For special pur- 
 poses they are given out for 
 a limited time. 
 
 Borrowers should not use 
 their library privileges for 
 the benefit of other persons. 
 
 Books of special value 
 and gift books, when the 
 giver wishes it, are not 
 allowed to circulate. 
 
 Readers are asked to re- 
 port all cases of books 
 marked or mutilated. 
 
 Do not deface books by marks and writing. 
 
 arV18952'"'™" """"""" "-""^ 
 A, text book of home nursini 
 
 ,. 3 1924 031 241 734 
 olin.anx 
 
The original of tliis bool< is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924031241734 
 
A TEXT BOOK OF 
 HOME NURSING 
 
THE MACMILLAN COMPANY 
 
 NBW YORK > BOSTON - CHICAGO ' DALLAS 
 ATLANTA ■ SAH FRANCISCO 
 
 MACMILLAN & CO., Limited 
 
 LONDON > BOMBAY • CALCUTTA 
 MELBOURNE 
 
 THE MACMILLAN CO. OF CANADA, Lm. 
 
 TOSONIO 
 
A TEXT BOOK OF 
 
 HOME NURSING 
 
 \ 
 
 MODERN SCIENTIFIC METHODS 
 FOR THE CARE OF THE SICK 
 
 BY 
 EVELEEN HARRISON 
 
 Second Edition Revised 
 
 Jl3eto gotb 
 
 THE MACMILLAN COMPANY 
 1918 
 
 A.11 rights reserved 
 
A.3?31o) 
 
 OOFTBIQHT, 1900, 
 
 By the macmillax company. 
 
 Set up and electrotyped February, 1900. Reprinted May, 
 1900; August, 1905; April, 1906; Marcb, October, 1909; 
 March, 1914; October, 1915; August, 1917. 
 
 Nkw Edition 
 coptbiqht, 1918 
 
 bt the macmillan company 
 
 Set up and electrotyped. Published November, igzS 
 
' Ask God to give thee skill 
 
 In comfort's art — 
 That thou may'st consecrated be 
 
 And set apart 
 Unto a life of sympathy. 
 For heavy is the vreight of ill 
 
 In every heart, 
 And comforters are needed much 
 
 Of Christ-like touch." 
 
 A. E. Hamilton. 
 
PEEFACE 
 
 " Efficiency " is the keynote in the work of the world to- 
 day, and no other profession is more up to date than the 
 profession of nursing, with its efficient modern methods in 
 the care of the sick, and the alleviation of suffering. 
 
 In this second edition of " A Textbook on Home Nurs- 
 ing " the author has made every effort to take advantage 
 of the latest knowledge in the science of nursing, without 
 losing sight of the original purpose (as indicated by the 
 title) for which this little book was written. 
 
 The question of diet, in relation to disease, is an impor- 
 tant study, these days ; and particular emphasis is laid on 
 the number of " calories " or " heat units " required to 
 keep the body in proper condition, so a chapter has been 
 devoted to the special foods that give a right balance in 
 nourishment A chapter of recipes for invalid cooking 
 will also be found of value when planning the diet list. 
 
 " Outdoor treatment " in the cure of disease has proved 
 of enormous value ; so the preparation of an outdoor sleep- 
 ing bed, methods of ventilation, and fresh air baths, have 
 been described in fidl. 
 
 A great majority of patients nursed at home are suffer- 
 ing from chronic diseases, or convalescing from severe 
 illnesses; and one chapter has been devoted to comforts 
 and conveniences for the patient which mean so much in 
 the life of a " shut in." 
 
 Chapters on emergencies; preparation for a surgical 
 . operation at home ; care of sick children ; baths, their im- 
 portance and rules of procedure; contagious diseases, isola- 
 tion and disinfection, etc., form part of the subject matter 
 of the book. 
 
PREFACE 
 
 The title of " rnirse " has a larger significance since the 
 call to arms has sounded throughout the civilized world, 
 and highly trained nurses by the thousands have been 
 called to the colors, overseas, under the Eed Cross organi- 
 zation. Now as never before, the woman at home is on 
 the alert to train for service and " carry on " in nursing 
 as well as in other professions. There are -thousands of 
 homes throughout the land where "comforters will be 
 needed much, of Christ-like touch " and in this great serv- 
 ice a textbook on Home Nursing will find its place. 
 
CONTENTS 
 
 CHAFTEB FADE 
 
 I Choice and Pbepaeatioh' or Eoom and Bed. At- 
 
 MOSPHEEIC TeMPEEATITBE. VENTILATION ... 1 
 
 n Comforts fob the Patient 15 
 
 m Temperature. Pulse. Eespibation. The Giving 
 
 of Medicines 30 
 
 IV Baths — Cleansing and Medicinal ..... 43 
 
 V Symptoms and Nubsing op Infectious Diseases . 59 
 
 VI Prevention and Care of Coughs and Colds. Nurs- 
 ing IN GeiPj Bronchitis, and Pneumonia ... 89 
 
 VII Observation op Symptoms in the Nursing op Chil- 
 dren 100 
 
 Vm Counter-Ibritants. Dodohes. Enemata . . . Ill 
 
 IX How to Prepare fob a Surgical Operation. Care 
 
 op Patients Before and After Operations , . 129 
 
 X First Aid in Emergencies 142 
 
 XI Dietetics — Dainty Dishes and How to Serve 
 
 Them 154 
 
 XII Eecipes for Invalid Cooking 174 
 
A TEXT BOOK 
 OF HOME NURSING 
 
 OHAPTEE I 
 
 CHOICE AND PEEPAEATIOW OF EOOM AND BED. 
 ATMOSPHERIC TEMPEEAT0BE. VENTILATION 
 
 Choice of room for the patient. We hear a great 
 deal of " proper environment " in these twentieth century 
 days; when sickness invades the home, undermining 
 the vitality of the hody and exhausting the nervous sys- 
 tem, nothing is more essential to quick recovery than the 
 proper environment for our patient. 
 
 Ideals. Space, good ventilation, sunshine, and cleanli- 
 ness are the ideals for a room to he used during sickness. 
 The keynote — cheerfulness. It is not always possible to 
 choose the most suitable room from a medical standpoint, 
 for in a slight illness the members of the family prefer to 
 remain in their own quarters — but in contagious diseases, 
 chronic illness or long weeks of continual suffering, the 
 very best room in the home is gladly given to the patient. 
 In contagious diseases, or acute nervous troubles, a room 
 on the top floor or in an extension close to a bathroom is 
 to be desired; so that it may be isolated from the family 
 and in a quiet atmosphere. Household noises that are un- 
 avoidable and not noticeable in health become a real trial 
 in times of sickness. 
 
 Out-door porch. We are learning the value of fresh 
 air treatment both in sickness and health; no drug can 
 
2 A TEXTBOOK OF HOME NURSING 
 
 equal it in effect; so while choosing a room for your pa- 
 tient, when possible, take one connecting with a small 
 balcony or sleeping porch, or a corner room with two win- 
 dows facing west and south. 
 
 Preparation of room. In preparation for the care of 
 a patient with a contagious fever or about to undergo a 
 surgical operatiop, the carpet, heavy curtains and all un- 
 necessary furniture should be removed ; but in other cases 
 do not dismantle the room too much, for you may depress 
 your patient with the fear of a serious illness. Space is 
 one of our ideals, however, and the majority of rooms are 
 overcrowded with furniture ; so, many articles may be re- 
 moved (especially when the room is small). The essen- 
 tials are — bed, bureau, two small tables, two or three 
 comfortable chairs (rocking chairs irritate sick people), 
 and a sofa or lounging chair. In addition dainty muslin 
 curtains, a few restful pictures and books, with plenty of 
 fresh flowers, will help to create the atmosphere of a 
 " proper environment." 
 
 The bed. Of supreme importance to both patient and 
 nurse is the bed. Eest in bed for the patient is impos- 
 sible unless the bed is comfortable, and the Home Nurse, 
 who has frequently many other duties to perform, and in 
 chronic cases has to look forward to a long period of nurs- 
 ing, should be eased of every possible annoyance. Of 
 course, a simple, iron, hospital bed, two and a half feet 
 from the floor to the top of the mattress is our ideal — 
 but, again, in short cases of illness the patient prefers her 
 own bed, and it is not necessary to change. When the 
 ilLaess extends over a few days, a single iron bed may 
 be transferred from some other room ; and, for the nurse's 
 comfort (when the bed is low), raise the four legs on 
 blocks of wood, or use two mattresses, so that the faithful 
 Home Nurse may not suffer from back-ache. 
 
 The mattress. A firm hair mattress is necessary. 
 Should a hollow be found in the middle (most mattresses 
 
PREPARATION OF ROOM AND BED 3 
 
 become depressed in spirit after much service), two flat pil- 
 lows under the mattress, or a heavy, folded blanket will 
 make it comfortable. Perhaps the mattress may be lumpy 
 with age, in unexpected places; then stretch a blanket 
 folded lengthwise over the mattress, under the lower sheet, 
 and the hillocks of hardness will disappear. Always turn 
 a mattress from top to bottom. When turned from side to 
 side, the same part of the mattress will again bear the 
 heaviest part of the body and will soon develop a hollow 
 space. 
 
 Bedclothes. Sheets: cotton, not linen, are best, and 
 three will be needed; upper, lower, and draw sheet (so 
 called because it may be drawn from one side of the bed to 
 the other when it gets warm, and will thus make a cool 
 spot for the feverish body). 
 
 Eubber sheeting : about % of a yard wide so that it will 
 reach from the pillow, down to the knees ; and long enough 
 to tuck well in on both sides. 
 
 Blankets : the number of blankets must be regulated by 
 the need of the patient and the temperature of the room ; 
 one or two during the day, but extra ones should always 
 be on hand at night, and within easy reach of the patient, 
 so that the Home Nurse may not be disturbed unneces- 
 sarily. 
 
 Spread: heavy, white spreads are out of place during 
 illness. A thin, dimity spread or even a clean white sheet 
 gives no extra weight and is easily laundered. 
 
 Making the bed. Eirst the under sheet is put on per- 
 fectly straight to avoid wrinkles (which sometimes lead 
 to pressure sores), well tucked in at top and sides. When 
 your patient is restless, or very heavy, pin the sheet at the 
 four corners with safety pins. Next comes the piece of 
 rubber sheeting; then the draw sheet folded lengthwise, 
 placed over the rubber sheeting pulled tightly and well 
 tucked in under both sides. When tucking in sheets, com- 
 mence in the center and then tuck towards the foot and 
 
4 A TEXTBOOK OF HOME NURSING 
 
 head of the bed. The great advantage of a draw sheet is 
 that it may be changed as often as necessary without much 
 disturbance of the patient, and it serves to keep the under 
 sheet clean for a longer period. The top sheet is then 
 put on, with the hem wrong side up, so that the right side 
 will turn up over the blanket; leave a good margin to 
 cover the blanket at top (most people dislike the feel of a 
 blanket near their face), and plenty to tuck in well at the 
 foot. Have you ever examined a well made hospital bed, 
 with its immaculately tucked in comers? Try to copy 
 it with your home bed, following these directions : 
 
 After putting on the top sheet, tuck it in first at the 
 foot, then fold the corners back like an envelope, and tuck 
 in the folded parts and the sides undetr the mattress. The 
 blankets are put on in the same way. The spread, after 
 being folded back over the bed, envelope fashion, and the 
 folds tucked in, the ends on both sides are allowed to hang 
 down over the sides of the bed. Of the greatest impor- 
 tance — do not tuck in the sides and bottom of the bed- 
 clothes so tightly that your patient's feet will be impris- 
 oned. We love to see a neat bed, but our patient's com- 
 fort must come first. 
 
 In bed making the three points of special interest to the 
 patient are — cleanliness, absence of wrinkles, and no 
 crumbs after meals. We have learned how to make a 
 bed without wrinkles, but, to keep it so, pull the draw 
 sheet tight and tuck it in firmly two or three times during 
 the day. Crumbs may be brushed out with a whisk broom 
 after every meal. Should fresh linen be at a premium ; 
 the pillow cases changed at night and hung out to air will 
 serve a second day — and the upper sheet well aired and 
 folded may be used as a draw sheet. 
 
 Pillows. Is there anything so comforting during ill- 
 ness as an extra pillow tucked under a tired, aching back, 
 between weak knees, supporting an aching arm or leg, or 
 holding the weight of the bedclothes from touching sensi- 
 
PREPARATION OF ROOM AND BED 5 
 
 tive parts of the body ? Pillows — small and big, fat and 
 thin, square and oblong — the Home Nurse will find of 
 infinite value, especially in long, chronic cases. And 
 these extra pillows are so easily made (as we are making 
 the ambulance pillows for the soldiers) by cutting up in 
 very small pieces soft old cotton, linen or flannelette, or 
 using cotton batting broken up in tiny pieces and covering 
 it with cheese-cloth or odd scraps of cretonne. Hair pil- 
 lows are excellent when a firm support is needed for ele- 
 vating legs and feet as in cases of phlebitis, etc. In fever 
 cases when the head is very warm, the pillows should be 
 turned frequently, as they soon get hot and uncomfortable, 
 and they also need a good shaking occasionally, which, how- 
 ever, must not be done on the bed, as it jars the patient. 
 A hair pillow will be found much cooler than feathers, 
 when the fever is intense. One confirmed invalid makes 
 use of no less than twenty small pillows; and by chang- 
 ing them around in different positions finds great rest 
 and refreshment. 
 
 Changing the pillows. In order to raise a sick per- 
 son while changing the pillows or to draw her up in bed, 
 let her clasp her arms firmly around your neck, then place 
 one hand well under her back, and lift gently and slowly, 
 while with the other hand you slip out the soiled pillow 
 and put in the clean one. When the patient is too sick 
 to help herself, get some one to assist you, and with one 
 person on each side of the bed, clasping each other's wrists 
 firmly under the shoulders and back of the patient, you 
 can raise and draw her up in bed without any strain. 
 
 Position of bed in room. Pulled out from the wall 
 on all sides, it will allow a current of air to circulate and 
 also helps the Home Nurse to reach her patient easily, 
 from every direction. 
 
 Should the size of the room not permit you to turn the 
 head of the bed away from the light; put your patient's 
 head at the foot of the bed and protect from draughts by 
 
6 A TEXTBOOK OF HOME NURSING 
 
 a screen. This is particularly to be noted during a long, 
 chronic illness, when the patient wishes to read or sew 
 and requires a light from behind. At night, shade the 
 light, or place it behind the patient's head. 
 
 Out-door sleeping bed. A celebrated doctor writes, 
 " I am convinced there is no measure comparable in its 
 effects on the vital centers, to fresh, live air in the open." 
 In making a " fresh air bed " on sleeping pqrch, balcony 
 or roof, for open air treatment, observe the following rules : 
 Eight over the springs spread a blaiiket, large enough to 
 cover up over bottom and sides of the mattress ; next the 
 blanket, a large rubber sheet or heavy paper, extending 
 out as far as the blanket; then the mattress, making the 
 bed as usual. The patient in flannel under-suit, stockings 
 and hood, with hot water bottle to feet, and only the face 
 exposed, is well tucked in and the under blanket and 
 rubber sheeting folded up like an envelope right over the 
 outside of the bedclothes. Cold air cannot creep up around 
 or through a bed made in this manner. 
 
 Screens will protect from draughts; or extra pillows 
 may be placed at each side of the face forming the letter V. 
 Should there be no out-door sleeping porch and your pa- 
 tient requires a double supply of fresh air, take out the 
 window sashes, replace them with fine cheese-cloth. Move 
 the bed right up beside the window (with screen to pre- 
 vent draught). Use all precautions of out-door sleeping, 
 and supply any one entering the room with extra shawl 
 or wrap. In cases of pneumonia, fresh air treatment may 
 be thus given at home, with splendid results. The nurse 
 in charge must, of course, be dressed for out-doors. 
 
 Changing sheets with a patient in bed. With re- 
 gard to changing the sheets on a bed when the patient is 
 in it, you may easily manage after a little practice. Have 
 the clean sheets ready, well aired and warmed, and shut 
 the door and windows, so that the room may be comfort- 
 able. Turn the patient over on one side, away from you, 
 
PREPARATION OP ROOM AND BED 7 
 
 fold the soiled sheet tightly in flat folds, close up to the 
 patient. Lay the clean sheet on the side of the bed near 
 you, half of it folded up against the roU of the soiled 
 sheet, so that they can both be slipped under the body at 
 the same time. Tuck in the clean sheet on that side of 
 the bed, then cross to the other side, turn your patient back 
 on the opposite side, gently pull out the soiled sheet from 
 underneath, and afterward draw the folds of the clean one. 
 Pull straight, firmly, and tuck in neatly. It is quite easy 
 in this way to change the draw sheet, rubber sheeting, and 
 under sheet all at the same time. To change the upper 
 sheet without exposing your patient, loosen all the clothes 
 at the foot of lie bed, and spread the clean sheet and 
 blanket on top of the other bedclothes. Then with one 
 hand hold the clean sheet and blanket up to the neck of 
 your patient and with the other slip down the soiled 
 clothes underneath right over the foot of the bed; tuck 
 in the fresh bedclothes and put on the counterpane. All 
 this may be accomplished in almost as short a time as it 
 takes to tell it, and without any special fatigue to the 
 invalid. Sitting on the side of the bed or leaning heav- 
 ily against it, while working over your patient should be 
 avoided, as it is very trying to a nervous patient. 
 
 Nightgowns. It is always most refreshing to keep on 
 hand two nightgowns or pajamas and undervests (if they 
 are worn), one for day duty and the other for night, 
 changing the last thing at night and after the morning 
 bath. It may be possible to have a clean nightgown or 
 pajamas every day, but if not this change will be very 
 delightful, and it wiU be found restful as weU as refresh- 
 ing to change the clothes that have been worn for twelve 
 hours. Another consideration is that the gowns are kept 
 cleaner, and thus the washing, always a serious item in 
 sickness, is much lightened. Tor long illnesses, gowns 
 open all the way down the back are much to be preferred. 
 
 To change the nightgown : Have your patient lie on 
 
8 A TEXTBOOK OF HOME NURSING 
 
 her back, with knees bent up. Raise her slightly, and 
 pull the gown up from under the back as far as the neck. 
 Then slip one hand through the upper armhole of the 
 sleeve, bend her elbow, while with the other hand you 
 draw off the sleeve, slip the gown over the head and off 
 the other arm. Should there be an injured arm, or one 
 stiff with rheumatism, neuritis, etc., always remove the 
 sleeve from the well arm first, but when you put on a 
 clean gown, put the sleeve on the injured arm first. When 
 putting on the clean nightgown, one arm is first drawn 
 into the sleeve, the gown then pulled over the head, then 
 the other arm is slipped into the sleeve, and the gown 
 pulled down under the back. 
 
 Support for bedclothes. If any part of the body is 
 injured and unable to bear the weight of the bedclothes, 
 you can manufacture a support to take the place of the 
 iron cradles used in hospitals. Two or three barrel hoops 
 wiU answer the purpose, or a round band-box large enough 
 to slip the injured limb through. Sometimes pillows laid 
 on each side of the bed will answer as well by keeping 
 the clothes a couple of inches from the sensitive part of 
 the body. 
 
 Bed-rests. Bed-rests, which are of such great service 
 when the patient first sits up in bed, are not as a rule 
 on hand in private houses. But one may easily be con- 
 trived from a chair with the legs turned upward on the 
 bed, when the long sloping back will form a capital sup- 
 port for pillows piled in one behind another to the top. 
 Then if you put a small pillow under the knees, to pre- 
 vent the body from slipping down in the bed, your patient 
 will be made very comfortable. 
 
 Changing position of helpless patient. This can be 
 accomplished when the bed is a double one by keeping one 
 side for the day and the other for night. You can easily 
 move your patient by loosening all covers at ends and 
 sides, and drawing her over on a sheet (if she is too feeble 
 
ATMOSPHERIC TEMPERATURE 9 
 
 to roll over alone) ; it is almost as restful for your pa- 
 tient as being moved on to a fresh, bed. Should there be 
 two small beds in the room, the same change can be made 
 by putting a large sheet across the two beds and allowing 
 the patient to roll over, or draw her with the sheet. 
 When the illness extends over a few weeks, the change 
 from one bed to another will be of the greatest rest and 
 comfort to the sufferer. 
 
 Light. Sunlight is one of our ideals in a room for the 
 sick Should the windows have to be darkened, at the 
 beginning of an Ulness, gradually draw up the shades 
 a little higher every day, for sunlight is a great purifier 
 and healer, and during convalescence a " sun bath " brings 
 new strength. 
 
 Temperature of room. The atmospheric temperature 
 of the room will be regulated by the doctor. Between 65° 
 and 70° F. is usual, except in special cases. In these days 
 of modern heating, various kinds of stoves may be used 
 to supplement the regular heat of the house during very 
 cold weather, for an even temperature is always desired 
 in illness. Hang your thermometer near the middle of 
 the room, some distance from window and fireplace, so that 
 an exact record may be kept. Whenever extra heating is 
 used (oil or gas stove) a kettle of hot water in the room 
 will moisten the atmosphere. 
 
 In the early morning hours, between three and five 
 o'clock, the atmosphere is colder than during any other 
 part of the day, and as the vitality of the body is always 
 lower at that time, care must be taken to have extra blan- 
 kets on hand for the invalid, and if necessary give a hot 
 drink and apply a hot water bag to the feet. A small 
 blanket folded under and over the feet between the sheets, 
 for elderly people, gives them great comfort during the 
 night. 
 
 Fireplaces. Open fireplaces are delightful in a sick 
 room, for beside their bright, cheery appearance, and the 
 
10 A TEXTBOOK OF HOME NURSING 
 
 heat they give forth, they are a great help in regard to 
 ventilation. Coal may be renewed at any time without 
 disturbing your patient, by carrying it in, wrapped in a 
 newspaper, and placing paper and coal together on the 
 fire. A poker made from a piece of wood will cause no 
 noise, and will be found quite as useful as one of iron 
 or brass. In summer time, when there is no need of fire, 
 a lighted candle or a lamp placed in the fireplace will have 
 the same effect as a fire in the way of ventilation, by 
 causing a draught up the chimney. 
 
 Ventilation. Fresh air and health go hand in hand, 
 therefore a plentiful supply of fresh air night and day, 
 is our ideal in sickness. Even when food, nursing and 
 medicine have been almost unattainable, sick soldiers cared 
 for in tents during war time, have made wonderful re- 
 coveries. They have had an unlimited amount of fresh 
 air and sunshine. Open air treatment for fever cases, is 
 universally adopted, and with success; hence the value 
 of a veranda or sleeping porch connecting with the sick 
 room. Even in slight illness, or chronic sickness, the 
 Home Nurse should make proper ventilation her first con- 
 sideration and cultivate the habit of noticing closely, when 
 entering her patient's room, the condition of the air, odor, 
 heat, draughts, etc. It is a real reproach to a nurse, 
 should the doctor remark that the " room feels close." 
 
 Respiration and perspiration are two of the principal 
 causes of impurities in a sick room. Oxygen is contin- 
 ually taken from the air in the act of inspiration ; and the 
 temperature and humidity of the air are greatly increased 
 by expiration. Even when in good health, headaches and 
 lassitude soon result when one is in an overcrowded room 
 for any length of time. Nearly two quarts of water leave 
 the body daily in perspiration, and passing into the air 
 add to its humidity. In sickness, even more fresh air is 
 required to tone up the body tissues than in health, and 
 
VENTILATION 11 
 
 may be provided, in the coldest weather, without draughts. 
 
 Take into consideration the size of the room, the num- 
 ber and position of the windows. If there are two win- 
 dows at opposite sides of the room, open one at the top, 
 the other at the bottom (even one inch in very cold 
 weather), placing a piece of cardboard, or thin strip of 
 wood, six inches wide, over, but a little away from the 
 opening at the bottom. Then the air will not blow di- 
 rectly into the room, but will be guided in an upward 
 direction. Hot air ascends, and cold aii descends, so the 
 impure air will escape through the top and the fresh air 
 enter at the bottom. If there is only one window in a 
 room, open at the top and bottom, but it will be necessary 
 to flush out the air of the room, at intervals. 
 
 In bronchial cases (especially with children), a breath 
 of out-door air causes paroxysms of coughing, so one must 
 ventilate through an adjoining room, either by filling the 
 room with fresh air, allowing it to warm, and then open- 
 ing the door into the sick room; or by leaving a window 
 open top and bottom in an adjoining room with a screen 
 at the door. Open the window for a few minutes, morn- 
 ing and evening, covering your patient carefully about 
 head and shoulders, but leaving the mouth and nose ex- 
 posed. Opening the window for a minute before meals, 
 will stimulate a poor appetite. 
 
 In cases of high f everj it is almost inlpossible for a pa- 
 tient to catch cold; and cold, clean air will hasten the 
 recovery. 
 
 Open air treatment for pneumonia has proved its place 
 in the medical world, leading always, to stronger heart 
 action and quick recovery. 
 
 Electric fans are excellent to keep air circulating ; and 
 electric lights give out no impurities, such as come from 
 gas or lamp light. 
 
 We have overcome the harmful opinion about night air. 
 
12 A TEXTBOOK OF HOME NURSING 
 
 and now appreciate the fact that it is even cleaner and 
 purer than during the day, and that open windows at 
 night are an absolute necessity. 
 
 An unpleasant odor in the roona will soon disappear if 
 a towel or newspaper is waved gently while the window 
 is open, and during summer this also cools and refreshes 
 a hot room. 
 
 SUMMARY 
 
 Choice of room. 
 
 Proper environment. 
 
 Ideals — space. 
 
 Good ventilation. 
 
 Sunshine. 
 
 Cleanliness. 
 
 [Keynote — cheerfulness. 
 
 Room on top floor or extension preferred. 
 
 Near bathroom. 
 
 Quiet atmosphere. 
 
 Out-door porch when possible. 
 
 Importance of out-door treatment. 
 
 Preparation of room. 
 
 In contagious diseases and surgical operations. 
 Stripped of unnecessary furniture. 
 Essentials required. 
 
 The bed. 
 
 Hospital type best. 
 
 Comfort of patient and nurse. 
 
 Two ways of raising bed. 
 
 Mattress. 
 
 How to turn mattress. 
 
 Bedclothes required. 
 
 Sheets. 
 
SUMMARY CHAPTER I 13 
 
 Rubber sheeting. 
 
 Blankets. 
 
 Spread. 
 
 Making the bed. 
 
 Care about wrintles. 
 
 Advantage of draw sheet. 
 
 How to tuck in corners. 
 
 Three points of interest to patient : cleanliness, absence of 
 
 wrinkles, and no crumbs after meals. 
 How fresh linen may be saved. 
 
 Pillows. 
 
 Their use. 
 
 How to make extra pillows. 
 
 Comfort of shaking up and re-arrangement. 
 
 How to change with very sick patient. 
 
 Position of bed in room. 
 
 To allow air circulation. 
 
 To have proper light for patient's eyes. 
 
 Out-door sleeping bed. 
 
 Importance of fresh air. 
 
 How to make the bed. 
 
 Blanket and rubber sheet under mattress. 
 
 Patient's costume. 
 
 Screens or pillows to protect from draughts. 
 
 When no sleeping porch — adapt a room. 
 
 Nurse dressed for out-doors. 
 
 Changing sheets with a patient in bed. 
 
 Clean sheets on hand. 
 
 Room warm. 
 
 Under sheet first. 
 
 Upper sheet without exposing patient. 
 
14. A TEXTBOOK OF HOME NURSING 
 
 Nightgowns. 
 Two on. hand. 
 How to change witH sick patient. 
 
 Support for bedclothes. 
 
 Making one in an emergency. 
 
 Bed-rest. 
 
 Made with a chair. 
 
 Changing position of helpless patient. 
 
 Drawing on sheet from one side of bed to the other. 
 Changing from one bed to another. 
 
 Light. 
 
 Importance of sunlight. 
 
 Temperature of room. 
 
 68° F. to 70° F. usual. 
 
 65° F, in fever cases. 
 
 Thermometer to be consulted. 
 
 Care during early hours when temperature is low. 
 
 Fireplaces. 
 
 Coal put on without noise. 
 
 Lamps or candles used in summer, to create a draught. 
 
 Ventilation. 
 
 Fresh air. 
 
 Open air treatment for fever cases. 
 
 Home Nurse's duty to detect bad air. 
 
 Causes of impurities in air of room. 
 
 How to ventilate with one or two windows. 
 
 Guarding from draughts. 
 
 Opening windows to flush out room. 
 
 Benefit in night air. 
 
 To get rid of odors. 
 
CHAPTER II 
 
 COMFO'ETS FOB THE PATIENT 
 
 During an illness rest of mind is necessary to assure 
 rest of body. We realize how small trials and worries 
 oppress us out of all proportion to their importance, when 
 we are physically or mentally tired, at the end of a day's 
 work. Add to this the pain and weakness of real sick- 
 ness and the " little things that chafe and fret " will ap- 
 pear as immovable mountains in the eyes of your patient. 
 
 Household. worries are diflScult to keep out of the sick 
 room, especially if your patient happens to be the mother 
 of the family: but some simple suggestions may well be 
 carried out to retain the quiet comfort of her mind as 
 well as body. Never whisper in or near the sick room, 
 even when your patient appears to be asleep ; it irritates, 
 and often alarms the invalid. Banging doors, and rattling 
 windows must be guarded against especially in nervous 
 cases; also, oil the hinges of doors and windows so that 
 they will not squeak when opened or closed. 
 
 Sitting on the bed, or leaning against it, often jars the 
 nerves; and talking in a loud voice, clattering dishes, or 
 moving heavy furniture should be absolutely forbidden. 
 
 Changing of position. Bed patients tire quickly of 
 their position, and especially when they are unable to 
 move themselves. We have spoken of the comfort of pil- 
 lows and pads, to tuck in around and under the body and 
 relieve the strain. Hot water bottles, partially filled, 
 often relieve local pain; pillows (folded, and tied firmly 
 together) under the knees will relax the muscles of the 
 abdomen. Hair pillows or sand bags wiU be of great 
 
 15 
 
16 A TEXTBOOK OF HOME NURSING 
 
 comfort in elevating tlie legs in neuritis or rheumatism, 
 but must extend the whole length of the leg, gradually 
 rising higher towards the foot. 
 
 Eubher air rings are invaluable to relieve pressure on 
 the lower part of the spine, and to prevent bed sores. 
 
 Pressure sores and bed sores. Our Home Nurse 
 will have to be on the alert to guard against bed sores 
 caused by pressure. Even in a short illness, with very 
 sensitive skin and when pressure is continued without 
 change of position, a bed sore may develop. In long 
 chronic illnesses (cases which so often fall under the care 
 of the Home Nurse), especially in old age, when the vi- 
 tality is low, with very thin or very heavy people, and 
 in high fever cases — the greatest care is called for; be- 
 cause once the skin is broken, the healing involves a long, 
 painful process. 
 
 Location of bed sores : When the bony parts of the 
 human body such as — elbows, shoulder-blades, back of 
 the head and heels; also the buttocks, are pressed for a 
 long period against the bed, pressure sores may develop. 
 
 Causes : Lack of cleanliness, wrinkles in bed, gown or 
 sheets, crumbs, moisture in the bed (from perspiration 
 or incontinence of urine) and lying in one position for 
 many hours, are the predisposing causes of bed sores. 
 
 Prevention : It is far easier to prevent bed sores than 
 to cure them, especially in paralytic cases and with elderly 
 people. The first symptoms are a redness of the skin with 
 a pricking, burning sensation. Bathe the parts with hot 
 water and soap, at least three times in the day ; then rub 
 with alcohol, and powder to remove aU moisture. Watch 
 for crumbs after meals, and pin the draw sheet at the four 
 corners under the mattress to keep it absolutely free from 
 wrinkles. Persuade your patient to turn over in differ- 
 ent positions frequently; or, when she is helpless, relieve 
 the pressure by the judicious use of rubber rings, pillows, 
 air cushions, pads, etc. A word about rubber rings ^ — 
 
COMFORTS FOR THE PATIENT 17 
 
 when you blow them up, only allow enough air to keep 
 the sore part of the body from touching the bed. If you 
 make them full of air, hard and firm, they are most un- 
 comfortable and useless. Also wind the ring with cotton 
 gauze or old muslin, or put it into a pillow case. With 
 unconscious patients the greatest watchfulness is necessary, 
 if you wish to avoid bed sores. When there are involun- 
 tary evacuations, change the clothing at once, wash and 
 powder the body. If you use a pad of oakuni, on top of 
 newspapers under your patient, it may be changed quickly 
 and will keep the bed clean. 
 
 The Home Nurse should not take any responsibility 
 about the treatment of bed sores, but consult the doctor at 
 once when any sign of trouble is discovered. Do not wait 
 until the skin breaks, for with the lowered vitality of 
 bodily sickness it is most diSicult to heal. 
 
 Care of the back. Even when there is no sign of a 
 pressure sore, patients grow tired of lying for days on 
 their back or sides. A few minutes' gentle rubbing of 
 the body with alcohol will take away the restlessness ; also 
 pulling the draw sheet from side to side will cool the bed, 
 and turning pillows or changing their position will be 
 received with gratitude. 
 
 Bed-pans. Warm the pan always, before giving it to 
 your patient. You can hold it under hot water, or near 
 a fire or cover the end with a hot pad. When inserting the 
 pan, have your patient bend her knees up, then should she 
 be unable to raise herself, slip your hand under the lower 
 part of her back, and raise her enough to place the pan 
 underneath. To avoid spilling the contents, be sure to 
 raise the back again when withdrawing the pan. Bathe 
 your patient after using the bed-pan, with a piece of gauze 
 and warm water; always note the contents of the pan 
 for your report to the doctor. 
 
 Care of the mouth and teeth. The mouth is an in- 
 dex to the stomach, and requires frequent care during ill- 
 
18 A TEXTBOOK OF HOME NURSING 
 
 ness. Before and after meals, a simple mouth wash is 
 most refreshing. Listerine, well diluted, or lemon juice, 
 boric acid (2 per cent.) and albolene are good prepara- 
 tions. Washing the teeth after meals (especially if there 
 is a false plate) will keep the mouth fresh. In fever 
 cases special care of the mouth is necessary; the doctor 
 will order a mouth wash. When your patient cannot use 
 the mouth wash herself, take a tooth pick or flat piece of 
 thin wood wrapped in gauze, dip it in the solution and 
 wash gently all around the mouth and teeth. Make a 
 number of these little mouth sticks and keep them on 
 hand, as you will require three or four for each washing. 
 
 Care of the hair. Every woman is a bit vain about 
 her hair, and likes to keep it in order, especially during 
 illness. 
 
 Should your patient be a woman, a dainty boudoir cap 
 is quite an addition to the invalid's costume and may be 
 made most attractively to match with the little bed jacket. 
 But a boudoir cap does not take the place of well brushed 
 and braided hair, particularly when your patient has to 
 lie down flat on the pillows. 
 
 Part the hair in the center, brush and comb one side 
 at a time, beginning at the end of the hair and working 
 gradually up to the head; hold the hair firmly in your 
 hand and you will not pull or jerk the head. A little 
 vaseline or alcohol will help to remove tangles. Two 
 braids, one on each side, is most comfortable when the 
 head has to lie flat on the pillow, but do not braid too 
 tightly as it will make a hard knot under the ears, and 
 this will be uncomfortable to lie on. A few minutes' 
 gentle massaging of the head at night will soothe the 
 nerves and induce sleep; it is also a preventive against 
 hair falling out after an illness. 
 
 Bed jacket. A loose flannel or silk jacket, nightingale, 
 or shoulder cape will be required, even when your patient 
 
COMFORTS FOR THE PATIENT 19 
 
 is lying flat down in bed, for it allows the arms to be kept 
 out from under the bedclothes without taking cold. 
 
 Bed socks. Bed socks have solved the question of 
 keeping a patient's feet warm; especially elderly people, 
 and during a long illness. They are made from eider 
 down flannel, shaped to the foot, and reaching above the 
 ankles, easily laundered, and of great value at night, when 
 hot water bottles grow cold. 
 
 Screens. A screen of some kind is indispensable, espe- 
 cially one of light weight that may be moved in a moment 
 to protect from draughts. The Home Nurse can easily 
 manufacture one with a clothes horse and a few yards 
 of art muslin, cheese-cloth or unbleached muslin. 
 
 Refrigerators. A small refrigerator or ice-box will be 
 a necessity if the illness is a long one. They are divided 
 into compartments and will hold ice, fruit, jelly, broth, 
 milk, etc. Think of the steps this saves for the Home 
 Nurse, especially if the sick room is at the top of the 
 house. Once a day a tray may be carried up with all 
 the little extras for the twenty-four hours, and the " be- 
 tween meals " refreshments will be on hand cool and fresh. 
 
 Care of food or drink for the patient. During in- 
 fectious fevers, all eatables for the patient may be kept 
 in the small ice-box quite separate from the family sup- 
 ply. When the illness is of short duration, or if these 
 little ice-boxes are too much of a luxury, the best way to 
 preserve the ice is to wrap it in a piece of flannel, and 
 place it on a bowl or cup turned upside down inside a large 
 hand-basin. You may then place the broths, milk, or jel- 
 lies in the basin resting against the ice, and cover all with 
 a towel or table-napkin and stand the basin near an open 
 window. For cracking the ice, miniature ice-picks may 
 be purchased, or an ordinary pin serves to break it very 
 nicely. When necessary to crack a large quantity of ice 
 for an ice-bag or ice-cap, put the ice in a towel and break 
 
20 A TEXTBOOK OF HOME NURSING 
 
 it with a hammer or iron. If it is absolutely necessary to 
 keep water or milk in the room, always have it carefully 
 covered. Sometimes broth or milk is needed during the 
 night, and where there is no ice on hand, you will be able 
 to keep it cool by wrapping the pitcher or bottle in a damp 
 towel and standing it outside the window. 
 
 Fly curtain. Unless the house is properly screened 
 during the summer, or if your patient spends part of the 
 time on an out-door sleeping porch or open balcony, you 
 will need a fly-curtain. Fasten a large piece of mosquito 
 netting to a hook in the ceiling and allow it to touch the 
 floor on all sides of the bed. 
 
 Flowers. Plant life is an important help in purifying 
 the air of a room. It gives out a large supply of oxygen, 
 especially during daylight and in strong sunshine; it is 
 one of our most active agents for air purification. Plants 
 should be watered daily ; and cut flowers re-arranged every 
 morning. At night remove them from the sick room, and 
 they return fresh and with new interest to your patient 
 in daylight. 
 
 Gifts of flowers are as a rule appreciated more than 
 anything else by our invalid friends. To some people 
 they prove a better tonic than medicine, especially grow- 
 ing plants, bulbs, and bright-colored flowers, without too 
 strong a perfume : a never failing center of interest, they 
 recall hosts of pleasant memories. 
 
 Order in the sick room. A patient with an orderly 
 mind will sometimes almost reach nervous prostration 
 should the sick room remain untidy. After the daily bath 
 is given, and the bed changed, a carpet sweeper or damp 
 cloth over the broom will remove dust without annoy- 
 ance. For a duster use a piece of cheese-cloth wrung out 
 of hot water and dust gently without unnecessary disturb- 
 ance. Soiled clothing and evacuations of course are re- 
 moved at once. Bed-pans and urinals rinsed first in cold 
 water before washing in hot water, for heat hardens the 
 
COMFORTS FOR THE PATIENT 21 
 
 albmnin in the urine and makes it difficult to remove. 
 For a disinfectant 2 per cent, formalin will remove all 
 odors. Empty dishes and glasses lying around are most 
 untidy. Medicine bottles and surgical appliances should 
 be kept out of sight of the patient. Stains from nifidi- 
 cines and other causes may be removed by Javelle water. 
 
 Visitors. One of the unsolved problems of the sick 
 room is what to do about visitors. If people would only 
 use a little common sense when visiting their sick friends, 
 their visits would do good to the patient instead of some- 
 times causing trouble. 
 
 Do not allow a visitor to enter the sick-room straight 
 from the open air on a cold or wet day. Ask him to wait 
 in an adjoining room for a few moments until his clothes 
 lose their dampness and become warm. Visitors should 
 be warned to put aside all depressing news, and be as 
 bright and cheery as possible, bringing in with them a 
 little sunshine and news of the outside world, instead of 
 retailing to the patient the sorrows, sickness, or death of 
 mutual friends. 
 
 It is necessary to discriminate carefully as to whom you 
 admit to visit the invalid, as sometimes a visit from a rela- 
 tive who is fussy and irritating will do your patient a 
 great deal of harm, while a loving, sympathetic friend 
 may have it in her power to refresh and strengthen the 
 sufferer. 
 
 After a serious illness, when the doctor allows visitors 
 to be seen, one friend during the day is sufficient for the 
 first few days, and this visit should be limited to a very 
 few minutes. At the end of the prescribed time, if the 
 visitor has not the tact to leave, you should not hesitate 
 to request her to do so. Unless one has been through a 
 serious illness it is impossible to realize how exciting it 
 is to see even a very intimate friend, after being shut out 
 from the busy everyday world for days or weeks. A 
 nervous patient should never be allowed to see two visitors 
 
22 A TEXTBOOK OF HOME NURSING 
 
 at the same time. It fills one with the deepest sympathy 
 for the invalid to see two friends, seated on opposite sides 
 of the hed, talking across at each other, while the poor 
 sufferer lies in the middle, trying not to look distressed 
 and tired with the effort she has to make to watch and 
 listen to them both at the same time. 
 
 Have a chair placed facing the invalid, and near enough 
 for her to hear what is said without an effort, and the 
 first indication of weariness should be the signal for the 
 immediate departure of the visitor. 
 
 Household worries of all kinds ought to be kept out- 
 side the door as far as possible, and only the bright side 
 of life allowed to cross the threshold. It is only human 
 nature that when we are sick little things affect and worry 
 us, which we would scorn to notice in perfect health. 
 
 Convalescence. The convalescent period is very try- 
 ing both to nurse and patient. As soon as the invalid 
 begins to sit up every day, she will require a great deal 
 of encouragement to brace her up, as it is then she will real- 
 ize her weakness. 
 
 Sitting up. An easy chair will be required, with a 
 sloping back, plenty of pillows (under your patient and 
 at her back), also a second chair or foot-rest for her feet. 
 Place the chair close to the bed, so that there may be no 
 unnecessary steps for the patient. Arrange a blanket 
 corner-wise over the pillows in the chair, so that it will 
 wrap well around and over your patient. 
 
 Stockings and wrapper will be suffioient additional 
 clothing the first time of sitting up. After these are put 
 on, draw your patient to the edge of the bed, bend her 
 knees over the side, slip one arm around her back, and 
 the other under her thighs and lift her gently into the 
 chair. 
 
 It is not wise to allow the patient to sit up long at a 
 time ; half an hour the first day will be found quite suffi- 
 cient, and after the first day sitting up for a short time, 
 
COMFORTS FOR THE PATIENT 23 
 
 twice in the day instead of a longer period at one time, 
 will be found far less tiring. Turn the mattress and 
 allow the bed to air while your patient is out of it. The 
 pleasure of being up at first is so great, that people are 
 apt to go beyond their strength, not realizing that a reac- 
 tion will come afterward, so you must insist upon the 
 invalid returning to bed before the slightest weariness is 
 felt. Sitting up in an easy chair is better than reclining 
 on a sofa, as it is a complete change from the bed, and 
 helps to restore the strength more rapidly. 
 
 After the first day or two, unless the doctor gives spe- 
 cial directions about it, a few steps should be taken, in- 
 creasing them slowly each day until the limbs have re- 
 gained their strength. Some invalids lose all desire to 
 walk, and have to be coaxed and encouraged to commence. 
 In one case it was found necessary to put the chair a lit- 
 tle farther from the bed each day, and insist on the patient 
 walking to it, so that by slow degrees she was persuaded 
 to walk across the room. 
 
 When the patient is well enough to sit up, though un- 
 able to go out of doors, you may give her a great deal of 
 pleasure and fresh air, by wrapping her in blankets and 
 shawls, taking care to cover the head completely, and then 
 open wide the window and close the door to prevent 
 draughts. Let her sit near the window or walk around 
 the room for half an hour. This will be found almost as 
 refreshing as a drive through the streets. After shutting 
 the window, do not remove the extra wraps for a few 
 minutes until the room becomes warm. 
 
 Amusements. Eeading aloud is a delightful way to 
 pass away the time, but a little tact must be exercised in 
 selecting the books to be read, and do not tire your pa- 
 tient by reading too long without intermission. The strain 
 of listening for more than an hour at a time is very tiring 
 to the nerves. Simple little games that are not too ex- 
 citing make a pleasant variety in the long day. Do not 
 
24 A TEXTBOOK OF HOME NURSING 
 
 allow the invalid to read or write for more than half an 
 hour without resting, if the eyes are weak ; as using them 
 while in a recumbent position is likely to strain them. 
 As soon as possible get your patient out into the open air. 
 This can be done even before she is able to walk down- 
 stairs, by having her carried down, seated in an ordinary 
 chair. There is great healing property in the open air — 
 healing to both mind and body, and a drive of even fifteen 
 minutes or half an hour in God's glorious sunshine will 
 often do more than any medicine. 
 
 Tact. Tact is of the utmost importance in nursing the 
 sick. Sometimes it is necessary to insist upon their doing 
 things to which they strongly object, and it is only by 
 gentle persuasion th^t they will yield. Ordering or in- 
 sisting upon the fulfillment of your object will be of no 
 avail and only excite and annoy them. During convales- 
 cence it is especially necessary to tempt the appetite with 
 dainty dishes, nicely served. Some patients try to get well 
 too quickly, and have to be held back, as they run the risk 
 of having a relapse by drawing too much on their newly 
 acquired strength. 
 
 Infinite patience is needed to put up with all their 
 little whims and fancies. It is not always wise to keep 
 asking an invalid what she would like, or what she wishes 
 you to do, whether it be a drink, a pillow changed, a blind 
 closed, a little reading, or any other attention. Do what 
 you think best at the time, unless it is absolutely necessary 
 to consult her, and, in nine cases out of ten, what you do 
 will be appreciated much more than if the patient had 
 been called upon to decide the question. 
 
 Anything in the shape of a little surprise, either some- 
 thing dainty to eat or drink, a few flowers, a new book or 
 magazine, a pretty picture, or simply some cheery bright 
 words of sympathy and comfort, will go a long way in 
 brightening the weary days, and will bring many a gleam 
 of sunshine into the shut-in life. 
 
COMFORTS FOR THE PATIENT 25 
 
 Routine of nurse's daily duties. The Home Nurse 
 has to plan her daily routine so that the care of the in- 
 valid may be included in the " common round and daily 
 tasks " of housekeeping, and home-making. This is espe- 
 cially to he observed should it develop on the "Home 
 Mother " to assume the duties of nursing. 
 
 The order of the day (varying to meet the individual 
 case) might run as follows: 
 
 1. Wash patient's face and hands, swab out mouth or 
 have him clean his teeth, shake up the pillows and open 
 wide the windows. 
 
 2. Prepare family breakfast, but serve the patient first. 
 
 3. Plan out meals for the day, tidy the house. 
 
 4. Give patient a bath (see page 44), get him up on 
 chair or sofa (if not confined to bed), straighten up the 
 sick room (see page 20). Give patient " between meals " 
 nourishment, and any necessary medication. 
 
 5. Prepare dinner or lunch. 
 
 6. Serve patient's dinner first, clean away dishes. 
 
 7. Make patient comfortable, to sleep or rest for two 
 hours. 
 
 8. Serve four o'clock nourishment. 
 
 9. Prepare evening meal; serve patient first. 
 
 10. Get ready for the night, face and hands washed, 
 back rubbed, draw sheet and nightgown changed (see page 
 7). Give extra nourishment about 9 p. m. 
 
 11. See that all supplies are on hand for the night, 
 nourishment for early morning hours, smaU stove, extra 
 bedclothes, etc. 
 
 12. Always arrange for a friend or member of the fam- 
 ily to relieve the Home Nurse for at least two hours' walk 
 in the open air during the day. When the illness is such 
 that constant care is required during the night, a night 
 nurse should be engaged, so that the Home Nurse may 
 have the uninterrupted sleep required. 
 
26 A TEXTBOOK OF HOME NURSING 
 
 SUMMARY 
 
 Comforts for the patient, mental and physical. 
 
 Eest of mind. 
 
 Avoid household worries. 
 
 Whispering. 
 
 Banging doors and rattling windows. 
 
 Oil hinges to prevent squeaking. 
 
 To be avoided: 
 
 Sitting on bed. 
 
 Talking in loud voice. 
 
 Walking heavily. 
 
 Clattering dishes. 
 
 Moving heavy furniture. 
 
 Changing position of patient. 
 
 Comfort of pillows and pads. 
 Hot water bottles. 
 Elevating legs. 
 Rubber rings. 
 
 Pressure sores and bed sores. 
 
 Necessity for watchfulness. 
 
 Vitality low in long chronic illness. 
 
 When skin is broken it is difiBcult to heal. 
 
 Location of pressure sores. 
 
 Causes of pressure sores. 
 
 Prevention of pressure sores. 
 
 Easier to prevent than to heal. 
 
 Symptoms of bed sores. 
 
 Care of the affected parts. 
 
 Crumbs removed. 
 
 Bed free from wrinkles. 
 
 Care of rubber rings. 
 
 Moving your patient to change position. 
 
 Use appliances to relieve pressure. 
 
SUMMARY CHAPTER II 27 
 
 How to prepare rubber rings for service. 
 Carefulness with involuntary evacuations. 
 Oakum pad. 
 
 Consult doctor at first sign of pressure sores. 
 Resting a tired back by rubbing. 
 
 Bed-pans. 
 
 Warm before using. 
 
 Support back of patient when inserting pan. 
 
 Bathe parts after use of pan. 
 
 Note contents of pan for doctor's record. 
 
 Care of mouth and teeth 
 Before and after meals. 
 Simple mouth wash. 
 Special care in cases of fever. 
 
 Doctor will prescribe mouth wash to use when patient is 
 unable to wash her teeth. 
 
 Care of the hair. 
 
 Boudoir caps. 
 
 Well brushed hair. 
 
 How to comb and brush the hair without troubling the 
 
 patient. 
 Vaseline or alcohol to remove tangles. 
 Two braids most comfortable to patient. 
 Massaging head at night, helpful to sleep and prevents 
 
 hair falling out. 
 
 Bed jackets. 
 
 Three kinds. 
 Comfort in use. 
 
 Bed socks. 
 
 Especially helpful with elderly patients. 
 
38 A TEXTBOOK OF HOME NURSING 
 
 Screens. 
 
 Indispensable in sick room. 
 
 Light weight. 
 
 How to make screens at home. 
 
 Sick room refrigerators. 
 
 Necessity in long illness. 
 
 Different compartments. 
 
 Save steps of Home Nurse. 
 
 Once a day all supplies carried upstairs to refrigerator. 
 
 Eefreshments on hand all the time. 
 
 During infectious diseases patient's food must be kept 
 separate from that of family. 
 
 How to preserve ice without refrigerator. 
 
 Cracking ice for ice-bag or ice-cap. 
 
 Keeping milk, broth or water during night without re- 
 frigerator. 
 
 Fly curtain. 
 
 When screens are not available. 
 On out-door sleeping porches. 
 
 Flowers. 
 
 Various kinds. 
 
 Delight to patient. 
 
 Care of plants. 
 
 Plant life important as air-purifier. 
 
 Order in the sick room. 
 
 Necessary for patient. 
 Caring for floors, furniture, etc. 
 Remove soiled clothing. 
 Cleaning of bed-pans. 
 Prevention of bad odors. 
 Removal of empty dishes. 
 Medicine appliances out of sight. 
 
SUMMARY CHAPTER II 29 
 
 Stains removed from carpet or bed. 
 
 Visitors. 
 
 Difficult problem in sickness. 
 
 Not allowed to enter with damp clothing. 
 
 'No depressing news, 
 
 Number and kinds of visitors, and length of visit. 
 
 Convalescence. 
 
 Difficult period for patient and nurse. 
 
 About sitting up. 
 
 How to arrange chair and patient. 
 
 The first few steps. 
 
 Fresh air bath. 
 
 Reading aloud. 
 
 Eyes weak. 
 
 Getting out of doors. 
 
 Tempting appetite. 
 
 Tact of great importance. 
 
 Routine of nurse's daily duties. 
 
CHAPTEK III 
 
 TEMPEEATUKE. PULSE. EESPIEATION. THE GIVING 
 OF MEDICINES 
 
 Temperature. The temperature of the body is a very 
 important factor in the treatment of disease. When any 
 part of the system is out of order, it is at once shown by 
 a rise or fall of temperature; and if there should be a 
 difference of more than a degree above or below the normal 
 mark, without any apparent cause, such as sudden alarm 
 or intense nervous excitement, you may take it as a sign 
 that trouble is brewing somewhere. 
 
 It is not diflScult to take a person's temperature, and 
 at least one member of every family should be able to use 
 a little clinical thermometer. 
 
 The normal temperature of the body is 98.6° F. ; the 
 normal pulse about 72 beats to the minute ; and the respi- 
 ration 18 breaths to the minute. These are considered 
 the average marks, but it must be remembered that there 
 is apt to be a slight variation above or below the average, 
 according to the temperament of the individual. For in- 
 stance, an easy-going, placid person will have a slower 
 pulse, and frequently a lower normal temperature, than 
 one of a nervous excitable disposition. A rise in tempera- 
 ture, or an increase in the pulse and respiration, is not as 
 important in a child as in an adult. 
 
 The temperature of the body in health is always slightly 
 higher in the evening than in the morning ; about 6 p. m. 
 it is at the highest then gradually declines until morning. 
 Children have a higher average temperature than " grown 
 
 30 
 
TEMPERATURE. PXJLSE. RESPIRATION 31 
 
 ups " ; and in elderly people the temperature is, as a rule, 
 on a lower average. 
 
 A temperature below 95° F. almost invariably means 
 death, as it indicates that there is not enough heat to en- 
 able the vital organs to do their necessary work. 
 
 How to use a thermometer. Before using a clinical 
 thermometer shake it carefully (holding the bulb end 
 downwards), until the mercury falls below the mark 96° 
 F. ; then insert the bulb end in your patient's mouth, well 
 under the tongue, make her close the lips firmly so that no 
 air will enter, and leave it there for a full three minutes. 
 Unless the lips are kept tightly closed all the time you will 
 not get the true temperature of the body. At the end of 
 three minutes remove the thermometer and note carefully 
 the exact position of the mercury, that is to say, at what 
 number on the thermometer the mercury stands. 
 
 Care of the thermometer. Before using the ther- 
 mometer it is always necessary to wash the bulb in cold 
 water, and after you have finished dip it in a little alcohol, 
 or some disinfectant solution, to guard against any chance 
 of infection. 
 
 In fever cases the thermometer, which is frequently 
 used during the twenty-four hours, should be kept stand- 
 ing all the time in a glass containing 1:1000 bichloride 
 of mercury, or in alcohol. A piece of cotton wool in the 
 bottom of the glass will prevent the thermometer break- 
 ing, and it should be rinsed off in plain water and wiped 
 with cotton, before being placed in the patient's mouth. 
 
 When to take the temperature. It is necessary to 
 take your patient's temperature about the same hour 
 morning and evening, so that you will be able to notice 
 exactly any changes that may take place from day to day. 
 Stimulating meats and drinks tend to elevate the tempera- 
 ture of the body, and therefore half an hour or an hour 
 should elapse after meals before using the thermometer. 
 Do not allow hot or cold drinks or ice to be taken for at 
 
33 A TEXTBOOK OF HOME NURSING 
 
 least fifteen or twenty minutes before using the thermome- 
 ter by mouth, as it will prevent your getting the exact 
 temperature. 
 
 Temperature by rectum. In the case of a child 
 under four or five years of age it is almost impossible to 
 take the temperature by mouth as it is diflScult to prevent 
 the child biting the thermometer, and impossible to make 
 her keep her mouth closed firmly for even three minutes. 
 The only safe way is to take it by the rectum. This is 
 also necessary in the case of a delirious or unconscious 
 patient, and in typhoid fever, where the temperature has 
 to be closely watched, as the rectal temperature is consid- 
 ered more accurate. To take a rectal temperature, after 
 shaking down the mercury, cover the bulb with oil or vase- 
 line, and with the patient lying on the left side, insert the 
 thermometer slowly and gently, about an inch and a half 
 into the rectum, holding it there three minutes. Try and 
 keep the child from crying, if possible, by distracting her 
 attention, as crying would elevate the temperature. It is 
 important to remember that a rectal temperature always 
 registers about one degree higher than the temperature 
 taken by mouth. When taking the rectal temperature 
 of a child, or of an hysterical or delirious patient, do not 
 leave them until you have withdravra the thermometer. 
 
 Pulse. While the thermometer is being used you may 
 at the same time take the pulse and respiration. The 
 pulse is counted by placing the first and second finger of 
 one hand very lightly on the inside of your patient's wrist. 
 After pressing gently but firmly you wUl feel in a few 
 seconds the steady beat of the pulse. Then time the beat 
 by a watch, counting either by the half minute, and 
 doubling the result, or else counting the full minute. It 
 is always best, when taking the pulse, to go over it twice 
 for fear of making a mistake. The pulse can be counted 
 on other parts of the body besides the wrist, but that is the 
 easiest and most convenient place to get it except in spe- 
 
TEMPERATURE. PULSE. RESPIRATION 33 
 
 cial cases. Sometimes when the patient is sleeping you 
 will be able to count the pulse in the temple better than at 
 the wrist without disturbing her. Never try to count a 
 pulse with your thumb, the little pulse beat that is in 
 your own thumb will interfere with an accurate account 
 of the pulse beat in your patient's wrist. 
 
 Points to be noted. The principal points to be no- 
 ticed in taking the pulse are : the strength, frequency, and 
 regularity of the beat. Never press too firmly against 
 the wrist, or you will not be able to detect the pulse beat ; 
 also see that your patient's hand and arm are at rest, and 
 not in a strained position. It is not necessary in this lit- 
 tle book for Home Nurses to go into details about the 
 different kinds of pulse beats and what they indicate; 
 that can only be acquired by a great deal of practice and 
 study, and does not come within the sphere of Home Nurs- 
 ing. 
 
 Change in the pulse beat. The pulse is always 
 quicker when the patient is standing or sitting up, than 
 when lying in bed ; therefore it is more accurate to count 
 the pulse when your patient is in the same position each 
 day. A very slight cause will often be the means of in- 
 creasing the pulse beat perceptibly, and in nervous or 
 excitable people the pulse sometimes varies according to 
 their feelings. The pulse of a nervous patient will jump 
 up when there is a knock at the door, or if the doctor 
 enters unexpectedly. When the temperature and pulse 
 rise at the same time, and do not show any signs of going 
 down again within a couple of hours, it is almost certain 
 that there is trouble somewhere, and you wiU do well to 
 consult the family doctor. 
 
 Respiration. If possible, count the respiration with- 
 out the knowledge of your patient, because if she is con- 
 scious that you are watching her respiration, it will be 
 impossible for her to breathe naturally. You can easily 
 see the rise and fall of the, chest with every breath, and if 
 
S4. A TEXTBOOK OF HOME NURSING 
 
 not distinct enough during sleep you can feel it by placing 
 your hand lightly on the chest. Eespiration below twelve 
 or above thirty to the minute should always be watched 
 and reported. Temperature, pulse, and respiration will 
 be found more accurate if you take them when your pa- 
 tient is lying down in a restful position instead of sitting 
 or standing. Lying flat on the back is a great rest and 
 refreshment to the system, and generally relaxes and 
 soothes the nerves. A well-known physician writes that 
 a woman should never stand when she can sit, and never 
 sit when she can lie down. During sleep the pulse is a 
 little slower than when awake, but with delirious people 
 and children it is necessary to count the pulse and respira- 
 tion while they sleep, as it is almost impossible to take 
 them accurately when they are awake. 
 
 Medicines. There is much to be learned about the 
 giving of medicines, but we will only mention a few sim- 
 ple rules that can easily be followed, and are necessary to 
 all who try their hand at nursing. 
 
 Caution about medicines. All medicine bottles and 
 boxes should be most distinctly labeled and kept carefully 
 locked away out of the reach of children. A pathetic 
 story is told of a child who one day told her mother glee- 
 fully that she had given baby a pretty white candy she 
 had found in a little box, and that baby had gone to sleep 
 immediately! On investigation the poor mother found 
 that the child had given baby a morphine pill, and that 
 it was impossible to save the little one's life. Another 
 child was discovered by her mother building a little bridge 
 with strychnine tablets she had taken from their " pretty 
 pink box." 
 
 Rules in giving medicines. Never give a medicine 
 of any kind, no matter how well you know the bottle, vidth- 
 out first taking it to the light and reading the name very 
 carefully. Some authorities go so far as to say that the 
 label ought always to be read twice before giving the medi- 
 
THE GIVING OF MEDICINES 35 
 
 cine, first before pouring it out, and then again after meas- 
 uring it. So many dreadful accidents have occurred from 
 unintentional carelessness regarding this important rule, 
 that one cannot enforce it too strongly. Another error that 
 must be carefully guarded against is the practice of mix- 
 ing solutions or lotions in various bottles and letting them 
 stand about without any label to show what the mixture 
 is. 
 
 When water is ordered to be mixed with the medicine, 
 use it very cold or very hot ; lukewarm water is nauseating, 
 and is quite sufficient to upset a delicate stomach. When 
 a powder has to be given from the paper wrapping, pour 
 it well back on the tongue, and have a glass of ice cold 
 water ready to drink. Oil of any kind is more easily 
 taken when a piece of ice is first melted in the glass or 
 spoon, and some small pieces of ice on hand to su(i after- 
 wards. 
 
 Nearly all medicines need to be well shaken before being 
 poured out, so as to thoroughly mix the ingredients, and 
 if you pour the medicine from the side of the bottle away 
 from the label, you will keep the label clean and prevent 
 its being blotted out by drops falling from the mouth of 
 the bottle. 
 
 Always replace the cork immediately after using a bot- 
 tle. All tinctures should be kept in a dark place. Some 
 drugs change character when kept many months, ,so the 
 family medicine chest should be thoroughly gone over 
 every six months at least, and the remedies no longer 
 needed destroyed. Pills that have been kept any length 
 of time get so hard that they will not dissolve in the 
 stomach, and pass out of the system without doing any 
 good. In giving sleeping medicine wait until all is quiet 
 for the night, and your patient comfortably arranged m 
 bed. A hot drink given with a sleeping powder will 
 hasten its effect. 
 
 When to give medicines. Medicines to stimulate the 
 
36 A TEXTBOOK OF HOME NURSING 
 
 appetite are given before meals, tonics generally one-half 
 hour after meals. Laxatives are given at night, unless a 
 very quick effect is desired when they are given before 
 breakfast. Medicines should always be given at exactly 
 the time ordered, not half an hour earlier or later, unless 
 the patient is sleeping and is not to be disturbed; and 
 about half an hour should be allowed between medicine 
 and food. Iron and cod-liver oil are amongst the medi- 
 cines given after meals, and iron must be taken through 
 a tube if in liquid form, as it is injurious to the teeth. 
 When a course of iron is prescribed it will, as a rule, be 
 found very constipating, and a laxative of some kind 
 will be needed every few days. Lemon juice taken in the 
 mouth before and after a disagreeable dose, or chewing 
 a crust of bread or a clove, will be of great assistance in 
 removing the taste. You may sometimes disguise the taste 
 of medicine altogether in food or drink of some kind when 
 you have a delirious patient or a child who refuses to take 
 it. When that is impossible make the dose very small by 
 not adding much water, and compress the nostrils, when 
 the patient will be obliged to open her mouth for breath, 
 and you will be able to slip the medicine down her throat. 
 
 Some people find it very difficult to swallow pills. One 
 of the easiest ways to manage is to place the pill under 
 the tip of the tongue, instead of on top of it, take a drink 
 of water, and the pill wiU disappear. If you prefer, you 
 may crush the pill into powder and give it dry on the 
 tongue, or roll it in jam or bread. Other people object 
 to powders, and this may be overcome by placing the 
 powder in a little gelatine wafer. They then slip down 
 the throat easily. These wafers may be bought at any 
 dru^st's, and are inexpensive and useful. Another way 
 to dispose of a powder is to dissolve it in water, and when 
 it does not mix well, use a little glycerine first to moisten 
 it, then add the water. 
 
 How to measure medicines. Medicines should be 
 
THE GIVING OF MEDICINES 37 
 
 measured very carefully, as with some drugs even a drop 
 more or less will make a great difference. The graduating 
 glass will be found the most accurate for measuring, or a 
 glass dropper with a rubber bulb at one end, when the 
 dose has to be measured by drops. Children need much 
 smaller doses of medicine than adults, and the amount 
 must be regulated according to their ages. A child 
 three years old takes one-sixth the dose of an adult. 
 Speaking generally, and for home remedies, one teaspoon- 
 ful equals a fluid drachm, and a tablespoonful equals half 
 an ounce. 
 
 Disguising the taste of medicines. In giving castor 
 oil, it is very easy to disguise the taste completely. Given 
 in orange juice to a child, it is taken with delight; half 
 the juice is poured into a glass, then the oil, and afterward 
 the remainder of the juice on top. The best way to mix 
 it for an adult, is to pour one teaspoonful of whiskey, 
 brandy, lemon juice or orange juice, in a wine glass, let 
 it run all around the surface of the glass to wet it. Then 
 dip the teaspoon in very hot water (so that the oil may 
 not stick) and measure out five teaspoonfuls of oil into 
 the wine glass, add a little more of ihe orange or lemon 
 juice on top. If the patient will suck a piece of orange 
 or lemon, immediately before and after taking the oil she 
 will not taste it. Castor oil can also be completely dis- 
 guised in soda water, with a good deal of flavoring. 
 
 Rules about prescriptions. When a prescription for 
 medicine is given by a doctor it is always well to ask the 
 druggist for a copy of the prescription; you will then be 
 sure you are getting exactly what has been ordered, and 
 if you need the medicine renewed at any time when away 
 from home, you have the prescription to which to refer. 
 It is also of great importance sometimes to know what 
 you are giving or taking in the way of medicine, as drugs 
 affect people differently. Some patients cannot stand 
 even a small dose of certain medicines. We know of one 
 
38 A TEXTBOOK OF HOME NURSING 
 
 family, no member of which can take the smallest amount 
 of opium in any form, without showing signs of poisoning. 
 It is not a safe thing to prescribe drugs for your friends 
 without a doctor's direction, except in the most simple 
 household remedies. 
 
 A lady told me once that having found ten grains of 
 phenacetine very helpful when she had a nervous head- 
 ache, she recommended it to her sister who was suffering 
 in a similar manner. Shortly after taking it her sister 
 went into a state of collapse, and it was hours before she 
 recovered from the effects. They discovered that the girl 
 had some heart trouble entirely unknown to herself or the 
 family, and the phenacetine proved too depressing. 
 
 When giving medicine put it into a small dainty glass, 
 perfectly clean, with a glass of ice water, and a piece of 
 orange or lemon on a little tray covered with a snowy nap- 
 kin, and thus by making the dose look attractive, you will 
 lighten very much the disagreeable task of taking it. 
 
 Medicines given in suppositories. Oil the supposi- 
 tory very thoroughly (vaseline is best) and gently push it 
 up as far into the rectum as you can. After which, hold 
 a napkin, or towel close pressed against the rectum, until 
 the muscles relax, and there is no fear of the suppository 
 being returned. 
 
 How to use eye drops. The doctor may order drops 
 for your patient's eyes. Many people think the drops 
 should be put in the corner of the eyes near the nose, but 
 that is not right ; to be properly absorbed all over the eyes, 
 the drops should be dropped in the center of the eye. Hold 
 the lower lid down with your finger, and while your patient 
 turns her eye to the ceiling, drop the medicine under the 
 lower lid in the center of the eye. When she blinks her 
 eyes the medicine will go all over the eye ball, not disap- 
 pear down through the nose as it would if dropped into 
 the corner. 
 
 Medicines given by inhalation. In croup, asthma, 
 
THE GIVING OF MEDICINES 39 
 
 laryngitis, etc., the doctor may order medicines such as 
 creosote, and tincture of benzoin, etc., to be put in boiling 
 water and inhaled through the steam. 
 
 An ordinary pitcher may be used ; heat it well with 
 boiling water, poured over it, then fill it three quarters full 
 of boiling water, add the medicine, fold a towel around 
 the patient's nose and mouth and over the top of the 
 pitcher so that she may draw in the steam and have the 
 full effects of the drug. 
 
 How to make a croup kettle. A croup kettle, or an 
 ordinary kitchen kettle is of great service for inhaling. 
 You may keep it boiling by means of a little stove (gas, 
 oil, or electricity) near your patient's bed; then make a 
 cone of stiff paper or cardboard, covered with a towel, fit 
 the small end over the spout of the kettle, and the large 
 end over the patient's mouth. 
 
 Croup tents may be needed in a home when there are 
 children. An umbrella or three-sided screen answers the 
 purpose, an old blanket is thrown over this support to 
 absorb the moisture, then a sheet to make it tidy; the 
 kettle at the side or back of the bed on a little stove. 
 Great care should be taken to guard against fire; also 
 that the patient is protected from touching the spout of 
 the kettle or having the steam touch her face directly. 
 
 SUMMARY 
 
 Temperature. 
 
 In treatment of disease what a rise or fall of temperature 
 
 indicates. 
 A degree above or below normal to be watched. 
 One member in family able to use clinical thermometer. 
 Normal temperature. 
 Pulse. 
 Respiration. 
 How they vary. 
 
40 A TEXTBOOK OF HOME NURSING 
 
 Rise in temperature in adult more important than in child. 
 Temperature of body in health highest in evening. 
 Meaning of temperature below 95° F, 
 
 How to use a clinical thermometer. 
 
 Shake down carefully until mercury is below 96° F. 
 
 How to insert thermometer in mouth. 
 
 Eemove in three minutes and note result. 
 
 Care of thermometer before and after using. 
 
 Special care in fever cases. 
 
 Time of taking temperature. 
 
 Foods and drinks that influence temperature. 
 
 Temperature by rectum. 
 
 When taken by rectum how to use thermometer. 
 
 Keep child or patient quiet. 
 
 Rectal temperature highest register. 
 
 Never leave patient alone with thermometer in rectum. 
 
 Pulse. 
 
 How to count it and where. 
 
 Light gentle pressure. 
 
 Counting twice over to be accurate. 
 
 Pulse may be counted different parts of body. 
 
 Do not count pulse with your thumb. 
 
 Principal points in taking pulse. 
 
 Reason for not pressing too firmly when counting. 
 
 Patient's hand and arm at rest. 
 
 Not necessary to describe different kinds of pulse beat in 
 
 this book. 
 Pulse always quicker with patient standing and sitting 
 
 than lying down. 
 Slight causes increase the pulse beats. 
 Importance of noticing if temperature and pulse rise at 
 
 same time. 
 
SUMMARY CHAPTER III 41 
 
 Respiration. 
 
 When and how to count it. 
 
 Best during sleep. 
 
 Temperature, pulse, respiration taken more accurately 
 
 when patient is lying down. 
 Pulse slower during sleep. 
 
 Medicines. 
 
 Few simple rules when giving medicines. 
 
 Bottles and boxes to be carefully labeled and kept out of 
 
 reach of children. 
 Bead label first before giving medicine. 
 Terrible accidents result from neglect of this rule. 
 No bottle to be kept without a label. 
 Water used with medicines, very hot or very cold. 
 How to give a dry powder. 
 
 Ice used when giving oil will help to disguise taste. 
 Shake medicine well before pouring out. 
 Pour medicine from side of bottle away from label. 
 Cork to be replaced after using. 
 Tinctures to be kept in dark place. 
 Drugs deteriorate with age. 
 
 Medicine chest to be gone over every few months. 
 How to give sleeping powders. 
 Medicines to be given exactly on time. 
 When to administer tonics, laxatives, etc. 
 Disguising the taste of medicines. 
 Giving medicines to a child. 
 Easy way to give pills and powders. 
 Measuring of medicines. 
 Doses for children. 
 Castor oil given without taste. 
 Copy of prescription from druggist. 
 Never prescribe medicine to friends. 
 Dainty way to administer disagreeable doses. 
 
42 A TEXTBOOK OF HOME NURSING 
 
 Medicines given in suppositories. 
 Oil carefully 
 Insert gently. 
 Eestrain muscles firmly. 
 
 How to use eye drops. 
 Where to insert drops. 
 Never in corner of eye. 
 How to hold lid. 
 
 Medicines given by inhalation. 
 
 In cases of croup, asthma, laryngitis, etc. 
 
 Pitcher may be used. 
 
 How to prepare it. 
 
 A " croup kettle " made at home. 
 
 Appliances needed — stove, stiff paper over kettle. 
 
 Arrange tent over bed. 
 
 Guard against burns from stove or steam. 
 
CHAPTEK IV 
 
 BATHS CLBAJifSIWG A1TI> MEDICINAX. 
 
 Baths. If every one understood how necessary baths 
 are in the prevention as well as the cure of disease, and 
 how much they add to bodily comfort, the daily baths 
 would never be omitted, in health or sickness. 
 
 Once upon a time in the days of our great, great grand- 
 mothers, a weekly bath (usually Saturday night) was 
 considered to be all that any one could demand in the way 
 of cleanliness. But we have learned the great importance 
 of the daily bath to keep our bodies in perfect physical 
 condition, by opening the pores of the skin, and thus re- 
 moving the waste material from the blood, brought to the 
 surface by numerous little sweat glands. 
 
 Also we recognize the good moral as well as physical 
 effect that is experienced when one emerges from the bath- 
 tub, skin fresh and glowing as a result of hot water and 
 friction; for bathing stimulates the circulation, and thus 
 helps the blood to throw off impurities. 
 
 Therefore during an illness, thorough cleanliness of the 
 body is a most positive aid to the restoration of health. 
 
 There are two classes of baths ; a bath to make one clean, 
 and a bath for medicinal purposes. 
 
 For herself — the Home Nurse will find a quick plunge 
 into cold water, or a cold sponge bath, and brisk rub with 
 rough bath towel before breakfast, a wonderful stimulant 
 for her day's work (especially if her sleep has been broken 
 with night nursing). 
 
 For your patient, an hour or two after breakfast is the 
 time for baths, though sometimes a bath at night before 
 " sleeping time " will be found more restful. In either 
 
 43 
 
44) A TEXTBOOK OF HOME NURSING 
 
 case, the strict rule of allowiag one hour between meal and 
 bath should never be broken. The bath stimulates circu- 
 lation and takes from the stomach some of the blood re- 
 quired by the glands of the stomach, to digest food — and 
 therefore indigestion, nausea and headache frequently fol- 
 low when a bath is given inmiediately after eating. 
 
 Daily bath in bed for cleanliness. During sickness 
 an extra need exists for the use of soap and water, espe- 
 cially when there is any fever, as the pores of the skin 
 require to be kept open. The daily bath is also most re- 
 freshing and stimulating when the system is weakened 
 with sickness; besides this, the muscles have no chance 
 of working while lying in bed, so that a little gentle rub- 
 bing each day after the bath will be found to be of great 
 service in keeping them in good shape. When rubbing the 
 surface of the body, a little vaseline or cold cream should 
 be used on the hands to make them pass smoothly over the 
 skin. 
 
 Preparation for bath. Before giving a bath in bed, 
 you should have everything needful at hand, so that you 
 need not stop in the middle of the bath, leaving your pa- 
 tient half dried, while you run for extra towels, clothing, 
 or other necessaries. If you intend putting on a clean 
 nightgown, undervest, or pajamas, hang them over a chair 
 in front of the fire or register so that they may not chill 
 the patient. Should he be weak or liable to take cold 
 easily, have a hot water bag filled ready to apply to the 
 feet, and be careful that the windows are shut, the room 
 warm and that no draughts may reach the bed. Place a 
 chair or small table at the side of the bed ready for the 
 basin or foot-tub, which is to be filled with very hot water ; 
 and a little extra hot water should be on hand, as it is apt 
 to cool quickly in a large wide basin. Two wash cloths 
 are better to use than sponges, one for the upper and one 
 for the lower parts of the body, also a bath towel and a 
 couple of soft ones for the face and hands. Castile soap 
 
BATHS — CLEANSING AND MEDICINAL 45 
 
 is the best and purest, and a little alcohol or salt in the 
 water will be found very refreshing and is a safeguard 
 against taking colds. 
 
 Giving the bath. "When all is quite ready and the 
 room warm and comfortable, remove your patient's cloth- 
 ing and place him between two blankets, or, if you prefer 
 it, use one blanket over, the bath towel underneath the por- 
 tion of the body you are washing, moving it from one side 
 to the other as you work. Never expose your patient more 
 than is absolutely necessary. A bath may be given en- 
 tirely under the blanket, so that the surface of the body 
 will not be exposed to the air. 
 
 The face is bathed first, then the neck, arms, chest, and 
 abdomen ; turn the patient on one side and bathe the back, 
 and finish with the legs and feet. Do not uncover the 
 body more than is necessary to wash each particular por- 
 tion. Dry each part carefully as soon as you wash it, 
 especially behind the ears, between fingers and toes, under 
 the arms, and the pelvic region. Eemove the towels and 
 blankets, and put on the fresh warm clothing. The feet 
 may be placed right in a small tub of water. To do this : 
 bend up your patient's knees, and lift the legs and feet 
 with one hand while with the other you insert the foot- 
 tub and rubber to protect the bed. A nervous patient will 
 find great quietness to the nerves when the feet are allowed 
 to remain in the tub five or ten minutes, and are then well 
 dried and rubbed with alcohol. If the bath has proved 
 exhausting, give a drink of hot milk, broth, or eggnog, and 
 place a hot water bag at the feet. After the bath, always 
 clean the finger and toe nails, and brush the hair. 
 
 A bath in bed given according to these directions will 
 only take at the outside from fifteen to twenty minutes, 
 and will prove of great comfort to the invalid. And when 
 once your patient is persuaded to have a bath, he is quite 
 surprised at the ease with which it can be given, and the 
 comfort and refreshment resulting. 
 
46 A TEXTBOOK OF HOME NURSING 
 
 Bath for the hair. Follow the same rule in regard to 
 having everything on hand required. Canthrox, soap so- 
 lution, or Castile soap; cold and hot water, towels and a 
 piece of rubber sheeting. Draw your patient over to the 
 edge of the bed, then cover the pillow with a piece of rub- 
 ber sheeting and heavy bath towel ; turn the lower ends up 
 around her neck to pin them under her chin ; make a littld 
 hollow under the head, by extra pillows on each side to 
 hold the rubber sheet up at the edges. Have the basin or 
 foot-tub on a chair on a lower level than the pillow, and 
 make a trough with the rubber sheet, down into it for 
 the water to run off. Eub the shampoo into the hair, and 
 scalp, then pour a little hot water over the head to wash 
 off the soap; repeating this two or three times, rinse off 
 with cold water; dry the hair as well as possible, remove 
 the rubber sheet and bath towel, cover the pillow with a 
 warm dry towel, and spread the hair out on both sides. 
 
 Baths for babies. The Home Nurse may frequently 
 be called upon to bathe a small child, or even a tiny infant, 
 and the following suggestions should be followed : 
 
 Regarding the temperature of the water: the rule is, 
 the younger the child, the hotter the water. A three 
 months' baby requires water at 95° to 100° F. A year- 
 old baby can stand from 85° to 90° F, and a two-year-old 
 about Y5° to 80° F. Never give a bath to a baby without 
 a bath thermometer for the skin of a baby is very sensitive 
 and easily hurt. 
 
 A tiny baby about a month old should not be in the tub 
 more than two or three minutes. 
 
 Giving the bath. Before giving the bath have all the 
 appliances on hand, put on a rubber apron and heavy bath 
 apron; undress the baby and wrap her in a bath blanket. 
 It is wiser with a tiny infant to wash face, ears, fingers, 
 toes, buttocks, etc., before putting her in bath, then sup- 
 port the back of her head and shoulders with your left 
 
BATHS — CLEANSING AND MEDICINAL 47 
 
 hand and hold the legs with your right while you place 
 her in the tub (a small towel placed in the bottom of the 
 tub is best for an infant to rest on). 
 
 A warm towel will be needed to dry her off, then a little 
 powder to prevent chafing of the skin. A child over three 
 years of age should be sprayed off with cold water after 
 the bath, as this hardens the system and prevents taking 
 cold. 
 
 Baths for medicinal purposes. There are many 
 kinds of different baths required during sickness, and 
 some of them will have to be given by the Home Nurse 
 under the doctor's directions, when no trained nurse is 
 available. 
 
 Baths to reduce temperature, stimulate the circulation, 
 soothe the nerves, cause perspiration, as counter-irritants, 
 etc. All kinds of medicated baths are of course given 
 only by the doctor's orders, and he will supervise the ar- 
 rangements. Some of the therapeutic baths cannot be 
 given outside a hospital, such as electric baths, light baths, 
 vapor baths, etc. We will therefore discuss only the kind 
 of baths that may be given with the limited appliances 
 of a private home, and by the Home Nurse. 
 
 Cold baths in fever cases. "Water is a very valu- 
 able instrument in overcoming the evil results of fever," 
 writes one of our celebrated physicians. In fever cases 
 the purpose of the cold bath is to improve the condition 
 of the heart, lungs, and kidneys, to reduce temperature 
 and soothe nervousness and mental conditions. At the 
 same time it must be remembered that cold baths are often 
 depressing and may result in shock when the system is 
 weakened by sickness. So the Home Nurse should never 
 give a cold bath of any description, to her patient, with- 
 out the approval of the doctor. For over twenty-five years, 
 cold tub baths and sponge baths have been used in this 
 country as a treatment in fever cases, and it is well for 
 
48 A TEXTBOOK OF HOME NURSING 
 
 tlie Home Nurse to be acquainted with the routine of 
 these baths so that she may know what to do in case of 
 an emergency. 
 
 Cold tub bath. Eequired articles are as follows : 
 
 A bath tub (a tin one might be procured and raised on 
 blocks to the level of the bed, or the patient carried into 
 the regular bath tub). 
 
 One pillow or rubber ring to support the head. 
 
 Bath thermometer. 
 
 Basin with pieces of ice (to add to the water when it 
 gets warm). 
 
 Gauze compress for the head. 
 
 Cotton to insert in the ears, to prevent the water enter- 
 ing. 
 
 Towel, or binder for the patient's loins. 
 
 Hot water bag to put in bed for the feet. 
 
 Dry towels. 
 
 Two blankets. 
 
 Piece of rubber sheeting. 
 
 Clean sheets. 
 
 Safety pins. 
 
 The physician will order the temperature of the water, 
 according to the age and constitution of the patient, about 
 70° F. to 80° F. is the general rule ; but a higher tempera- 
 ture is employed in the case of children and elderly people. 
 
 Giving the bath. Two or three people are always re- 
 quired to help. If a trained nurse is not in charge of 
 the case, the doctor will remain to take charge, and watch 
 the patient's pulse and general condition. Place the bath- 
 tub close to the bed, three quarters full of water. Some- 
 times in private homes the patient has to be carried into 
 the bathroom for the bath. Fasten a sheet over the top 
 end of the bathtub to ijiake a rest for her head and to 
 support air cushion or rubber ring, pin the binder round 
 her loins, put cotton in the ears, take off the nightgown, 
 and cover your patient with a sheet. Draw her to the 
 
BATHS — CLEANSING AND MEDICINAL 49 
 
 side of the bed, nearest the bathtub. There •will noit be 
 a stretcher in a private home, but a hammock net will an- 
 swer the purpose, or three people can lift her, or an iron- 
 ing board may be used covered with a blanket. One as- 
 sistant will grasp her under the arms and support the 
 head, a second will lift the waist and the upper parts of 
 the thighs, and the third the legs and feet. If the patient 
 holds herself stiff and straight it is easier to lift her, but 
 she must not be allowed to exert herself. The doctor will 
 order hot coffee or a stimulant, if necessary, before the 
 bath. Lower her gently into the bathtub, the cold com- 
 press (gauze dipped in ice water) is placed on the head, 
 and two assistants commence at once to rub the body to 
 cause friction. Cold water and friction must go hand in 
 hand, as one is not of value without the other. One assist- 
 ant rubs the arms, back and chest; the other, legs, thighs, 
 and feet. 
 
 In typhoid fever the abdomen should never be rubbed, 
 as it may produce a hemorrhage. 
 
 Friction must be kept up as long as the patient is in 
 the water, generally about fifteen minutes. Also the com- 
 press must be continually changed on the head to keep 
 it cold. When the bath thermometer shows that the water 
 in the tub is getting warm, a little ice is added to keep 
 it at the prescribed temperature. 
 
 • While the bath is given, one assistant should get the 
 bed ready, turn the mattress, put on a fresh under-sheet, 
 draw-sheet, and cover the bed with a blanket, rubber sheet 
 and cotton sheet in the order given; arrange hot water 
 bags (well covered) for the feet. 
 
 Before lifting the patient back into bed, unpin the 
 binder and let it drop off, then put a dry sheet over the 
 patient and lift her on to the bed; dry with the sheets, 
 slip out the two wet sheets and the rubber sheet and your 
 patient will lie on the blanket. Cover with another blan- 
 ket and place a hot water bag at her feet. Give her a hot 
 
50 A TEXTBOOK OF HOME NURSING 
 
 drink, broth or beef-tea (milk would not digest well after 
 such a bath). 
 
 The Home IS'urse will seldom if ever be called upon to 
 give a bath as just described, but as a substitute a slush 
 bath or tub bath in bed may be ordered by the doctor and 
 in the absence of a trained nurse the Home Nurse will 
 be in charge. 
 
 Slush bath or tub bath in bed. Appliances required 
 are the same as are used for a tub bath, omitting the tub. 
 
 The bath may be given by means of pouring the water 
 over your patient from a pitcher, while friction is kept up 
 by an assistant, or using a spray made by a rubber tubing ; 
 funnel and spray-end, extending from a tub or pail of 
 water placed on a table above the level of the bed. Again 
 the temperature of the water will be ordered by the doc- 
 tor. In giving a slush bath the water becomes warm rap- 
 idly, and small pieces of ice must be added to keep it at 
 the required temperature. 
 
 How to give the bath. A large rubber sheet is placed 
 imder the patient, and a cotton sheet over her (with a 
 towel across her loins), cold compresses for the head and 
 a hot water bottle at the feet. 
 
 There are two ways to make a trough for the water, to 
 run away, either by a roll of blankets at both sides of the 
 bed, and across the foot over which the rubber sheet is 
 well tucked in; or what is better, a clothes line fastened 
 all around the bed, or from a bar at the head of the bed 
 to a bar at the foot on both sides, and the edges of the 
 rubber sheet put over the cord, and if necessary fastened 
 there with clothes pins, or tie with cord sewed on to the 
 rubber. Then if you can have the head of the bed raised 
 on two pieces of wood, and the rubber sheet at the foot 
 folded close, pushed through the foot of the bed and di- 
 rected into a pail, the water will run off without trouble. 
 
 Friction must be kept up all the time, and must not be 
 too heavy as the skin will become sore. The patient's 
 
BATHS — CLEANSING AND MEDICINAL 51 
 
 back must not be neglected, the patient can be turned 
 slightly on her side when necessary. About ten or fif- 
 teen minutes is usually the length of this bath, then, re- 
 move the rubber sheet, dry your patient, cover with a 
 blanket and administer a hot drink. 
 
 Cold sponge baths. The Home Nurse will be called 
 upon to give sponge baths far more frequently than tub 
 baths or slush baths, for reducing temperature and toning 
 up the system. These baths should be given as quietly as 
 possible so that your patient may not be disturbed more 
 than is absolutely necessary. 
 
 Appliances. A foot-tub or large basin is filled with 
 water of temperature between 70° F. and 80° F. 
 
 A small basin containing pieces of ice to lower the tem- 
 perature of the water when necessary. Be careful not to 
 allow your patient to know the temperature of the water, 
 or to see the ice, as she may become nervous. 
 
 A bath thermometer. 
 
 Two large wash cloths. 
 
 Two cotton sheets. 
 
 One rubber sheet. 
 
 Bath blanket. 
 
 Hot water bottle. 
 
 Place the rubber sheet with towel over it under your 
 patient, remove nightgown, and cover your patient with 
 a sheet, then put a roUed-up blanket under the edge of 
 the rubber on each side of the bed, forming a hollow around 
 the body, and it will prevent the water dripping over the 
 mattress. Wring out a compress of gauze from the ice 
 water to cover the head (change it every three minutes but 
 do not let it drip into the ears). Before using the water 
 rub the body gently (except the abdomen) to promote cir- 
 culation. Sponge the arms and chest first, with long 
 even, downward strokes, changing the wash cloth after 
 every fourth stroke, and use plenty of water. Should 
 you have no one to assist you, sponge with one hand and 
 
52 A TEXTBOOK OF HOME NURSING 
 
 rub with the other, as friction must be kept up contin- 
 ually. After the arms and chest turn the patient gently 
 on one side and sponge the back, then the legs. About 
 five minutes should be given to each part except the legs, 
 which do not require so much sponging as they grow cold 
 quicker than the rest of the body. 
 
 Never under any circumstances rub or sponge the abdo- 
 men in typhoid fever, as there would be great danger of 
 hemorrhage or perforation. Exposure to the air will not 
 hurt the patient, and will reduce the temperature much 
 more quickly than if you keep all the body covered during 
 the bath. A sponge bath of this kind should last about 
 fifteen or eighteen minutes, and plenty of cold water to 
 drink ought to be given during the bath to cool off the 
 inside of the body. Then wrap the patient in a blanket 
 for ten minutes, to rest before replacing the clothing. 
 
 As a rule a hot drink of some kind is ordered before or 
 after the bath. Of course these baths should never be at- 
 tempted without the doctor's orders, and they are usually 
 given under his directions, as there are many cases where 
 the heart is weak and they would prove too exhausting to 
 the patient. 
 
 Sponge bath with alcohol and water. When the 
 fever is not very high and it is only necessary to give a 
 light sponge bath, use alcohol 25 per cent, and water, tem- 
 perature about 80° F., and two pieces of gauze. Do not 
 uncover the patient, but slip your hand under the bath 
 blanket that you put over the patient in place of the sheet, 
 and go over each part in a slow, gentle manner, and your 
 patient will be soothed and rested. 
 
 Salt tub baths. Salt baths are of great tonic value, 
 especially in nervous cases, kidney trouble, and heart dis- 
 ease, and they can usually be given warm, about 80° F., 
 or a little higher. Sea salt may be used, about one and 
 a quarter pounds to every gallon of water, or ten pounds 
 
BATHS — CLEANSING AND MEDICINAL 63 
 
 to a tub half full of water. Allow the salt to dissolve well, 
 before the bath. Your patient remains in the water about 
 three minutes the first day and a little longer each day, 
 until fifteen minutes is reached. Eub gently all over the 
 body while she is in the tub. 
 
 Salt rubs. Salt and alcohol, or salt alone is often used 
 to allay nervous symptoms, it is a good tonic in nervous 
 cases. Wet salt or salt and alcohol is rubbed with the 
 hand all over the body of your patient, until the skin is 
 red ; then bathe off with cold water, wrap her in a warm 
 dry sheet, and dry quickly. 
 
 Hot baths. Very hot tub baths are sometimes given 
 during illness, to cause profuse perspiration. The tem- 
 perature of the water may be as high as 100° F. and 
 slowly increased until as hot as 110° F. Cold cloths 
 must be kept on the head, and after the bath wrap the 
 patient in blankets, and give plenty of hot water to drink. 
 The blankets are left on for about an hour, then the body 
 rubbed dry, and a refreshing sleep will follow. 
 
 When giving a bath to a very stout person dry carefully 
 under the breasts between the folds of the groins and the 
 thighs, and powder afterward, because if moisture is al- 
 lowed to remain in these places the skin wiU become raw 
 and irritated. 
 
 Foot baths. During an illness when there is severe 
 headache and restlessness, and the feet are cold, a hot foot- 
 bath will be found very soothing and quieting to the 
 nerves. It can easily be given even when the patient is 
 unable to leave the bed. Fill the foot-tub half full of wa- 
 ter, temperature about 106° F. and, turning up the bed- 
 clothes from the feet to the knees, place the foot-tub on the 
 bed, bend the knees up, and put the feet into the water, 
 covering the feet and legs with a double blanket. The 
 water must be as hot as can be borne, and the bath should 
 last for about twenty minutes. As the water cools, add 
 
S4> A TEXTBOOK OF HOME NURSING 
 
 some very hot water but do not allow it to touch your pa- 
 tient's feet, pour it slowly into one corner of the tub until 
 the water is as hot as your patient can bear it. 
 
 Mustard baths. Where there is much fever, and the 
 head is very hot and heavy, as in fever cases, sunstrokes, 
 bronchitis, and sometimes in grippe and other illnesses, 
 a mustard foot-bath is frequently ordered by the physi- 
 cian. A high pail or foot-bath is filled with hot water, 
 and the amount of mustard used varies according to the 
 age of the patient. For an adult, about a tablespoonful 
 of mustard to every gallon of water is the usual quantity. 
 Dissolve the mustard first in lukewarm water to develop 
 the oil, then add to the bath, water at a temperature of 
 100° F. The water should reach almost to the knees. 
 Cover the patient's legs and the tub with heavy blankets 
 to promote perspiration ; for the same reason a hot drink 
 should be taken while the bath goes on. At the end of 
 twenty minutes, dry the feet gently, roll them in a blanket, 
 and put your patient back to bed. 
 
 For a mustard tub bath the same proportion of mustard 
 is required. Your patient lies quietly in the tub for about 
 fifteen minutes, then wrap her in a warm sheet; and dry 
 by patting, not rubbing. 
 
 Bicarbonate of soda and bran baths. In some fever 
 cases, such as measles, when the skin is irritated and causes 
 itching or when there is an eruption on the skin caused 
 by prickly heat, hives, etc., the doctor may order a tub 
 or sponge bath with bran or bicarbonate of soda. 
 
 The bran bath is made with a cheese-cloth bag contain- 
 ing between one' and two pounds of bran. This bag may 
 be either boiled in water for half an hour, then the water 
 drained off and poured into the bath tub half full of 
 warm water, or the bran bag may be allowed to soak in a 
 foot-tub of water until the water becomes milky, when 
 the bran bag is removed, and the water used for a sponge 
 bath. 
 
SUMMARY CHAPTER IV 65 
 
 With bicarbonate of soda, the amount used is about 
 seven or eight ounces of the soda to every gallon of water. 
 Allow the soda to melt completely, then proceed as de- 
 scribed in giving a mustard bath. 
 
 SUMMARY 
 Baths. 
 
 Necessary for prevention as well as cure of disease. 
 
 Daily bath. 
 
 Importance of bath. 
 
 Moral as well as physical effect. 
 
 Necessity during illness. 
 
 Two kinds of baths. 
 
 Bath for Home Nurse. 
 
 Hour of bath. 
 
 Time allowed between meal and bath. 
 
 Reason for an hour's delay. 
 
 Baths for cleansing the skin. 
 
 Keeping pores open during illness. 
 
 Rubbing good for the muscles. 
 
 Giving a bath in bed. 
 
 Everything necessary on hand. 
 
 Clean clothing warmed. 
 
 Hot water bag. 
 
 Room warm, window closed. 
 
 Appliances : Foot-tub, water, soap, wash cloths, towels. 
 
 Giving the bath : Do not uncover more than is necessary. 
 
 Wash and dry each part separately. 
 
 Feet placed in foot-tub. 
 
 Hot drink after bath. 
 
 Comfort to patient in bath. 
 
 Bath for the hair. 
 
 Everything on hand, before starting. 
 Appliances required: 
 
56 A TEXTBOOK OF HOME NURSING 
 
 Pillow covered with rubber sheeting and towel, ends pinned 
 
 under chin. 
 Hollow trough made for water. 
 Method of bath. 
 
 Baths for babies. 
 
 Temperature of water. 
 
 Eule to be followed. 
 
 Importance of bath thermometer. 
 
 Length of bath. 
 
 Bath aprons for nurse. 
 
 Method of bathing a tiny infant. 
 
 An older child sprayed o£E with cool water after batL 
 
 Baths for medicinal purposes. 
 
 Different kinds may have to be given by Home Nurse un- 
 der doctor's directions. 
 Baths for many purposes. 
 Some baths may be given only in hospital. 
 Baths described that may be given at home. 
 
 Cold baths in fever cases. 
 
 Value of water in fever cases. 
 Object of cold bath. 
 Care required in giving cold baths. 
 Never to be given to patient without doctor's orders. 
 Used for over twenty-five years, in treatment of fevers. 
 Necessary for Home Nurse to know routine in case of 
 emergency. 
 
 Cold tub bath. 
 
 Appliances required : 
 
 Two or three assistants necessary. 
 
 Doctor will take charge in absence of a trained nurse. 
 
 Method of giving bath: (Page 48.) 
 
 Preparing patient. 
 
SUMMARY CHAPTER IV 57 
 
 Substitute for stretcher. 
 
 Importance of friction. 
 
 Preparing bed for patient. 
 
 Care of patient when returned to bed. 
 
 Hot water bag. 
 
 Hot drink. 
 
 Home Nurse seldom called upon to give such a bath. 
 
 Slush bath often used as substitute or tub bath in bed. 
 
 Slush bath or tub bath in bed. 
 
 Method of giving bath: (Page 50.) 
 Arrangement of bed — two methods. 
 Duration of bath. 
 Importance of friction. 
 After-care of patient. 
 
 Cold sponge baths. 
 
 More frequently given by Home Nurse. 
 
 Do not disturb patient more than necessary. 
 
 Appliances: (Page 51.) 
 
 Method of giving bath. (Page 51.) 
 
 After-care of patient. 
 
 Exposure to air not harmful to patient. 
 
 Never to be given without doctor's orders. 
 
 Sponge bath with alcohol and water. 
 Given under cover. 
 Soothing to nervous patient. 
 
 Salt tub baths. 
 
 Their value. 
 
 Temperature of water. 
 
 Amount of salt. 
 
 Method of procedure. (Page 53.) 
 
 Salt rubs. 
 
 Salt and alcohol ; or salt alone. 
 
58 A TEXTBOOK OF HOME NURSING 
 
 Good tonic for system. 
 
 Hot baths. 
 
 To cause profuse perspiration. 
 
 Temperature of water. 
 
 Care in giving baths to stout people. 
 
 Foot baths. 
 
 Curative power. 
 
 Methods of procedure. 
 
 Temperature of water. 
 
 Duration of bath. 
 
 Care not to scald patient when adding hot water. 
 
 Mustard baths. 
 
 When given. 
 
 Amount of mustard. 
 
 How to prepare bath. 
 
 Giving the mustard in foot bath. 
 
 Method of mustard tub bath. 
 
 Patient lies quietly in water. 
 
 Patting the skin dry not rubbing. 
 
 Bicarbonate of soda and bran baths. 
 
 Por irritation and itching of skin. 
 
 Preparing a bran bath. 
 
 Two methods. 
 
 Preparing a bicarbonate of soda bath. 
 
CHAPTEE V 
 
 SYMPTOMS AND WTJESING OF INFECTIOUS DISEASES 
 
 Infectious diseases. Modem science has greatly re- 
 duced the danger of epidemics from infectious diseases, 
 by awakening the world to the meaning of such terms as — 
 isolation, disinfection, prevention, antitoxin,^ etc. 
 
 Prevention. The appearance in the home of a case of 
 infectious fever, in the days of our grand-parents, usually 
 led to a severe epidemic spreading all over the neighbor- 
 hood. Friends and relatives, even children were frer 
 quently allowed to come into the sick-room, where scarlet 
 fever, measles or diphtheria, reigned king; and even 
 household pets — dogs, cats, birds, etc., carried germs 
 broadcast throughout the community; the result, fre- 
 quently, was untold suffering, weakened constitutions, and 
 death. 
 
 To-day the Board of Health's placard on a house is the 
 first warning against spreading disease; and when this is 
 followed by the faithful observance of the rules for isola- 
 tion, and disinfection, it has become possible to confine a 
 case of infectious fever, not only to one family, but even 
 to one member of the family. 
 
 But with all the modern knowledge of the cause and 
 prevention of disease, people are not always as particular 
 as they might be to protect others when there is an in- 
 fectious disease in their ovpn home; often going out of 
 the sick-room into a neighbor's house, a crowded car, or 
 a public meeting place, without proper change of clothing ; 
 thus carrying numerous little germs in the folds of their 
 garments, these germs fasten themselves upon others, espe- 
 
 59 
 
60 A TEXTBOOK OF HOME NURSING 
 
 cially those whose system is run down and consequently 
 more liable to contract disease. 
 
 Contagious and infectious fevers. Infectious dis- 
 eases are such as are caused by some germ. Contagious 
 diseases are such as are communicated by direct personal 
 contact, as by touch or by exhalations. The distinction 
 is not of great importance now. 
 
 Some fever germs are carried in milk and water, more 
 especially typhoid, tuberculosis, and diphtheria ; these are 
 called " water borne diseases." Typhoid germs have been 
 found in butter, oysters, water-cress, ice-cream, etc. When 
 there is a suspicion of these fevers being in the neighbor- 
 hood, the water and milk ought always to be sterilized 
 before using. Milk is a common vehicle of infection, be- 
 cause in it the bacteria develop rapidly. Flies have also 
 been proved to spread typhoid, carrying the germs in their 
 feet and wings ; of course malaria is carried by mosquitoes. 
 Prevention is at all times easier than cure. So absolute 
 cleanliness in and around all parts of the house, sunlight 
 and fresh air are the best preventatives to disease. 
 
 What is fever? Fever is a symptom, not a disease 
 itself. It is present in all infectious and contagious dis- 
 eases. When the disease commences to yield to treatment, 
 then the fever disappears of itself — so modern science 
 concerns itself first with the care of the disease, and not 
 primarily with the reduction of fever, as was formerly 
 the practice. 
 
 Five principles in treatment of fevers. Eest, diet, 
 fresh air, water, drugs are the five special principles 
 summed up by one of our best medical authorities to be 
 observed in the treatment of infectious diseases. 
 
 Rest. Both mental and bodily rest are necessary, and 
 these will only be found in good nursing, cheerful atmo- 
 sphere, absence of all household or business worries, and 
 cool, quiet, well-ordered congenial surroundings. 
 
 Diet. Sufficient food, well cooked, daintily served and 
 
NURSING INFECTIOUS DISEASES 61 
 
 of the right proportion of calories to build up the body. 
 
 Water. AH the patient can drink, offered frequently 
 during the day and night, without waiting for a request 
 (if possible never ask a sick person what she wishes to 
 eat or drink, bring to the bedside what is ordered and 
 there is far more possibility of its being accepted). Un- 
 der water ; is also included baths of aU kinds, external and 
 internal, compresses and packs. 
 
 Fresh air. All that can be introduced into the sick- 
 room without draughts, and when possible open air treat- 
 ment as described on page 6. 
 
 Drugs ; — but as the prescribing of drugs is outside 
 the province of the Home Nurse, we will not discuss the 
 subject. 
 
 To apply these principles in the treatment of infectious 
 diseases, we must consider the choice and care of a suit- 
 able room, isolation, disinfection, and the special require- 
 ments of patient, physician and nurse. 
 
 Choice of room. Choose the room best, suited for the 
 comfort of both patient and nurse. The special require- 
 ments of the patient are — free ventilation, good light, 
 sunshine, space and quiet ; and for the nurse — nearness 
 to the bath-room, and her own sleeping room. 
 
 Of course a top floor, or an extension with bath-room 
 and balcony is our ideal; so that the patient may be en- 
 tirely isolated from the rest of the family. But in a city 
 apartment, this is impossible, and the nurse must choose 
 whatever room may be the most easily isolated from the 
 rest of the house. 
 
 Preparation of the room. For cleanliness and ease 
 in nursing, before the patient enters the sick-room, take 
 up the carpet, remove heavy curtains, upholstered furni- 
 ture and all chairs, tables, etc., not actually required; 
 especially anything that may be hurt with the daily use 
 of disinfectants. During warm weather, or when the 
 room is small, everything but the bed, one table and a 
 
62 A TEXTBOOK OF HOME NURSING 
 
 couple of chairs should be removed — to allow the air to 
 circulate freely ; for the same reason draw the bed out into 
 the middle of the room, and protect the head from draughts 
 with a screen. 
 
 In the case of a very contagious and infectious fever, a 
 sheet wrung out of carbolic acid 1 :50 or bichloride of mer- 
 cury solution 1:1000 should be hung up over the door; 
 and if a whole floor cannot be given up to the patient, all 
 doors leading to other rooms should have strips of paper 
 gummed over the cracks. 
 
 The bed. Your patient will not gain real rest in bed 
 unless the bed is comfortable. See page 2 for directions 
 how to make the bed, according to hospital rules. 
 
 The bed covering must be as light as possible in fever 
 cases, a sheet and one blanket being sufficient. Instead of 
 a spread, use a thin sheet, as it is only needed to keep the 
 blanket clean. The oldest bed linen and night-clothes in 
 the house should be used, so that they will not be hurt by 
 frequent boiling and disinfecting. In fever cases the bed 
 linen and night-clothes ought to be changed as often as 
 possible, as there is always a slight odor from the fever 
 unless everything is kept immaculately clean. 
 
 Disinfection of bedclothes. As soon as the linen is 
 taken off the bed, roll it carefully, and at once, so that the 
 germs may not be spread about the room, and soak it for 
 at least two hours in a pail containing a solution of 1 :50 
 carbolic, after which it may be taken downstairs and 
 boiled in soap and water. Carbolic is better than bi- 
 chloride for disinfecting clothing, as the latter is likely 
 to turn the clothes yellow. 
 
 Care of the room. To clean the floor and woodwork 
 every morning, a cloth wrung out of bichloride solution 
 1:1000 should be passed over it; if a broom is used, it 
 must be covered with a damp cloth. The cloth that is 
 used for dusting should also be dampened with a disin- 
 fectant, and if you fill some vessels with a two per cent. 
 
NURSING INFECTIOUS DISEASES 63 
 
 formalin solution, and stand them in different parts of 
 the room, it will purify the air by absorbing some of the 
 germs floating about. These solutions must be renewed 
 every twenty-four hours, as they lose their strength when 
 exposed to the air for any length of time. A great deal 
 may be done to prevent the spread of disease, by scrupu- 
 lous cleanliness, and the free use of disinfectants. 
 
 Open fireplace. An open grate fire is particularly 
 useful in contagious cases. Apart from its cheery aspect, 
 and help in ventilation, you can burn small pieces of gauze 
 or linen which have been used around the patient, with- 
 out removing them from the room. 
 
 Atmospheric temperature. The temperature of the 
 room should not be higher than 68° F. In summer time 
 the air can be kept cool by means of an electric fan. 
 Standing bowls of ice around the room will also help to 
 keep it cool. The ventilation must be carefully attended 
 to night and day. Fresh air is of the utmost importance, 
 also an abundance of sunshine. 
 
 Care of food. No food of any kind should stand in 
 the room, lest it become infected. When a bedroom re- 
 frigerator is not available, all eatables should be kept in 
 another room, or outside the window. A wooden box se- 
 curely fastened with cords outside the window forms a 
 convenient cupboard for jellies, milk, and broths, etc. 
 
 All glass, china, or silver in service during the illness 
 ought to remain with the patient, and not be removed to 
 the family dining-room until properly disinfected. 
 
 Books, papers, and toys used during a contagious fever 
 will have to be destroyed, as they can never be thoroughly 
 disinfected. 
 
 Disinfection of utensils. Each time before the bed- 
 pan, urinal, or sputum cup is used, put a little carbolic 
 solution in it, 1:12, and before emptying the contents, 
 cover it completely with carbolic or formalin and allow it 
 to stand for haK an hour, so that it will be thoroughly 
 
64 A TEXTBOOK OF HOME NURSING 
 
 disinfected. These precautions are especially to be ob- 
 served in tbe case of typhoid fever, as the germs of that 
 disease are found in the stools in great abundance, also 
 in the urine and sputum, and may be easily communicated 
 to any one nursing the case, unless particular care is 
 observed. It is also necessary in typhoid fever, if there 
 are involuntary movements, to steep the bed linen imme- 
 diately in a strong solution of carbolic for a couple of hours. 
 
 Except when quite unavoidable, no member of the fam- 
 ily should use the water-closet where the evacuations of a 
 typhoid fever patient are emptied daily. If it is abso- 
 lutely necessary to do so, plenty of disinfectants should 
 be used all the time. Formalin is one of the best for this 
 purpose,, and the closet should be flushed with boiling wa- 
 ter two or three times a day. 
 
 Care of the patient. The rules for general nursing 
 given in Chapter II apply also in contagious diseases, but a 
 few extra points are here noted to meet the need of fever 
 cases. 
 
 A tepid sponge bath every day should be given to the 
 patient (see baths). Physicians recommend flannel night- 
 gowns, and should the flannel be irritating to the skin, a 
 thin gauze or silk undervest may be worn. 
 
 Treatment of eruption. With the eruption, there 
 may be an intense itching of the skin ; this will be soothed 
 by a sponge bath, adding one teaspoonful bicarbonate of 
 soda to three pints of water ; and when peeling commences, 
 oil of some kind should be gently rubbed over the skin 
 after the daily bath. One physician prescribes a warm 
 sponge bath twice a day, followed by alcohol rub, and then 
 an application of oil or vaseline. 
 
 There is generally a great deal of headache when the 
 fever runs high, and it is relieved by keeping the head 
 cool with ice cloths. Cold compresses to the back of the 
 neck, or an ice bag, will also be found to relieve head- 
 ache. Hot water bottles at the feet will help to cool the 
 
NURSING INFECTIOUS DISEASES 65 
 
 head ; and a rub with alcohol for a few moments will warm 
 the feet quickly, when they become cold and clammy. 
 
 When the fever is very intense, the feet become dry and 
 stiff, and much relief will be given by a daily application 
 of sweet oil and menthol mixed. 
 
 Small pieces of cracked ice for the mouth, and water 
 without limit to drink will help keep the mouth and throat 
 in good condition. One authority states that an inflamed 
 condition of the mouth and bad digestion is often due to 
 insuflSciency of drinking water, and nourishing food. 
 Drink should be offered every hoUr, and not left to the 
 patient to ask for it. Over two quarts of fluid should be 
 taken in the twenty-four hours. 
 
 After each feeding, wash the mouth with an antiseptic 
 mouth wash. 
 
 In typhoid fever the tongue and gums become thickly 
 coated with a dark brown coating, called " sordes," which 
 if allowed to dry and crack will make the mouth exces- 
 sively sore; this can only be prevented by frequent wash- 
 ing with an antiseptic solution and a small piece of gauze 
 or cotton wool, which should be burned immediately. 
 
 A little cold cream or glycerine and rose-water on the 
 lips will prevent their chapping with the fever. 
 
 In preparing for the night, rub the back and limbs 
 with alcohol, and bathe the face and hands. The rubbing 
 will soothe the restless feeling that comes after lying 
 in bed many days, and it is also a great inducement to 
 sleep. Always rub from the feet upward, in long, quiet, 
 strokes. 
 
 Absolute rest of mind and body are necessary to insure 
 a quick recovery. A dim light should be kept burning 
 all night, either in the room, well shaded from the pa- 
 tient's eyes, or outside the door, because while in a fever- 
 ish condition the patient may have bad dreams, and wake 
 up in the dark frightened and nervous. 
 
 When the fever breaks profuse perspiration is the xe- 
 
66 A TEXTBOOK OF HOME NURSING 
 
 suit, and there is serious danger of contracting a cold. 
 Rub the body with a warm, dry towel, put on a fresh, well- 
 heated, flannel nightgown, and, if necessary, dry sheets. 
 During some fever cases, it is necessary to change the pa- 
 tient two or three times in the night to prevent a chill. 
 
 Instead of handkerchiefs, keep on hand a supply of 
 cheese-cloth, cut it up into small squares and burn them 
 as soon as they are used. This is a very necessary pre- 
 caution against spreading the disease, especially in cases 
 of tuberculosis and diphtheria. 
 
 A daily record must be kept for the doctor, noting any 
 little change during his absence that may be of assistance 
 to him in his treatment of the case. The urine ought to 
 be measured and recorded, especially during scarlet fever, 
 as Bright's disease is one of the complications that some- 
 times follows this fever, and is first shown by the urine; 
 so that any particular change in the amount, color, or odor 
 of the urine ought to be reported. 
 
 Diet. A small gas stove is indispensable in nursing 
 diseases that have to be isolated, so that plenty of hot water 
 may be obtained at all times. 
 
 In all fever cases the diet for the first stages of the 
 disease is given in liquid form. This generally consists 
 of milk and broths. When there is any nausea, pepton- 
 ized milk, or milk and lime-water are preferred. About 
 two or three ounces, at least, ought to be given every two 
 hours while the fever is at its height, increasing the 
 amount gradually when the temperature lowers. 
 
 Never give stimulants without the doctor's orders, un- 
 less in a case of collapse ; but it would be well to provide 
 for this beforehand by asking the physician exactly what 
 you ought to do if such an emergency should arise during 
 his absence. 
 
 All through the day give your patient plenty of water 
 to drink, for which he will be most grateful. Do not wait 
 
NURSING INFECTIOUS DISEASES 67 
 
 for him to ask you, but give a drink about every hour, as 
 it is a great help in reducing the fever. This drinking 
 water must be boiled and then allowed to grow cold in the 
 refrigerator, as it is much safer than using the ordinary 
 ice-water. 
 
 When " light-diet " is allowed : your patient will need 
 cereals, gruels, bread, milk, milk toast, ice-cream, or lemon- 
 ice ; after the first few days, eggs, custards, oysters, vege- 
 tables ; last of all meat. 
 
 Drinks of lemonade and grape-juice and orangeade are 
 most refreshing, between meals. 
 
 Nourishment at night is often necessary in fever cases ; 
 as the high temperature is a great drain on the system. 
 Ask the physician if it is best to wake the patient at night 
 for nourishment. 
 
 Precautions to be taken by the Home Nurse. In 
 the absence of a trained nurse, one member of the family 
 should take it upon herself to be personally responsible 
 for the care of the patient and the sick-room, and when 
 relieved from duty, by the necessities of daily exercise, 
 meals, and sleep, she should give careful directions to 
 whoever takes her place. 
 
 Dress of nurse. A plain cotton dress must always be 
 worn when nursing an infectious fever, so that it can be 
 boiled and disinfected constantly. It is unwise to have 
 starch in dress or petticoat, as the rustling caused by it 
 is very irritating to a nervous patient. A cap or veil 
 made from cheese-cloth or muslin, and pinned firmly over 
 the forehead and under the hair at the back of the neck 
 will prevent germs resting in the hair. Eubber gloves 
 should be worn when emptying secretions, and caring for 
 the throat ; and the mouth and nose covered in gauze wet 
 in 1 :5000 solution bichloride of mercury while spraying 
 or swabbing out the throat of a diphtheria patient; this 
 rule is most important, for should the patient cough sud- 
 
68 A TEXTBOOK OF HOME NURSING 
 
 denly, the nurse would receive all the germs that fly out 
 of the mouth. Also, in stooping over your patient, be 
 very careful not to inhale her breath. 
 
 When nursing a fever case, if the Home Nurse takes a 
 good walk in the open air every day, regular meals out- 
 side the sick-room, at least six hours' sleep in the twenty- 
 four, a thorough warm bath daily, besides obeying the 
 common-sense rule, — never to enter the sick-room when 
 tired without eating or drinking something to refresh the 
 system, — there is very little danger of contracting the 
 disease. 
 
 The Home Nurse should not sleep in the same room as 
 the patient. If no other member of the family is able 
 to take her place at night, a room adjoining the sick-room 
 should be given to the nurse, or even if necessary, a bed 
 arranged in the hall. A bell beside the patient will call 
 the nurse in an emergency ; and she will easily train her- 
 self to wake at regular intervals to administer medicine, 
 nourishment, etc. In serious cases, especially if the pa- 
 tient is delirious, another member of the family must take 
 her place while the nurse sleeps. 
 
 One of the most important rules that the Home Nurse 
 needs to remember is — never to eat anything in the sick- 
 room, as the air will be full of disease germs which are 
 very fond of hiding themselves in food. Before going to 
 her meals she should always rinse her mouth with an anti- 
 septic mouth wash, such as listerine, or a solution of boric 
 acid, to remove the germs that collect in the mouth, around 
 the gums, and under the tongue, and to prevent their 
 being washed down the throat and absorbed into the sys- 
 tem. 
 
 A physician, in speaking on this subject, attached the 
 greatest importance to this precaution, so much so that 
 he said he believed that in a few years people would not 
 eat at any time without first rinsing out the mouth with 
 an antiseptic mouth wash. Microbes of all kinds are 
 
NURSING INFECTIOUS DISEASES 69 
 
 continually flying around us, entering our mouths every 
 time we open them to breathe or speak, and lodging there 
 waiting to be absorbed into the system with the food we 
 eat, where they often develop and cause disease. 
 
 The nurse's hands must also be dipped in a disinfectant 
 solution each time after she has been caring for the pa- 
 tient, and the nails ought to be kept very short and scrubbed 
 with a nail-brush, as they form a hiding-place for germs. 
 
 Dress of the physician. Frequently the physician is 
 obliged to enter other homes, after visiting a case of in- 
 fectious or contagious disease; every possible care must 
 be taken riot to spread the disease. A gown, or sheet 
 (which is easily pinned into a gown) to covet all his cloth- 
 ing, a cap made from a folded towel or a piece of cheese- 
 cloth for his head, a basin of hot water, soap, a bowl of 
 disinfectant solution, alcohol, towels and a pair of rubber 
 gloves and rubbers for his feet, should always be in readi- 
 ness for his use before he enters the sick-room. 
 
 Fumigation. As soon as you have received permis- 
 sion from the doctor to move the patient into another room, 
 give him a good, hot bath, and then sponge him all over, 
 including the hair, with a weak solution of bichloride of 
 mercury, 1 :5000. Wrap him in sheets, and take him into 
 an adjoining room that has previously been prepared and 
 made comfortable. It is of great importance that after 
 an infectious disease the sick-room should be thoroughly 
 and carefully disinfected, as the troublesome little disease 
 germs have a disagreeable way of lingering round for 
 months and even years in various nooks and crannies. 
 
 As soon as you have moved your patient out of the sick- 
 room, take all the bedclothes and put them into a pail of 
 1 :20 carbolic solution, and let them steep for some hours. 
 Wrap up the mattress and pillows and send them to one 
 of the special establishments for sterilizing and disinfect- 
 ing bedding, to be found in almost every city. Should 
 there be no such place at hand, after a severe case of scar- 
 
70 A TEXTBOOK OF HOME NURSING 
 
 let fever or small-pox, do not hesitate to burn up the mat- 
 tress as it is impossible to disinfect it thoroughly at home. 
 
 To prepare the room for fumigation; open all closets, 
 and bureau drawers as the gaseous disinfectants only have 
 a surface effect ; pull down shades and stretch a line across 
 the room on which to hang blankets or rugs. Books and 
 toys had better be destroyed. Cover all cracks of doors and 
 windows, even the key-hole, with gum strips of paper (gum 
 is better than paste, and more easily removed afterwards). 
 Be sure that fireplaces, ventilators and registers are well 
 closed. A kettle of water boiling on a small stove will 
 be required, as moisture is always needed for gaseous dis- 
 infectants, also heat; so have the room as warm as possible 
 before fumigating. 
 
 Two disinfectants are used, formaldehyde and sulphur ; 
 the former is considered best. A tub of hot water is placed 
 in the middle of the room, and in this a pail about a foot 
 high to hold the formaldehyde. 
 
 To fumigate with sulphur ; allow five pounds to a me- 
 dium sized room, spread the sulphur on a pan and saturate 
 well with alcohol ; — the pan should stand on a brick or 
 iron ; in a tin pail of water. Set fire to the sulphur, close 
 the door, and seal it on the outside. Twelve hours is re- 
 quired for thorough fumigation, then open the windows 
 and air the room well. 
 
 Symptoms and stages in infectious diseases. Infec- 
 tious diseases, as a rule, run a definite course. In each 
 case special symptoms have to be observed, reported, and 
 treated. It will be of help to the Home Nurse to classify 
 the infectious diseases most likely to occur in families, 
 the special symptoms that appear in each case, and some 
 important rules to be followed. 
 
 There are three general periods, or stages, in fever cases 
 1 — incubation, eruption, and desquamation. 
 
 Incubation — The patient has been exposed to the dis- 
 
SYMPTOMS IN INFECTIOUS DISEASES 71 
 
 ease, which is gradually working its way through the sys- 
 tem. 
 
 Eruption — When the rash appears, and the nature of 
 tiie disease is declared. 
 
 Desquamation — Peeling or shedding of the skin, after 
 the fever has disappeared. 
 
 Scarlet fever. After being exposed to scarlet fever it 
 may develop at any time from one day to three weeks. A 
 sudden chill (or with small children, sometimes convul- 
 sions), followed by headache, high fever and sore throat, 
 herald the approach of the eruption, at the end of twenty- 
 four or thirty-six hours; neck, chest, back; and then the 
 face and whole body are covered by the rash. The throat 
 and tongue are inflamed, the tongue appears first very 
 white and coated ; after a day or two becomes swollen and 
 red {" strawberry tongue," it is called). Special compli- 
 cations to be watched for are: inflammation of the ears 
 and kidney trouble. The physician should at once be 
 notified if the patient complains of pain in the ears: and 
 a careful record kept daily of the amount, and color, of 
 the urine, and frequency of urination. 
 
 The mouth and throat must be attended to faithfully, 
 according to the physician's directions. All the fresh air 
 possible must be admitted into the sick-room, day and 
 night. 
 
 After the daily bath, oil, cocoa-butter, vaseline or oint- 
 ment should be rubbed gently all over the body to allay irri- 
 tation, and specially to prevent spread of infection by the 
 tiny particles of skin that peel off and fly about the room. 
 
 Strict quarantine, including disinfection of both patient 
 and nurse, is important. Scarlet fever is both infectious 
 and contagious ; adults rarely take it more than once, but 
 may carry it to others. Children should be carefully 
 guarded from infection, and when possible removed from 
 the house. Dogs and cats must be absolutely excluded 
 
72 A TEXTBOOK OF HOME NURSING 
 
 from the sick room, as they carry the germs broadcast 
 over the community. For the general nursing see page 
 64. 
 
 Smallpox. Nowadays we hear and see little of this 
 terrible disease — thanks to the strict rules enforced re- 
 garding vaccination. (If the Home Nurse has not had 
 smallpox, she should be vaccinated afresh, before she un- 
 dertakes to nurse the patient; it is also best to have the 
 whole family vaccinated when a case develops in the 
 home.) 
 
 Incubation period is a little longer than in scarlet fever, 
 and after exposure, three weeks must elapse before all 
 fear of taking the disease has passed. 
 
 High fever coming on suddenly, sometimes accompanied 
 by a chill, headache, pain in the back and eyes, vomiting ; 
 these are followed about the third day with the distressing 
 rash; sometimes the rash develops into separate pustules, 
 which gradually increase in size and run close together; 
 pus is in the pustules, and runs from them. Itching is 
 most intolerable, and only the greatest care will prevent 
 a lasting disfigurement of the skin, by the formation of 
 little pits, wherever the patient scratches off the head of 
 the pustules. 
 
 Many remedies are used to help the itching. Frequent 
 prolonged, warm, tub baths ; lasting if necessary for hours, 
 have proved to be successful. Oily substances, vaseline, 
 sweet oil, ointments, etc., used in quantities over the whole 
 body and renewed frequently ; cold compresses to face and 
 hands where the itching is most intense; these are some 
 of the simpler remedies. Constant warning must be given 
 to the patient, not to scratch herself; and in the case of 
 children, gloves should be tied on the hands ; and at night, 
 the hands fastened so that the child cannot reach her 
 face. A mask of lint and ointment is sometimes laid on 
 the face. The eyes must be irrigated every three hours, 
 with boric acid solution; and vaseline, gently applied to 
 
SYMPTOMS IN INFECTIOUS DISEASES 73 
 
 the edge of the lids will prevent their sticking together. 
 
 Absolute isolation must be strictly enforced, with the 
 most careful disinfection; and again, fresh air and per- 
 fect cleanliness are of the first importance. 
 
 Diphtheria. Sore throat, glands swollen, and general 
 feeling of all-over sickness, appearing within ten days 
 after exposure to diphtheria infection, marks the begin- 
 ning of the disease. 
 
 Antitoxin is now used extensively, and with splendid 
 results ; it lessens the effect of the disease in the patient, 
 and when administered at once to other members of the 
 family generally renders them immune to an attack. 
 After twenty-four hours a pale gray membrane forms over 
 the red, swollen throat. The Home Nurse should wear 
 glasses, rubber gloves, and cover her mouth and nose with 
 gauze wet in disinfectant, when spraying or swabbing 
 the throat of her patient. This is of the greatest impor- 
 tance; as all the infection comes from discharges of the 
 nose and throat. 
 
 Heart failure is the most dangerous complication ; and 
 until advised by the physician, the patient should never 
 be allowed to sit up in bed, even during convalescence. 
 
 Encourage your patient to drink quantities of water, 
 and give all the nourishing food possible. 
 
 Typhoid fever. Typhoid fever involves so much dif- 
 ficult and prolonged nursing, that, if a trained nurse is not 
 available, the patient should be taken to a hospital, when- 
 ever it is possible. 
 
 In the emergency of a Home 15'urse caring for a typhoid 
 case, most careful and complete directions from the physi- 
 cian should be written down daily ; a detailed record kept 
 of every hour of the twenty-four, and some member of the 
 family must relieve the Home l^urse daily, so that she 
 may take out-door exercise; plenty of time for her food, 
 and sufficient sleep away from the patient. 
 
 Between two and three weeks is covered by the incuba- 
 
•74) A TEXTBOOK OF HOME NURSING 
 
 tion period in typhoid fever. Pains in back, abdomen, 
 and eyes, headache, nausea, diarrhea and sometimes nose 
 bleed, are among the symptoms. The temperature is char- 
 acteristic — rising steadily higher evening and morning 
 during the first week ; the second week remaining high in 
 the evening but occasionally lower in the morning, the 
 third week shows a gradual drop in temperature, morning 
 and evening, when the case is normal. 
 
 Infection in typhoid fever comes through discharges 
 and through the mouth, by means of food and drink. Ex- 
 treme care must be taken that all drinking vessels, spoons, 
 forks, china, etc., used by the patient are boiled daily ; and 
 kept entirely for separate use by the patient. 
 
 Care of the mouth and gums are of more importance in 
 typhoid fever, than in any other disease, as the infected 
 germs lodge around the gums and teeth; and are washed 
 down into the stomach. 
 
 The tongue becomes almost black in the center, with 
 mucus covering the back of the tongue and the throat. 
 Before and after every feeding, even a drink of milk, 
 swab out the mouth, especially the back of the tongue, with 
 whatever solution the doctor orders, using a swab made 
 with a tooth-pick and absorbent cotton, dipped in solu- 
 tion; then apply a soothing lotion to prevent cracking of 
 the lips and tongue. 
 
 Great care is required to guard against bed-sores, which 
 are liable to appear owing to long continued pressure and 
 lowered vitality. No moisture should be allowed to re- 
 main on the back ; an alcohol sponge or rub should be given 
 two or three times a day over the back, especially the but- 
 tocks and heels, followed by talcum powder; a firm rub- 
 bing is useful to stimulate circulation; frequent change 
 of position from side to side, rubber rings and pillows to 
 support the back are useful. When changing his position 
 do not allow your patient to exert himself in any way, for 
 fear of hemorrhage or perforation. 
 
SYMPTOMS IN INFECTIOUS DISEASES 75 
 
 ThrouglioTit the disease disinfection of clothing, bed- 
 ding, and utensils is of the utmost importance. When 
 changiitg clothing or bedding, fasten each article at once 
 in a bundle and carry at arm's length out to a pail or tub 
 ready with disinfectants, 1 :20 carbolic, or formalin three 
 ounces to a gallon. 
 
 After the passing of a stool, wash the patient locally, 
 and change the draw sheet if soiled in the slightest. 
 
 The Home Nurse should be exceedingly careful to wash 
 her hands at once after coming in touch with the bed- 
 clothes or utensils used with her patient. 
 
 Quiet for the patient is also of great importance, no 
 visitors, no excitement, and no family troubles must be 
 allowed to cross the threshold of the sick-room; nor must 
 the patient be allowed to sit up or be supported in bed for 
 fear of heart failure, hemorrhage, or perforation of the 
 bowels. For this reason a typhoid patient when in the 
 least delirious should never be left alone for a moment, 
 as there is great danger of his trying to get out of bed. 
 
 Frequent drinks of water should be administered be- 
 tween feedings, as much as two or three quarts a day, and 
 special care used that the diet ordered, be strictly carried 
 out, as the question of diet in typhoid fever is of the ut- 
 most importance. Milk, cream, eggs, sugar, bread and 
 butter are the basis of diet used with great success in one 
 of our big hospitals. Individual cases require various 
 treatment, however, and a diet sheet written out by the 
 physician in charge will be the guide to be followed by 
 the Home Nurse. 
 
 Cold baths in one form or another, see page 47, will be 
 ordered by the physician. 
 
 Hemorrhage, perforation and phlebitis are dangerous 
 complications that may occur. The symptoms of hemor- 
 rhage are : rapid pulse, sudden drop in temperature, great 
 restlessness, and blood appearing in the stools. All 
 through the course of the disease, the stools should be 
 
76 A TEXTBOOK OF HOME NURSING 
 
 examined carefully, and any sign of blood reported at once 
 to tbe physician. 
 
 Phlebitis is shown by increase in temperature and pain 
 in one or both legs, tenderness and swelling. When these 
 symptoms are observed, report at once to the physician. 
 
 Acute, sudden pain in the abdomen, is the special symp- 
 tom of perforation. Immediate notice must be given the 
 physician as an operation may be imperative to save the 
 patient's life. 
 
 Tuberculous. Except cancer, there is perhaps no dis- 
 ease that fastens upon its victim such long drawn-out 
 suffering. Under the name of " consumption," our fore- 
 fathers accepted this disease as a sort of inherited heir- 
 loom; and no care was taken to guard against infection. 
 Now we know that tuberculosis is not inherited, although 
 a tendency towards weak lungs may be handed down from 
 parent to child. 
 
 Some authorities state, that every one inhales the tu- 
 bercle bacilli; and that many individuals have a short 
 attack without knowing it. 
 
 As infection lies in the sputum, saliva, and nasal dis- 
 charges, it is easy to see how the whole world is in danger 
 of inhaling germs. During the last ten years, giant 
 strides have been made towards stamping out the spread 
 of this dread disease, more especially by the prevention 
 of expectoration in public cars and trains, etc. The chief 
 of these measures are the doing away with the common 
 drinking cups and towels, and the establishment of tuber- 
 culosis clinics, exhibits, and lectures that educate the 
 masses and teach the proper treatment of patients in fam- 
 ily life. Above all, we may place the fresh air and clean- 
 liness propaganda. 
 
 When a patient expectorates on the ground, the sputum 
 dries, blows about in the air, and is carried by flies into 
 uncovered food. For this reason, covered sputum cups 
 should always be carried by patients ; and all gauze used 
 
SYMPTOMS IN INFECTIOUS DISEASES 77 
 
 for mouth or nose burned at once. Kissing is also re- 
 sponsible for spreading the bacilli, especially with chil- 
 dren. 
 
 Every part of the body may be affected — bones, joints, 
 spine, glands, etc. In adults the lungs are generally the 
 seat of the disease, while in children other parts of the 
 body are more often affected. 
 
 Some of the symptoms are : loss of appetite, night sweats, 
 general weakness, daily loss of weight, cough, pain in 
 lungs, hectic color in cheeks ; the temperature lower in the 
 morning and rising every evening. 
 
 Every prospect of complete recovery may be given, if 
 the disease is at once discovered and all medication faith- 
 fully carried out. 
 
 Open air treatment is of supreme importance, winter 
 and summer; two special points in this fresh air treat- 
 ment are, — keeping the patient warm, and out of all 
 draughts; flannel clothing day and night may be worn; 
 outing-flannel sheet, hood, mittens; and hot water bags 
 for feet. See directions for making out-door bed, page 
 6. 
 
 Measles. Infection comes from the skin, and the se- 
 cretions of nose and mouth. All children are highly sus- 
 ceptible to measles. 
 
 About ten days after being exposed to the disease, the 
 eruption appears ; first around the mouth, chin, forehead, 
 neck and finally all over the body. In three or four days 
 the rash disappears, and the skin peels off. 
 
 General rules of nursing are followed, with special at- 
 tention paid to the eyes. A shade may be worn for the 
 first few days, the eyes bathed frequently with boric acid 
 two per cent., and if necessary the room darkened. Even 
 during convalescence no reading should be allowed. 
 Measles is serious on account of the complications that so 
 often follow ; great care should therefore be taken in dis- 
 infection and isolation of the patient. 
 
78 A TEXTBOOK OF HOME NURSING 
 
 Erysipelas. The infection conies through, a cut, or 
 wound in the skin. The most frequent kind of erysipelas 
 is in the face and head. Following a chiU, and high tem- 
 perature the face (commencing around the nose and 
 mouth) becomes red, swollen and greatly inflamed. As a 
 rule isolation is not necessary when the dressings, and 
 compresses from the part affected are burned at once. 
 Rest, fresh air, good food are the principal needs of the 
 patient. The physician will prescribe ointments or cold 
 compresses for application. 
 
 Poliomyelitis. We have learned by bitter experience 
 the great danger and far reaching consequences of this 
 disease. It is a child's disease, and only very rarely found 
 in older girls and boys. 
 
 Infantile paralysis is the name in common use, coming 
 from the fact that the spinal cord is inflamed and paralysis 
 of some part of the body almost invariably follows. 
 
 Infection is frequently carried through a third person, 
 also through the patient, even after his recovery. Isola- 
 tion, therefore, for both patient and nurse for at least 
 three weeks should be enforced. The nose and mouth 
 should be sprayed or gargled with antiseptic daily. Cases 
 have been known of a friend paying a visit to a patient 
 suffering from the disease, and carrying the germ to an- 
 other family. 
 
 Absolute rest of limbs and muscles is necessary ; and no 
 massage should be given until after the acute stage has 
 passed. 
 
 The beginning is very sudden, with fever, and convul- 
 sions and paralysis of some part of the body. All kinds 
 of massage and electric baths are used during convales- 
 cence, so too, are good nourishing food, and out-door treat- 
 ment. 
 
 Meningitis. A sudden chill, convulsions, headache, 
 and vomiting, with stiff muscles of the neck, usher in this 
 disease of the spinal cord. Delirium comes quickly, with 
 
SYMPTOMS IN INFECTIOUS DISEASES 79 
 
 the legs drawn tip and the head bent back. A great deal 
 depends on the faithfulness in nursing and in carrying out 
 the physician's instructions. Absolute quiet in a cool, 
 dark room is necessary. 
 
 It is difficult to persuade the patient to take food, and 
 it has to be given, as a rule, with a tube. Disinfection and 
 isolation are required for patient and nurse, as the dis- 
 ease is carried through a third person. 
 
 Malaria. Modern research places the entire blame of 
 this disease on the mosquito, hence the great activity of 
 the last few years in draining swampy ground. 
 
 The symptoms are, distressing chills, at regular inter- 
 vals, generally every second or third day, followed by high 
 temperature, headache, nausea. The treatment is qui- 
 nine; generally in large doses, about one hour before the 
 regular hour for a chill. During the chiU, put the pa- 
 tient to bed, vnth plenty of blankets, hot water bottles at 
 the feet, under the arms, and over the heart; and give 
 him hot drinks (not milk, for it disagrees with quinine). 
 When the fever rises, — remove all hot water bottles and 
 blankets, place a cold compress over the head and give 
 an alcohol rub or sponge bath. 
 
 Dysentery. As a rule hot weather is the season for 
 dysentery and with children it is often called summer 
 diarrhea. 
 
 It is infectious through the stools, and care in disin- 
 fecting utensils, and clothing should be carried out. 
 Gauze or paper napkins are best to use with children, and 
 they should be burned at once. 
 
 Unwise eating during hot weather, unclean surround- 
 ings, and impure drinking water added to lowered vital- 
 ity, form a combination that quickly develops the germ, 
 once it is taken into the system. Blood and mucus seen 
 in the stools, with pain over the abdomen, indicate dysen- 
 tery. It would be very unwise for the Home Nurse to 
 prescribe any course of treatment. 
 
80 A TEXTBOOK OF HOME NURSING 
 
 A physician should be consulted, and his rules as to 
 diet and treatment carried out faithfully. 
 
 Pasteurized milk and gruels generally form the diet 
 until the stools become normal. 
 
 Cleanliness of body and clothing, especially after every 
 stool is important. Heat to the abdomen is most helpful, 
 such as hot fomentations, turpentine stupes, or mustard 
 leaf. Change of air frequently brings relief from the 
 disease. 
 
 Whooping cough. We have been accustomed to con- 
 sider -whooping cough as a child's disease; but adults 
 in the fsimily frequently contract it. Infection comes 
 through the sputum and cough. It is difficult at first to 
 diagnose the disease, until the characteristic whoop ap- 
 pears with the cough, followed by vomiting and sometimes 
 nose bleed. 
 
 Open air treatment, when possible day and night, good 
 nourishing food, and separation from all other children 
 are the principal points in nursing, with flannel under- 
 wear, both day and night, because a chill might follow the 
 heavy sweats after a paroxysm of coughing. 
 
 Mumps. This is not dangerous, but is painful and 
 most uncomfortable, besides being highly infectious with 
 children. Swelling of the glands just below the ear, 
 nausea, headache, and pain in eating indicate mumps. 
 
 Rest in bed, liquid diet, and special care in washing out 
 the mouth and gums before and after every feeding, are 
 all the nursing required 
 
 SUMMARY 
 
 Infectious Diseases. 
 
 Prevention, Board of Health placards a warning. 
 
 Observation of rules about isolation, and disinfection. 
 
 Care of patient. 
 
 Care of nurse and family not to spread disease. 
 
SUMMARY CHAPTER V 81 
 
 Contagious and infectious fevers. 
 
 Various kinds. How fever germs are carried, water and 
 milk special agents ; best preventative absolute clean- 
 liness. 
 
 What is fever? 
 
 Symptom not a disease, in all contagious and infectious 
 diseases. 
 
 Modern science treats the disease, fever then disappears 
 itself. 
 
 Five special principles : Rest, diet, fresh air, water and 
 drugs. 
 
 Rest — good nursing, absence of worry, well ordered sur- 
 roundings. 
 
 Diet — well cooked; right proportion, daintily served. 
 
 Water — abundance to drink, baths of all kinds. 
 
 Fresh air — when possible open air treatment. 
 
 Drugs — left to the physician. 
 
 Choice of room. 
 
 Best suited for comfort of patient and nurse. 
 
 Special requirements, ventilation, light, space, nearness to 
 
 bathroom and nurse's room. 
 Top floor best when possible. 
 
 Preparation of room. 
 
 Remove carpet, curtains, heavy furniture. 
 
 Bed, table, chairs all that is necessary. 
 
 Hot weather, draw bed into middle of room. 
 
 Door protected by sheet wet with disinfectant. 
 
 Bed must be comfortable. 
 
 Light weight bedclothes. Use old linen. 
 
 Change frequently. 
 
 Disinfection of bedclothes. 
 
 How to disinfect them properly. Carbolic 1:50 then 
 boiled. 
 
82 A TEXTBOOK OF HOME NURSING 
 
 Care of room. 
 
 Floor and woodwork wiped with bichloride 1 :1000 daily. 
 Broom covered with damp cloth, also duster. 
 Free use of disinfectants, scrupulous cleanliness great aid 
 to prevent spread of disease. 
 
 Open fireplace. 
 
 Particularly useful in contagious diseases. 
 Besides good ventilator, helpful to burn gauze or linen used 
 around patient. 
 
 Atmospheric temperature. 
 Not higher than 60° F. 
 Electric fan in summer. 
 Fresh air important. 
 
 Care of food. 
 
 Not allowed to stand in sick room. 
 
 Absorbs microbes. Bedroom refrigerator good. 
 
 Wooden box outside window. 
 
 All dishes disinfected daily. 
 
 Books, papers, toys destroyed. 
 
 Disinfection of utensils. 
 
 Carbolic acid 1 :12 before and after using. 
 
 Specially in typhoid fever. 
 
 Bed linen when soiled, disinfected at once. 
 
 Toilets used only for patient, or carefully disinfected. 
 
 Formalin good. 
 
 Care of patient. 
 
 Rules for general nursing. 
 
 Extra points to meet fever cases. 
 
 Sponge bath daily. Flannel nightgown recommended, 
 
 thin gauze undervest. 
 When rash covers the body. 
 To soothe itching, bicarbonate of soda in water of bath. 
 
SUMMARY CHAPTER V 83 
 
 When skin peels. 
 
 Oil rubbed over skin. 
 
 Headache relieved by ice to head, heat to feet. 
 
 Oil on feet prevents dryness. 
 
 Cracked ice to swallow, plenty of water to drink, keeps 
 
 mouth and digestion well. Drink offered every hour. 
 After feeding rinse out mouth. 
 In typhoid, necessary to wash mouth and gums frequently 
 
 with antiseptic. 
 Back rubbed, with alcohol at night. 
 Soothes restlessness. 
 Rest of mind and body necessary. 
 Dim light burned at night. 
 When fever breaks, rub body with warm towel, fresh night 
 
 clothes. 
 Cheese-cloth used in place of handkerchiefs. 
 Daily record kept for physician. 
 Measuring of urine important. 
 
 Diet. 
 
 Small gas or electric stove to warm drinks and water. 
 
 Liquid diet at first, milk and broths. 
 
 l^o stimulant without doctor's orders. 
 
 Ask what to do in emergency. 
 
 Water given all through day, boiled, cooled in refrigerator. 
 
 Light diet (see page 164). 
 
 Lemonade, grape juice, orangeade, between meals. 
 
 Ask physician about nourishment at night. 
 
 Precautions taken by Home Nurse. 
 
 One member of family responsible for nursing patient. 
 
 Dress of nurse cotton, may be boiled and disinfected. 
 
 No starch in clothes, causes rustling noise disturbing to 
 
 patient. 
 Gauze cap covering hair, rubber gloves when emptying 
 
 secretions and spraying throat of patient. 
 
84 A TEXTBOOK OF HOME NURSING 
 
 IT^ose and mouth of nurse covered with wet gauze when 
 caring for diphtheria patient. 
 
 Do not inhale breath of patient. 
 
 Walk in open air daily, regular meals outside sick room, 
 good sleep, daily bath. 
 
 Never enter sick room when tired without eating or drink- 
 ing something nourishing. 
 
 Home Nurse not to sleep in sick room if possible. 
 
 In serious cases relieved by some one while she gets proper , 
 rest. 
 
 Before eating rinse out mouth, wash hands and face. 
 
 Microbes lodged in mouth, around teeth, will be absorbed 
 into system with food. 
 
 Dress of physician. 
 
 To prevent spread of disease, a gown or sheet to cover his 
 
 clothing. 
 Cap made from towel, rubber gloves, and rubbers for feet. 
 Disinfectant for hands. 
 
 Fumigation. 
 
 Give patient hot bath, sponge over with bichloride 1 :5000. 
 
 Take into another room. 
 
 Importance of proper disinfection of room. 
 
 Bed clothes disinfected in 1 :20 carbolic. 
 
 Mattress and pillows sent to be sterilized or burned. 
 
 Directions for fumigating room. 
 
 Two disinfectants, and how to use them. 
 
 Symptoms and stages in infectious diseases. 
 
 Diseases run definite course. Three periods namely, 
 
 incubation, eruption, desquamation. 
 Incubation — Exposure to disease. 
 Eruption — Rash appears. 
 Desquamation — Shedding of skin after fever disappears. 
 
SUMMARY CHAPTER V 85 
 
 Scarlet fever. 
 
 Develops in one day to three weeks. 
 
 Symptoms: chill (convulsions often in children), head- 
 ache, fever, sore throat. 
 
 Eash appears in twenty-four hours. Throat and tongue 
 inflamed. 
 
 Special complications — inflammation of ear drum, and 
 kidney trouble. 
 
 Mouth and throat to receive careful attention. 
 
 Plenty of fresh air. 
 
 After daily bath, oil or ointment rubbed over body. 
 
 Strict quarantine, disinfection of nurse and patient. 
 
 Fever both infectious and contagious. 
 
 For general nursing see Chapter II. 
 
 Smallpox 
 
 Vaccination important. 
 
 Symptoms: fever, chill, headache, nausea. Eash third 
 
 day. 
 Eash forms into pustules. 
 Itching intolerable, great care to prevent pits forming by 
 
 scratching. 
 Treatment, for itching, prolonged baths. 
 Oil, ointment rubbed on body, cold compresses on face and 
 
 hands. 
 Gloves tied on hands of children. 
 Eyes irrigated frequently, boric ointment on eyelids. 
 Absolute isolation, and disinfection. 
 
 Diphtheria. 
 
 Symptoms: sore throat, feeling of sickness, fever, head- 
 ache. 
 
 Antitoxin used, lessens effect of disease. 
 
 Home iN^urse requires glasses, rubber gloves, and cover 
 mouth and nose, when spraying throat of patient. 
 
 Dangerous complication, heart failure. 
 
86 A TEXTBOOK OF HOME NURSING 
 
 Patient not allowed to sit up in bed. 
 
 Typhoid fever. 
 
 Careful nursing required. Best to take patient to hos- 
 pital when possible. 
 
 Directions of physician written down. 
 
 Careful record kept. 
 
 Symptoms ; pain in back and abdomen, headache, nausea, 
 diarrhea, fever. 
 
 Characteristic temperature. 
 
 Infection through discharges, and by means of food and 
 drink. 
 
 Careful disinfection of all articles used by patient. 
 
 Care of mouth and gums important. 
 
 Swab out mouth before and after feeding. How to make 
 a swab. 
 
 Care to guard against bed sores. 
 
 Alcohol rubs, rubber rings. 
 
 Change of position. 
 
 Disinfection of bed linen. 
 
 Quiet for patient important. 
 
 Never leave typhoid patient alone when delirious. 
 
 Give abundance of water to drink. 
 
 Special care of diet, only what is ordered. 
 
 Cold baths used. 
 
 Complications, hemorrhage of bowels, perforation, phle- 
 bitis. 
 
 Symptoms of hemorrhage. 
 
 Stools to be watched carefully. 
 
 Symptoms of other complications to be watched for. 
 
 Tuberculosis. 
 
 Not inherited. 
 
 Infection in sputum, salita and nasal discharges. 
 Great advance made to stamp out; methods to prevent 
 spread of disease. 
 
SUMMARY CHAPTER V 87 
 
 Different parts of body affected. 
 
 Symptoms : loss of weight, night sweats, loss of appetite, 
 
 cough, pain in lungs, fever. 
 Favorable prospects if disease is taken in time. 
 Open air treatment most important. 
 Two points, keeping patient warm and out of draughts. 
 
 Measles. 
 
 Eruption ten days after exposure. 
 General rules of nursing followed. 
 Especial attention to eyes. 
 Serious on account of complications. 
 
 Erysipelas. 
 
 Infection through cut or wound. 
 Symptoms ; chill, fever, redness of face. 
 Isolation not necessary. Dressings burned. 
 Treatment; rest, good food, ointment or compresses for 
 skin. 
 
 Poliomyelitis. 
 
 Child's disease, spinal cord inflamed, paralysis in some 
 
 form follows. 
 Infection may be carried through third person. 
 Absolute rest, no massage until acute stage passes. 
 During convalescence, electric baths, good food, out-door 
 
 life. 
 
 Meningitis. 
 
 Symptoms : chill, convulsions, headache, nausea, stiff mus- 
 cles of neck, delirious. 
 
 Absolute quiet, dark room, careful nursing, food given 
 by a tube. 
 
 Disinfection and isolation. 
 
 Malaria. 
 
 Carried by mosquito. 
 
88 A TEXTBOOK OF HOME NURSING 
 
 Symptoms: chills at regular intervals, high fever, head- 
 ache, etc. 
 
 Treatment, quinine, patient put to bed during chill, heat 
 to feet, cold to head. 
 
 When fever comes, sponge bath. 
 
 Dysentery. 
 
 Infection through stools. 
 Care to disinfect all utensils, and bedclothes. 
 Watch food in hot weather, and drinking water. 
 Blood and mucus in stools, pain over abdomen. 
 Doctor's rules carried out. 
 Milk and gruels for diet. 
 
 Heat to abdomen, cleanliness of body and clothing, change 
 of air. 
 
 Whooping cough. 
 
 May be contracted by adults. 
 Characteristic cough. 
 
 Treatment, open air day and night, good food, flannel 
 underwear. 
 
 Mumps. 
 
 Infectious -with, children especially. 
 
 Rest in bed, liquid diet. 
 
 Care of mouth and gums. 
 
CHAPTEE VI 
 
 PEEVENTIOir AND CAEE OF COUGHS AHD COLDS. OTTRS- 
 ING IN GEIP, BBOWCHITIS, AND PNEUMONIA 
 
 Prevention o£ coughs and colds. The old-time 
 adage, "Prevention is better than cure," if remembered 
 and acted upon a little oftener than it is, would save a 
 world of suffering and trouble. 
 
 Take for instance the coughs and colds that are so gen- 
 eral in the early part of winter. When the weather com- 
 mences to change, one of the family is sure to come home 
 complaining of feeling chilly, sick, and miserable, with 
 aching bones and all the first symptoms of a heavy cold. 
 In nine cases out of ten, no immediate attention is paid 
 to these symptoms, as they are considered too slight to be 
 " doctored." Most people wait until the cold is in full 
 swing before they try to stop it. Instead, if a little trou- 
 ble is taken at the beginning to prevent it from really as- 
 serting itself, a great amount of unnecessary suffering 
 would be saved, and in some cases an attack of bronchitis 
 or pneumonia avoided. 
 
 One of the best precautions against taking cold is the 
 plentiful use of cold water. A good plunge bath every 
 morning, or at least sponging the throat, arms, and chest 
 with cold water for a few moments, will cause the blood 
 to circulate freely and brace up the system. Breathing 
 through the nose instead of the mouth, when in the open 
 air, will often prevent sore throat. Damp skirts and wet 
 shoes should be changed immediately, and if the feet are 
 cold and wet, dip them into cold water for a minute, and 
 rub briskly with a rough towel. The passages of the 
 
 89 
 
90 A TEXTBOOK OF HOME NURSING 
 
 nose and throat should be kept thoroughly cleared so that 
 the air can circulate freely through them, and thus prevent 
 any clogging that might cause catarrh. 
 
 Care of coughs and colds. Once the symptoms of a 
 cold really establish themselves, there are some simple 
 remedies that can be tried to overcome it. The first thing 
 which all doctors recommend is a good cathartic to clear 
 out the system and reduce the feverish symptoms. This 
 is always best taken at night so as to act the first thing 
 in the morning. Almost every one has some simple home 
 remedy he is accustomed to use, and it should be followed 
 in the morning by a Seidlitz powder or one of the many 
 mineral waters in general use. With children a dose of 
 castor oil is the safest and best remedy to use, especially 
 when there is any sign of croup. As a rule, calomel acts 
 well with adults, in overcoming a cold; either in doses of 
 one-tenth of a grain tablets, two taken every fifteen min- 
 utes until ten or twelve have been consumed ; or one-quar- 
 ter grain tablets, one every half hour for four doses. 
 Calomel should always be followed in a few hours by a 
 mineral water or salts of some kind to prevent its re- 
 maining in the system. 
 
 When there are any feverish symptoms with the cold, 
 as headache, flushed cheeks, skin dry and hot, etc., a hot 
 mustard foot-bath will draw the fever down from the head 
 and promote free perspiration. After the foot-bath, tuck 
 your patient in bed with hot water bags and give him a 
 hot drink of any kind, heat being the principal object; 
 either milk, bouillon, or lemonade. In the morning a 
 cold sponge over arms and chest, and a generous dose of 
 mineral water, will often be the final touch necessary to 
 drive the cold out of the system. Camphor taken in some 
 form at the very beginning of a cold is most helpful; it 
 can either be taken in camphor pills, in the rhinitis tab- 
 lets which contain a good deal of camphor, or spirits of 
 camphor, ten drops on a lump of sugar. 
 
CARE OF COUGHS AND COLDS 91 
 
 Five or six grains of quinine, taken at bedtime, and 
 again in the morning, is also of great service in some cases 
 in the commencement of a cold. 
 
 Tonsilitis. Inflammation and swelling of the tonsils, 
 or an ordinary sore throat, will often disappear with the 
 use of a gargle made pf peroxide of hydrogen mixed with 
 water, equal parts of each, used freely every one or two 
 hours. Iodine, glycerine and water equal parts is a splen- 
 did gargle to use every hour. Touching the tonsils with 
 a cotton swab dipped ifi. iodine helps greatly to reduce the 
 inflammation. Douching or spraying out the throat with 
 hot salt solution as described in chapter VIII also gives 
 great relief. 
 
 During an attack of tonsilitis the diet should be very 
 light. Sometimes it is necessary to touch the tonsils with 
 an astringent, but that would come under the doctor's 
 treatment. A cold pack made by wringing a handkerchief 
 out of ice cold water and applied to the throat at bedtime, 
 a small mustard paste or an application of capsicimi vaser 
 line, helps to draw out the inflammation. Little pieces of 
 ice mixed with glycerine, and allowed to melt in the mouth, 
 cool the throat and are very soothing. Should your pa- 
 tient be troubled with a disagreeable little tickling in the 
 throat, which obliges him to cough incessantly, especially 
 when lying dovra, you will soothe it very much by the use 
 of glycerine and whiskey, or glycerine and lemon juice, 
 equal parts, adding a little water if the mixture is too 
 strong. This sirup is taken in little sips and allowed to 
 go slowly down the throat. It is especially useful at night, 
 as it may be prepared at bedtime, and kept on a table near 
 at hand. 
 
 When suffering from sore throat the throat should be 
 kept moist by frequent drinks of very hot or ice cold 
 liquids (the hot drinks are best), or by using some cough 
 drops and letting them dissolve slowly in the mouth. A 
 simple but useful little cough mixture is made by boiling 
 
92 A TEXTBOOK OF HOME NURSING 
 
 some flax-seed and marsh-mallow root togetlier, strain care- 
 fully, add the juice of half a lemon, and sweeten to taste. 
 
 Grip, or Influenza. During the past few years grip 
 has become so universal in the winter season that it is well 
 to know how to treat it when it enters the family. In the 
 first place it has been proven beyond all doubt that it is 
 an infectious disease, and even in some instances has been 
 also contagious. 
 
 To prevent it from spreading through the household 
 you must keep the patient apart as much as possible from 
 the other members of the family, and especially guard 
 against any one inhaling his breath or sleeping in the 
 same room. The first symptoms of grip are, usually, se- 
 vere headache, fever, often as high as 102° or 103° T., 
 heavy cold in the head, and a very tired, depressed, list- 
 less feeling, with aches in every bone in the body. These 
 general symptoms are often followed by various complica- 
 tions, as grip seems to have the faculty of attacking any 
 part of the body that is at all weak or delicate. 
 
 If it is possible to do so, as soon as the first symptoms 
 appear, put the sufferer to bed and keep him warm and 
 quiet for a few days, and you will most likely be able 
 to prevent the disease going farther. But it is not pos- 
 sible always to indulge in the luxury of bed, as those en- 
 gaged in business often feel obliged to keep on their feet 
 until the last moment. 
 
 A very hot tub bath at bedtime is most soothing to the 
 aching bones, hot drinks, and hot-water bags at the feet, 
 and some counter-irritant, as capsicum vaseline, oil of 
 wintergreen, or vaseline and turpentine rubbed on wher- 
 ever there are pains and aches, will be- of great assistance. 
 
 Cold compresses on the head will relieve the headache. 
 
 Seidlitz powder, citrate of magnesia or Rochelle salts 
 should be given, and liquid diet for a day or two will be 
 the best treatment. 
 
 If the temperature keeps up a physician should be called. 
 
GRIP, BRONCHITIS AND PNEUMONIA 93 
 
 When there is intense pain in any locality, a mustard 
 plaster will generally soothe it. 
 
 Quinine taken in two- or three-grain doses every three 
 hours acts as a general tonic. Phenacetine and salol, two 
 and a half grains of each in tablet form taken every three 
 hours, is also most helpful. 
 
 Almost every one has some pet remedy he prefers to 
 try before calling in the aid of a physician. But when 
 the disease does not yield to simple remedies, you must 
 perforce persuade your patient to take a holiday from 
 business, and to spend it in bed or confined to one room 
 for a few days under the doctor's directions. Keep the 
 room at an even temperature and avoid excitement of any 
 kind, the bowels opened freely every day, and a simple but 
 nourishing diet of broth, eggs, milk in any form and other 
 easily digested foods. A tonic of some kind helps to 
 stimulate the appetite. For the rest, following out the 
 doctor's orders carefully, and a complete rest of mind and 
 body will bring about a speedy recovery. So many com- 
 plications may come from even a slight attack of grip, and 
 it so often develops into bronchitis or pneumonia, that you 
 cannot be too prompt at the outset in checking its course. 
 
 Even when there is no complication, after a severe at- 
 tack the system is liable to remain weak and delicate for 
 months. Grip, in the case of old people, is especially dan- 
 gerous, and frequently ends in pneumonia or heart fail- 
 ure. Eor this reason the necessity for preventing the dis- 
 ease or stopping it in the very beginning cannot be too 
 strongly enforced. 
 
 Bronchitis. Some of the first symptoms that appear 
 in a case of bronchitis are, chill, fever, oppressed feeling 
 in the chest, irritation in the bronchial tubes, which causes 
 paroxysms of coughing, aching limbs and head, and a rest- 
 less, nervous condition of the whole body. When these 
 symptoms appear, a physician should be summoned, and 
 hia directions carefully carried out. 
 
94) A TEXTBOOK OF HOME NURSING 
 
 One of the important things to be watched during an 
 attack of bronchitis is the temperature of the room, which 
 should be kept as even as possible, and never allowed to 
 fall below 68° F. A moist atmosphere is of great assist- 
 ance, and this can be accomplished by a kettle of water 
 kept boiling in the room night and day. 
 
 Give light but nourishing food every two or three hours, 
 such as milk, eggs, oysters, etc., and during convalescence 
 feed the patient well. Be sure and keep the feet very 
 warm, with hot water bags and bed socks, as cold feet 
 will increase the tendency to cough. At the beginning 
 of the attack a mustard foot-bath will be found most sooth- 
 ing and restful and also plenty of hot drinks. 
 
 During the first few days there is generally a paroxysm 
 of coughing in the very early hours of the morning, be- 
 cause during sleep mucus is apt to collect in the bronchial 
 tubes, and cause a great deal of irritation. In order to 
 ease the coughing, raise the head and slip two or three 
 pillows under it, give a drink of hot milk with a dessert- 
 spoonful of glycerine. Inhaling steam from a kettle also 
 gives the greatest relief, and it can easily be managed by 
 surrounding the spout of the kettle with paper, widening 
 it out at the upper end to cover the mouth completely, 
 then forming a tent over the patient's head with a sheet 
 and letting him inhale the steam slowly and carefully, 
 see page 104. Mustard plasters relieve the oppression on 
 the chest. 
 
 Talking more than is necessary should not be allowed, 
 as it irritates the bronchial tubes. Should the doctor order 
 poultices of any kind, make them very light, so that they 
 will not weigh heavily on the chest. 
 
 Pleurisy. One of the principal symptoms of pleurisy 
 is a sharp pain in the side, which is felt with every breath. 
 The disease generally starts with a chill, followed by fever, 
 and there is a frequent dry cough. The respiration in- 
 creases very rapidly. 
 
GRIP, BRONCHITIS AND PNEUMONIA 95 
 
 Wbile awaiting the physician's arrival, apply a linseed 
 poultice or mnstard paste over the seat of pain. The 
 physician will prescribe a regular course of treatment, 
 and the same general rules for nursing are to be followed, 
 as in cases of bronchitis or pneumonia. 
 
 A tight strapping with adhesive plaster over the ribs 
 is frequently used by physicians and gives great relief. 
 Should the physician prescribe poultices, mustard paste 
 or hot fomations follow the directions given in chapter 
 
 A circular ice-bag filled with small pieces of cracked ice 
 is also of service in reducing the temperature or soothing 
 the sharp pain. 
 
 Pneumonia. Pneumonia is generally, but not always, 
 ushered in with a chill, high fever, with headache, and 
 pain in the chest after coughing. The breathing is rapid, 
 and the pulse gradually rises, accompanied by intense 
 restlessness and nervousness. 
 
 Absolute rest is most important ; so, too, is freedom from 
 all care and worry. The bed must be comfortable and 
 well made, see directions in chapter I. 
 
 A sponge bath daily is a necessity to keep the body in 
 good condition. 
 
 The mouth must be most carefully treated to prevent 
 further infection ; it should be rinsed out after every feed- 
 ing and the gums and teeth cleansed with a cotton swab 
 dipped in boric acid four per cent. 
 
 The room must be kept cool, at about 65° F. So long 
 as the fever is high keep the patient as quiet as possible ; 
 no visitors should be allowed without the physician's per- 
 mission. A fluid diet, given every two hours in small 
 quantities, is necessary while the temperature remains 
 high. The stomach is often weak in pneumonia, and 
 different preparations of milk and broth have to be tried 
 to ascertain what can most easily be retained. Ask the 
 physician to make out a diet slip. 
 
96 A TEXTBOOK OF HOME NURSING 
 
 Give the nourishment either very hot or ice cold, as 
 anything lukevs^arm is very nauseating. 
 
 Milk and cream, milk-sugar, hominy, rice, raw, or 
 coddled eggs, broths and various milk preparations as mat- 
 zoon, buttermilk, etc., form the best diet. Broths are good, 
 especially chicken and mutton, also beef juice. 
 
 Drinks of water must be offered frequently to the pa- 
 tient ; every hour is not too often. Water is of great value 
 in keeping the mouth and tongue moist, and helping the 
 action of the bowels and kidneys. 
 
 Frequently in the night, after the fever breaks, there 
 will be a profuse perspiration, and the night clothes be- 
 come cold and clammy with moisture. Eemove all the 
 damp clothes, rub your patient quickly with warm towels, 
 and put on fresh clothes well aired and heated. Nourish- 
 ment is needed during the night, and especially in the 
 early morning hours, when the vitality will be found very 
 low. It is wiser to waken your patient for nourishment 
 than to allow him to continue sleeping when he is in a very 
 weak condition. Keep his head low, and on no account 
 allow him to get out of bed without the physician's orders, 
 for fear of heart failure. 
 
 Open air treatment brings splendid results in pneu- 
 monia, in stimulating, and toning up the nerves and vital 
 centers. A bed arranged on a sleeping porch (as de- 
 scribed in chapter I) is by far the best; when that is 
 not possible, windows should be opened wide or entirely 
 removed out of their frame ; while the bed is well protected 
 from draughts. 
 
 If the temperature rises above 105° F. ice cold baths 
 are sometimes given, and in some cases they have had a 
 splendid effect, but as a rule they are only resorted to in 
 most extreme cases. Frequent sponging with alcohol and 
 water, and very light covering will help to reduce the 
 fever, also plenty of cold water to drink. 
 
 Ohest compresses are used by many physicians; made 
 
SUMMARY CHAPTER VI 9t 
 
 of linen folded and fitted to spread over the entire chest ; 
 covered on both sides by thin flannel. The linen is wrung 
 out of water at a temperature of 60° F. One fold of 
 flannel is placed directly over the skin, the other over the 
 compress. About every hour it is necessary to change 
 the compress while the temperature remains high. 
 
 Recovery depends greatly on faithful nursing and con- 
 stant care. The physician's orders must be strictly 
 obeyed ; and it will assist him very materially if you keep 
 a record of the case, note the temperature, pulse, and 
 respiration every three hours ; the character and frequency 
 of the cough and expectorations; amount of food taken, 
 character of stools, and quantity of urine passed in twenty- 
 four hours; and any special symptom that may show it- 
 self during the physician's absence. 
 
 During convalescence, fresh air is of great value, day 
 and night. 
 
 SUMMARY 
 
 Prevention of coughs and colds. 
 Precaution against taking cold ; use cold water. 
 Plunge bath, or sponge bath braces up system. 
 Breathing through nose not mouth. 
 Damp skirts, and shoes changed immediately. 
 Dip feet in cold water, dry quickly, when cold. 
 Keep passages of nose and throat clear. 
 
 Care of coughs and colds. 
 
 Simple remedies to be tried. 
 
 Good cathartic, castor oil, calomel, etc. 
 
 Hot mustard foot-bath to reduce fever. 
 
 Put patient to bed, hot drink, hot water bag. 
 
 Cold sponge bath in morning. Camphor good. 
 
 Tonsilitis. 
 
 Peroxide of hydrogen, good gargle. 
 
98 A TEXTBOOK OF HOME NURSING 
 
 Also iodine, glycerine and water. 
 Touching tonsils with iodine helpful. 
 Spraying and douching throat good. 
 Diet light. Cold pack to throat useful. 
 Sirup of glycerine helps tickle in throat. 
 Keep throat moist, hot and cold drinks. 
 Flaxseed and naarshmallow mixture. 
 
 Grip or Influenza. 
 
 Infectious disease. Keep patient from other people. 
 
 Symptoms : headache, fever, cold in head. 
 
 Depression, body aches all over. 
 
 Treatment, bed when possible, hot tub bath, hot drinks, 
 
 hot water bags. 
 Counter-irritant to relieve aching limbs. 
 Cold compresses on head. 
 Cathartic-, liquid diet. 
 Doctor called if temperature increases. 
 Temperature of room to be kept even. 
 Follow doctor's orders, complete rest of mind and body. 
 Complications often follow, so care is required. 
 In case of old people especially dangerous. 
 
 Bronchitis. 
 
 Symptoms; chill, fever, paroxysms of coughing, nervous 
 condition of body. 
 
 Treatment, send for doctor. Temperature of room impor- 
 tant. 
 
 Moist atmosphere good. 
 
 Diet nourishing, feed patient well. 
 
 Keep feet warm ; cold feet increases cough. Mustard foot- 
 bath good. 
 
 How to control cough in early morning. 
 
 Pillows, hot drinks, steam, mustard on cheat. 
 
 Talking not allowed. Poultices. 
 
SUMMARY CHAPTER VI 99 
 
 Pleurisy. 
 
 Principal symptom, sharp pain in side. 
 Poultices or plaster while awaiting doctor. 
 See directions in chapter VIII. 
 General rules for nursing followed. 
 
 Pneumonia. 
 
 Symptoms; chill, fever, headache, pain in chest after 
 
 coughing. 
 Rapid breathing, restlessness, nervousness. 
 
 Nursing. 
 
 Absolute rest important. 
 
 Comfortable bed. 
 
 Sponge bath daily. 
 
 Care of mouth important. 
 
 Temperature of room low. !No visitors. 
 
 Fluid diet, nourishment very hot or ice cold. 
 
 Milk preparations best. Broths and beef juice. 
 
 Quantity of water to drink important. 
 
 Water of great value. 
 
 How to care for night sweats, when fever breaks. 
 
 Nourishment at night. Keep patient's head low. 
 
 Open air treatment splendid. 
 
 Out-door sleeping bed(see chapter I). 
 
 Ice cold baths in extreme cases. 
 
 Frequent sponge baths. 
 
 Chest compresses used. How to make and apply them. 
 
 Faithful nursing important. 
 
 Keep record for doctor. 
 
 Fresh air day and night. 
 
CHAPTER VII 
 
 OBSEEVATrON (XE SYMPTOMS IN THE NUESING OP 
 CHrLDEEN 
 
 Observation of symptoms in children. At all times 
 cliildren require a great deal of patient care and watch- 
 fulness. But especially when they are ill, it is necessary 
 to combine with patience both tact and sympathy. 
 
 Children under four or five years of age are quite un- 
 able to describe their symptoms, and, indeed, older chil- 
 dren very often cannot explain where exactly the trouble 
 lies, or how it affects them. It is especially requisite, 
 therefore, in dealing with children (though also of great 
 importance with older people), that we cultivate the habit 
 of observation; and the eye can very soon be trained to 
 notice signs of illness, especially in those we love. 
 
 Significances of a child's cry. " Soft infancy that 
 nothing can'st but cry," is very clearly illustrated when 
 a child is sick, but even the manner in which a child 
 cries is quite suggestive as to where the pain lies. 
 
 Crying immediately after coughing shows that the cough 
 has caused pain in the chest. 
 
 Incessant crying in a very young child is a sure indica- 
 tion of pain or hunger. If from hunger, the child will 
 stop crying as soon as he is fed. 
 
 When there is pain in the ear the child will frequently 
 put up his hand to his ear. 
 
 When there is pain in the abdomen the cry will be very 
 loud, and the child vnll draw his little legs up against the 
 abdomen. 
 
 100 
 
SYMPTOMS IN CHILDREN 101 
 
 Sharp screams at intervals, followed by low moans, are 
 a sign of brain disease. 
 
 Illness indicated by position. A great deal can also 
 be observed by watching the child sleep. The position he 
 takes in bed is very suggestive, as he will unconsciously 
 assume the position that gives him the greatest relief from 
 pain. In lung troubles, the child will lie on the side af- 
 fected, so that the air will have a better opportunity to 
 enter the well lung, and thus enable him to breathe more 
 comfortably. 
 
 Knees drawn up against the abdomen during sleep, and 
 a twitching of the upper lip, often indicate peritonitis. 
 
 When suffering from colic, a child will turn over and 
 lie on his stomach. T'rowning and a continuous contrac- 
 tion of the eyebrows accompany pain in the head. Rest- 
 lessness and twisting of the eyelids, while the thumb is 
 flexed in the palm of the hand, is a beginning of convul- 
 sions. 
 
 Should a child complain frequently of headache, after 
 he is old enough to commence studying, while his general 
 health seems to be all right, you will often find that there 
 is some affection of the eyes, even though the sight may not 
 appear to be troubled. Dark rings under the eyes come 
 sometimes from imperfect circulation. 
 
 If a very young child keeps putting his hand to the ear, 
 head, or throat, it often means inflammation or irritation 
 of some kind in that locality. Many of these symptoms 
 apply to grown-up people as well as children, but as a 
 rule they can explain to you where the trouble lies and 
 can describe the symptoms ; while a child has to be treated 
 almost altogether from observation, and it is of inestimable 
 value to the physician, in making his diagnosis, if the 
 mother, sister, or aunt, as the case may be, will note any 
 little change or new symptom that appears during his ab- 
 sence. 
 
 Children are so often frightened or nervous while a 
 
102 A TEXTBOOK OF HOME NURSING 
 
 doctor is making Ms visit ihat they seldom, appear as nat- 
 ural as when alone with familiar faces. 
 
 " First-aid remedies." Should the stomach or liver 
 be out of order, you may tell it at once by looking at the 
 tongue, as it will appear to have a yellowish white coating 
 at the back and down the middle. 
 
 A slight sore throat often comes from indigestion, and 
 will soon disappear after a good dose of medicine. 
 
 It is a safe rule to follow, that, as soon as a child shows 
 any symptoms of illness, such as sick stomach, diarrhea, 
 cough, accompanied by listlessness or irritability of tem- 
 per, to put him in a good hot bath, and then to bed for 
 a few hours, giving him a dose of castor oil or calomel. 
 By doing this you will often be enabled to ward off an 
 attack of biliousness, croup, or other ailment. If there 
 is any concealed rash, the hot bath will help to bring it 
 out and will reduce the feverish symptoms. 
 
 A child's temperature goes up to 102° to 103° F. with 
 very little provocation. Sometimes constipation or indi- 
 gestion will send it up rapidly in a few hours. 
 
 Proper care of a child. To keep a child in good 
 health, very regular habits should be formed, as regards 
 his sleep, food, daily bath, regulation of the bowels, and 
 outdoor exercise. 
 
 It is a mistake to suppose that children will become 
 hardened by exposure to cold ; on the contrary, a great deal 
 of sickness will be prevented by dressing them with a 
 flannel garment next the skin, both winter and summer. 
 
 Many of the ills of childhood arise from improper food, 
 causing various intestinal disturbances. Gastro-intestinal 
 irritation frequently leads to convulsions in young chil- 
 dren. 
 
 When any particular form of food disagrees with a 
 baby, he will lose weight, become restless, and often cry 
 incessantly from pure hunger. 
 
 Constipation. If children are troubled with constipa- 
 
NURSING OF CHILDREN 103 
 
 tion, every effort should be made to overcome it by estab- 
 lishing regular habits. A very gentle massage over the 
 left side of the abdomen, with a little vaseline on the hand, 
 for eight or ten minutes twice a day after meals; or a 
 small suppository made of Castile soap slipped into the 
 rectum right after breakfast, will be of great service in 
 overcoming this diiEculty. Outdoor exercise, oatmeal por- 
 ridge, bran, given before meals mixed in water (or sprin- 
 kled on the cereal), plenty of cooked fruit and orange juice, 
 will be found of assistance in promoting a regular action 
 of the bowels every day. 
 
 The daily bath is of great importance to a child, and 
 should be given either before breakfast or at bedtime. As 
 a child's skin is very sensitive and easily chapped, it must 
 be dried very thoroughly, especially in all crevices, and a 
 simple baby powder used to prevent moisture. 
 
 A very young child's mouth should be washed out after 
 feeding, with a weak solution of boracio acid. 
 
 Wind colic. Wind colic is one of the baby's first 
 troubles. To cure it, keep him very warm near the fire, 
 lying on his stomach. Give him some peppermint and 
 hot water, and rub the abdomen gently in a circular direc- 
 tion. 
 
 Croup. This disease, so much dreaded by mothers, 
 sometimes appears without any warning, and almost in- 
 variably at night. The child wakes with a peculiar hoarse 
 cough, which once heard is never forgotten. The breath- 
 ing is labored and long drawn out, with a little whistle 
 in every breath. In severe cases while awaiting the doc- 
 tor a hot bath should at once be prepared, or if that is im- 
 possible, a mustard foot-bath, to relieve the spasms and 
 promote a profuse perspiration. After the bath wrap the 
 child in a blanket, put him to bed, wring a flannel cloth 
 from very hot water, and apply it to the throat, changing 
 it every three minutes to keep up a steady heat. Give a 
 teaspoonful of sirup of ipecac, repeating in half an hour 
 
104. A TEXTBOOK OF HOME NURSING 
 
 to cause free vomiting, and a simple soap-suds enema (see 
 page 123) to relieve the bowels. 
 
 Steam is of great service in croup, to relieve the throat. 
 A croup kettle may easily be arranged. Make a large 
 cone with cardboard or stiff paper, fit it over the spout 
 of a kettle fuU of boiling water, and place the kettle on a 
 little alcohol or electric stove close to the bed. A croup 
 tent may also be made at home, by covering an umbrella, 
 or a screen with an old blanket, and then a sheet ; pin the 
 sides down well around the head of the bed. The spout 
 of the kettle is pushed in between the pins in the sheet 
 above the head of the child, but far enough out of reach 
 so that he cannot touch it. A second blanket should be 
 thrown over the top of the tent to absorb the moisture, and 
 great care taken to prevent the blankets coming in touch 
 with the stove. 
 
 Should the child be subject to croup, you can frequently 
 ward off an attack by giving a dose of castor oil in the 
 afternoon, as soon as any symptoms of cold appear in the 
 system. Protect the child well from draughts and cold 
 feet, and keep him on a simple diet of milk, broths, and 
 cereals for a few days. 
 
 In the case of membranous or true croup, the membrane 
 forms quickly across the throat and is exceedingly dan- 
 gerous. The temperature may go up to 104° E., and 
 great exhaustion is evident. A physician should be sum- 
 moned at once, for if the child is unable to cough up the 
 membrane, it must be forcibly removed, and sometimes 
 an operation for intubation, or tracheotomy, will be foimd 
 necessary to save the child's life. 
 
 Convulsions. Convulsions arise from various causes, 
 and may be either a symptom of a disease not fully de- 
 veloped, a complication in some severe illness, or they may 
 be caused by indigestion, teething, or other diseases. 
 When they occur in adults, it is almost always in connec- 
 tion with some severe illness or in poisoning cases. When 
 
NURSING OF CHILDREN 106 
 
 convulsions are caused in children by some irritation of 
 the stomach or bowels an emetic should be given, followed 
 by an enema. 
 
 A hot mustard bath or pack is the best remedy, while 
 awaiting the arrival of the doctor. 
 
 One tablespoonful of mustard to a gallon of water (mix 
 the mustard first in cold water then add to the bath of 
 hot water) the temperature of the bath about 100° F. 
 The water should be deep enough to cover the child up to 
 the neck, and the bath last about ten minutes. Then the 
 child is dried gently and rolled in blankets. 
 
 To give a mustard pack, allow one tablespoonful of mus- 
 tard to one quart of water, dip a towel in this mixture, 
 wring it out and wrap it around the child, covered with a 
 blanket. The physician will probably prescribe some 
 soothing medicine, and the child must be kept warm and 
 quiet. 
 
 When convulsions occur during teething, lancing the 
 gums will give instant relief. 
 
 Diarrhea. Though not a disease of childhood, diar- 
 rhea is more serious in a child than in an adult, as the 
 child is quickly exhausted with the continuous strain on 
 the system. 
 
 A very slight cause will bring on diarrhea, especially in 
 delicate children, and during the warm weather, if not 
 checked it may very easily turn to dysentery. The first 
 and most important symptom of dysentery is the appear- 
 ance of blood and mucus in the stools, vnth severe grip- 
 ing pains. A physician should be at once summoned, as 
 prompt treatment is necessary to check the disease, Eapid 
 change of temperature or diet is sufficient to start diarrhea, 
 especially when there is want of care or knowledge in the 
 treatment of a child with such a tendency. 
 
 Keep the child scrupulously clean, especially during the 
 hot weather, give him plenty of fresh air, and guard 
 against his taking cold while bathing, or lying without 
 
106 A TEXTBOOK OF HOME NURSING 
 
 covering at night. This care, in addition to the boiling 
 all the water he drinks, will be of great assistance in pre- 
 venting an attack. As soon as the diarrhea appears, a 
 dose of castor oil is the best remedy to remove any irri- 
 tating substance that may have caused the trouble. It is 
 wiser not to check the diarrhea immediately, but if it does 
 not stop after the oil has acted, a little bismuth powder 
 will help to stop it. When it is possible to do so, keep 
 the patient in bed until the diarrhea ceases. Burnt brandy 
 helps to relieve the pain and is also slightly constipating. 
 The best diet is boiled milk and arrowroot. Flour and 
 water whipped to a thick cream, a teaspoonful taken every 
 hour, is useful in stopping the disease, and sometimes a 
 starch enema is necessary, but must never be given with- 
 out the doctor's orders. Hot stupes or dry heat applied 
 to the abdomen will be found very soothing. In the case 
 of a child, if the temperature should rise very high, a cold 
 pack will help to reduce the fever immediately. 
 
 If the diarrhea shows no sign of disappearing after a 
 few hours, the physician should be summoned. 
 
 Gastric catarrh. Very often about holiday time, or 
 after any especial festival, it is not unusual for a child to 
 have an attack of gastric catarrh or, as it is generally 
 called, a bilious attack, caused by eating too many rich 
 dainties. If this is not checked at once, it may develop 
 into bilious fever. 
 
 The symptoms are, a heavily coated tongue, offensive 
 breath, nausea, sometimes accompanied by vomiting, lan- 
 guid feeling, headache and fever. The temperature some- 
 times rises to 103° F. 
 
 A good dose of castor oil should be given immediately. 
 Then put the child to bed and sponge him off with alcohol 
 and water. 
 
 Nothing but milk, broths, and cereals should be allowed 
 for a few days, and great care should be taken to prevent 
 him from contracting cold. 
 
NURSING OF CHILDREN lOT 
 
 Falls or blows upon the head. Children frequently 
 receive a blow on the head by a fall or other accident. If 
 the blow is severe enough to cause unconsciousness, a doc- 
 tor must be sent for at once. While awaiting his arrival, 
 take the child into a quiet room, unfasten the clothing 
 around the neck, apply ice-cloths to the head, and hot 
 water bags to the legs and feet; but on no account give 
 any alcoholic stimulant. If the stomach is not nauseated, 
 a drink of hot milk will be reviving. 
 
 In some severe cases days may elapse before the child 
 regains consciousness, and during that period nourish- 
 ment must be given in the form of nutritive enemata. 
 
 St. Vitus' dance. This trouble is confined almost al- 
 together to children with a highly nervous temperament, 
 and to overcome it a great deal of patience and careful 
 watching are required. Plenty of sleep is an absolute 
 necessity, and when the nerves are too excited to allow 
 of natural sleep, hypnotics must be resorted to. A quiet, 
 easy life should be followed, with simple amusements and 
 plenty of outdoor exercise, light but bountiful diet, with- 
 out meats or stimulating foods, and a free action of the 
 bowels daily. A shower bath or brisk sponge bath every 
 morning, commencing with lukewarm water, and gradu- 
 ally making it colder, and gymnastic exercises to strengthen 
 the muscles, are very beneficial. 
 
 A child should always urinate at least once in every 
 six hours, and nervous children who cannot control the 
 urine, especially at night, should not be punished, but 
 taught as far as possible the power of self-control, and 
 be treated by the family physician. 
 
 Loss of weight is sometimes one of the first signs of 
 ill health in children, and it may be well to have them 
 weighed often, especially when they are growing very 
 rapidly. 
 
 Do not move sick children more than is necessary; it 
 is a mistaken idea that it is wise to take them out of bed 
 
108 A TEXTBOOK OF HOME NURSING 
 
 and rock them in jour arms when they are suffering from 
 pneumonia or other diseases. There is great danger of 
 fresh cold, and besides that, children are so easily excited, 
 and their temperature goes up so rapidly with the slight- 
 est cause, that the quieter you can keep them when sick, 
 the better. 
 
 SUMMARY 
 
 Observation of symptoms. 
 
 Many children unable to describe symptoms. 
 
 Habit of observation to be cultivated by nurse. 
 
 Crying after coughing, indicates pain in chest. 
 
 Incessant crying means pain or hunger. 
 
 Child's hand held up to ear, indicates earache. 
 
 Pain in abdomen, cry loud, legs drawn up. 
 
 Sharp screams, and low moans, signs of brain disease. 
 
 Illness indicated by position. 
 
 Child assumes position that gives greatest ease. 
 Lung trouble, child lies on side affected. 
 Knees against abdomen, twitching of lips in sleep, symp- 
 toms of peritonitis. 
 Colic, one symptom, child lies on stomach. 
 Restlessness, twitching of eyelids, symptom of convulsions. 
 Headaches often due to affection of eye. 
 
 First aid remedies. 
 
 Sick stomach, diarrhea, coated tongue ; give castor oil, hot 
 
 bath, put child to bed. 
 Child's temperature rises with small cause. 
 
 Proper care of child. 
 
 Form regular habits, in sleep, food, exercise, bath. 
 
 Importance of flannel underwear. 
 
 Improper food, the troubles it causes. 
 
SUMMARY CHAPTER VII 109 
 
 Constipation. 
 
 Try to overcome by forming regular habits. 
 Massage, suppository of Castile soap. 
 Diet to include oatmeal, bran, fruit, etc. 
 Daily bath important. 
 
 Wind colic. 
 
 Warmth important, peppermint and hot water. 
 Rub abdomen. 
 
 Croup. 
 
 Peculiar, hoarse cough, breathing long, whistle in breath. 
 Treatment ; hot bath, mustard foot bath. 
 Hot flannel stupes to throat. Ipecac. 
 Simple soapsuds enema. 
 
 Steam of great service, croup kettle, and how to make it. 
 Croup tent. 
 
 To prevent croup, give castor oil when symptoms first ap- 
 pear. Simple diet. 
 In membranous croup send for doctor. 
 Operation sometimes necessary. 
 
 Convulsions. 
 
 Arise from various causes. 
 
 Treatment, hot mustard pack or bath while awaiting doc- 
 tor. 
 How to prepare the bath. Mustard pack directions. 
 
 Diarrhea. 
 
 More serious in child than adult. 
 
 Often turns to dysentery, send for doctor. 
 
 Keep child clean, fresh air, guard against cold. 
 
 Boil drinking water. 
 
 Do not check diarrhea at once. 
 
110 A TEXTBOOK OF HOME NURSING 
 
 Keep patient in bed. 
 
 Diet, boiled milk and arrowroot. 
 
 Hot stupes and dry beat to abdomen. 
 
 Gastric catarrh. 
 
 Symptoms, tongue coated, breatb offensive, vomiting, bead- 
 ache, fever, temperature. 
 Treatment, castor oil, put child to bed, alcohol sponge. 
 Diet ; milk, cereals, broths, guard against taking cold. 
 
 Fall or blow on head. 
 
 Send for doctor, take child into quiet room, unfasten 
 
 clothing. 
 Ice cloth to head, heat to feet. - 
 
 St. Vitus' Dance. 
 
 Extra amount of sleep needed. 
 
 Sleeping powders sometimes ordered. 
 
 Quiet life, out-door amusements, simple diet, free action 
 
 of bowels daily. Cold bath mornings. 
 Loss of weight, sign of ill health. 
 Do not move sick children, keep quiet in bed. 
 
CHAPTER VIII 
 
 OOTJN'TEE.-IHEITAWTS. DOTJCHES. ENBMATA 
 
 Poultices. Should your patient suffer' locally, from 
 pain, caused by inflammation or congestion, the doctor 
 may order some kind of counter-irritant, to be applied to 
 the surface of the body to relieve the pain by reducing the 
 inflammation. We will here discuss only the simpler 
 forms of counter-irritants that a Home Nurse may be 
 called upon to administer. 
 
 Linseed poultices. linseed poultices are more fre- 
 quently used than any other kind of poultices, and it is very 
 necessary to know exactly how to make them ; they should 
 always be very hot, light and moist; never try to make 
 them unless the water is really boiling. Between one and 
 a half and two cups of water is enough for an ordinary- 
 sized poultice. As soon as the water boils, take a large 
 spoon in one hand, and in the other a handful of meal, 
 shake the meal into the water, at the same time stirring 
 briskly. When it is as thick as a good batter, and evenly 
 mixed, it is ready for use. A little mustard may be 
 added, or any other medication that has been prescribed. 
 When mustard is added to a linseed poultice, for an adult, 
 use two tablespoonfuls of mustard to every cup of lin- 
 seed ; for a child, one tablespoon to a cup. The mustard 
 should first be dissolved in cool or lukewarm water; and 
 only added to the poultice after it has been taken from the 
 fire. Never use hot water when mixing mustard, as the 
 heat kills the ferment in the mustard, and prevents the 
 oil being freed to cause irritation. 
 
 Pour the poultice out evenly on a piece of old linen or 
 
 111 
 
113 A TEXTBOOK OF HOME NURSING 
 
 muslin, which should be twice the size needed for the 
 poultice, so as to leave a large margin to turn up all around. 
 After turning up the edges, put in a few stitches around 
 the sides — if you have a needle and thread ready it 
 will not take a moment — then you may be absolutely 
 certain that the poultice will not fall to pieces and cause 
 your patient great discomfort. Never make a poultice 
 too thick; it is far better to make it thin and change a 
 little oftener than to have a heavy weight resting on a 
 sensitive part of the body. One teaspoonful of bicarbonate 
 of soda, well beaten into the poultice, just before pouring 
 it out will make the poultice lighter in weight. When a 
 poultice has to be carried any distance before being ap- 
 plied, up a flight of stairs or through a cold hall, cover 
 it with a piece of flannel or put it between two hot plates, 
 as it should be applied as hot as your patient can endure 
 it. 
 
 Applying a poultice. Great care must be taken not to 
 burn your patient with a hot poultice; put it on very 
 slowly, lifting it up two or three times before you finally 
 allow it to remain on the skin. 
 
 Poultices need to be changed about every hour, as they 
 cause more harm than good if allowed to get cold and chiU 
 the patient. When changing a poultice be careful not to 
 uncover your patient more than is absolutely necessary 
 to make the change quickly. Wipe the moisture from the 
 skin each time before applying a fresh poultice; and, 
 when the skin is red, rub on a little vaseline before the 
 fresh poultice; and if you cover the poultice with a thin 
 layer of cotton wool, and place over that a piece of oil 
 silk, it will retain its heat for a full hour. When apply- 
 ing a poultice, a bandage about ten inches wide should be 
 flrmly pinned round the body to keep it in place. There 
 is always danger of the patient taking cold after poultices 
 have been applied for any length of time, as they tend to 
 make the system very susceptible, so that when they are 
 
COUNTER-IRRITANTS 113 
 
 no longer necessary, put an extra covering of cotton wool 
 (cotton batting quilted between two pieces of gauze) or 
 flannel for a few days over the spot where the poultice has 
 been. 
 
 Mustard paste and mustard leaves. Mustard may 
 be applied either in the form of a regular mustard paste, 
 or you may buy a package of mustard leaves from any 
 druggist all ready for use, and they are very convenient 
 (especially when traveling), being easily carried, and 
 applied by moistening the leaf with warm water, and 
 placing a thin piece of muslin or gauze between the leaf 
 and the skin. Vaseline or oil must first be rubbed on the 
 skin and the leaf left on only about fifteen minutes, some 
 skins are very sensitive and the mustard leaf ought to be 
 lifted at the end of five minutes for fear of a blister. 
 After the mustard leaf is taken off, wash the skin care- 
 fully with soap and warm water as small particles of 
 mustard remaining will surely result in a blister. 
 
 Mustard paste. The ordinary mustard paste is made 
 by using flour mixed with mustard, making the applica- 
 tion any strength required. For children it is wiser to 
 use six or eight teaspoonfuls of flour to one of mustard,, 
 as their skin is very tender and sensitive ; but for an adult 
 three or four teaspoonfuls of flour to one of mustard is 
 about the right strength, only as formerly stated, the oil 
 in the mustard will not be properly released if the mus- 
 tard is mixed with hot water; and therefore to get the 
 full strength of the mustard, cold or barely lukewarm 
 water must be used. Mix the flour and mustard together, 
 then add the water slowly until the paste is smooth and 
 about the consistence of thick cream. 
 
 Applying mustard paste. Spread the paste upon a 
 piece of old linen or gauze, leaving at least four or five 
 inches on each side to turn up over the paste. Cover the 
 outer side with a large fold of gauze or a small towel, and 
 apply the inner side to the patient's skin. If you lay the 
 
114 A TEXTBOOK OF HOME NURSING 
 
 mustard plaster on a very hot plate or against a hot water 
 bag for a few moments before applying it, you will pre- 
 vent the disagreeable sensation that is caused when the 
 plaster is applied cold. Using white of egg instead of 
 water when mixing the mustard removes some of the dan- 
 ger of blistering, and this danger may also be guarded 
 against by rubbing the skin with vaseline before applying 
 the plaster. A mustard paste does its work very quickly 
 and should be removed as soon as the skin is a bright red 
 color. Never allow your patient to fall asleep with the 
 paste on, or a blister may be the result. A little vaseline 
 or sweet oil on a piece of linen should be applied after the 
 paste is removed. 
 
 Plasters. Plasters are ordered when a strong counter- 
 irritant is needed to draw out the inflammation from some 
 part of the body. Before applying a plaster wash the 
 skin carefully with soap and water, rub with alcohol, and 
 dry thoroughly. Apply the plaster and cover very loosely 
 with a bandage, leaving plenty of room for the skin to 
 rise with the blister. After about five or six hours, re- 
 move the plaster gently, taking care not to break the skin. 
 Do not prick the blister, unless under the doctor's orders ; 
 as a rule, it is now considered best to allow it to remain 
 unbroken; apply carefully a dressing of boric acid oint- 
 ment or a sterilized gauze compress, very loosely. 
 
 Hot stupes. Moist heat is of great service in reducing 
 inflammation and it may best be applied in the form of 
 hot stupes. These stupes are made about eight or ten 
 inches square, from a piece of flannel or old blanket. In 
 order to wring them out of the hot water without burning 
 the hands, have a towel ready, folded lengthwise ; catch the 
 hot stupe by one comer, drop it into the towel, wrap it 
 up tightly, and twist the ends of the towel in opposite di- 
 rections until squeezed dry. Then carry it to the bedside, 
 but do not remove the hot stupe out of the towel until 
 ready to apply, as it cools very rapidly. Apply slowly 
 
COUNTER-IRRITANTS 115 
 
 as with a poultice, for fear of burning your patient. Cover 
 over with cotton wool or a piece of flannel, and oil silk to 
 retain the heat. Flannel stupes must be changed every 
 ten or fifteen minutes to keep up an even temperature, 
 then wipe the skin dry and apply a pad of cotton or soft 
 flannel. 
 
 Turpentine stupes. Turpentine does not mix well 
 with water, and requires a little oil to guard against caus- 
 ing a blister. The best way is to mix one part of turpen- 
 tine to two parts of oil (one to eight for a child), then 
 with a piece of cotton rub this mixture well over the skin 
 and immediately put on the hot stupe. When applying 
 a hot stupe to the breast, cut a small hole in the center 
 of the flannel, for the nipple, because it is not wise to 
 cover it with the hot stupe. 
 
 Hot compresses for the eye. Hot compresses are 
 composed of small pieces of absorbent cotton about two 
 inches square; the water as hot as 115° F. Squeeze out 
 the tiny compress with your fingers, and change every two 
 minutes. 
 
 You may keep the water hot over a tiny alcohol lamp 
 or gas stove, or have boiling water in a pitcher, ready to 
 add to the basin. From twenty to thirty minutes is the 
 usual length of time to apply the eye compresses. When 
 there is a discharge from the eye, the compress should 
 never be used more than once; have a number on hand 
 in a basin, and burn the old one as soon as you take it from 
 the eye. 
 
 Dry heat. When dry heat is required flannel may be 
 heated in the oven or against a hot brick or iron, and 
 applied as hot as can be borne. 
 
 Bags of salt warmed in the oven are also of great use 
 when dry heat is required. The bags should be covered 
 with flannel. 
 
 Hot water bags are also serviceable in applying dry 
 heat. The bag should be only half full, and all the air 
 
116 A TEXTBOOK OF HOME NURSING 
 
 pressed out before putting in the stopper; screw on the 
 top very firmly and place the hot water bag in a flannel 
 bag, covering the neck and stopper. One cause for the 
 leakage of hot water bags is that the little rubber washer 
 around the stopper gets worn out and needs renewing 
 frequently. Hot water bags may be bought of all sizes, 
 from the tiny rubber ones, three or four inches long, which 
 are so useful in f aceaohe or earache, to the large ones hold- 
 ing two or three quarts. 
 
 Circular aluminum hot water cans are invaluable; 
 they retain their heat for hours and are not liable to be 
 destroyed as quickly as the rubber ones. 
 
 Electric pads are now used extensively when dry heat 
 is required. Care must be taken in using these pads that 
 the electric power is turned off when the pad is sufficiently 
 warm — also that the wire tubing is kept in good order, 
 so that the insulation may remain perfect or the bedclothes 
 may be set on fire. 
 
 Iodine. Iodine is a good counter-irritant ; Churchill's 
 iodine being the strongest kind. It is applied with a 
 camel's hair brush or cotton swab. When the skin is very 
 sensitive and the iodine is likely to cause a blister, it may 
 be removed with alcohol. 
 
 Oil of wintergreen is another counter-irritant, espe- 
 cially in cases of grip when there are pains in the limbs 
 and back from cold. It should be rubbed in rather lightly 
 at first and repeated in a few hours. 
 
 Equal parts of turpentine and vaseline are useful 
 especially when there is a heavy cold on the chest. Melt 
 the vaseline over the fire or lamp and mix in the turpen- 
 tine. When applying any of these liniments, protect the 
 clothing from coming in contact with them, as the oil con- 
 tained in them leaves unsightly stains. 
 
 Ammonia when used for a counter-irritant is poured 
 upon a piece of gauze or absorbent cotton and laid next 
 the skin. Cover vnth oiled muslin and a gauze dressing. 
 
COUNTER-IRRITANTS 117 
 
 After about five minutes, take it off, otherwise you may 
 have a blister. 
 
 Antiphlogistin. Great relief is given to pain caused 
 by congestion, by the use of antiphlogistin. When or- 
 dered by the doctor; take the paste and spread it upon 
 muslin or gauze, then put your poultice on a tin plate 
 and place it in a warm oven to heat. Another method, 
 is to put the antiphlogistin into a double boiler and heat 
 it thoroughly before spreading upon the gauze or muslin. 
 A hot water bag should be placed over the poultice after 
 you have bound it on your patient, as continuous heat is 
 required to prevent the paste becoming hard and dry. 
 
 Cold applications. In some forms of acute inflamma- 
 tion, cold applications are indicated instead of hot. Ice- 
 coils are often used on the head or abdomen, but they are 
 troublesome to manage and, as a rule, ice-caps are used 
 instead outside the hospital. In filling an ice-cap the ice 
 must not be cut too small (pieces about the size of a wal- 
 nut are best), or it will melt away very quickly, and a 
 piece of linen or gauze must always be placed between the 
 ice-cap and the skin, so that the cold will not be too intense. 
 Never fill an ice-bag too full, or the weight of it will do 
 more harm than good. You must also bear in mind that 
 ice-caps lose their utility if allowed to get warm, so they 
 must be changed as soon as the ice melts. Paper ice-caps 
 (made from Japanese paper) are frequently used if a 
 rubber ice-cap is too expensive and if the treatment is 
 only for a few hours they answer the purpose well. 
 
 Cold compresses of old linen, gauze or muslin are of 
 infinite value in cases of nervous headache, sore throat, or 
 intense fever or delirium. The best way to manage them 
 is to put a large piece of ice into a basin, pour a little 
 alcohol or bay-rum over it, and lay pieces of linen on the 
 ice, when they will become cold without being too wet. 
 Any one subject to headaches knows how uncomfortable 
 it is to have a cold, wet cloth on the head that drips down 
 
118 A TEXTBOOK OF HOME NURSING 
 
 at each corner into the ears and down the back of the 
 neck. This can be entirely avoided by placing the com- 
 presses on ice instead of in water. 
 
 Douches. Douches both external and internal are 
 used to reduce inflammation and congestion. 
 
 Ear douche. Spraying or douching the ears is a very 
 delicate proceeding and must be done most carefully; as 
 a rule the doctor will prefer to attend to it in the absence 
 of the trained nurse, but occasionally it may be necessary, 
 in an emergency, for the Home Nurse to take it in hand. 
 The following rules are important : 
 
 Boric acid solution or salt solution is generally used, 
 temperature about 100° F. (if there is much pain a little 
 higher temperature can be used). The irrigation bag 
 must hang above the patient's head, and the nurse must 
 be careful that all the gas is expelled from the long tube 
 and solution run through it before the nozzle is inserted 
 into the ear. Fasten a towel around your patient's neck 
 and shoulders; and have a small basin held against the 
 neck, under the ear. Another point to be noted, do not 
 push the nozzle up too far into the ear, as it will prevent 
 the solution coming out properly; a clamp is necessary 
 on the rubber tubing to control the flow of water; if al- 
 lowed to enter too rapidly the drum of the ear will suffer. 
 The ear should be well dried out with absorbent cotton; 
 a small pointed swab of the cotton gently inserted into 
 the ear will absorb all the moisture in a few seconds. Do 
 not leave any cotton in the ear unless ordered by the doctor. 
 
 Douche for the nose. The same appliances are re- 
 quired for douching out the nose. The patient must keep 
 her mouth open and breathe through the mouth, not the 
 nose. The solution when gently inserted up one nostril 
 will run out the other; only a very small quantity of so- 
 lution is used at one time, and it must be hot; abotlt 105° 
 F. The syringe bag should be only a few inches above 
 the patient's head, so that the solution may run slowly. 
 
DOUCHES 119 
 
 Your patient must hold her head forward, and try not to 
 swallow during the irrigation; also, if one nostril is stopped 
 up (as in a heavy cold) insert the solution into the other 
 nostril first, and it will work out the obstruction, instead 
 of driving it up into the tube leading to the ear. This 
 douche also is a very delicate matter, and may only be used 
 with extreme care. 
 
 Douche for the throat. During an attack of tonsil- 
 itis, great relief to the congestion in the throat may be 
 had by douching the throat with very hot salt solution, 
 every two or three hours. The same rules apply as for 
 douching the nose and ears. The patient must bend her 
 head well over a basin to allow the solution to run out by 
 mouth. Move the nozzle of the syringe from side to side, 
 so that all parts of the throat may be reached. 
 
 Vaginal douches. Vaginal douches must always be 
 taken lying flat on the back, so that the water may reach 
 the inflamed parts. A glass nozzle is the best to use, as 
 it may be boiled before every douche, and so kept perfectly 
 clean. A fountain syringe and granite douche-pan are 
 necessary. Any medication ordered by the physician 
 ought to be well mixed in a pitcher before being poured 
 into the syringe-bag. This is especially to be noted in 
 the use of carbolic acid, as the oil in the acid requires , 
 very hot water to dissolve it, and if it is not thoroughly 
 mixed, will bum the patient. It should, therefore, stand 
 for about twenty minutes before being used. 
 
 For cleansing purposes either normal salt solution or 
 boric acid solution two per cent, is used. 
 
 The douche nozzle should be boiled for about five min- 
 utes before using, and the douche-pan well warmed before 
 inserting under your patient, a small pillow slipped under 
 your patient's back just above the douche-pan will relieve 
 all strain from the back. 
 
 Giving the douche. Be sure that all the air is ex- 
 pelled from the tube, and the solution allowed to run 
 
120 A TEXTBOOK OF HOME NURSING 
 
 through it before you insert the nozzle. The nozzle is 
 pointed downwards and backwards and inserted very 
 gently. Move it around while the solution is flowing, so 
 that all parts of the inner cavity may be reached. 
 
 When the douche is finished, shut the little clamp on 
 the tube, and remove the nozzle from your patient, while 
 there is still some of the solution in the tube ; this will pre- 
 vent the entrance of gas into the vagina. 
 
 When giving a vaginal douche only one pillow is neces- 
 sary under your patient's head, as her shoulders ought to 
 be lower than her pelvis, to allow the solution to enter 
 properly. Continue the douche for about twenty minutes ; 
 one of the chief functions of these douches, is the con- 
 tinuous application of heat to soothe irritation; and if 
 given too rapidly this purpose will be defeated; for this 
 reason the solution should run through the tube slowly. 
 
 Enemata. Enemata are used for various purposes, 
 and every, one should know how to give an enema in case 
 of emergency, either as a purgative, stimulant, or for nu- 
 trition. There are various medicated enemata prescribed 
 by the doctor; for removal of flatulence, in treatment of 
 diarrhea, to expel worms, etc. Such are enemata con- 
 taining turpentine, asafetida, quassi, etc., but medica- 
 tion does not lie within the province of the Home Nurse. 
 The doctor will give directions when and how these medi- 
 cated enemata are to be given. They are followed usually 
 with a soapsuds enema. 
 
 Purgative enemata. Soapsuds solution to cleanse the 
 bowels is made with the purest soap (generally ivory or 
 castile; never use laundry soap), and about two or three 
 pints of hot water, for an adult ; for a child, one pint is 
 sufficient. When your soapsuds solution is ready its tem- 
 perature should be 105° F. for by the time the solution 
 enters the bowels it will be much cooler. The solution is 
 poured into a fountain syringe bag, or douche can, which 
 is hung up about two feet above your patient. A clamp 
 
ENEMATA 121 
 
 is necessary on the rubber tubing to regulate the flow of 
 the solution. When possible use a rubber rectal tube, and 
 connect it with the tube of the fountain syringe by a small 
 glass connecting tube. The soft rubber rectal tube is bet-, 
 ter than the hard rubber end supplied with the fountain 
 syringe bag, for two reasons ; it will reach up higher into 
 the bowel, and is so soft that it will not injure the tender 
 mucous membrane lining the intestines. 
 _ Giving the enema. Let the patient lie upon the left 
 side, with knees drawn up (this will relax the muscles of 
 the abdomen) ; protect the bed with a piece of rubber 
 sheeting and a bath towel or cotton sheet. Turn down 
 the bedclothes, and cover your patient with a blanket. 
 
 Allow some of the solution to flow through the tube, so 
 that all gas may be expelled ; then oil the rectal tube, and 
 insert gently, and slowly, without pressure. 
 
 Should you feel any obstruction (probably caused by 
 fecal matter), allow a little solution to run into the bowel, 
 and it will be overcome. After the tube has been inserted 
 about five or six inches, open the clamp and allow the so- 
 lution to flow slowly. If pain is caused, shut the clamp 
 on the tube and stop the current for a minute, then let it 
 flow again. Never hurry the giving of an enema; allow 
 about flfteen minutes ; because the slower the solution en- 
 ters the bowels the better will be the result. After re- 
 moving the tube, press a towel against the anus. If the 
 patient lies quiet and retains the enema for fifteen or 
 twenty minutes, you will have a good result. 
 
 When there is a good deal of constipation the enema 
 will be more successful if given in the knee-chest position, 
 that is, with the patient resting on the knees and chest in 
 bed, the head very low; also use the long, flexible rubber 
 rectal tube on the end of the syringe. This is called a 
 high enema. Adding olive oil and glycerine to the soap- 
 suds will prove effective if the simple enema is not suffi- 
 cient. About one ounce of oil and half an ounce of glycer- 
 
123 A TEXTBOOK OF HOME NURSING 
 
 ine is the usual amount. Castor oil may also be given 
 in this way; but it is necessary to consult the doctor be- 
 fore using any medication besides the plain soapsuds. 
 
 Oil enemata. Sometimes the doctor orders an oil 
 enema to be given first and retained for an hour, followed 
 by a soapsuds enema. In that case, six ounces of hot olive 
 oil are injected first and allowed to work slowly through 
 the bowels before giving the soapsuds enema. 
 
 Starch enemata. In cases of acute diarrhea these 
 enemata are sometimes ordered, and are made by mixing 
 a dessertspoonful of starch with cold water into a smooth 
 paste and then adding three ounces of boiling water. Boil 
 two or three minutes, add suflBcient water to make the mix- 
 ture as thick as cream. It must be as cool as 103° F. 
 before using. Sometimes a Davidson bulb syringe is 
 found best to give the medicated enemata, as the medica- 
 tion can be forced through the tube better than with an 
 irrigation bag. A small rubber catheter or rectal tube 
 should be attached to the nozzle of the bulb syringe and 
 inserted into the rectum. 
 
 Stimulating enemata. These are given in cases of 
 shock or collapse, and should be very hot, as they will 
 be more easily retained. The usual amount is one table- 
 spoonful of whiskey or brandy, and four ounces of very 
 hot water, as hot as the patient can stand ; or salt solution, 
 is sometimes substituted. 
 
 Hot water should be run through the syringe first, that 
 the tube may be thoroughly heated, and the enema should 
 be given with a long flexible rectal tube, as it must go into 
 the upper bowel to be retained. 
 
 Nutritive enemata. When the stomach is much dis- 
 turbed during a severe illness so that food cannot be di- 
 gested, or in cases of delirious patients, and after some 
 operations about the mouth and throat, nutritive enemata 
 are given to nourish the system. They are sometimes kept 
 up for days and weeks. Various formulae are used; one 
 
SUMMARY CHAPTER VIII 123 
 
 of the best is: Peptonized milk two ounces; one table- 
 spoonful of whiskey, and one egg with a pinch of salt. 
 (Peptonized milk may be made with Fairchild's tubes of 
 peptonized powder), peptonized beef extract, or beef juice 
 may also be used. The milk is heated, but not over 115° 
 P., then add the beef if used, and the egg mixture, beating 
 it up. A simple soapsuds enema once a day is necessary 
 to wash out the lower bowel, when your patient is fed by 
 nutritive enemata. 
 
 Enemata given to children. Children do not retain 
 the solution from an enemata long enough to cause a 
 proper result. , It is better to place the child on the bed- 
 pan before trying to give the enema. A rubber catheter 
 is used instead of a rectal tube, and salt solution is con- 
 sidered less irritating for a child than soapsuds. 
 
 SUMMARY 
 
 Counter-irritants. 
 
 Ordered to relieve inflammation and congestion. 
 
 Simpler forms, that a Home Nurse can use. 
 
 Poultices. 
 
 Linseed poultices ; how to make them, hot, moist, and light. 
 
 Should mustard be added, lukewarm water used to mix 
 
 it; amount required. 
 Applying a linseed poultice. 
 Bicarbonate of soda added to make it light. 
 Important points to be noted when applying and changing 
 
 poultices. 
 [After care of patient, to prevent taking cold. 
 
 Mustard leaves and paste. 
 
 How to use mustard leaves. 
 
 Oil or vaseline rubbed on skin first. 
 
 To prevent blisters skin washed after leaf is removed. 
 
124. A TEXTBOOK OF HOME NURSING 
 
 Mustard paste ; made with flour and mustard, proportions 
 
 for adult and child. 
 Reason for mixing mustard in cool water. 
 How to make and apply mustard paste. 
 Care against burning patient. 
 
 Plasters. 
 
 Care of skin before applying plaster. 
 
 How to apply plaster. 
 
 Care taken that blister is not broken. 
 
 Dressing after plaster is removed. 
 
 Hot stupes. 
 
 Use of moist heat. 
 
 Flannel stupes. 
 
 Method of making stupes, without burning hands. 
 
 Apply slowly, cover with cotton wool, and change every 
 
 ten or fifteen minutes. 
 After-care of patient. 
 
 Turpentine stupes. 
 
 Turpentine does not mix well; oil used; proportion for 
 
 adult and child. 
 How to apply mixture, followed by hot stupe. 
 Care to be used in applying hot stupe to breast. 
 
 Hot compresses for the eyes. 
 
 Absorbent cotton two inches square; temperature of water; 
 how to apply. 
 
 Change every two minutes; water kept hot with stove or 
 lamp; length of time for applying compresses. 
 
 When there is a discharge from eye never use same com- 
 press twice. 
 
 Dry heat. 
 
 DifFerent kinds; flannel, bricks, bags of salt, hot water 
 bags. 
 
SUMMARY CHAPTER VIII 125 
 
 How to fill hot water bags ; flannel bag to cover the rubber. 
 Aluminum hot water cans very serviceable; retain beat 
 
 longer than rubber ; also wear better. 
 Electric pads used frequently ; care taken to turn off power 
 
 when pad is hot; also watch insulator for fear of 
 
 burning bedclothes. 
 
 Iodine. 
 
 How to use iodine. 
 
 May be removed with alcohol. 
 
 Oil of wintergreen. 
 
 For pains in back and limbs ; rubbed in lightly ; repeated 
 in few hours. 
 
 Turpentine and vaseline. 
 
 Equal parts; good counter-irritant for cold on the chest. 
 Melt vaseline and then mix in turpentine. 
 Care to protect clothing from stains. 
 
 Ammonia. 
 
 Poured on gauze or absorbent cotton. 
 
 Covered with oiled muslin. 
 
 Watch every few minutes for fear of blister. 
 
 Antiphlogistin. 
 
 Spread paste on gauze, and put it on tin plate in oven to 
 heat ; or use double boiler to heat paste, then spread 
 on gauze or muslin; hot water bag used over paste, 
 continuous heat necessary. 
 
 Cold applications. 
 
 Ice-cap, how to fill it ; gauze between cap and skin ; kept 
 
 cold by changing often. 
 Paper ice-cap takes the place of rubber when only required 
 
 for few hours. 
 
126 A TEXTBOOK OF HOME NURSING 
 
 Cold compresses for head and throat; hov to make and 
 apply. 
 
 Douches. External and internal. 
 
 Ear douche, must be done carefully; rules for Home 
 Nurse important. 
 
 Solution ; temperature ; bag hung up above patient's head ; 
 aU air expelled from tube before nozzle is inserted; 
 towel about patient's neck; small basin under ear; 
 nozzle not pushed in too far ; clamp on tube to regu- 
 late flow; must not run too quickly; ear well dried; 
 no cotton left in ear. 
 
 Nose douche. 
 
 Same appliances as used for ear douche ; patient to keep 
 mouth open to breathe ; insert solution up one nostril, 
 small quantity at one time; temperature required; 
 should one nostril be stuffed up, irrigate other nostril 
 first; use with extreme care. 
 
 Throat douche. 
 
 For inflammation of throat, relieves congestion, hot salt 
 solution, same rules as apply for ear and nose douche, 
 move nozzle from side to side. 
 
 Vaginal douches. 
 
 Always taken lying down. 
 
 Glass nozzle best, boiled before every douche, fountain 
 syringe and douche pan. 
 
 Medication ordered by doctor, mixed in pitcher before 
 pouring into bag. 
 
 For cleansing douche, salt solution or boric acid solution 
 two per cent. Nozzle boiled five minutes before 
 using, douche pan warmed before inserting under 
 patient, small pillow under back, relieve strain. 
 
 Air expelled from tube, solution run through it, nozzle 
 pointed down, and backwards ; gently inserted. 
 
SUMMARY CHAPTER VIII 12T 
 
 Insert nozzle slowly, move it frequently from side to 
 
 side. , 
 To prevent entrance of gas, shut clamps on tube, remove 
 
 nozzle while solution is still in tube. 
 Head low, while douche is given; time twenty minutes, 
 
 giving slowly. 
 Continuous heat is applied to soothe irritation. 
 
 Enemata. 
 
 l^ecessary to know how to give in an emergency. 
 
 Various kinds; medication prescribed by doctor. 
 
 Purgative enemata. 
 
 Soapsuds, made with purest soap, amount required for 
 adult and child, temperature when ready. 
 
 Appliances — fountain syringe, rectal tube, glass connect- 
 ing tube; soft rubber tube better than hard rubber 
 nozzle, as it reaches higher, and will not injure pa- 
 tient. 
 
 How to give enema; position of patient; protection of 
 bed; gas expelled from tube; rectal tube well oiled, 
 inserted gently; no pressure; how to overcome ob- 
 structions; when inserted five or six inches, if pain 
 is caused, stop current for a moment; give enema 
 slowly, result better; patient retains enema fifteen 
 or twenty minutes if possible. 
 
 When to use knee chest position ; how to give high enema ; 
 should oil or glycerine be ordered, amount required ; 
 if doctor orders oil enema, method of giving it. 
 
 Starch enemata. 
 
 Sometimes ordered in acute diarrhea, amount used and 
 how to mix it ; temperature ; a Davidson bulb syringe 
 best for medicated enema; small rubber catheter 
 sKpped on end of syringe and inserted into rectum. 
 
128 A TEXTBOOK OF HOME NURSING 
 
 Stimulating enemata. 
 
 Given in cases of shock or collapse; temperature; salt so- 
 lution or stimulant, amount required; hot water run 
 through syringe first to heat tube; long rectal tube 
 best, to reach upper bowel. 
 
 Nutritive enemata. 
 
 When food cannot be taken by mouth, sometimes kept up 
 for days or weeks. 
 
 Formulae used, how to make peptonized milk, mixing 
 enema. 
 
 Soapsuds enema necessary once a day when nutritive ene- 
 mata is used. 
 
 Enemata given to children. 
 Difficult for child to retain solution. 
 
 How to give it; rubber catheter instead of rectal tube; 
 salt solution in place of soapsuds. 
 
CHAPTER IX 
 
 HOW TO PEEPAEE FOE A STJEQICAl OPEBATION 
 CAEB OF PATIENTS BEFOEE AHD AFTEB OPERATIONS 
 
 How to prepare for a surgical operation. In these 
 advanced days when surgery is used so generally and so 
 effectually, it is almost a necessity to know something 
 about the preparations necessary for a surgical operation 
 at home. It sometimes happens, that a sudden emergency 
 calls for an operation where the presence of a trained 
 nurse is an impossibility. This chapter, therefore, will 
 be devoted to a short description of how to provide for 
 such an emergency, in a private family when a Graduate 
 Trained Nurse is not available. 
 
 If the operation is to be in the early morning, have 
 everything on hand the night before, so that neither doc- 
 tors nor patient may be kept waiting. Almost every sur- 
 geon has a list of what he will require you to provide in 
 special cases, therefore a general idea of the things that 
 are always necessary will be given in this chapter. It is 
 not necessary, in this little book to enter into the prepara- 
 tions needed for a major operation, as in that case, if a 
 trained nurse is not available, the doctor will most likely 
 take his patient to the nearest hospital, or else superintend 
 the preparations himself. 
 
 Necessary appliances for an operation. The appli- 
 ances required at every operation in a private house are 
 as follows : 
 
 1 strong kitchen table (for the patient to lie on). 
 
 3 small tables (for instruments and dressings). 
 
 129 
 
130 A TEXTBOOK OF HOME NURSING 
 
 3 large hand basins (for solutions, sterilized dressings, 
 
 etc.). 
 2 small hand basins. 
 2 large pitchers (for solutions). 
 1 fountain syringe. 
 1 bottle of alcohol. 
 
 1 bottle of bichloride of mercury tablets. 
 1 bottle of carbolic acid. 
 
 1 bottle of green soap solution. 
 
 2 new wooden nail brushes. 
 2/. slop jars or pails. 
 
 1 piece of rubber sheeting. 
 
 3 clean sheets. 
 1 small blanket. 
 1 heavy blanket. 
 
 1 package of safety pins. 
 
 1 small pillow. 
 12 clean white towels. 
 
 Preparation of the room. In choosing a room for the 
 operation the first consideration is light, as the more light 
 you are able to have the better. If possible, have a room 
 adjoining the bedroom which the patient will occupy after- 
 ward. If this cannot be, and you are obliged to use the 
 bedroom itself, push the bed into a corner and remove 
 all unnecessary furniture. When the operation is to be 
 a major one, the carpet must be taken up, and the floor 
 washed over with soap and water and 1:120 carbolic 
 solution, before commencing the arrangement of the room. 
 In these cases no rugs or spread will be necessary on the 
 floor; but if the operation is a minor one, the carpet can 
 be well swept and the room dusted with a damp cloth, and 
 then the covering laid down over the carpet right in front 
 of the largest window, and over that a large cotton sheet. 
 A tack put in each corner will keep the sheet in place 
 without injuring it. 
 
 In the middle of the sheet place the kitchen table, which 
 
1 
 
 HOW TO PREPARE FOR AN OPERATION 131 
 
 is to be covered first with a heavy blanket, then the piece 
 of rubber sheeting pinned firmly at the four corners with 
 safety-pins, and covered with a clean sheet. A small 
 pillow is placed at one end, and a sheet and small blanket 
 laid on top ready to spread over the patient. 
 
 On each side of the large table put the small ones, two 
 at one side and one at the other, leaving room to walk 
 between. Cover the little tables with clean white towels, 
 and if they have polished tops, put under the towels a 
 piece of oilcloth or rubber sheeting. A couple of plain 
 chairs are needed in the room in case the surgeon requires 
 to operate sitting down. On one of the small tables put 
 two china basins, thoroughly cleansed, first with carbolic 
 solution, 1:40, and rinsed off with boiled water; these 
 are for washing the sponges the surgeon will provide. The 
 third basin is for sterilized towels. One slop-jar is needed 
 under or beside the large table, and the other near the 
 table that holds the sponges. All utensils used should 
 first be scoured vrith bon-ami, then well washed off, and 
 rinsed in solution. 
 
 The window curtains must be either tied far back or 
 taken down, to give plenty of light. Then fasten a small 
 piece of thin muslin or cheese-cloth over the lower sash of 
 the window for protection from curious outsiders. A 
 strong screw fastened at a convenient height in the wall 
 near the window will be needed to hang up the fountain 
 syringe that will be filled with sterilized water, unless the 
 surgeon requires some solution in it to irrigate the wound. 
 A bureau or table covered with a clean towel may be util- 
 ized to hold the dressings. 
 
 The surgeon will bring the instruments, dressings, and 
 anesthetic, and should he not bring an ether cone, one may 
 be quickly made with a newspaper folded inside a clean 
 towel. 
 
 The room must be about the temperature of 70° F. and 
 well aired. 
 
132 A TEXTBOOK OF HOME NURSING 
 
 Sterilized water and towels. Plenty of boiling water 
 will be required, and the washboiler is tbe best thing in 
 which to boil it, after it is well scrubbed with bon-ami, 
 and then washed outside and in, with hot green soap solu- 
 tion. 
 
 One boiler full of water should be prepared in time 
 to cool before the operation, and a second boiler full will 
 be required steaming hot. The water must boil for about 
 half an hour to be well sterilized, and a sterilized towel 
 must be tied over the top of the boiler to keep the water 
 pure. 
 
 In these days surgeons prefer to use plain sterilized or, 
 as it is usually called, boiled water almost entirely in- 
 stead of any antiseptic solution; but if solutions are re- 
 quired, they can be made in a few moments when there 
 is a plentiful supply of sterilized water. The two solu- 
 tions most likely to be called for are bichloride of mercury 
 and carbolic acid. It is well to make a 1 :1000 solution 
 of bichloride and then dilute it as required. One little 
 bichloride tablet added to a pint of water will make a 
 1 :1000 solution. Six teaspoonfuls of pure carbolic acid 
 added to one pint of water will make about a 5 per cent, 
 or 1 :20 solution, 
 
 A little pure vaseline or cold cream will be needed to 
 rub on the face round the nose and mouth of the patient, 
 before using the anesthetic, to prevent burning the skin. 
 
 The new nail-brushes, together with a basin of 1 :1000 
 bichloride solution, some alcohol, and sterilized towels, a 
 basin of green soap and orange sticks to cleanse the nails ; 
 should all be conveniently placed in the bath-room for 
 the surgeon's use. The surgeon will bring his own rub- 
 ber gloves sterilized. The nail brush and orange sticks 
 must be boiled for five minutes, and then placed in a 
 bowl of carbolic 1 :20. 
 
 Many surgeons order a can of oxygen, so as to have it 
 on hand in case of emergency, and it should be tried be- 
 
HOW TO PREPARE FOR AN OPERATION 133 
 
 fore the operation to be sure that it is in working order 
 and ready for use at a moment's notice. 
 
 The only way to prevent infection of wounds at an 
 operation, is in the absolute cleanliness of the room where 
 the operation is to be performed: sterilizing of all sup- 
 plies, and everything that may come in touch with the 
 patient ; including the hands of nurses and surgeons. 
 
 Surgical bed. Now that the room is arranged, we will 
 attend to the bed. For surgical cases a simple iron bed- 
 stead is always best, but this is not an absolute necessity 
 except for a major operation. First put on the undersheet 
 smoothly ; tuck it in on all sides ; across the middle of the 
 bed place the rubber sheeting, cover with the draw-sheet, 
 fastened under the mattress with safety pins; as an 
 ether patient is sure to be restless and toss the bed- 
 clothes. The top sheet and blanket may be tucked in at 
 the foot of the bed, and then turned back well dovm to the 
 bottom ready for the patient. Another blanket must be 
 placed under the top sheet, so that the patient may have 
 some extra warmth for the first few hours. One or two 
 hot water bags are then placed in the center and covered 
 with a blanket, but they should be removed from the bed 
 as soon as the patient is put in it, and not replaced until 
 he is completely out from under the influence of the 
 anesthetic. So many accidents have occurred with hot 
 water bags or bottles burning a patient while unconscious, 
 that the majority of surgeons refuse to allow them to be 
 put in the bed until the patient is quite conscious. When 
 they are replaced they must be carefully watched and put 
 at some distance from the patient. 
 
 No pillow will be necessary on an ether bed, as the head 
 must be kept very low on account of the nausea, but a 
 towel is laid at the head, and a few extra ones will be 
 needed, with a small basin, in case of voniiting. 
 
 The patient. Last, but not least, the patient must be 
 ready when the surgeon arrives. The day before the 
 
134. A TEXTBOOK OF HOME NURSING 
 
 operation a thorough hot bath is given the patient includ- 
 ing washing the hair. The surgeon will probably order 
 a cathartic the night before, and, if necessary, an enema 
 in the morning. As to diet, the day before the operation 
 good nourishing food should be given, easily digested ; no 
 breakfast is allowed if the operation is in the morning, 
 except a cup of bouUlon or coffee taken about six hours 
 before the opferation. If, however, the operation is to be 
 in the afternoon, a light breakfast of coffee and toast is 
 the rule. 
 
 The hair, if long, should be neatly braided and covered 
 with a muslin cap ; and the clothing should consist of un- 
 dervest, drawers, nightgown, wrapper, stockings, and slip- 
 pers. The wrapper and slippers are to be removed and 
 the bladder emptied just before the anesthetic is admin- 
 istered, also any false teeth or plate in the mouth must 
 be removed. 
 
 Have a little whiskey in readiness in case of collapse, 
 when it might be necessary to give a stimulating enema, 
 and aromatic spirits of ammonia or smelling salts which 
 will be of service in controlling the nausea. 
 
 Preparation of skin for operation. As to the prep- 
 aration of the surface of the body, where the operation 
 will occur — there are many different methods used ; and 
 the surgeon in charge will give directions to be carefully 
 followed. The most common procedure is to wipe the 
 skin dry, paint with tincture of iodine, and cover with 
 sterilized gauze six hours before the operation. The iodine 
 penetrates the skin and disinfects it better than a wet 
 dressing : special point to be remembered is, do not put the 
 iodine on very thickly, because when the skin is imme- 
 diately covered with a compress, there wiU be danger of a 
 blister. 
 
 Care of the patient after the operation. When your 
 patient has been carried back to bed, he must lie between 
 blankets until the natural warmth of the body is restored. 
 
CARE OF PATIENT 135 
 
 A word in regard to hot water bottles. So many serious 
 burns have been caused by leaving hot water bottles in 
 the bed with unconscious ether patients, that the rule is to 
 remove the hot water bags or bottles until the patient is 
 completely out of ether. If they must be left in the bed, 
 put them in flannel bags, and be careful that a fold of the 
 flannel blanket is between the patient and the hot water 
 bag ; furthermore, watch closely — move them from place 
 to place, and see that the patient's skin does not get in the 
 least red. 
 
 The easiest way to carry the patient from the operating 
 table to the bed, is to use a long ironing board, covered 
 with a blanket — it takes the place of a stretcher in a 
 private house, and prevents any unnecessary strain on the 
 patient. Two folded sheets, placed cross-wise under the 
 patient, are of great service in helping to lift him gently 
 on the bed from the improvised stretcher. 
 
 It is absolutely necessary to have some one remain 
 beside the patient until he is perfectly conscious, espe- 
 cially if the nature of the operation is such, that any sud- 
 den movement might cause a hemorrhage. Keep the head 
 low to prevent nausea, and watch the pulse and respiration 
 carefully. If the nausea be very great an ice-compress on 
 the throat often relieves it, but it will gradually pass off. 
 One of the ways to keep an ether patient, quiet is to make 
 him as comfortable as possible. Eub the back with alcohol, 
 place small pillows behind the back and between or under 
 the knees. Cold compress on the head will relieve head- 
 ache. 
 
 When vomiting begins, turn the head on one side, and 
 wash out the mouth frequently, it will relieve the intense 
 thirst and take away the odor and the taste from the 
 vomiting; ask the surgeon when you may commence giv- 
 ing tiny pieces of ice or teaspoonfuls of very hot water. 
 The surgeon will also give special instruction in regard 
 to medication and diet to suit the case, and his orders 
 
136 A TEXTBOOK OF HOME NURSING 
 
 ought to be -written down and not trusted to the memory. 
 
 Hemorrhage, One of the most important complica- 
 tions to watch for immediately after an operation is hem- 
 orrhage; some of the symptoms of hemorrhage are: great 
 pallor of the face, weak and sighing respiration, faint- 
 ness, a weak, rapid, irregular pulse, and, frequently, 
 blood on the dressings. The outside dressing of the wound 
 should be looked at very frequently to notice if there is 
 any appearance of blood, and if it increases. If a hemor- 
 rhage should occur during the surgeon's absence, you must 
 do aU in your power to check it while awaiting his arrival. 
 Do not allow your patient to get worried or excited ; and 
 remain as quiet as possible yourself. Elevate the wounded 
 part. If it is the arm, hold it above the head; if the 
 leg, support it with pillows. When the wound is in the 
 trunk, elevate the foot of the bed and keep the head very 
 low. Do not give alcohol or stimulants of any kind, as 
 they only increase the hemorrhage by making the blood 
 flow more rapidly. Apply hot water bags to the feet and 
 legs. If it is possible to reach an artery above the wound, 
 firm pressure upon it will check the flow. Firm but gen- 
 tle pressure over the wound with a pad of gauze bound 
 on tightly will sometimes help to stop the hemorrhage. 
 When the hemorrhage is internal small pieces of ice should 
 be swallowed whole, and ice-cloths applied over the abdo- 
 men. 
 
 Get ready some sterilized salt solution, made by adding 
 one teaspoonful of fine table salt to a pint of water and 
 letting it boil for half an hour, as the surgeon may find 
 it necessary on his arrival to infuse it into the veins. 
 
 Rules for nursing. The principal rule to be observed 
 in caring for a surgical case is absolute cleanliness. 
 Everything about the patient and bed must be kept im- 
 maculately clean, and you should never touch a wound, 
 or even the dressings on a wound, without first scrubbing 
 your hands with soap and water (especially the nails, as 
 
SUMMARY CHAPTER IX 137 
 
 they form a great hiding-place for germs), and then soak- 
 ing the hands for two or three minutes in a 1 :1000 bi- 
 chloride solution. Many cases of blood poisoning have 
 arisen from the neglect of this simple rule in regard to 
 the surgical cleanliness of the hands. An open wound 
 causes the patient to be particularly susceptible to infec- 
 tion, and for this reason it is also necessary to be care- 
 ful whom you allow into the sick-room, and to examine 
 carefully any package or papers of any kind that come by 
 mail, for there is always a chance that they may have 
 been sent from a house where there is a contagious dis- 
 ease. 
 
 If the surgeon has left the wound open for drainage, 
 and there is a great deal of discharge, this will prove a 
 heavy drain on the system, and therefore it will be neces- 
 sary to keep up the patient's strength vdth extra attention 
 to diet. Nourishing foods of all kinds will be needed, 
 and a tonic will probably be prescribed by the doctor. It 
 is of great importance to keep a special record, noting 
 down any change in your patient during the surgeon's 
 absence. Many complications are likely to arise after 
 surgical operations, and even the smallest symptoms are 
 most important; for when discovered early, and at once 
 reported to the surgeon, he is able to tteat them without 
 delay. For the rest, the general rules for nursing out- 
 lined in a former chapter apply equally well in surgical 
 work. A great deal of the ultimate success of an opera- 
 tion depends upon careful nursing and cheerful surround- 
 ings ; and the happier, brighter, and more comfortable you 
 make your patient, the quicker and more complete will be 
 his recovery. 
 
 SUMMARY 
 
 How to prepare for a surgical operation. 
 
 In sudden emergency, necessary to know how to get ready. 
 Operation in morning, everything on hand night before. 
 
138 A TEXTBOOK OF HOME NURSING 
 
 Surgeon's list of requirements. 
 
 Not necessary to enter into preparation for major opera- 
 tions. 
 Necessary appliances for operation, see page 129. 
 
 Preparation of room. 
 
 First consideration, light. 
 
 Room adjoining bedroom best for operation. 
 
 Carpet removed if major operation.' 
 
 Floor washed — soap, water, 1 :120 carbolic. 
 
 If minor operation, sweep, dust, cover carpet. 
 
 Place kitchen table, cover with blanket, rubber and sheet. 
 
 One small pillow, sheet and blanket on top. 
 
 Two small tables, covered with towels and oilcloth. 
 
 Chairs, two basins, washed, disinfected for sponges. 
 
 One basin for sterilized towels. 
 
 Two slop jars. 
 
 All utensils scoured with bon-ami, washed and rinsed. 
 
 Window curtains tied, back or removed. 
 
 Small screw for fountain syringe, near window. 
 
 Table or bureau for surgical dressings. 
 
 Surgeon brings instruments, dressings, anesthetic. 
 
 How to make an ether cone if necessary. 
 
 Temperature of room, 70° E., well aired. 
 
 Sterilized water and towels. 
 
 Use wash boiler, scrubbed inside and out. 
 
 Two boilers full required. 
 
 Boil water for half an hour, sterilized towel over top. 
 
 Solutions made from sterilized water. 
 
 How to make solutions of bichloride of mercury and of 
 
 carbolic acid. 
 Vaseline to rub around nose and mouth of patient. 
 New nail brush, disinfectants, green soap for surgeon. 
 Surgeon brings rubber gloves. 
 Nail brush and orange stick sterilized. 
 
SUMMARY CHAPTER IX 139 
 
 If oxygen is ordered, have can in working order. 
 To prevent infection, absolute cleanliness. 
 
 Surgical bed. 
 
 Iron bedstead best, not absolutely needed in minor opera- 
 tions. 
 How to make surgical bed (see page 133). 
 About hot water bags. 
 
 Removed from bed until patient is conscious. 
 Great care required not to burn patient. 
 No pillow necessary, head low, to control nausea. 
 Towels on hand, and small basin. 
 
 The patient. 
 
 Ready when surgeon arrives. 
 
 Day previous, hot bath, including hair. 
 
 Surgeon orders cathartic. 
 
 No breakfast if operation in morning. 
 
 Coffee and toast if operation is in afternoon. 
 
 Hair braided, muslin cap. 
 
 Clothing required, see page 135. 
 
 Wrappers and slippers removed, bladder emptied before 
 
 anesthetic is given. 
 Remove false teeth from mouth. 
 Whiskey on hand for emergency. 
 Spirits of ammonia or smelling salts. 
 
 Preparation of skin for operation. 
 
 Surgeon will give directions. 
 
 The most common method, iodine, and sterilized dressing. 
 
 Iodine good disinfectant. 
 
 Care in applying, not too thick ; danger of blister. 
 
 Care of patient after operation. 
 
 Lie between blankets until natural warmth returns. 
 
 Serious burns have occurred from hot water bottles. 
 
140 A TEXTBOOK OF HOME NURSING 
 
 Cover bottles with flannel bags, and fold of blanket. 
 Watch that patient's skin does not get red. 
 
 How to carry patient. 
 
 Ironing board, covered with blanket. 
 Two sheets cross-wise under patient. 
 Necessary for some one to remain to guard patient until 
 
 conscious. 
 Sudden movement may cause hemorrhage. 
 Head low, watch pulse and respiration. 
 If nausea is great, ice-compress on throat good. 
 Make patient comfortable. 
 Eub back, arrange pillows, cold to head. 
 When vomiting, turn head to one side. 
 Wash out mouth, relieves thirst. 
 Get directions about drink and food. 
 Write down doctor's orders. 
 
 Hemorrhage. 
 
 Complications to be watched for. 
 Symptoms (page 136). 
 Watch dressings for blood. 
 
 How to act until doctor arrives. 
 
 Keep patient from worrying. 
 
 Elevate wound ; do not give stimulants. 
 
 Firm pressure on artery or over wound. 
 
 If internal, small pieces of ice swallowed. 
 
 Ice cloths over abdomen. 
 
 Have sterilized salt solution ready. 
 
 Rules for nursing. 
 
 Principal rule, absolute cleanliness. 
 
 Never touch dressing without disinfecting hands. 
 
 Open wound very susceptible to infection. 
 
 Care about visitors. 
 
SUMMARY CHAPTER IX 14>1 
 
 Extra diet if wound is drained. 
 
 Special record of case important. 
 
 Small symptoms often show complications. 
 
 Success requires careful nursing, cheerful surroundings. 
 
CHAPTEE X 
 
 FIRST AID IN EMERGENCIES 
 
 Preparedness. It is necessary to be prepared in some 
 measure for the many unforeseen emergencies which are 
 likely to arise in the home life. In case of an accident, 
 it is the greatest relief to know how to he of assistance to 
 the sufferer. So a few home remedies, within the reach 
 of every one, and which may he easily administered, will 
 be of service. 
 
 It goes without saying, that in every accident the first 
 thing to do is to send for a physician ; but frequently im- 
 mediate assistance has to be rendered the patient while 
 awaiting the arrival of the doctor. 
 
 Burns and Scalds, There are three classes of burns, 
 and they ought to be treated according to the class to 
 which they belong. 
 
 Burns of the first degree. When the skin is not 
 broken, it is called a burn of the first degree, and is best 
 treated by covering thickly with bicarbonate of soda, or 
 a layer of cotton wool to exclude the air, and a bandage 
 put on very gently. 
 
 Bums of the second degree. Burns of the second 
 degree are so called when the outer skin is destroyed. In 
 these cases dry powder is not so useful, as it will adhere 
 to the injured part and become very difficult to remove. 
 When the skin is broken it should be treated as a surgical 
 wound, kept perfectly clean, and if possible, washed off 
 with salt solution or sterilized water. The burn can tlien 
 be dressed with gauze dipped in a solution of bicarbonate 
 of soda or carron oil; if there is nothing else on hand, 
 
 142 
 
FIRST AID IN EMERGENCIES 143 
 
 pure vaseline may be used. Spread tbe dressing on a 
 piece of old but surgically clean, linen; apply it to the 
 burn, cover with cotton wool and a loose bandage. Some 
 authorities advise washing the burn first with a solution 
 of bicarbonate of soda and water, as they claim that it 
 relieves the intense pain. When changing the dressing on 
 a burn, have the fresh dressing all ready to apply before 
 removing the old one, so that no air will touch the burn. 
 The more carefully you keep it covered, the less will be 
 the pain. When a blister has formed it must not be 
 opened before the burn is dressed. 
 
 Burns of the third degree. A burn of the third de- 
 gree is so called when the tissues are completely destroyed, 
 and it is wisest to apply only a temporary dressing while 
 awaiting the doctor's arrival. Even a burn that does not 
 extend very deeply under the surface may be dangerous. 
 When it covers a large surface of the body it is often fol- 
 lowed by shock or collapse. If it be at all extensive, a 
 physician should be summoned, as serious complications 
 frequently follow, especially if steam or smoke has been 
 inhaled; and pneumonia, bronchitis, or inflammation of 
 the intestines are not uncommon results. 
 
 Should the clothing catch fire, roll the person over and 
 over on the floor, and cover him with rugs, blankets, or 
 any woolen covering. If there are symptoms of shock 
 accompanying the burn, treatment for that must be car- 
 ried out immediately, — before attending to the wound, — 
 as it often proves fatal, especially with children. 
 
 Shock. Symptoms. Shock and collapse are the re- 
 sult of a severe injury to the system, caused by accident, 
 serious operation, extreme fear, or sometimes from weak- 
 ness during the course of a severe disease. The symp- 
 toms are : quick, weak pulse ; respiration slow and shallow; 
 surface of the body very cold, especially the extremities, 
 and the temperature below normal. 
 
 Shock. Treatment. Lay the patient down flat, with- 
 
144. A TEXTBOOK OF HOME NURSING 
 
 out raising the head, elevate the foot of the bed, put on 
 plenty of blankets, and rub the body aU over with hot 
 alcohol or whiskey. Apply hot water bags, bottles, or 
 hot bricks to the feet and about the legs, and a light hot 
 water bag over the heart and plenty of fresh air. Avoid 
 all noise or excitement, and give a spoonful of hot coffee 
 or hot water every ten or fifteen minutes. 
 
 There is one important rule to be remembered in the 
 treatment of shock, that is, if the shock has been caused 
 by some injury to the head, as, for instance, a blow or fall, 
 never give alcoholic stimiilants of any kind whatsoever, 
 but use instead strong hot coffee, tea, or hot milk. 
 
 In all cases of shock a physician should be called imme- 
 diately. 
 
 Frost-bite. Cold, not heat, must be applied in all cases 
 of frost-bite. One of the best remedies is rubbing the 
 frozen surface with a handful of snow or a piece of ice ; 
 and then with a coarse towel until the whiteness disappears 
 and the blood fliows freely. On no account allow the pa- 
 tient to go near a fire or into a hot room, xmtil circulation 
 is entirely restored. 
 
 Fainting. This can be quickly overcome by laying the 
 patient flat on the ground, with the feet higher than the 
 head; ammonia or smelling salts held in front of, but not 
 too near, the nostrils; loosening the clothing about the 
 throat, opening the windows, and sprinkling a little cold 
 water on the face. Alcoholic stimulants are as a rule 
 unnecessary; spirits of camphor on a lump of sugar or a 
 spoonful of aromatic spirits of ammonia in water, will 
 prove valuable heart stimulants. 
 
 Nervous hysteria. In cases of nervous prostration, or 
 with very nervous excitable people, overtired or worried, 
 you may meet with an attack of nervous hysteria. It 
 needs to be treated in a firm but gentle manner. A tea- 
 spoonful of aromatic spirits of ammonia in a little water, 
 or a small dose of bromide solution or paregoric, which- 
 
FIRST AID IN EMERGENCIES 145 
 
 ever you have on hand, will help to quiet the nerves. 
 Open the windows wide, even in winter, and when there 
 is an oppression on the chest after violent crying, a small 
 mustard leaf or plaster applied for a few moments has 
 a wonderfully soothing effect. 
 
 Poisoning. Accidental poisoning, which may be 
 caused in various ways, needs generally the most imme- 
 diate attention to save life. These accidents are often 
 caused by pure carelessness in the giving or taking of 
 medicine in the dark or without looking carefully at the 
 label, or by leaving dangerous drugs within the reach of 
 children. 
 
 Immediate treatment. When any one is poisoned, 
 and you are not sure of the antidote, do not hesitate a mo- 
 ment, but give an emetic of some kind while awaiting the 
 arrival of the doctor. Mustard and salt will be found in 
 every household, and are very effective. For an adult 
 give a teaspoonful of mustard or salt to every glass of 
 lukewarm water. Make the patient drink two or three 
 glasses, no matter how he objects, and then by tickling 
 the throat with the finger, the irritation will cause vomit- 
 ing. Repeat in ten minutes so that the stomach will be 
 thoroughly emptied. In Case of children give ipecac in- 
 stead of mustard and water. When there is any delay 
 in getting the mustard pr salt, use plain, lukewarm water 
 in large quantities. After the stomach is thoroughly 
 emptied, give an enema if the doctor has not arrived. 
 When the poisoning is caused by canned goods or stale fish, 
 give a large dose of castor oil as soon as the vomiting 
 ceases. There are various antidotes to be used according 
 to the poison that has been taken, and it is well to have 
 a list of them on hand. 
 
 Antidotes for poisons. For Acid Poisons, such as 
 Carbolic Acid, Nitric Acid, Oxalic Acid, give two or three 
 glasses of milk and lime-water; no oil of any kind, as it 
 would only help to dissolve the acid. Do not give emetics, 
 
146 A TEXTBOOK OF HOME NURSING 
 
 as the acid would a second time tear the tissue of the throat, 
 during vomiting. 
 
 For Irritant Poisons, such as Tartar Emetic, Arsenic, 
 Paris Green, Eough on Rats, Iodine, Iron, Lead, Mer- 
 cury: First give an emetic; then give plenty of milk, 
 white of egg, or flour and water. 
 
 For Alkaline Poisons, such as Ammonia, Lime, Salt- 
 peter : After an emetic, give lemon juice or vinegar, fol- 
 lowed by castor oil. 
 
 For Narcotic Poisons the treatment is as follows : 
 
 Aconite: Emetic, then stimulants and hot applications. 
 
 Belladonna: Emetics, artificial respiration, heat, hot 
 mustard baths. 
 
 Alcohol: Emetics, cold to the head, and heat to the 
 feet. 
 
 Digitalis: Emetics and a dose of strychnin, keep the 
 patient quiet. 
 
 Opium: Emetics, strong black coffee by mouth and 
 rectum, and active exercise. Patient must be kept awake. 
 
 In all poison cases give plenty of hot water to drink, 
 as it flushes out the system (as much as three quarts is 
 sometimes used), and keep up the treatment without in- 
 termission, no matter what objection the patient may 
 make. 
 
 Care is needed for the first few days after poison has 
 been in the system, especially in regard to diet, which 
 should be very simple. 
 
 Poison from ivy. In case of poison ivy, wet dressings 
 of bicarbonate of soda well wrapped around the inflamed 
 surface is the best treatment. 
 
 Poison from stings of insects. Ammonia and water, 
 salt and water, or bicarbonate of soda; any one of these 
 remedies will remove the pain and swelling. 
 
 Sprains. Very hot or very cold water is the best treat- 
 ment for a sprain. Hold the limb under running water 
 
FIRST AID IN EMERGENCIES 147 
 
 as hot as can be borne for about half an hour, or keep it 
 covered in hot water, renewing the water as it cools. Then 
 apply a moist dressing of alcohol and water or arnica, and 
 bandage firmly, beginning at the extremity and working 
 upward to a good distance above the sprain. Moisten the 
 dressing every two hours, and the inflammation will sub- 
 side. Repeat the bathing in hot or cold water morning 
 and evening, and give the limb perfect rest. Of course, 
 if within reach of a surgeon, send for one, as what may at 
 first appear a simple sprain may really lead to serious 
 trouble, and many surgeons nowadays treat a sprain by 
 putting the limb into plaster of Paris, or bandaging with 
 strips of adhesive plaster. 
 
 Bruises or cuts. Hot sterilized water is the safest and 
 easiest remedy to apply to a bruise or a cut, as it fulfills all 
 the need of surgical cleanliness and at the same time re- 
 duces inflammation. Bathe the wound with a piece of 
 old linen which has been boiled. If the wound is an open 
 one, keep it under water until perfectly clean, and wash 
 out all foreign bodies carefully. If the bleeding is trou- 
 blesome hold the injured member up in the air (above the 
 head, if possible) for a few moments, at the same time 
 applying a little pad of linen pressed firmly on the wound. 
 Dress it with sterilized linen or gauze, and change the 
 dressing daily. When the skin is not broken allow the 
 injured part to remain in hot water as long as possible. 
 The water will be very soothing, and will help in subduing 
 the inflammation. Styptic cotton, which is made up in 
 small boxes, is very useful in dressing a cut or bruise, 
 and will immediately stop the bleeding. It is antiseptic 
 and heals a wound very quickly. Every household should 
 have something of this kind on hand. 
 
 Never touch a cut or open wound without well scrub- 
 bing your hands and nails, and dipping them into an anti- 
 septic solution. If you havp no dry sterilized dressing 
 
148 A TEXTBOOK OF HOME NURSING 
 
 on hand, in an emergency, dip a piece of clean cheese- 
 cloth or fine cambric into sterilized water and iron with 
 a very hot iron nntil dry. 
 
 Hemorrhage from the lungs. Although hemorrhage 
 from the lungs appears very alarming, still it is not, as 
 a rule, a sign of immediate danger, and can be controlled 
 with a few remedies. Give plenty of cracked ice. Put 
 an ice-bag on the chest, or, if you have no bag on hand, 
 wrap some ice in a piece of rubber sheeting. Prop up 
 the patient in bed and keep him absolutely quiet. 
 
 Hemorrhage from the nose. This can generally be 
 stopped by putting the patient flat on the back, with hands 
 held up over the head; then compress the nostrils. Ice 
 should be applied to the back of the neck, bridge of the 
 nose, and to the wrists, and the tongue should be pressed 
 firmly against the roof of the mouth, with a pad of paper 
 between to increase the pressure. 
 
 Should the bleeding point prove very obstinate, plug 
 the nostrils with a bit of absorbent cotton or small pieces 
 of linen with a string tied to them, for a few hours. 
 
 Frequent hemorrhages sometimes come from great ac- 
 tivity of the brain, but more often from ulcers or growths 
 of some kind which should be attended to. 
 
 Hemorrhage of legs or arms. Elevate the limb as 
 high as possible, and if necessary apply a tourniquet, made 
 with a handkerchief or bandage. In the center of the 
 knot tied in the bandage over the artery, place a small 
 stone or other hard substance, or tie a hard knot in the 
 middle of the bandage, then tie the bandage tightly and 
 twist with a stick until the bleeding stops. This tourni- 
 quet must not be kept on Jonger than one hour. 
 
 Foreign body in eye. When a foreign body gets into 
 the eye, do not rub it in, but pull the upper lid down over 
 the lower two or three times, and the irritating little atom 
 may be left on the cheek. If not, turn back the upper lid 
 
FIRST AID IN EMERGENCIES 149 
 
 over a darning needle and brush off the atom with a corner 
 of soft linen or absorbent cotton. 
 
 Inflammation of the eyes. When the eyes are sore or 
 overtired, bathe them night and morning with a solution 
 of boracic acid (one teaspoonful of the acid to a pint of 
 boiling water) or salt solution; apply with a small piece 
 of absorbent cotton. Salt solution is also of use in 
 strengthening the eyes. 
 
 Sore eyes of any kind are very contagious, so that any 
 piece of cotton or gauze used in washing them must be 
 immediately burned. When the eyes are inflamed from 
 cold or any other cause, cut some pieces of linen, about 
 two inches square, lay them on ice in a dish, and then 
 place them over the eyes, changing them every three min- 
 utes, so that they will not have time to become warm. 
 You will find that this treatment gives great relief, and 
 it reduces the inflammation quicker than anything else. 
 Should lime accidentally get into the eyes, wash them 
 immediately with equal parts of vinegar and water, until 
 all the particles are removed. Then bathe them well in 
 warm water, and keep the patient in a dark room for a 
 few hours. 
 
 Foreign body in ear. If a foreign body, such as an 
 insect, should get into the ear, a few drops of hot sweet 
 oil will float it to the surface, whence it can be easily 
 removed. 
 
 Earache. Heat of some kind is the most direct cure 
 for earache. Hot water bags, especially the small, thin, 
 black rubber ones, are very useful, but should be frequently 
 refilled. 
 
 Salt heated in the oven and put in a flannel bag retains 
 the heat a long time, or a piece of hot flannel tied firmly 
 over the ear is very soothing. 
 
 Cotton saturated with equal parts of laudanum and 
 glycerine often gives the greatest relief. Should these 
 
150 A TEXTBOOK OF HOME NURSING 
 
 simple remedies not avail to ease the pain, syringing the 
 ear with boiled water at a temperature of 108° to 110° 
 F., every two hours, will give the greatest comfort, and 
 almost invariably stops the pain, but the syringing must 
 be done most carefully and gently. A teaspoonful of 
 boracic acid should be added to the boiled water, and a 
 regular ear nozzle with a fountain syringe used, so as to 
 have a continuous flow. Hold the ear downward and a 
 little backward ; let the water run very gently, not straight 
 into the ear, but a little to one side. Great injury may 
 be caused unless the syringing be done very carefully and 
 slowly. A little of the hot water allowed to remain in 
 the ear for a few moments is very soothing. Be careful 
 not to expose the ear to any cold air after syringing with 
 hot water. Earache is sometimes caused by an accumu- 
 lation of wax in the ear, and in that case the hot water 
 will cure it. 
 
 Never fill an ear with cotton wool when there is a run- 
 ning discharge. 
 
 Toothache. This can be much relieved by holding hot 
 Pond's extract or hot water in the mouth until it becomes 
 cool, and then taking a fresh mouthful, keeping it up 
 as long as possible; you will be surprised at the comfort 
 and relief it gives. 
 
 When there is a hollow in the tooth, put a couple of 
 drops of pure carbolic acid, creosote, or oil of winter- 
 green on a piece of cotton wool, and push it firmly into the 
 hole, taking care not to touch the gums. Consult a dentist 
 without delay. 
 
 A tiny piece of mustard leaf applied to the gums, or 
 iodine painted on, will help the pain when it comes from 
 general face-ache. Hot water bags should not be used in 
 toothache, for fear of forming an abscess. 
 
 Foreign body in the nose. When a child gets some- 
 thing up his nose, you may dislodge it by making him 
 sneeze with pepper or snuff. 
 
FIRST AID IN EMERGENCIES 151 
 
 Foreign bodies in the throat. It sometimes happens 
 that a fish bone gets stuck in the throat, and it is im- 
 possible to reach it with the finger. In that case a raw 
 egg swallowed quickly will generally carry it into the 
 stomach. If a pin, a piece of glass, or any foreign body 
 with a sharp edge is swallowed by mistake, do not give an 
 emetic, but make your patient eat solid food, as potatoes or 
 bread, so that the object may become embedded in the food 
 and carried out of the system without injuring the intes- 
 tines. 
 
 Hiccoughs. You can often stop hiccoughs by making 
 the person sneeze half a dozen times, or letting him sip 
 water and hold his breath as long as possible between each 
 sip. Another method is to pour vinegar on a lump of 
 sugar and swallow it whole. 
 
 Vomiting. Violent vomiting is often controlled by a 
 Seidlitz powder divided into three parts, and one part 
 taken every fifteen minutes, at the same time a mustard 
 paste should be applied over the pit of the stomach. A 
 spoonful of boiling water every ten minutes is of service 
 in settling the stomach. 
 
 Hydrophobia. Should a child be bitten by a dog, and 
 there is any fear of the dog being mad, and you are out 
 of reach of a doctor, bind the limb tightly between the 
 wound and the heart, to prevent the poison being absorbed 
 into the system. The bandage should not remain on for 
 more than half an hour for fear of stopping the circula- 
 tion. 
 
 The wound should also be cauterized with pure carbolic 
 acid, nitrate of silver, or a knitting-needle heated to a 
 white heat. 
 
 Epilepsy. This trouble is unfortunately only too com- 
 mon, and it is well to know how to act should a fit occur 
 in your presence. It may come on at any time, and is 
 generally, but not always, preceded by a peculiar cry ; the 
 patient falls to the ground unconscious, and the body is 
 
153 A TEXTBOOK OF HOME NURSING 
 
 rigid for a few seconds, and then begins to twist and 
 jerk. 
 
 Treatment. Loosen the clothing about the neck, put 
 something between the teeth to prevent the patient from 
 biting his tongue, and do not try to restrain his move- 
 ments ; give him plenty of fresh air, and he will come to 
 in a few moments and fall into a heavy sleep. 
 
 Apoplexy. One of the small blood vessels breaking 
 causes pressure on the brain. 
 
 The symptoms are, unconsciousness, flushed face, slow, 
 loud breathing. Loosen the clothing about the neck, ele- 
 vate the head and chest, ice cloths on the head and heat 
 to the feet. Be careful never to give stimulants. 
 
 Asphyxiation. Accidents sometimes arise from suf- 
 focation caused by gas, smoke, sulphur, etc. When such 
 an accident occurs, remove the sufferer at once into the 
 fresh air, loosen all clothing about the neck and chest; 
 throw cold water on the face and chest. If necessary, 
 artificial respiration must be resorted to until natural 
 breathing is restored. 
 
 Artificial respiration. The knowledge of how to keep 
 up artificial respiration after an accident has happened 
 from narcotic poisoning, suffocation, or drowning is of 
 great importance and has saved many lives. Place the 
 patient on his back with the shoulders slightly raised ; pull 
 out the tongue and hold it with a handkerchief around it 
 tied under the chin. Then, kneeling at the head, grasp 
 the forearm between elbow and wrist and draw the arms 
 up gently and slowly over the head until the hands touch 
 behind the head. Keep them there for two seconds, so 
 as to allow some air to enter the lungs, then carry them 
 slowly back and press them against the sides of the chest 
 to expel the air. After a couple of seconds repeat the 
 movements, and keep them going at the rate of sixteen to 
 the minute until there is some sign of life. It has some- 
 times been found necessary to work thus for a long time 
 
FIRST AID IN EMERGENCIES 153 
 
 before breathing is reestablished. Cases on record show 
 recovery after two hours of artificial respiration. 
 
 Schaef er's method of artificial respiration is the best. 
 This has been described as follows : " The patient is 
 placed on the ground, with his face downward, and with 
 a thick folded garment or pillow under the lower part 
 of the chest. Care must be taken that the entrance to 
 the mouth and nose is clear. The operator places him- 
 self in a kneeling posture astride of the patient, facing 
 the patient's head, his knees being opposite the patient's 
 hips. He then places his hands flat over the back of the 
 lower ribs, one hand on each side, and gradually throws 
 the weight of his body forward, so as to make firm pres- 
 sure on the lower ribs. By this means the chest is com- 
 pressed and air is forced out of the lungs. The operator 
 then brings his own body up into the semi-erect position, 
 but still retaining his hands in position, thereby relaxing 
 the pressure on the ribs, and enabling air to be drawn 
 into the lungs by the elastic reaction of the chest wall. 
 The process is repeated regularly about 15 times a minute, 
 and should be continued for at least half an hour." 
 
 Sunstroke and heat prostration. Ice cloths to the 
 head, or cold baths with constant rubbing is the best treat- 
 ment ; keep the patient quiet, and watch the pulse as heart 
 failure may result. 
 
 Fractures. There are different kinds of fractures, 
 simple, compound, comminuted, etc. 
 
 The best first aid treatment when a leg or arm is broken, 
 until the arrival of a doctor, is to keep the limb quiet, by 
 binding on both sides, a splint made from walking sticks, 
 umbrellas, pieces of board, strong cardboard, etc., then 
 apply ice cold compresses to reduce the swelling. 
 
 The greatest care must be used in handling the pa- 
 tient, for if the fracture is a compound one the wound 
 in the flesh may be greatly increased ; and a simple frac- 
 ture may be made compound by any careless movement 
 
CHAPTER XI 
 
 DIETETICS DAINTY DISHES AND HOW TO SEEVB 
 
 THEM 
 
 Food. Its importance in sickness. How to select 
 and prepare the proper kind of food ; when to give it ; and 
 in what proportions. These are most important points 
 in the education of a Home Nurse. Diet in the treatment 
 of all diseases is of primary importance now-a-days. 
 Feeding the sick is described by a medical authority, as, 
 " a science and an art " ; for one must consider the great 
 laws of supply and demand, and how to apply them to the 
 individual patients. 
 
 "Calorie," is a term with which we are fast becoming 
 familiar. " Heat units," describes the term in a way to 
 be better understood by the laity. Every human body 
 requires fuel, in the form of " heat units " to keep it in 
 normal condition and when invaded by disease, especial 
 care has to be observed that a proper proportion of " heat 
 units " is taken into the system daily, to counteract the 
 lowered vitality caused by disease. 
 
 There is a great difference in the requirement of food 
 for a human body at rest, or one employed in active work, 
 also in the requirements of an adult in distinction to a 
 child. 
 
 Should the Home IsTurse face the problem of caring for 
 
 a chronic invalid, or a patient whose constitution has been 
 
 weakened from a severe illness, it would be well for her 
 
 to keep on hand a good book on " Food values," and 
 
 " Dietetics " (found in almost every Public Library) so 
 
 that she may supply the right number of " Calories " or 
 
 154 
 
FOOD AND HOW TO SERVE IT 165 
 
 " heat units " required to build up the constitution of her 
 patient. 
 
 Functions of Food. Food has three important func- 
 tions to perform inside the human body, namely : Giving 
 heat, forming tissues, repairing waste. 
 
 During illness, when the appetite for food has to be 
 stimulated the utmost daintiness should be observed in the 
 preparation and serving of meals. 
 
 Those of my readers who have passed through an illness 
 will readily understand what a difference it makes at meal- 
 time if the food is well cooked and daintily served, inviting 
 enough to create an appetite, even where there is little 
 desire to eat. 
 
 Suggestions about patients' food. One of the first 
 suggestions I should like to make is, never ask your patient 
 beforehand what he or she would fancy in the way of food ; 
 for, even in health, if you are always aware what is to be 
 placed before you, the chances are that you will go to the 
 table without the ghost of an appetite. This is especially 
 so in sickness, and sometimes when there is not the slight- 
 est desire to eat, a little delicacy nicely cooked, daintily 
 served, and kept a profound secret until uncovered at the 
 bedside will be received with favor and enjoyed thor- 
 oughly. 
 
 Preparing the food. The preparation of extra dishes 
 ought not to be left in the hands of an ordinary cook, un- 
 less you are blessed with an exceptionally good one. As 
 a rule, they are too busy or indifferent, to take any extra 
 trouble to have everything piping hot and done to a turn. 
 It does not take more than a few moments to broil a steak, 
 bird, or chop, and if you superintend the cooking, you will 
 always be sure that it is carefully done. I know of noth- 
 ing more annoying than, after ordering some especial 
 dainty for an invalid, to have it completely spoiled by 
 careless cooking. 
 
 Leave directions with the cook to have everything in 
 
156 A TEXTBOOK OF HOME NURSING 
 
 readiness for you, and then slip down to the kitchen ten 
 or fifteen minutes before the meal-time, and either broil 
 the meat or bird yourself or superintend its cooking. 
 Broiling should be done over a very quick fire to retain 
 the juice in the meat. Allow it to be a rich brown on the 
 outside, and still remain slightly red and juicy in the 
 middle. All hot meats must be served at once on hot 
 plates straight from the fire to the bedside, without being 
 kept standing round on the stove or in the oven getting 
 hard and dry. Always cover dishes containing hot food 
 while carrying them through passages and upstairs. Hot 
 water plates arranged with a compartment under the 
 plate to be filled with boiling water, thus keeping the food 
 hot all through the meal, are very useful in cases of long 
 illness. 
 
 The tray. To make a tray look attractive is almost as 
 important as having the food properly cooked. Cover it 
 with a snowy napkin or tray-cloth (if possible you should 
 use a fresh one for every meal). Choose the prettiest and 
 daintiest china and glass in the house. Do not cling to 
 the idea that it is necessary to use thick, cheap china in 
 the sick-room for fear of breakage, for this can be avoided 
 by careful handling, especially when washing the dishes, 
 and your invalid will appreciate her meals twice as much 
 when allowed to use the best of china. The cup to be 
 used for tea, coffee, or bouillon, is first filled with very 
 hot water so that it shall be thoroughly heated. Tea or 
 coffee should be put in a little tea-pot or covered pitcher, 
 and not poured into the cup, as it is sure to spill over into 
 the saucer, and become cold before it reaches the bedside. 
 Besides, it is of great interest to some people to pour out 
 their own tea or coffee, adding just the amount of sugar 
 and cream they desire. Cut sugar is needed in a dainty 
 glass or silver bowl, and cream or hot milk in a small 
 pitcher. A glass of ice water must never be forgotten 
 on the tray, as well as pepper and salt, as tastes differ in 
 
FOOD AND HOW TO SERVE IT 157 
 
 regard to seasoning, and for this reason, when preparing 
 the food, do not put in all the pepper and salt that you 
 think necessary, but leave room for the patient to add a 
 little or not as she desires. Plates for hot meat must he 
 very warm. Hot rolls or biscuits are placed between the 
 folds of a table napkin. 
 
 One of the most important rules is not to crowd a tray 
 with dishes and food, but to give very small portions of 
 everything. Large, untidy pieces of meat swimming in 
 greasy gravy will take away any invalid's appetite. Toast 
 cut in " ladies' fingers " and also baked potatoes look very 
 inviting peeping from the folds of a snowy napkin. Toast 
 should be made from bread not fresh, cut about half an 
 inch thick, the crusts removed, and toasted on a fork or 
 broiler over a very hot fire, crisp and yet not burned, soft 
 and yet not soggy, and served immediately. Graham or 
 wheaten bread, rusks or zwiebach, make a pleasant change 
 from the ordinary white bread. 
 
 Jellies look best in glass dishes, and when serving an egg 
 fill the egg-glass with hot water and roll the egg in a 
 doily ; do not open it before reaching the bedside. 
 
 A tiny sprig of parsley or water-cress used to garnish 
 the meat dish, and a fresh-cut flower beside the table nap- 
 kin, will help to make the tray very attractive. 
 
 Preparing fruit. Fruit should be placed on ice for a 
 little while before meals to make it cold. Grapes need 
 to be washed and put in a glass dish on small pieces of 
 ice. If you wish to make the grapes especially dainty, 
 remove the skins and the seeds. Oranges are sliced with 
 sugar after being carefully peeled, or they are cut in half 
 like grape-fruit, all hard fibers removed from the center, 
 the skin loosened around the edges, and served with pow- 
 dered sugar. When preparing peaches, do not cut them 
 until just before serving and then use a silver or plated 
 knife. A steel knife will leave a taste on the peaches, 
 and if they are prepared even half an hour before the 
 
158 A TEXTBOOK OE HOME NURSING 
 
 meal, they will become dark in color and will not be half 
 so attractive. 
 
 The following is a nice little dessert for a hot day in 
 summer, and is easily prepared: slice an orange, lemon, 
 apple, and peach, in a saucer; add a few cherries and a 
 little pineapple, and serve with cream and sugar; or, if 
 you have some wine-jelly on hand, put it on the fire for a 
 moment, then add to it the cut-up fruit, turn all together 
 into a jelly-mold, and place it on the ice to cool. It will 
 make a delicious dessert. 
 
 The more attractive you can make your tray look, and 
 the more variety you arrange in the way of food, the greater 
 will be your patient's pleasure and enjoyment in the meal ; 
 and you will find it takes very little more care and trouble 
 to arrange a tray daintily, than to put it before the in- 
 valid in an untidy and slovenly manner. 
 
 Serving the meal. Before serving a meal, open the 
 window fbr a moment to freshen the air. Wipe the pa- 
 tient's hands and face with a damp towel, and she will 
 be ready to appreciate her food. After carrying the tray 
 upstairs, place it on a table near the bed. If your patient 
 is allowed to sit up, support her back with a bed-rest and 
 pillows, and throw a shawl over her shoulders. A bed- 
 tray or bed-table is very useful, and almost a necessity 
 in long cases of illness, as it takes all the weight off the 
 patient. Should there be none at hand, you can impro- 
 vise one by placing two or three books on each side of the 
 bed and laying a tray or cutting board across them, mak- 
 ing the books on each side high enough to prevent the tray 
 resting on the knees. Cover the tray or board with a 
 table napkin, and, even if the meal is a very simple one, 
 serve it in courses, one dish at a time. With fastidious 
 people, it frequently takes away any appetite they may 
 have if all the food is put before them at the same time. 
 In cutting up the meat and opening the egg, try and do 
 so in the daintiest manner possible. 
 
FOOD AND HOW TO SERVE IT 169 
 
 Cut up the bird or meat on a side-table, open the potato 
 and season it, butter the toast, and when necessary pour 
 out the tea and coffee; then, unless you have something 
 jolly or interesting to talk about, take up a book and read 
 some bright little extract, or leave the patient alone to 
 enjoy her meal. Do not sit down in silence and watch 
 every mouthful she takes, thus causing her to hurry and 
 taking away the enjoyment of the meal. It frequently 
 happens that listening to some interesting story will divert 
 your patient's attention from herself — and she will be 
 likely to eat twice as much as if allowed to stop and con- 
 sider every mouthful. Sick people have to be humored 
 a little in their fancies, and anything likely to give them 
 a distaste for food is to be carefully avoided. 
 
 As soon as the meal is ended, take all the empty dishes 
 out of the room immediately, remove the extra pillows, 
 brush out any crumbs that may have found their way 
 under the bedclothes, and allow your patient to lie down 
 quietly while you go to your own meal and the chances 
 are that on your return you will find her sleeping com- 
 fortably. 
 
 Time for serving meals. It is a good plan to serve 
 the invalid's meals half an hour before those of the rest 
 of the family, so that she can be properly cared for, and 
 the food will be hot and comfortable. 
 
 Coaxing the appetite. When the appetite is very 
 poor, give only one dish at each meal, instead of two or 
 three, and solid food will be more appreciated as a rule, 
 and is more nourishing than sweets in any form. A tiny 
 quail or squab, daintily cooked and served on a slice of 
 crisp toast, a small finger of broiled steak, a chop, a tiny 
 piece of the breast of chicken or sweetbread with cream 
 sauce — any of these dainties, prepared without the knowl- 
 edge of the patient, will not fail to tempt the appetite. 
 Small pieces of crisp celery, served in a glass dish on 
 pieces of ice, are a great addition to a meal, and celery is 
 
160 A TEXTBOOK OF HOME NURSING 
 
 easily digested and considered very soothing to the nerves. 
 Or a few tender leaves from the heart of the lettuce, crisp 
 and cold, may be served with French dressing. When 
 tomatoes are served, plunge them for a second into very 
 hot water, and the skin will peel off easily; then lay them 
 on the ice for an hour before the meal, so that they will be 
 firm and cold before serving. Cut them in thin slices 
 and serve with any dressing required. 
 
 Feeding helpless patients. When feeding helpless 
 patients, it should be done with great care and delicacy. 
 Do not have the glass or cup more than half full, or it will 
 surely spill down the neck. Eaise the head gently, but 
 not too much forward, or you will prevent your patient 
 swallowing easily. Do not give the food too fast. A 
 small cup with a wide top will be found the easiest kind 
 from which to drink when the head is low. 
 
 If your patient is only allowed one or two tablespoon- 
 fuls at a time, do not tantalize her by filling the glass half 
 full and telling her to take a few sips. Just put in the 
 exact amount to be given, and allow her to drain every 
 drop. When children are only allowed a certain quantity 
 at one time they will be much more contented if you fill 
 a small glass full, instead of giving them a small quantity 
 in a larger glass. 
 
 If a feeding-cup is used, a glass one is the best, as you 
 can see jus't how quickly the fluid is flowing, and you 
 vsdll not be likely to choke your patient by giving it too 
 rapidly. But a glass tube is better than a feeding-cup 
 and is more easily managed. If it is not bent at the 
 right angle, hold it over the flame of an alcohol lamp for 
 a second, and you can then bend it any shape you desire. 
 With some patients it is better to give them their nourish- 
 ment at short intervals and in small quantities; and 
 again, others need to wait three or four hours between 
 meals to allow the stomach to empty itself thoroughly be- 
 fore being fiUed again. It depends so much upon the 
 
FOOD AND HOW TO SERVE IT 161 
 
 nature of tlie disease, and the condition of the patient, 
 that no regular law can be laid down in regard to how 
 often nourishment should be given. When there is a 
 great drain on the system in the way of a discharge from 
 an open wound, or a generally run-down condition; or 
 after a high fever has exhausted the vitality, a great deal 
 of extra nourishment is necessary to keep up the strength, 
 and you must induce your patient to eat and drink as 
 much as possible. During convalescence something like 
 the following may be used : 
 
 Bill of fare for one day. Breakfast, about 8 a. m.^ 
 consisting of a little fruit (raw or cooked) ; one of the 
 many cereals nicely prepared ; an egg in some form, or 
 a small piece of broiled fish or bacon; tea or coffee and 
 toast. Hot cakes or biscuits are not easily digested when 
 one is confined to bed. 
 
 About 11 A. M., if tired after the daily bath, a cup of 
 bouillon, eggnog, or milk punch will be refreshing. 
 
 At 1 p. M. the heartiest meal of the day should be taken. 
 Oysters, with the hard part cut out, or soup to begin with, 
 then some meat, either rare broiled steak, chop, quail, 
 squab, chicken, or sweetbread, with one vegetable such 
 as baked potato, string beans, spinach, or stewed celery. 
 A simple dessert, if desired, as custard, milk pudding, 
 rennet, or ice-cream. 
 
 In the middle of the afternoon a little fruit, cup of 
 cocoa or chocolate, or thin bread and butter and tea, is 
 acceptable and helps to break the monotony of the day, and 
 at six o'clock a simple supper of egg in some form, scraped 
 beef sandwich, or creamed chicken; with milk-toast and 
 a baked apple or preserved fruit should be served. 
 
 Nourishment at night. When nourishment is neces- 
 sary during the night or in the early morning hours, as 
 it often is when the patient is recovering from a severe 
 illness, broth, hot milk, bouillon, or cocoa is best. Should 
 your patient be on a milk diet, she ought to take at least 
 
162 A TEXTBOOK OF HOME NURSING 
 
 four ounces of milk every two hours, and, if possible six 
 ounces. 
 
 The juice of fresh fruit is at all times better than the 
 pulp, and is more easily digested. 
 
 Hints about feeding. In all cases of illness food 
 plays an important part and should be given careful at- 
 tention. It either helps or hinders a rapid recovery. 
 
 The appetite of a sick person has to be coaxed and en- 
 couraged, as a rule, and you will generally find that many 
 things they care for in health become very distasteful 
 when confined to bed, so that the more change and variety 
 you can devise in the bill of fare, the more likely your 
 invalid will be to take the desired amount of nourish- 
 ment. Arrange every morning what you decide to give 
 for the next twenty-four hours, and then see that all neces- 
 sary supplies are on hand. If it should be the house- 
 keeper of the family who is ill, try and make all arrange- 
 ments without referring to her, and you will find that 
 she win enjoy whatever you set before her, particularly 
 if you contrive some new dish, that she has not tasted 
 before. 
 
 Diet of children. Children when sick, require the 
 very simplest food. It is difiicult to get them to take more 
 than a few mouthfuls when they do not feel hungry, so 
 they ought to have the most nourishing food in small quan- 
 tities about every two hours, and if you can call it by 
 odd names and turn the meal into play, they will often 
 forget themselves and be coaxed into taking a sufficient 
 quantity. 
 
 Foods that are easily digested by adults do not always 
 agree with children, and growing children require more 
 food than adults. Of course eating at any time that one 
 is hungry, as many children are allowed to do, is very 
 wrong. Regular hours are necessary, make four or five 
 meals, at stated times, for food, and keep to your schedule. 
 For sick children between two and thirteen years the f ol- 
 
FOOD AND HOW. TO SERVE IT 163 
 
 lowing list is a good one to draw from: Milk, beef-juice, 
 broths, chicken, lamb, milk puddings, jellies, eggs, fruit, 
 cereals, bread and butter, cocoa, and fruit juice. 
 
 Children when ill sometimes object to taking milk. 
 One mother was bright enough to add a few drops of 
 vanilla essence and a little sugar to the glass of milk, and 
 called it " liquid ice-cream," and her little boy drank it 
 with great delight, although he would not touch a glass of 
 plain milk. Sometimes the addition of a little hot water 
 and sugar, and one teaspoonful of tea, will insure the 
 milk being received with favor by the little one under the 
 name of " cambric tea." The white of an egg well beaten 
 and mixed with an equal part of water and a few drops 
 of iVanilla essence or lemon juice is very nourishing and 
 stimulating. 
 
 Diet in disease and convalescence. In all cases of 
 illness, when a physician is in attendance, no food of any 
 kind should be given without his permission, as sometimes 
 great harm may be done by giving what appears to be a 
 very simple food, but which in reality is most harmful 
 to the patient. 
 
 There are some diseases in which it is necessary to be 
 especially strict in the diet, as, for instance, typhoid fever, 
 Bright's disease, gout, and many others. 
 
 In the following pages I have given a few suggestions 
 that may be of service regarding nourishment in some of 
 the ordinary cases of illness, but as complications are likely 
 to arise in any disease, the physician should always be 
 consulted. 
 
 When convalescence is reached after any disease, as a 
 rule the patient is put on " light diet," the various forms 
 of which are left to the discretion of the nurse, and these 
 suggestions are to assist the Home Nurse in arranging 
 some variety in the food, and to give her a general idea 
 of the diet best suited to the disease. 
 
 Diet in fever cases. Physicians do not starve a fever 
 
164 A TEXTBOOK OF HOME NURSING 
 
 case in these days as they used to do half a century ago ; 
 scientific research has shown that plenty of nourishment 
 is required to replace the waste of tissue caused hy the 
 fever, and also that large quantities of fluid are necessary 
 to wash out the kidneys and to reduce the temperature. 
 
 An even diet should be maintained to supply about 
 3,000 calories or " heat units " in the system during the 
 twenty-four hours. When the temperature is high, how- 
 ever, two points must be considered in choosing the proper 
 food : First, the digestion of the patient is weakened by 
 the disease; and second, the action of the stomach and 
 bowels is greatly interfered with by the effect of the high 
 temperature on the system. 
 
 During that period of the disease when the fever is 
 high, nourishment is given in fluid form, such as milk in 
 its various preparations — whichever agrees best with the 
 patient ; as milk and lime-water, milk and Vichy, pepton- 
 ized milk, buttermilk, kumyss, somal, etc. ; broths, light 
 soups, beef -juice, and gruels. The amount and frequency 
 of administration is regulated by the physician. When 
 the fever declines light diet is usually prescribed, and for 
 the first week at least the solid food should be given at 
 noon, or even a little earlier in the day, while Qae tem- 
 perature is low, as it is then more easily digested; and 
 during the afternoon and evening, when the temperature 
 is inclined to rise, nourishment should be given in liquid 
 form. 
 
 For light diet, during the early days of convalescence, 
 soups thickened with rice, barley, or arrovsrroot will be 
 more satisfying to the patient than clear soups and broths. 
 Farinaceous food, when nicely seasoned and carefully 
 cooked, is often acceptable; so, too, are eggs in various 
 forms, milk and cream toast, chicken and beef jelly, either 
 hot or cold. Sweet fruits, rare beef and green vegetables 
 are of particular importance to increase the red corpuscles 
 in the blood, and prevent anemia. 
 
FOOD AND HOW TO SERVE IT 165 
 
 The yolk of an egg well beaten with a little sugar, an 
 ounce of brandy, and some cinnamon-water is pleasant to 
 the taste and very nutritious. 
 
 Drinks between meals. Lemonade, not very sweet, 
 when given between meals is easily digested ; so, too, are 
 flaxseed tea, barley-water flavored with lemon, milk whey, 
 and the unfermented grape-juice now used extensively, 
 which is delightful to the taste, slightly stimulating, and 
 as a rule does not upset the stomach. Drinks of this 
 kind should be given frequently, not in large quantities 
 at one time, but a few spoonfuls at short intervals during 
 the day, as in the latter case the thirst is relieved more 
 effectually than when a large amount is given every three 
 or four hours. 
 
 Convalescent diet. During convalescence, coffee and 
 tea are generally allowed in small quantities when there 
 are no nervous symptoms. In regard to alcohol in any 
 form, that must be left entirely in the hands of the physi- 
 cian, as he will be the best judge of what is suited to the 
 case, and stimulants of any kind should never be given 
 without his permission. 
 
 When resuming solid food after a long period of fluid 
 diet, it must be done very gradually, so as not to overtax 
 the digestive organs. Meat when first given should be in 
 very small quantities, either minced, chopped very finely, 
 or scraped. Starchy foods are of great service in building 
 up the system. 
 
 Special dishes during convalescence. During con- 
 valescence from fevers, as soon as the physician decides 
 that solid food is desirable, some of the following dishes 
 may be given under the form of light diet and subject to 
 his approval, choosing the simpler ones for the first few 
 days. 
 
 Chicken broth with arrowroot or rice; milk or cream 
 toast; junket; scraped beef sandwiches, or scraped beef 
 in balls; sago or rice pudding; bread and milk; a little 
 
166 A TEXTBOOK OF HOME NURSING 
 
 cooked fruit; especially baked apples; chicken and beef 
 jelly; bouillon with, an egg beaten up in it; poached or 
 scrambled eggs; boiled or stewed sweetbreads; a little 
 wine or calf's-foot jelly; custard or tapioca cream; occa- 
 sionally a baked potato, very mealy and soft ; cocoa made 
 with equal parts of milk and water; chicken panada; 
 cream of celery soup ; and later on potato soup with crou- 
 tons in it; lightly broiled lamb chops or a small piece of 
 rare beefsteak; game, creamed potatoes; snow pudding 
 or orange jelly. 
 
 Diet in typhoid fever. Typhoid fever requires a very 
 much stricter form of diet than any other fever, as from 
 the nature of the disease the intestines are particularly 
 sensitive, and the physician's orders must be carefully ad- 
 hered to. 
 
 A relapse has been known to occur in typhoid fever at 
 the hospital, by the patient eating some food brought to 
 him by an over-anxious relative, without the knowledge 
 of doctor or nurse. As a rule, milk is the principal diet 
 throughout the disease, although where milk does not 
 agree well with the patient the physician sometimes finds 
 it best to vary it by light broths or gruel, but the broths 
 must be prepared most carefully, and be entirely free from 
 grease or fat. 
 
 Milk, cream, eggs, sugar, bread and butter is the sched- 
 ule for diet in typhoid fever carried out in one of our large 
 hospitals. The physician in charge will make an outline 
 of the diet best suited to the individual patient; and the 
 home nurse must follow it absolutely. 
 
 Typhoid-fever patients are as a rule almost ravenous 
 when they commence to convalesce, and the greatest care 
 has to be taken that they do not overload the stomach or 
 eat anything that may cause a relapse. A limited supply 
 of solid food must be given even for some weeks after the 
 temperature is perfectly normal. 
 
 Diet in pulmonary tuberculosis. In the treatment 
 
FOOD AND HOW TO SERVE IT 167 
 
 of pulmonary tuberculosis, diet is very important, as the 
 disease is generally of such long duration that plenty of 
 nourishment is required to keep up the strength. At the 
 same time great care is necessary in selecting the best 
 food to suit each individual case, for dyspepsia and diar- 
 rhea are two of the most frequent complications to be 
 fought against, especially in the advanced stages. 
 
 Milk, fats, and oils should form the principal diet ; meat 
 once a day is as a rule suflScient, and when taken should 
 be rare and juicy. Scraped beef or beef-juice is to be pre- 
 ferred as the disease advances. The heartiest meal should 
 be taken early in the day, as in the case of other fevers, 
 the temperature generally rises toward evening, and that 
 interferes with digestion. Eich cakes, sauces, fried meats, 
 and pastry should never be given ; but, instead, cereals of 
 all kinds, plenty of fruit cooked or raw, abundance of milk 
 in every form, eggs, game, jeUies, cream, butter, and nour- 
 ishing soups. 
 
 Warm milk taken slowly between meals is very benefi- 
 cial; sometimes if it is diluted with a little hot water or 
 Vichy, it agrees better with the patient; a pinch of salt 
 added to the milk will also be of service in helping the 
 digestion. Cream and hot water may also be recom- 
 mended. 
 
 After drinking milk the mouth must be thoroughly 
 rinsed with some simple mouth wash, otherwise a very 
 unpleasant taste will remain, and this may give the pa- 
 tient a strong dislike to milk, even amounting to nausea. 
 
 A large amount of food is required, as the disease rap- 
 idly wastes away the tissue, and when there is little or 
 no appetite extra nourishment has occasionally to be ad- 
 ministered by the stomach tube between meals. Some 
 form of light nourishment is advisable before retiring for 
 the night, and when the patient is troubled with heavy 
 night sweats a good milk punch made with brandy will 
 be found helpful in reviving him. 
 
168 A TEXTBOOK OF! HOME NURSING 
 
 A cupful of hot water, at a temperature of 14r0° F. 
 taken in sips half an hour before breakfast, helps to stim- 
 ulate the appetite and cleanses the stomach. 
 
 Diet in grip, bronchitis, pneumonia. During a se- 
 vere attack of grip, bronchitis, or pneumonia, while the 
 fever lasts, fluids are generally prescribed instead of solid 
 food, choosing the kind that agrees best with the patient, 
 as (especially in pneumonia) the stomach is easily nau- 
 seated. 
 
 A raw egg taken from the shell will help to soothe the 
 troublesome cough in bronchitis. Hot and cold drinks of 
 various kinds, as already described on page 165, should 
 be given very frequently. 
 
 After the temperature declines light diet is usually or- 
 dered, as in convalescence from fever, and even after 
 regular meals are established extra nourishment should 
 be taken between times, such as milk punch, eggnog, cocoa, 
 bouillon, or milk, as the system takes some weeks to re- 
 cover its natural tone. 
 
 Diet in tonsilitis. This disease calls especially for 
 fluid diet, as the difficulty with the throat will frequently 
 prevent the patient taking as much nourishment as is 
 required. It is best to concentrate the food as far as pos- 
 sible into the smallest amount of fluid, giving strong 
 beef extracts, beef-juice without being diluted, egg beaten 
 up and milk in various forms. 
 
 In tonsilitis, as well as in many fever cases, ice-cream 
 is generally well received by the sufferer, as the intense 
 coldness is grateful to the inflamed throat. 
 
 Diet in neuralgia. When suffering from an attack of 
 neuralgia all kinds of rich foods should be eaten: cream, 
 butter, fat meats, plenty of vegetables, eggs, milk, and 
 meat of all kinds, besides nourishment between meals. 
 Tea, coffee, confectionery, or highly seasoned foods are 
 to be avoided. 
 
FOOD AND HOW TO SERVE IT 169 
 
 Diet in surgical cases. Surgical patients oiaght to be 
 well fed, as wounds heal better and more rapidly when 
 the blood is in good condition ; at the same time care must 
 be taken not to overload the system while the patient is 
 confined to bed and unable to take any active exercise. 
 After minor operations, when there are no complications, 
 the ordinary diet is, as a rule, resumed after the first day, 
 with perhaps a little extra nourishment between meals if 
 desired by the patient. When there has been very severe 
 pain, or a great shock, solid food must be returned to very 
 slowly, as the digestion will probably be weak for some 
 little time; and when there has been much loss of blood, 
 a large amount of nourishment is required, which should 
 be given largely in fluid form. In long surgical cases, 
 where there is a constant discharge from a wound, plenty 
 of fresh vegetables, fats, fruits, milk, and the most nour- 
 ishing food is necessary to replace the continued drain on 
 the system. 
 
 Very much the same food that is recommended in con- 
 valescence from fevers may be given in the convalescence 
 of surgical patients, but as long as the patient is confined 
 to bed the plainest food should be chosen, and the heartiest 
 meal taken in the middle of the day. 
 
 Insomnia. Nervous people who suffer from insomnia 
 could be very much benefited by careful attention to diet, 
 instead of having recourse to hypnotics. It is better not 
 to sleep on an empty stomach, but always take some light 
 food, as cocoa, sandwich, malted milk, or a glass of milk, 
 just before retiring; or it should be at hand to take when 
 they become wakeful during the night. Besides their 
 ordinary meals, they should if possible take some light 
 refreshment every two hours if the digestion is good, omit- 
 ting tea and coffee altogether, and spending the greater 
 part of the day in the open air. 
 
 Diet in rheumatism. . Eheumatism is among the dis- 
 
170 A TEXTBOOK OF HOME NURSING 
 
 eases especially influenced by diet, in fact, diet forms one 
 of the greatest factors in ttie treatment of rheumatism, 
 either acute or chronic. 
 
 In acute cases of rheumatism a fluid diet is most suit- 
 able, such as gruels, vegetable soups, and all forms of 
 milk and cream. No alcohol should be allowed, but plenty 
 of acid drinks, especially lemonade without sugar may be 
 taken. When the acute symptoms subside, all varieties 
 of cereals and farinaceous foods, milk and cream toast, 
 and corn-meal pudding without sugar ; and when the reg- 
 ular meals are resumed milk, milk soups, cereals, rice, 
 oysters, eggs, chicken, spinach, celery, and fresh fruits 
 are among some of the best foods to take. Eich jellies', 
 confectionery of all kinds, and meat should be avoided, 
 though in chronic cases meat is usually allowed once a 
 day, while fish and poultry are taken at other meals. 
 
 In all cases of rheumatism and gout saccharin should 
 take the place of sugar ; being a product of coal-tar, it is 
 without any of the harmful effects of sugar, but supplies 
 the necessary sweet taste. 
 
 The gradual accumulation of a large amount of uric 
 acid in the system generally ends in an acute attack of 
 gout, and there are also many people who suffer from 
 chronic gout in a greater or less degree. Whenever it 
 is found in the system, even in a light form, especial at- 
 tention must be given to diet. Alcoholic drinks of all 
 kinds should be avoided as carefully as sweets and sugar. 
 Fresh vegetables, fruit, with a very small amount of mut- 
 ton, lamb, or beef once a day only, and some chicken, 
 toast or crackers, should form a large part of the daily 
 food. A stout person with gout in his system has to be 
 so careful of his diet that meal-time is to him a trial 
 rather than a pleasure. Only just sufficient food to sus- 
 tain the body should be eaten. Eating too much is very 
 harmful; three meals a day, rather slender ones too, at 
 regular intervals, are sufficient, and no eating between 
 
FOOD AND HOW TO SERVE IT 171 
 
 meals should be indulged in. During an acute attack the 
 diet is usually strictly laid out by the physician in charge, 
 with plenty of water, hot or cold, taken about half an hour 
 before meals, weak tea or alkaline drinks, such as lithia 
 water, apoUinaris, etc., graham bread or dry toast, farina- 
 ceous foods, and some of the plainest broths with no fat 
 or grease in them, cocoa nibs, and a tea or coffee sweetened 
 with saccharin. Shell-fish, — except oysters (which may 
 be eaten when the hard part has been removed), — rich 
 salads, sauces, or pastry must be omitted. 
 ^ Diet in diabetes. Eich foods of all kinds must be 
 avoided, and the diet depend principally on vegetables, 
 poultry, fish, fruit, etc. Starch and sugar must be 
 avoided. 
 
 In an acute attack all food is withheld for two or three 
 days except a small amount of milk. Then a light diet 
 is prescribed. Starchy food of any kind, sugar, beets, tur- 
 nips, potatoes, white bread, rich sauces and desserts with 
 sugar will have to be cut out entirely from the bill of 
 fare. Saccharin must be used in the place of sugar. 
 
 Diet in indigestion, dyspepsia. Slow eating ought 
 to be the rule in all cases of illness, but especially when 
 the trouble is indigestion or dyspepsia, as digestion really 
 commences in the mouth by the proper preparation of the 
 food to be received into the stomach. 
 
 The diet must be very plain; all heavy sauces, rich 
 pastries, pickles, entrees, and hot breads, starchy foods, 
 shell-fish except oysters, smoked meats, game, cheese, acid 
 fruits, and tea are left out of the menu. 
 
 When the dyspepsia is only slight, a few fresh vegetables 
 and a little starchy food is allowed. 
 
 Some of the following dishes are the best that may be 
 taken when suffering from indigestion and dyspepsia: 
 cereals, zwieback, or graham bread, small portion of but- 
 ter or bacon, well-cooked vegetables in limited quantities, 
 fresh fish without sauce, eggs lightly cooked if they agree 
 
172 A TEXTBOOK OF. HOME NURSING 
 
 with the patient; oysters, broiled or roast meats and 
 chicken, raw-beef sandwiches, kumyss, baked apples, 
 peaches and oranges, very weak tea without milk or sugar, 
 and postum cereal instead of coffee. 
 
 In very severe cases the patient is put on a strict diet 
 with hut little variety. Food must be taken very slowly, 
 and fluids are best taken between meals instead of with 
 them. It is wiser not to eat heartily when mentally ex- 
 hausted, but to take some light nourishment, and to rest 
 for half an hour, as the food will not digest well when the 
 nerves are overtired. All meals should be eaten at reg- 
 ular hours, and if possible, with bright conversation at 
 the table. 
 
 Diet in constipation. Chronic constipation may be 
 largely the result of improper feeding, and people with 
 small appetites often suffer with this trouble, especially 
 when very little fluid is taken. Eating hurriedly, taking 
 meals at irregular hours, and especially want of proper 
 exercise all tend to promote constipation. Fruits should 
 be eaten in abimdance, as they are laxatives, also spinach, 
 onions, and tomatoes, while potatoes, beans, or peas should 
 be indulged in very sparingly. Tea is also slightly con- 
 stipating, and too much milk, sweets, fried foods, and 
 eggs. Graham bread, buckwheat cakes, cereals (espe- 
 cially oatmeal, bran, and wheatena) and quantities of 
 water, both with meals and at other times, especially on 
 first arising in the morning, will be of service in curing 
 the trouble. 
 
 Diet in diarrhea, djrsentery. The opposite kind of 
 treatment is required in cases of diarrhea and dysentery ; 
 very little food should be taken, and especially no veg- 
 etables or fruits. If possible, no food of any kind taken 
 for the first eight or nine hours during an acute attack; 
 commence then with a little arrowroot or barley-water, 
 boiled milk and rice, followed by chicken broth and crack- 
 ers, and milk diluted with lime-water. 
 
FOOD AND HOW TO SERVE IT 173 
 
 The return to full diet must be very gradual, starting 
 with milk toast, chicken, and boiled rice, and perhaps a 
 baked potato. 
 
 With children, little or no milk should be given, but 
 instead beef-juice, barley gruel, broths freshly made, or 
 scraped beef, avoiding all patent foods or meat extracts. 
 The nourishment should be administered in small quan- 
 tities about every two hours, so that the stomach may 
 not be overcrowded. 
 
 When diarrhea turns to dysentery a most careful diet 
 must be followed; milk, if given, should be sterilized or 
 peptonized; beef -juice or scraped beef is serviceable. 
 
 During convalescence the patient may take rare roast 
 beef, broiled chicken, dry toast, and a little fish if desired. 
 Very small amounts of fluid should be taken, and all drink- 
 ing water must be carefully sterilized. 
 
CHAPTER XII 
 
 EECIPES FOB, INVAUD COOKIWO 
 
 Broths. Broths for sick people must be entirely free 
 from the slightest appearance of grease. When possible, 
 they should be made the day before they are used, and 
 allowed to stand in a cool place all night ; then the grease 
 will rise to the surface and can be easily skimmed off 
 before the broth is heated. If, however, there is the slight- 
 est appearance of grease after the broth is heated, run a 
 crust of bread, or better still a piece of coarse blotting pa- 
 per, over the top two or three times, and it will disappear. 
 
 Chicken broths. To make chicken broth nicely, take 
 an old chicken, clean it thoroughly, cut it in rather small 
 pieces, and put it in a deep sauce-pan covered with water ; 
 let it boil slowly for four or five hours, renewing the water, 
 if necessary. Then strain and set it aside over night ; it 
 ought to be formed into a thick jelly in the morning, and 
 will keep for days. A little rice or barley, boiled very 
 soft, added to the chicken broth, makes a nice variety. 
 
 Beef tea. The best way to cook beef tea is in a bottle. 
 Cut up a pound of beef into small square pieces ; put them 
 in a preserve bottle, and add two cups of cold water ; stand 
 the bottle on a saucer in a sauce-pan of hot water and let 
 it come almost to a boil. After remaining there about 
 four hours it will be ready for use, and when well sea- 
 soned is very good. 
 
 Mutton broth. Mutton broth ought to be cooked for 
 four or five hours, and the grease should be most carefully 
 removed before serving, as otherwise it is too rich. 
 
 Calf's-foot broth. Cut up two calves' feet and put 
 
 174 
 
RECIPES FOR INVALID COOKING 175 
 
 them in a saucepan with four pints of water, a little car- 
 rot, a few celery leaves, salt and mace. Boil for three 
 hours very slowly until half the amount is boiled away, 
 then strain, and if desired add additional seasoning. 
 
 Beef juice. Beef juice is one of the most useful forms 
 of nourishment in times of illness, when the stomach is 
 delicate, and the patient weak and without appetite. A 
 thick, juicy steak is needed to prepare the beef juice. Cut 
 the meat into pieces about two or three inches square; 
 warm it for a moment over the fire; then squeeze it into 
 a glass with the lemon-squeezer (if you do not have a meat 
 juice squeezer). About two ounces may be given at one 
 time. When you have squeezed it, stand the glass in a 
 cup of boiling water and let it heat slowly. Watch it 
 carefully ; for if it is allowed to get too hot the beef juice 
 will coagulate and spoil. Add plenty of salt and pepper, 
 and, if necessary, a little hot water. Sometimes the beef 
 juice can be taken better when cold ; in that case, add some 
 small pieces of cracked ice. All children are fond of beef 
 juice, and will often take it when nothing else pleases 
 them. 
 
 Biscuit soup. Take a large cupful of mutton broth or 
 beef -tea and two heaping teaspoonf uls of powdered biscuit ; 
 boil them together for fifteen minutes, stirring constantly ; 
 strain and serve hot with small pieces of dry toast. 
 
 Chicken puree. Take the white meat from the breast 
 of a nicely roasted chicken, and a large tablespoonful of 
 stale milk-bread crumbs. Pound the bread and meat to- 
 gether, mixing in a little chicken broth to moisten it to 
 the consistency of thick cream, flavor to taste, warm slowly 
 and serve in a small bouillon cup. 
 
 Oyster stew. Mix half a pint of milk with a teaspoon- 
 ful of com flour, boil until it thickens, stirring constantly. 
 To this add half an ounce of butter and season to taste. 
 Then throw in six or eight oysters and stew gently for 
 twenty minutes. Serve on a hot dish with some small 
 
176 A TEXTBOOK OF HOME NURSING 
 
 pieces of bread (that have been soaked in lemon juice and 
 toasted) surrounding the oysters. 
 
 Sago soup. Cook two tablespoonfuls of sago in one 
 cup of water until quite soft, then add the yolk of an egg 
 and half a cup of hot cream. Have ready a pint of beef 
 essence boiling hot and mix all well together. 
 
 Oatmeal beef-tea. Make about a quart of good beef- 
 tea ; after straining add to it half a cupful of fine oatmeal 
 which has been mixed to a paste with water, and season 
 to taste. Boil until the oatmeal is soft, theii strain and 
 serve either hot or cold. 
 
 Meat Soup. Take half a pound of mutton, Veal and 
 beef, cut up into small pieces ; put it into a saucepan with 
 one pint and a half of water, and a little salt. Allow it to 
 stew slowly for three hours; skim frequently; if desired, 
 parsley, celery, salt, or other seasoning may be added. 
 
 Panada. Wash well two ounces of pearl barley or rice, 
 put it into a saucepan with half a pound of mutton or veal 
 cut in small pieces, and a half a pint of water. Allow 
 it to simmer slowly for two hours ; then pound it up and 
 pass it through a fine sieve, add a little cream, and serve 
 hot or cold. 
 
 Milk preparations. Milk is considered the most per- 
 fect food in illness, as it contains all the necessary ingre- 
 dients to sustain life. It can be given in many different 
 forms, viz., diluted with lime-water or vichy, boiled, steril- 
 ized, peptonized, or in one of the prepared forms, as mat- 
 zoon, kumyss, somal, malted milk, or buttermilk. 
 
 When peptonizing milk, use the little tubes of peptoniz- 
 ing powder, and follow the directions carefully, do not pre- 
 pare more than a pint at a time, as, if allowed to stand 
 any length of time, it becomes bitter and unpleasant to the 
 taste. 
 
 Thick milk. This is easily digested and very palatable. 
 Put a quart of milk away in a cool place in a wide bowl 
 until it becomes thick and smooth like jelly, then set it on 
 
RECIPES FOR INVALID COOKING 177 
 
 the ice for half an hour, and serve it in a glass saucer with 
 cream, sugar, and grated nutmeg. 
 
 Kumyss. A quart bottle is filled almost to the top 
 with boiled milk; then stand it aside until lukewarm; 
 add to it a small piece of yeast about the size of a nutmeg 
 and a tablespoonful of sugar. Seal tightly and stand in 
 a cool, dark place, shake daily, and do not use for a week. 
 
 Sterilized milk. When there is no regular sterilizer 
 on hand in a private house, and it is necessary to sterilize 
 the milk, put it in small bottles which have previously been 
 scalded, and use absorbent cotton for corks. Then place 
 the bottles in a saucepan, half-filled with water, standing 
 them on a brick or a plate turned upside down in the bot- 
 tom of the saucepan, cover over tightly, and let them 
 steam slowly for two hours ; then put the bottles in a cool 
 place, and do not uncork them until you are ready to use 
 the milk. 
 
 Milk punch. Milk punch is very refreshing between 
 meals, and is made with three-quarters of a glass of milk, 
 half a teaspoonful of sugar, and two teaspoonfuls of whis- 
 key, also some cracked ice. When there is no milk-shaker 
 iDn hand, put all the ingredients into a glass and cover with 
 another one of the same size; then shake up and down 
 until quite frothy. 
 
 Eggnog. Take one egg, a tablespoonful of sherry, half 
 a glass of milk, and sugar to taste. Beat the white and 
 yolk separately, and keep out a little of the white for the 
 top. A little nutmeg grated on the top is an addition. 
 When wine is not required a few drops of vanilla essence 
 will flavor the eggnog. 
 
 Orange and vichy. A delicious drink can be made 
 from the juice of two oranges or a lemon, with half a 
 glass of vichy or soda water, and some ice. This is espe- 
 cially refreshing during the summer. 
 
 If your patient awakes in the morning with a disagree- 
 able taste in his mouth, the juice of an orange before 
 
178 A TEXTBOOK OF HOME NURSING 
 
 breakfast is most refreshing, and is also a help in keeping 
 the bowels in order. The juice of grape-fruit, with sugar 
 and ice, is also delicious. 
 
 Barley water. Take four tablespoonfuls of pearl bar- 
 ley, well washed ; put in a saucepan and add three cupfuls 
 of water, boil for about twenty-five minutes, sweeten and 
 flavor to taste. 
 
 Grape juice. This recipe is a very simple one and may 
 easily be prepared at home. 
 
 The grapes must be fresh and perfectly ripe, and about 
 three cupfuls of water is allowed to every quart of grapes. 
 Go over the grapes carefully, picking off the crushed ones 
 and the stems. Put the grapes on the fire, pour the water 
 over them and allow them to come to a boil very slowly ; 
 as soon as they come to the boil, take off the fire and strain 
 through a cloth, then put the juice back on the fire, allow 
 it to come to the boiling point, pour into the bottles and 
 cork tightly. Self-sealing jars or bottles with a patent top 
 should be used. They must be kept in a dark, cool place. 
 
 Gruel barley. Take one tablespoonful of barley, well 
 mixed with half a cup of cold water ; add to it a little salt 
 and a cupful of boiling water. Cook for ten minutes and 
 then add three-quarters of a cup of hot milk, sweeten to 
 taste, and serve immediately. 
 
 Gruel of milk peptonized. Take a cupful of rice, oat- 
 meal, or barley gruel; warm it on the fire; then to half 
 a pint of cold milk add five grains of pancreatic extract 
 and fifteen grains of soda, mix well together and throw 
 it into the gruel, take off the fire and serve when cold. 
 
 Irish moss or carrageen. Take half a cupful of the 
 moss, wash it well and let it soak for a little while in cold 
 water ; then pour off the water and add to it a pint and a 
 half of fresh water, let it boil for a quarter of an hour, 
 then strain and add flavoring and sugar to taste. When 
 cold it will be formed into a jelly. If it is preferred as 
 a drink, add double the quantity of water or milk. 
 
RECIPES FOR INVALID COOKING 179 
 
 Gruel, oatmeal. Take four tablespoonfuls of oatmeal 
 mixed with double the quantity of cold water. Put a pint 
 of water in a saucepan with a pinch of salt, let it come to 
 the boil, then stir in the oatmeal ; boil slowly for twenty 
 minutes, strain and serve. 
 
 Arrowroot gruel. Take a tablespoonful of arrowroot 
 mixed to the consistency of thick cream ; boil a cupful of 
 milk and stir in the arrowroot, let it boil for five minutes, 
 sweeten to taste. Just after taking it off the fire pour 
 in half a cupful of cream. 
 
 Gruel of rice. The same proportions are used as in 
 making oatmeal gruel, water or milk may be used in mix- 
 ing ; and this kind of gruel is of especial service in cases 
 of dysentery. 
 
 Coffee. To make a good cup of coffee for an invalid 
 put about eight teaspoonfuls of coffee (Java and Mocha 
 mixed is the best) into a granite coffee-pot, and pour on it 
 a large cupful of boiling water ; then place it on the stove 
 until it comes to the point of boiling, pour in a second cup 
 of boiling water, allow it to come to almost boiling point 
 again, then stand it aside to settle, and serve immediately 
 with cream. 
 
 Tea for invalids. The water must be freshly boiled, 
 and on the boil, when the tea is made. An earthenware 
 tea-pot is the best to use; first scald it with the boiling 
 water before putting in the tea (a very important point 
 to observe). The amount of tea varies according to the 
 quality; as a rule, one teaspoonful for each cup, and if 
 more than three cups are made an extra spoonful is al- 
 lowed. After pouring on the water the tea should only 
 stand for three minutes. Serve on a tray covered with a 
 snowy napkin, with a dainty cup and saucer, tiny cream 
 pitcher, sugar bowl, and small pitcher of hot water. Put 
 some of the boiling water in the cup to heat it, and allow 
 the patient to pour it out herself. 
 
 Poached eggs. When poaching eggs for invalids use 
 
180 A TEXTBOOK OF HOME NURSING 
 
 milk instead of water to poach them in, as it prevents their 
 becoming watery and gives them a delicate flavor. An- 
 other idea in poaching eggs is to remove the pan from the 
 fire the moment you have broken the eggs into the water, 
 and thus allow them to cook slowly j they will be much 
 more delicate. 
 
 Boiled eggs. The nicest way to boil an egg, when you 
 have plenty of time, is to place it in a bowl, cover with 
 boiling water, and let it stand for exactly five minutes; 
 then pour off the water, and add fresh boiling water; let 
 it stand for five minutes longer, and you will find the egg 
 cooked to perfection. 
 
 Scrambled eggs. Scrambled eggs should be prepared 
 at the last moment before serving. When allowed to 
 stand, even for a few moments, they become hard and in- 
 digestible. If you beat up an egg to a froth, with the ad- 
 dition of a little milk and then scramble it on a very hot 
 pan, it will be very delicate. 
 
 Omelette. An omelette can be made in a few moments 
 from the following recipe: break your eggs, whites and 
 yolks together, into a clean saucer, add a little salt and 
 pepper, and stir about fifteen or twenty times, always in 
 one direction. Have your pan hot and well greased, pour 
 the eggs in and let them " set " before you touch them ; 
 then slip your knife under the corners and under the 
 middle occasionally to prevent its sticking to the pan. 
 While the middle is still soft, double one-half over the 
 other, and roll it out on a very hot plate, cover with an- 
 other plate, and serve immediately. 
 
 A chafing-dish or alcohol lamp is invaluable in cooking 
 these little dainties, especially when traveling or living 
 at a hotel, as you never can insure their being cooked 
 properly in a large, busy kitchen, and after being carried 
 up three or four fiights of stairs they will arrive cold 
 and unpalatable. 
 
 Savory eggs. Beat up two eggs with salt, pepper, and 
 
RECIPES FOR INVALID COOKING 181 
 
 a tablespoonful of cream. Melt an ounce of butter in a 
 saucepan, then pour in the eggs, stirring constantly; as 
 they thicken throw in some small pieces of tender, cold 
 roast chicken. When all is well mixed and piping hot 
 serve on buttered toast. 
 
 Eggs poached with cream. Take two eggs lightly 
 poached, place on crisp toast on a hot plate and pour over 
 them half a cupful of hot cream. This makes a very 
 dainty and nourishing little dish. 
 
 Egg brandy. Take the white of one egg, beaten up to 
 a froth, and add to it two dessertspoonfuls of rich cream 
 and a tablespoonful of brandy; stir briskly together. 
 Sweeten to taste and serve ice cold. 
 
 Eggs poached in broth. Take two eggs poached care- 
 fully in well-seasoned broth instead of water. Be care- 
 ful that the eggs do not break. Put them on hot, buttered 
 .toast, and strain enough of the broth over them to moisten 
 the toast. 
 
 Egg cream. Beat up the yolks of two eggs until quite 
 frothy, add a dessertspoonful of sugar, juice of half an 
 orange, and a little of the rind grated. Place it in a bowl, 
 and stand the bowl in a saucepan of boiling water, allow- 
 ing it to cook slowly, stirring constantly. At the same 
 time have ready the whites of the eggs beaten to a stiff 
 froth, with a little sugar and a pinch of salt. When the 
 yolks of the eggs commence to thicken, throw in the whites, 
 mix all well together, pour out into small glasses, and serve 
 cold. 
 
 Egg caudle. Take a cupful of nicely cooked oatmeal 
 gruel, tablespoonful of sherry, egg well-beaten up, lemon 
 flavoring, sugar to taste. Stir well together, serve either 
 hot or cold. 
 
 Egg lemonade. Take the juice of a lemon and a little 
 of the grated peel; put into a glass, with sugar to taste. 
 Pour over it half a cup of boiling water ; allow it to stand 
 until cool. Strain into another glass, beat up an egg with 
 
182 A TEXTBOOK OF HOME NURSING 
 
 a tablespoonful of sherry to stiff froth, and mix it well 
 with the lemon and water. 
 
 Gruel egg. Beat up the whites of three eggs to a stiff 
 froth and stir them into a cupful of fresh barley gruel, 
 allow it to stand on the fire a few minutes without boiling, 
 then add any flavoring desired. 3?urn it into a mold, 
 serve cold with cream. 
 
 Wine whey. Wine whey makes a delicate little supper 
 dish, with half a cup of milk and three ounces of sherry. 
 Scald the milk, add the wine, take right off the fire, put on 
 the ice to get cold, and sweeten to taste. 
 
 Beef tea jelly. A third of a box of gelatin is steeped 
 in water for about an hour. Pour over it two cups of 
 boiling hot beef-tea, season to taste, cool in small cups. 
 Serve with toasted crackers. 
 
 Chicken jelly. Take a young chicken nicely prepared, 
 cut up into small pieces, put in a saucepan with three 
 pints of water, cook rather slowly, removing the grease 
 from the top continually. Allow it to cook for about five 
 and a half hours, season to taste with salt, pepper, celery, 
 and parsley; when finished stand aside to cool, for some 
 hours, then skim the grease off the top and serve either 
 hot or cold. 
 
 Arrowroot jelly. Take a dessertspoonful of arrow- 
 root, a little nutmeg, sugar, and half a pint of water. Mix 
 the arrowroot with a little cold water, add the remainder 
 of the water boiling hot, stir briskly until it comes to the 
 boil, strain into a bowl and place on the ice to cool. 
 
 Jelly made with prepared milk. Soak half a box of 
 gelatin for an hour in cold water, add to it two ounces of 
 boiling water, the juice of an orange and lemon, and a 
 little lemon peel, also two ounces of rum. When all is 
 well mixed together pour in a cupful of peptonized milk 
 very hot, sweeten to taste and strain into a mold. 
 
 Jelly of fresh fruit. Take a large cupful of clear, sweet 
 jelly, some ripe fruit (any variety you prefer) ; wash the 
 
RECIPES FOR INVALID COOKING 183 
 
 fruit and pick it over carefully, removing the skin, and 
 cut it up into small pieces. 
 
 Put a little jelly at the bottom of a bowl; when it is 
 cool arrange the fruit around the sides of the mold, then 
 pour in some more jelly; allow it to stand a little, and 
 add some more fruit. Fill up the mold with jelly and 
 fruit in layers, then set it on the ice until cold. 
 
 Sago jelly. Have a cupful of the fruit of raspberries, 
 or strawberries, or any other fresh fruit, three-quarters 
 of a cup of sago that has been washed and steeped in wa- 
 ter, and a cupful of sugar ; boil all well together until the 
 sago is soft, pour into a mold, and set on the ice to cool. 
 
 Lemon jelly. Take a cupful of sugar, the juice and 
 rind of two lemons, one pint of water, and one ounce of 
 isinglass. Boil for fifteen minutes, strain through a jelly 
 bag into a mold, and place it on the ice to cool. 
 
 Gelatin-blanc-mange. Add three tablespoonfuls of 
 gelatin to a quart of new milk, boil until all is dissolved ; 
 then pour in a cupful of cream, sugar to taste and any 
 flavoring desired, stir for five minutes on the stove, then 
 throw in the sugar and nutmeg and a little lemon if de- 
 sired, pour into a mold and set on the ice to cool. 
 
 Lemon sherbet. Take the juice of five lemons, three- 
 quarters of a cup of sugar, and a pint of water all well 
 mixed together ; strain and freeze solid on the ice. 
 
 Arrowroot blanc-mange. Mix two ounces of arrow- 
 root into a smooth paste with a little milk, sweeten to 
 taste, then boil in a covered saucepan until fairly thick, 
 stirring constantly to prevent burning, season with vanilla, 
 or lemon peel, turn into a mold, and serve ice cold with a 
 little jelly. 
 
 Rennet custard. Take one quart of milk, two table- 
 spoonfuls of sugar and flavoring to taste; into this stir 
 a teaspoonful of rennet, cover and stand in a warm room. 
 If it does not commence to thicken in an hour, add a little 
 more rennet. Serve with whipped cream. 
 
18* A TEXTBOOK OF HOME NURSING 
 
 Apple charlotte. Butter a deep pie dish, then shake 
 over the butter some granulated sugar, cover the bottom 
 of the dish with thin slices of bread and butter, on this 
 put a layer of sliced apples, a little sugar, and a few 
 cloves ; add the layers of bread and apples until the dish 
 is full, the top layer being apples ; put some small pieces 
 of butter on top and moisten the whole with a little water,' 
 bake in a tightly covered dish in a slow oven until quite 
 soft, then remove the cover and brown on the top. 
 
 Custard, boiled. Put one pint of milk into a white 
 porcelain saucepan with two ounces of sugar and the rind 
 of half a lemon; allow the milk to stand on the back of 
 the stove until well flavored with the lemon, then put it 
 on front of the stove ; allow it to come almost to a boil and 
 strain into a bowl. When it has become cool stir in three 
 well-beaten eggs, then put the bowl in a saucepan on the 
 fire and stir constantly one way until it thickens, but on no 
 account allow it to boil or it will curdle. Pour into cus- 
 tard glasses and grate nutmeg on the top. 
 
 Cream custard. Take half a pint of milk and a quar- 
 ter of a pint of rich cream, half an ounce of flour, sugar 
 to taste, and any flavoring desired. Mix the flour and 
 cream, add the milk boiling hot, then put in the flavoring 
 and sugar. Pour into a dish and bake a light brown on 
 top. 
 
 Tapioca custard. Two pints of milk are allowed to 
 reach the boiling point, then add the yolks of three eggs 
 well beaten, and one ounce of tapioca that has been steep- 
 ing for twelve hours in milk, sweeten to taste. Mix all 
 well together, when it commences to thicken turn it out in 
 a dish and spread on the top the whites of the eggs beaten 
 to a stiff froth with a little sugar, then place the dish in 
 the oven for flve minutes to brown. Serve either hot or 
 cold. 
 
 Raspberry cream. Take half an ounce of gelatin, put 
 it into a bowl; add enough milk to cover it, and allow it 
 
RECIPES FOR INVALID COOKING 185 
 
 to stand for half an hour. Then pour over it a cupful 
 of boiled milk sweetened to taste, add to this a pint of 
 fresh raspberries which have been cooked with a little 
 sugar, and strain through a fine cloth. Stir in a cup of 
 cream, beat all together until thick, then pour it into a 
 mold and place on the ice. 
 
 Banana cream. Take the skin off six bananas and cut 
 them up into a saucepan with half an ounce of gelatin that 
 has been dissolved in half a cup of water, add the juice 
 and peel of a lemon, and sugar to taste. Cook gently for 
 ten minutes, and then pour into it a cupful of cream, beat 
 all well together, and set in a mold to cool. 
 
 Sandwiches of fruit. Chop up some fruit into small 
 pieces, any kind preferred, dates, raisins, candied cherries, 
 oranges, lemons, bananas, etc. ; moisten with a little orange 
 juice, spread on very thin bread and butter, and cut into 
 small squares. 
 
 Broiled oysters on toast. Six large oysters are 
 broiled lightly over a very hot fire ; have ready two slices 
 of rather thin, crisp toast nicely buttered, put three oysters 
 on each slice, sprinkle with salt, pepper, and lemon juice, 
 and serve immediately with horseradish. 
 
 Creamed oysters on toast. Put six oysters, opened 
 freshly, into a saucepan with their juice, an ounce of milk, 
 salt, pepper, and mace to taste: after boiling five min- 
 utes add to it a little thickening, made with flour and 
 butter rubbed together; stir all until well mixed, then 
 pour out on a slice of crisp toast, and serve immediately. 
 
 Scalloped oysters. Butter a small pie dish, and put 
 in a layer of bread crumbs and then a layer of oysters up 
 to the top of the dish, the top layer being bread crumbs. 
 Add salt and pepper to taste, and on the top small pieces 
 of butter. Moisten with the juice of the oysters, and bake 
 in a quick oven for ten or fifteen minutes. 
 
 Tomato cream. Take one quart of cold milk that has 
 been boiled, four eggs well beaten, one cupful of tomatoes 
 
186 A TEXTBOOK OF HOME NURSING 
 
 that have been stewed and passed through a large strainer, 
 sugar to taste. Cook in a quick oven, in small custard 
 cups. 
 
 Meat, minced. Heat four tablespoonfuls of minced 
 meat with a little hot water, salt and pepper, and other 
 seasoning if desired. Add to it one ounce of fine bread 
 crumbs, mix well together, and bake in a buttered dish for 
 eight minutes or until brown on the top. 
 
 Sweetbreads, baked. Prepare the sweetbreads care- 
 fully, then dip them in a mixture of cracker crumbs and 
 egg ; cook slowly for nearly an hour on a pan with plenty 
 of melted butter poured over them; the oven should be 
 pretty hot, and they should be turned frequently. 
 
 Croutons. Croutons make a nice addition to soups or 
 broths for an invalid. To make them, take some slices 
 of bread, rather stale, cut them up into small diamond- 
 shaped or square pieces, put them on a tin plate in the 
 oven until quite dry and crispy, then spread them on a 
 broiler over the fire and toast quite brown; should be 
 served in the soup as soon as toasted and not allowed to 
 stand. 
 
 Oatmeal pudding. Two large apples are sliced into a 
 bowl, then add half an ounce of flour and half a pint of 
 oatmeal, which has been steeped for three hours, a pint 
 of water, sugar and salt to taste. Bake in a quick oven, 
 and serve hot with cream. 
 
 Rice cake. Beat up three eggs to a stiff froth, put 
 them in a double boiler, and stir briskly on the stove for 
 eight minutes, then add slowly three ounces of fine sugar 
 and a quarter of a cup of ground rice, also flavoring to 
 taste. When all is well mixed, pour into a buttered pan 
 and bake in a hot oven for twenty minutes. 
 
 Beef juice on toast. Take three or four ounces of 
 freshly squeezed beef-juice, add pepper and salt to taste, 
 warm it by putting the cup in a bowl of very hot water, 
 then make two slices of buttered toast, about half an inch 
 
RECIPES FOR INVALID COOKING 187 
 
 thick, put the toast on a hot plate, and pour the hot beef- 
 juice over it, serve at once. 
 
 Rice cookies. Take half a cupful of rice nicely boiled, 
 one egg, a teaspoonful of butter, and half a cup of milk, 
 add to this three tablespoonfuls of rice flour and a pinch 
 of salt, mix all well together and bake in small tins. 
 
 Chicken creamed. A tender young chicken is cut up 
 in rather small pieces and placed in a saucepan, add to 
 it two pints of hot water, two tablespoonfuls of butter, 
 part of an onion, pepper and salt, and if desired a little 
 lemon juice. Boil all together until the chicken is quite 
 tender, cooking very slowly. While the chicken is in 
 preparation the sauce may be made. Take four teaspoon- 
 f uls of flour and the same amount of butter, put in a small 
 saucepan on the fire, rubbing them well together until the 
 butter is dissolved, then add to it the yolk of an egg well 
 beaten up and a tablespoonful of cream. When all is well 
 mixed together strain, and laying the chicken on a hot 
 plate, pour the cream over it, surrounding the chicken 
 with some nicely boiled rice or mashed potatoes. 
 
 Scraped beef. Scraped beef either made into a sand- 
 wich or served on toast is very nourishing and easily di- 
 gested. Scrape the beef finely, and brown for a second 
 on a tin plate over the fire, season nicely, and spread it 
 between slices of thin bread and butter, toasted crackers, 
 or on toast. Another method is to put the scraped beef 
 between two thin slices of stale bread, and toast it between 
 a fine wire broiler. The heat makes the bread nice and 
 crisp, and sends the juice of the meat into it ; don't cook it 
 too much ; a little butter may be added if desired. It can 
 also be made into the form of a ball, by the addition of 
 the white of an egg well beaten to hold it together. 
 Scraped beef is often ordered raw, and when scraped very 
 finely, with plenty of pepper and salt, and placed between 
 thin bread and butter, it is easy to take, and is very nour- 
 ishing. 
 
INDEX 
 
 Ammonia, as counterirritant, 
 
 116, 125 
 Amusements, 23 
 Antidotes for poisons, 145 
 Antiphlogistin, 117, 125 
 Apoplexy, 152 
 Appetite, coaxing, 159 
 Apple charlotte, 194 
 Arrowroot blancmange, 183 
 
 jelly, 182 
 Artificial respiration, 152 
 Asphyxiation, 152 
 Atmospheric temperature, 63, 82 
 
 Babies, baths for, 46, 56 
 Back, care of, 17 
 Banana cream, 185 
 Barley water, 178 
 Baths, 43, 55 
 
 bicarbonate of soda, 54, 58 
 
 bran, 54, 58 
 
 cold, 47, 48, 51, 56, 57 
 
 foot, 53, 58 
 
 for babies, 46, 56 
 
 for hair, 46, 55 
 
 for medicinal purposes, 47, 66 
 
 hot, 53, 58 
 
 in bed, 44, 50, 57 
 
 mustard, 54, 58 
 
 salt, 52, 57 
 
 slush, 50, 57 
 
 sponge, 51, 52, 57 
 
 tub, 48, 50, 52, 56, 67 
 Bed, 2, 3, 12, 62 
 
 making, 3, 13 
 
 outdoor, 6 
 
 position in room, 5, 13 
 
 surgical, 133, 139 
 Bed-clothes, 3, 12 
 
 disinfection of, 62, 81 
 
 support for, 3, 8, 14 
 Bed-jacket, 18, 27 
 Bed-pans, 17, 27 
 
 189 
 
 Bed-rest, 8, 14 
 Bed-socks, 19, 27 
 Bed-sores, 16, 26 
 
 prevention of, 16 
 Beef -juice, 175 
 
 on toast, 186 
 Beef-tea, 174 
 
 jelly, 182 
 Bill of fare for one day, 161 
 Biscuit soup, 175 
 Blancmange, gelatin, 183 
 Blanket, 3 
 Blows upon head, in children, 
 
 107, 110 
 Boiled eggs, ISO 
 Bronchitis, 93, 93 
 
 diet in, 167 
 Broths, 174 
 Bruises, 147 
 Burns, 142 
 
 Calf's-foot broth, 174 
 
 Calorie, 154 
 
 Carrageen, 178 
 
 Catarrh, gastric, in children, 110 
 
 Changing position of patient, 15, 
 26 
 
 Chicken broth, 174 
 creamed, 187 
 jelly, 182 
 pur^e, 175 
 
 Children, blows upon head, 107, 
 110 
 colic in, 103, 109 
 constipation in, 102, 109 
 convulsions in, 104, 109 
 croup in, 103, 109 
 cry, significance of, 100 
 diarrhea in, 105, 109 
 diet of, 162 
 enemata for, 123, 128 
 falls upon head, 107, 110 
 
190 
 
 INDEX 
 
 Children, first aid remedies for, 
 102, 108 
 
 gastric catarrh in, 106, 110 
 
 illness in indicated by posi- 
 tion, 101, 108 
 
 observation of symptoms in, 
 100, 108 
 
 proper care of, 102, 108 
 Coffee, 179 
 Cold applications, 117, 125 
 
 compresses, 117 
 Colds, care of, 90, 97 
 
 prevention of, 89, 97 
 Colic, wind, in children, 103, 109 
 Comforts for patient, 15, 26 
 Compresses, cold, 117 
 
 hot, for eye, 115, 124 
 Constipation, 102, 109 
 
 diet in, 172 
 Contagious diseases, 60 
 Convalescence, 22, 29 
 
 diet in, 163, 165 
 Convulsions, in children, 104, 109 
 Counterirritants, 111, 123 
 Coughs, care of, 90, 97 
 
 prevention of, 89, 97 
 Croup, in children, 103, 109 
 
 kettle, 39 
 
 tents, 39 
 Croutons, 186 
 
 Cry, child's, significance of, 100 
 Custard, boiled, 184 
 
 cream, 184 
 
 rennet, 183 
 
 tapioca, 184 
 Cuts, 147 
 
 Daily routine, nurses', 25 
 Diabetes, diet in, 171 
 Diarrhea, 105, 109 
 
 diet in, 172 
 Diet, 60, 83 
 
 of children, 162 
 Dietetics, 154 
 Diphtheria, 73, 85 
 Disease, diet in, 163 
 Disinfection of bed-clothes, 62, 81 
 Douches, lis, 126 
 
 ear, 118 
 
 nose, 118, 126 
 
 Douches, throat, 119, 126 
 
 vaginal, 119, 126 
 Drinks, between meals, 165 
 
 care of, 19 
 Drugs, 61 
 
 Dry heat, 115, 124 
 Dysentery, 79, 88 
 
 diet in, 172 
 Dyspepsia, diet in, 171 
 
 Earache, 149 
 
 Ear, foreign bodies in, 149 
 
 Egg brandy, 181 
 
 caudle, 181 
 
 cream, 181 
 
 lemonade, 181 
 
 nog, 177 
 Eggs, 179 
 
 poached in broth, 181 
 
 poached with cream, 181 
 Electric pads, 116 
 Emergencies, first aid in, 142 
 Enemata, 120, 127 
 
 for children, 123, 128 
 
 high, 121 
 
 nutritive, 122, 128 
 
 oil, 122 
 
 purgative, 120, 127 
 
 starch, 122, 127 
 
 stimulant, 122, 127 
 Epilepsy, 151, 152 
 Eruption, in infectious diseases, 
 
 64 
 Erysipelas, 78, 87 
 Eye, drops, 38, 42 
 
 foreign bodies in, 148 
 
 hot compresses for, 115, 124 
 
 inflammation of, 149 
 
 Fainting, 144 
 
 Falls upon head, in children, 107, 
 
 110 
 Feeding helpless patients, 160 
 
 hints about, 162 
 Fevers, 60, 81 
 
 cold baths in, 47 
 
 diet in, 66, 83, 163 
 Fireplaces, 9, 14 
 
 First aid remedies, for children, 
 102, 108 
 
INDEX 
 
 191 
 
 Flowers, 20, 2S 
 Fly curtain, 20, 28 
 Food, care of, 63, 82, 19 
 
 functions of, 155 
 
 importance of, in sickness, 154 
 
 preparing, 155 
 
 suggestions about, 155 
 
 tray for, 156 
 Foot baths, 53, 58 
 Foreign bodies, in ear, 149 
 
 in eye, 148 
 
 in nose, 150 
 
 in throat, 151 
 Fractures, 153 
 Fresh air, 61 
 Frost bite, 144 
 Fruit, preparation of, 157 
 Fumigation after infectious dis- 
 eases, 69, 84 
 Fumigation of room, 70, 84 
 
 Gastric catarrh, 106, 110 
 Gelatin blancmange, 183 
 Grape juice, 178 
 Grip, 92, 98 
 
 diet in, 167 
 Gruel, arrowroot, 179 
 
 barley, 178 
 
 egg, 182 _ 
 
 milk peptonized, 178 
 
 oatmeal, 179 
 
 rice, 179 
 
 Hair, bath for, 46, 55 
 
 care of, 18, 27 
 Head, blows upon, 107, 110 
 
 falls upon, 107, 110 
 Heat, dry, 115, 124 
 
 prostration, 153 
 
 units, 154 
 Helpless patients, changing posi- 
 tion of, 8, 14 
 
 feeding, 160 
 Hemorrhage, after operations, 
 136, 140 
 
 from arms, 148 
 
 from legs, 148 
 
 from lungs, 148 
 
 from nose, 148 
 
 Hiccoughs, 151 
 
 Hot bags of salt, 115 
 
 compresses, for eye, 115, 124 
 
 flannel, 115 
 
 stupes, 114, 124 
 
 water bags, 115 
 
 water cans, 116 
 Hydrophobia, 151 
 Hysteria, 144 
 
 Ice-caps, 117 
 Ice-coils, 117 
 Indigestion, diet in, 171 
 Infectious diseases, 59, 60, SO 
 
 prevention of, 59 
 
 symptoms and stages of, 70 
 Influenza, 92, 98 
 Inhalation, medicines given by, 
 
 38, 42 
 Insomnia, diet in, 169 
 Insects, sting of, 146 
 Invalid cooking, recipes for, 174 
 Iodine, 116, 125 
 Irish moss, 178 
 Ivy, poison, 146 
 
 Jelly, made with prepared milk, 
 182 
 of fresh fruit, 182 
 
 Kumyss, 177 
 
 Lemon jelly, 183 
 
 sherbet, 183 
 Light, 9, 14 
 Linseed poultices. 111 
 
 Malaria, 79, 87 
 
 Mattress, 2 
 
 Meal, serving a, 158 
 
 time for, 159 
 Measles, 77, 87 
 Meat, minced, 186 
 
 soup, 176 
 Medicines, cautions about, 34 
 
 disguising the taste, 37 
 
 given by inhalation, 38, 42 
 
 given in suppositories, 38, 42 
 
 how to measure, 36 
 
 rules in giving, 35, 41 
 
192 
 
 INDEX 
 
 Hedicines, -when to give, 35 
 Meningitis, 78, 87 
 Milk preparations, 176 
 
 punch, 177 
 
 sterilized, 177 
 Mouth, care of, 17, 27 
 Moving patient, 15, 26, 135, 140 
 Mumps, 80, 88 
 Mustard baths, 54, 58 
 
 leaves, 113, 123 
 
 paste, 113, 123 
 Mutton broth, 174 
 
 Nervous hysteria, 144 
 Nightgowns, 7, 14 
 Nose, foreign bodies in, 150 
 Nourishment, at night, 161 
 Nurse, daily routine, 25 
 
 dress, in infectious diseases, 67, 
 83 
 
 precautions, in infectious dis- 
 eases, 68, 83 
 Nursing surgical patients, 129 
 
 Oatmeal beef- tea, 176 
 
 pudding, 186 
 Observation of symptoms, 100, 
 
 108 
 Oil of wintergreen, 116, 125 
 Omelette, 180 
 Open fireplace, 63, 82 
 Operation, after care of patient, 
 134, 139 
 hemorrhage after, 136, 140 
 necessary appliances for, 129 
 nursing after, 136, 140 
 preparation for, 129, 137 
 of bed, 133, 139 
 of patient, 133, 139 
 of room, 130, 137 
 of skin, 134, 139 
 Orange and vichy, 177 
 Order in the sick room, 20, 28 
 Outdoor porch, 1 
 
 sleeping bed, 6, 13 
 Oysters, broiled on toast, 185 
 creamed on toast, 185 
 scalloped, 185 
 stew, 175 
 
 Panada, 176 
 
 Patient, care of, in infectious dis- 
 eases, 64, 82 
 
 fumigation of, 69, 84 
 Physician, dress of, in infectious 
 
 diseases, 69, 84 
 Pillows, 4, 5, 13 
 Plasters, 114, 124 
 Pleurisy, 94, 99 
 Pneumonia, 95, 99 
 
 diet in, 168 
 Poached eggs, 179 
 Poisoning, 145 
 
 antidotes, 145 
 
 immediate treatment, 145 
 Poliomyelitis, 78, 87 
 Porch, outdoor, 1 
 Poultices, 111, 123 
 
 application of, 112 
 Preparation of food, 155 
 Prescriptions, rules about, 37 
 Pressure sores, 16, 26 
 Pulse, 32, 33, 40 
 
 Raspberry cream, 184 
 Recipes for invalid cooking, 174 
 Refrigerators, 19, 28 
 Respiration, 33, 41 
 
 artificial, 152 
 
 Schaefer's method, 153 
 Rest, 60 
 
 Rheumatism, diet in, 169 
 Rice cakeg, 186 
 
 cookies, 187 
 Room, care of, 62, 82 
 
 choice of, 1, 12, 61, 81 
 
 order in, 20, 28 
 
 position of bed in, 5 
 
 preparation of, 2, 12, 61, 81 
 for operation, 130, 138 
 
 temperature of, 9, 14, 63, 82 
 
 ventilation of, 10, 14 
 Rubs, salt, 53, 57 
 
 Sago jelly, 183 
 
 soup, 176 
 Salt rubs, 53, 57 
 Sandwiches of fruit, 185 
 Savory eggs, 180 
 Scalds, 142 
 
INDEX 
 
 193 
 
 Scarlet fever, 71, 85 
 
 Schaefer's method of artificial 
 
 respiration, 153 
 Scrambled eggs, 180 
 Scraped beef, 187 
 Screens, 6, 19, 28 
 Serving meals, 158 
 Sheets, 5 
 
 changing, with patient in bed, 
 6, 13 
 Shock, 143 
 Sitting up, 22 
 
 Sleeping bed, outdoors, 6, 13 
 Smallpox, 72, 85 
 Sprains, 146 
 Spread, 3 
 Sterilized towels, 132, 138 
 
 water, 132, 138 
 Stings of insects, 146 
 Stupes, turpentine, 115, 124 
 St. Vitus' dance, 107, 110 
 Sunstroke, 153 
 Suppositories, 38, 42 
 Surgical bed, 133, 139 
 
 cases, diet in, 169 
 
 operation, see Operation 
 Sweetbreads, baked, 186 
 
 Tact, 24 
 
 Tea for invalids, 179 
 
 Teeth, care of, 17, 27 
 
 Temperature, atmospheric, 63, 82 
 
 of patient, 30, 39 
 rectal, 32, 40 
 taking of, 31 
 Thermometer, use of, 31, 40 
 Thick milk, 176 
 Throat, foreign bodies in, 151 
 Tomato cream, 185 
 Tonsilitis, 91, 97 
 
 diet in, 168 ' 
 Toothache, 150 
 Trays for food, 156 
 Tuberculosis, 76, 86 
 
 diet in, 166 
 Turpentine and vaseline, 116, 
 
 125 
 Typhoid fever, 73, 86 
 
 cold tub bath in, 48 
 
 diet in, 166 
 
 Utensils, disinfection of, 63, 82 
 
 Ventilation, 10, 14 
 Visitors, 21, 29 
 Vomiting, 151 
 
 Water, 61 
 
 Whooping cough, 80, 88 
 Wind colic, 103, 109 
 Wine whey, 182 
 Wintergreen, oil of, 116, 125 
 
 Frinted in the United States of America. 
 
Dietetics for Nurses 
 
 By Fairfax T. Proudftt, 
 
 Formerly Instructor of Nurses in the Lucy Brinkly 
 Hospital, Memphis, Tenn. 
 
 Outside of Materia Medica and Anatomy and Physi- 
 ology, probably few subjects in the training of pupil nurses 
 are of such importance as are Dietetics and Nutrition, 
 which have, however, suffered greatly for an adequate text 
 up to this time. The former mistaken view, that Dietetics 
 begins and ends in the diet kitchen, is probably responsible 
 for this lack, but in this text the author has placed the 
 food preparation in the probationer's curriculum, where she 
 gives a comprehensive study of the food materials with 
 which the nurse comes constantly in contact. The entire 
 subject matter of this book is presented in the simplest 
 language possible and in a form which is both interesting 
 and scientifically correct. 
 
 The book is divided into three sections: First, Prelim- 
 inary or Probationer's Dietetics, covering the first months 
 of training before entering into the work of the hospital 
 proper ; Second, Junior Dietetics, in which the chemistry of 
 foods and nutrition are given ; and. Third, Senior Dietetics, 
 which includes the study of all diseases affected by diet, or 
 those which are the result of errors in diet at some period 
 of life. While the last named is the most interesting, the 
 nurse must have a first hand knowledge of food materials 
 and their relation to the normal body before undertaking it. 
 
 It is hoped that this book will enable the training schools 
 to give the subjects of Diet and Nutrition the attention they 
 deserve, making them a part of the regular curriculum with 
 a direct appeal to the interest of the pupil nurse. 
 
 THE MACMILLAN COMPANY 
 
 Publishers 64-66 Fiftb Avenue New York 
 
Textbook of Anatomy and Physiology for 
 Nurses 
 
 By DIANA C. KIMBER 
 
 Formerly Assistant Superintendent New York City Training School 
 for Nurses, Blackwell's Island, New York. New Fifth Edition 
 completely revised by Caeolyn E. Geay, R.N., Superintendent 
 of the Training School for Nurses, City Hospital, New York. 
 
 Illustrated, Cloth, 8vo, $2.60 
 
 After twenty-five years of use by many thousands of pupil nurses, 
 who have come to look upon it as the foundation of their training 
 school work, this book celebrates its Quarter Centenary notably in 
 two ways : first, through its adoption by the Army Training School 
 for Nurses, and hence its endorsement by the Surgeon General of the 
 Army as the ablest help in stress of war as in peace ; and, secondly, 
 by the publication of the New Fifth Edition which has been entirely 
 revised and reset. 
 
 While the plan of the book has been kept generally as before, the 
 text has been simplified even more. There has been no increase in 
 the Anatomy but much more Physiology has been added, while, among 
 many other important new features, the following are particularly 
 notable : 
 
 A small section on Nerve Tissue has been introduced, which gives 
 the main facts in regard to nerve tissues and serves as a helpful in- 
 troduction to the Nervous System early in the book; the chapter 
 on Muscles has been simplified and improved in accordance with the 
 teachings of Dr. Robert M. Lovett, who has employed so many nurses 
 in connection with his work on the aftercare of PoliomyeUtis cases ; 
 the Blood Vascular System and the Lsonph Vascular System have 
 been very much improved ; the chapter on the General Circulation 
 has been almost entirely rewritten; the chapters on Digestion and 
 Metabolism have been greatly improved, and contain only as much 
 Physiological Chemistry as it is possible to introduce into a book to 
 be used by many students who have not had real preliminary train- 
 ing in Chemistry; the nimiber of illustrations has been increased, 
 while many of the present illustrations have been entirely redrawn, 
 labelled and made much clearer. The book, therefore, remains with- 
 out a peer and still stands as the .foundation of nursing education. 
 
 THE MACMILLAN COMPANY 
 
 Fublishera 64-66 Fifth Avenue New York 
 
RECENT IMPORTANT BOOKS FOR NURSES 
 
 Materia Medica for Nurses 
 
 Second Revised Edition 
 
 ;by a. s. blumgarten, m.d. 
 
 ASSISTING VISITING PHYSICIAN TO THE LENOX HILL HOSPITAL; LECTnEEE 
 TO THE TRAINING SCHOOLS OF THE LENOX HILL HOSPITAL AND THE SKIN 
 AND CANCER HOSPITAL, NEW YORK; FIRST LIEUTENANT MEDICAL OFFICERS* 
 RESERVE CORPS, U.S. ARMY 
 
 Illustrated, Cloth, 8vo. Cross Index. $2.60 
 
 The announcement of a new edition of this very suc- 
 cessful book is of particular interest to training schools 
 desiring a thoroughly adequate text in this subject. The 
 work has been thoroughly revised and entirely reset, with 
 the addition of a chapter on the Administration of 
 Medicines, the application of the Harrison Law to nurs- 
 ing, and other important new features. 
 
 Blumgarten's text is in plain, simple English, intensely 
 interesting in style, and is written along strictly teaching 
 lines. It therefore contains clear, concise instructions 
 throughout. Stress has been laid upon teaching facts, 
 not words, with the result that, while thoroughly scien- 
 tific, the book is free from the technical terminology in 
 which seems to lie the fault of so many text-books for 
 nurses. 
 
 It will assist and train the nurse in the observation of 
 the effects of drugs as produced upon actual patients in 
 the wards. The physiological action is particularly 
 arranged to facilitate the retention of the facts presented. 
 A special feature will be found in an original and very 
 elaborate chapter on Solutions. It enables the nurse to 
 handle any problem in the calculation and administration 
 of a required dose of a drug, or to make up any required 
 solution. There is also a chapter on Prescription Read- 
 ing, and there are numerous tables such as Saturation 
 Points, Comparative Action of Various Drugs, etc., scat- 
 tered throughout the text. It also contains all the new 
 and non-official remedies in common use. 
 
 THE MACMILLAN COMPANY 
 
 PubliBhers 64-66 Fifth Avenue Hew Tork 
 
RECENT IMPORTANT BOOKS FOR NURSES 
 
 Bacteriology for Nurses 
 
 Second Edition, Revised. Including Schedule for Laboratory 
 Exercises, etc. 
 
 By ISABEL McISAAC 
 
 Late Superintendent United States Army Nurse Corps; Formerly 
 , Superintendent Illinois Training School for Nurses; 
 Author of "Hygiene for Nurses," etc. 
 
 Cloth, illuslrated, $1.25 
 
 This is^a completely revised edition of the well-known text-book 
 which has, for years, been the only book written distinctly for the use 
 of nurses, and much new material has been added. The author has 
 carefully confined herself to the needs of the class for whom it is in- 
 tended and she has been singularly successful in avoiding mmeces- 
 sary digression, making clear the practical as well as the theoretical. 
 
 The scheme of the original work has been maintained. There are 
 chapters on Structure, Mode of Development, and Composition of 
 Bacteria; The Effect of Physical and Chemical Agents upon Bac- 
 teria, and the Effects of Bacterial Growth ; The Relations of Bac- 
 teria to Disease; Immunity; Infiammation, Suppuration, Pneu- 
 monia, Epidemic Cerebro-Spinal Meningitis; Tjrphoid Fever (En- 
 teric Fever) ; Asiatic Cholera, Relapsing Fever ; Infectious Diseases 
 of Unknown Cause, and Bacteria in Air, Soil, Water, and Food. 
 
 Hygiene for Nurses 
 
 Bv ISABEL McISAAC 
 
 Cloth, i2ino, $1.2$ 
 
 The pages of this book are full of just the information that every 
 woman in charge of souls and bodies needs. The chapters on food, 
 ventilation, sewage, causes and dissemination of disease, household, 
 personal and school hygiene, the hygiene of occupation, disinfection, 
 etc., are aU of the most vital interest and value to the nurse. 
 
 THE MACMILLAN COMPANY 
 
 FabliBhers 64-66 Tifth Avenne New Tork 
 
jS-aa^tE^^ggi^^'H"!