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+The Project Gutenberg eBook of American Red Cross Text-Book on Home Hygiene and Care of the Sick, by Jane A. Delano and Anne Hervey Strong and American Red Cross
+
+This eBook is for the use of anyone anywhere in the United States and
+most other parts of the world at no cost and with almost no restrictions
+whatsoever. You may copy it, give it away or re-use it under the terms
+of the Project Gutenberg License included with this eBook or online at
+www.gutenberg.org. If you are not located in the United States, you
+will have to check the laws of the country where you are located before
+using this eBook.
+
+Title: American Red Cross Text-Book on Home Hygiene and Care of the Sick
+
+Author: Jane A. Delano
+        Anne Hervey Strong
+        American Red Cross
+
+Release Date: May 4, 2010 [eBook #32250]
+[Most recently updated: April 20, 2021]
+
+Language: English
+
+Character set encoding: UTF-8
+
+Produced by: Heiko Evermann, Fox in the Stars, S.D., and the Online Distributed Proofreading Team
+
+*** START OF THE PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***
+
+
+
+
+AMERICAN RED CROSS TEXT-BOOK
+
+ON
+
+HOME CARE OF THE SICK
+
+***
+
+DELANO
+
+
+
+
+  AMERICAN RED CROSS
+
+  TEXT-BOOK
+
+  ON
+
+  HOME HYGIENE
+
+  AND
+
+  CARE OF THE SICK
+
+  BY
+
+  JANE A. DELANO, R. N.
+
+  Chairman of the National Committee, Red Cross Nursing Service; Director,
+  Department of Nursing, American Red Cross; Late Superintendent
+  of the Nurse Corps, U. S. A.; of the Training Schools
+  for Nurses, Bellevue Hospital, New York City; and of the
+  Training School for Nurses, Hospital of the University
+  of Pennsylvania, Philadelphia
+
+  REVISED AND REWRITTEN
+
+  BY
+
+  ANNE HERVEY STRONG, R. N.
+
+  Professor of Public Health Nursing, Simmons College, Boston
+
+  _This is the Second Edition of the American Red Cross
+  Text-book in Elementary Hygiene and Home Care of
+  the Sick by Jane A. Delano and Isabel McIsaac._
+
+  PREPARED FOR AND ENDORSED BY
+
+  THE AMERICAN RED CROSS
+
+  PHILADELPHIA
+  P. BLAKISTON'S SON & CO.
+
+  1012 WALNUT STREET
+
+
+COPYRIGHT, 1918, BY AMERICAN RED CROSS
+
+THE MAPLE PRESS YORK PA
+
+
+
+
+PREFACE
+
+
+To the woman who wishes to protect her family from preventable diseases
+and is anxious to fit herself in the absence of a trained nurse to give
+intelligent care to those who are sick, this revision of the Red Cross
+text-book on Elementary Hygiene and Home Care of the Sick is
+particularly directed. It should appeal to men and to women who are
+interested in maintaining the health of their neighborhoods and
+communities and in affording effective coöperation to the public health
+authorities. To teachers wishing to impart protective health information
+to high school pupils, the book also should be useful as a class text as
+well as a guide.
+
+The war, which has caused the withdrawal from private practice of
+thousands of physicians and graduate nurses, makes it peculiarly
+important to the nation for every adult to have sound knowledge as to
+how to prevent contagion and epidemics, especially by precautionary
+attention to home and local sanitation. With nurses becoming more
+difficult to secure, the safety of the family demands that some member
+in each household know enough about elementary nursing to make a patient
+comfortable and to carry out accurately the instructions of the
+physician.
+
+The work of revision, based upon the latest knowledge of hygiene,
+sanitation and methods of home-nursing has been done by Miss Anne Hervey
+Strong, Professor of Public Health Nursing, Simmons College, under the
+personal direction of the author and the National Committee on Red Cross
+Nursing Service. The material has been painstakingly read by Dr. H. W.
+Rucker and Dr. Taliaferro Clarke of the United States Public Health
+Service, and Lieutenant Colonel Clarence H. Connor, Medical Corps,
+United States Army. Indebtedness to Dr. H. M. McCracken, President of
+Vassar College and Director of the Red Cross Junior Membership, for his
+valuable suggestion as to adapting the book for high school use as well
+as for the assistance rendered by his Department, also is gladly
+acknowledged.
+
+J. A. D.
+
+
+ACKNOWLEDGMENT
+
+I wish to express my gratitude to those who have so kindly helped in the
+work of preparing the present edition. Thanks are especially due to
+Professor Isabel Stewart, Miss Anna C. Jamme, Professor Curtis M.
+Hilliard, Professor Maurice Bigelow, Miss Katharine Lord, Miss Josephine
+Goldmark, and Miss Evelyn Walker.
+
+A. H. S.
+
+
+
+
+CONTENTS
+
+
+  PREFACE                                                            v
+
+  INTRODUCTION                                                      xi
+
+  CHAPTER I
+
+                                                                  PAGE
+
+  CAUSES AND PREVENTION OF SICKNESS                                  1
+
+     Communicable diseases, 1. Micro-organisms and bacteria,
+     1. Parasites, 3. Structure and development of parasites,
+     4. Bacteria, 4. Shape, 4. Size, 5. Motion, 5.
+     Multiplication, 5. Spores, 7. Distribution, 8. Protozoa,
+     8. Visible parasites, 8. Transmission of pathogenic
+     organisms, 9. Defenses of the body, 12. Immunity, 13.
+     Vaccination and inoculation, 15. Carriers, 17.
+     Non-communicable diseases, 20. Physical examinations, 22.
+
+  CHAPTER II
+
+  HEALTH AND THE HOME                                               27
+
+     Heredity, 27. Hygiene of environment and person, 28.
+     Ventilation, 29. Lighting, 32. Cleanliness of houses, 33.
+     Garbage, 37. Insects, 38. Sewage, 39. Personal
+     cleanliness, 41. Oral hygiene, 44. Treatment of teeth,
+     46. Clothing, 47. Food, 48. Elimination, 52. Rest and
+     fatigue, 53. Sleep, 55. Recreation, 55.
+
+  CHAPTER III
+
+  BABIES AND THEIR CARE                                             60
+
+     Growth and development, 64. Average size, 64. Muscular
+     development, 65. Development of special senses, of
+     speech, of teeth, 66. Normal excretions, 67. Clothing,
+     68. Sleep, 70. Fresh air, 72. Diet, 72. Intervals of
+     feeding, 73. Water, 75. Weaning, 75. Nursing bottles and
+     nipples, 75. Tables of diet, 78. Bathing, 78. Eyes, 80.
+     Mouth, 81. Nostrils, 81. Genital organs, 81. Development
+     of habits, 82. Exercise, 83. Play and toys, 85.
+
+  CHAPTER IV
+
+  INDICATIONS OF SICKNESS                                           88
+
+     Objective symptoms, 92. Temperature, 92. Pulse, 96.
+     Respiration, 99. General appearance, 100. Special senses,
+     101. Voice, tongue, throat, gums, 102. Cough, 103.
+     Appetite, 103. Excretions, 103. Loss of weight, 104.
+     Sleep, 104. Mental conditions, 104. Subjective symptoms,
+     105. Pain, 105. Records, 107. Tuberculosis, cancer and
+     mental illness, 107. Tuberculosis, 109. Cancer, 111.
+     Mental illness, 112.
+
+  CHAPTER V
+
+  EQUIPMENT AND CARE OF THE SICK ROOM                              117
+
+     Choice of a sick room, 118. Furnishing, 120. Ventilation,
+     123. Heating, 124. Lighting, 124. Cleaning, 126. The
+     attendant, 127.
+
+  CHAPTER VI
+
+  BEDS AND BEDMAKING                                               132
+
+     Bedsteads, 133. Mattresses, 135. Care of the mattress,
+     136. Pillows, 136. Protection of the mattress and
+     pillows, 137. Rubber sheets and pillow-cases, 138.
+     Sheets, 139. Draw sheets, 139. Pillow covers, 140.
+     Blankets, 140. Comforters and quilts, 141. Counterpanes,
+     141. Bedmaking, 141. To make an unoccupied bed, 143. To
+     change a patient's pillows, 146. Lifting a patient in
+     bed, 146. To turn a patient in bed, 147. To change sheets
+     while patient is in bed, 147. To move patient from one
+     bed to another, 150.
+
+  CHAPTER VII
+
+  BATHS AND BATHING                                                154
+
+     Cleansing baths, 154. Bed bath, 156. Care of the mouth
+     and teeth, 160. Care of the hair, 163. To wash the hair
+     of a bed patient, 164. Hot foot-baths, 165. Cool sponge
+     bath, 166.
+
+  CHAPTER VIII
+
+  APPLIANCES AND METHODS FOR THE SICK-ROOM                         169
+
+     Devices to give support, 172. Bedpans, 176. Daily routine
+     in the sick-room, 179. Time for visitors, 182.
+
+  CHAPTER IX
+
+  FEEDING THE SICK                                                 187
+
+     The digestive process, 188. Feeding the sick, 191. Liquid
+     diet, 192. Semi-solid diet, 192. Light or convalescent
+     diet, 193. Full diet, 193. Serving food for the sick,
+     195. To feed a helpless patient, 197.
+
+  CHAPTER X
+
+  MEDICINES AND OTHER REMEDIES                                     200
+
+     Action of drugs, 200. Amateur dosing, 202. Patent
+     remedies, 205. Administration of medicine, 206.
+     Suppositories, 209. Enemata, 210. Sprays and gargles,
+     213. Inhalation, 213. Inunction, 214. Household medicine
+     cupboard, 215.
+
+  CHAPTER XI
+
+  APPLICATION OF HEAT, COLD AND COUNTER-IRRITANTS                  220
+
+     Inflammation, 220. Hot applications, 225. Dry heat, 225.
+     Moist heat, 227. Stupes or hot fomentations, 229. Cold
+     applications, 231. Dry cold, 231. Moist cold, 232. Cold
+     compresses for the eyes, 232. Counter-irritants, 233.
+     Mustard paste, 233. Mustard leaves, 234.
+
+  CHAPTER XII
+
+  CARE OF PATIENTS WITH COMMUNICABLE DISEASES                      236
+
+     Incubation period, 238. Care of patients with colds or
+     other slight infections, 238. Care during more serious
+     infections, 242. Children's diseases, 246. Rules for
+     isolation and exclusion from school, 247. Disinfection,
+     248. Care of nose and throat discharges, 249. Care of
+     discharges from the bowels and bladder, 249. Bath water,
+     250. Care of the hands, 250. Care of utensils, 251. Care
+     of linen, 251. Disinfection of the person, 252.
+     Termination of quarantine, 252. Terminal disinfection,
+     253. Fumigation, 254.
+
+  CHAPTER XIII
+
+  COMMON AILMENTS AND EMERGENCIES                                  257
+
+     Conditions in which the nervous system is involved, 257.
+     Headache, 257. Sleeplessness, 258. Fainting, 259.
+     Convulsions, 260. Shock, 261. Stimulants, 263. Sunstroke
+     and heat exhaustion, 264. Conditions in which the
+     digestive tract is affected, 265. Nausea and vomiting,
+     265. Hiccough, 265. Diarrhœa, 266. Constipation, 266.
+     Colic, 266. Conditions in which the eyes or ears are
+     affected, 267. Styes, 267. Foreign bodies in the eye,
+     267. Disorders affecting the ears, 268. Conditions in
+     which the skin is affected, 269. Prickly heat, 269.
+     Insect bites and stings, 270. Ivy poisoning, 270. Other
+     emergencies, 270. Chills, 270. Croup, 271. Bleeding, 272.
+     Treatment of slight wounds, 272. Nose bleed, 274. Profuse
+     menstruation, 275. Other injuries, 275. Sprains, 275.
+     Bruises, 276. Burns and scalds, 277. Brush burn, 278.
+
+  CHAPTER XIV
+
+  SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS,
+  CHRONICS, AND THE AGED                                           280
+
+     Children, 281. Physical defects, 283. Eye-strain, 284.
+     Enlarged tonsils and adenoids, 284. Defective hearing,
+     285. Defective teeth, 286. Posture, 286. Predisposition
+     to nervousness, 292. Convalescent patients, 294. Chronic
+     patients, 299. Care of the aged, 303.
+
+  CHAPTER XV
+
+  QUESTIONS FOR REVIEW                                             312
+
+  APPENDIX                                                         319
+
+     Circulars of information issued by Division of Child
+     Hygiene, New York Department of Health.
+
+  GLOSSARY                                                         326
+
+  INDEX                                                            331
+
+
+
+
+INTRODUCTION
+
+
+Health and sickness, at all times momentous factors in the welfare of
+our nation, now as never before are matters of vital importance. To win
+its victories both in peace and in war, the nation needs all its
+citizens with all their powers, and it is a matter of more than passing
+interest that, as conservative estimates show, at least three persons
+out of every hundred living in the United States are constantly
+incapacitated by serious sickness. In 1910 these seriously sick persons
+numbered more than 3,000,000. Even more significant, perhaps, is the
+fact that at least half of our national sickness could be prevented if
+knowledge and resources that we now possess were fully utilized.
+
+The problem of sickness is by no means peculiar to our own day and
+generation. It has been a medical, a religious, and a social problem in
+every age. From the time of Job its meaning has baffled philosophers;
+from his day to ours thoughtful men have devoted their lives to
+searching for causes and cures. Yet before the middle of the last
+century little progress was made, either in scientific treatment or in
+prevention of disease.
+
+The invention of the microscope first made possible a real
+understanding of sickness. Through the microscope a new world was
+revealed,--a world of the infinitely small, swarming with tiny forms of
+animal and vegetable life. No one, however, appreciated the significance
+of these hitherto invisible plants and animals until the latter part of
+the 19th century, when the great French savant, Pasteur, proved that
+little vegetable forms, now called bacteria, cause putrefaction and
+fermentation, and also certain diseases of animals and man. Pasteur's
+discoveries were carried still further by other scientists, with the
+result that bacteriology has revolutionized medicine, agriculture, and
+many industries, and has made possible the brilliant achievements of
+modern sanitary science. For the first time in history the prevention of
+epidemics has become possible, and sickness is no longer regarded as a
+punishment for sin.
+
+Actual care of the sick, both in homes and in hospitals, has always been
+one of the responsibilities of women. The first general public hospital
+was built in Rome in the 4th century after Christ by Fabiola, a
+patrician lady. There she nursed the sick with her own hands, and from
+her day to ours extends an unbroken line of devoted women, handing down
+through the centuries their tradition of compassionate nursing service.
+It remained for Florence Nightingale, however, to give to the training
+its technical and scientific foundation, and thus to found the
+profession of nursing. As a result of her work, effectiveness was added
+to the spirit of service, that spirit which inspires the modern nurse no
+less than in an earlier day it inspired the Sisters of Charity who died
+nursing the wounded on the battlefields of Poland.
+
+But different generations have different needs, and to meet them the
+spirit of service must manifest itself in widely varying ways. The sick
+need care today no less than they did when St. Elizabeth bathed the feet
+of the lepers; but such limited service, however beautiful, is no longer
+enough. Today we serve best by preventing sickness. Cure of sickness and
+alleviation of suffering must never be neglected; not in cure, however,
+but in prevention lies the hope of modern sanitary science, of modern
+medicine, and of modern nursing.
+
+Nearly every woman at some time in her life is called upon to assist in
+caring for the sick. Indeed, approximately 90% of all sick persons in
+the United States are cared for at home, even in cities where hospital
+facilities are good. Moreover, every woman is largely responsible for
+maintaining her own health, and few escape responsibility at some time
+for maintaining the health of others. For such responsibility most women
+are poorly prepared. Every year in our own country thousands of persons,
+many of them babies and children, die merely because someone, in many
+cases a woman, is fatally ignorant of the laws governing sickness and
+health.
+
+Only prolonged and careful training, such as good hospital
+training-schools afford, can furnish the skill and judgment required in
+nursing persons who are seriously ill. Upon the trained nurse the modern
+practice of medicine makes great and ever-increasing demands: a nurse
+must perform complicated duties, meet critical situations, and carry out
+a wide variety of measures based on scientific principles which she must
+understand. Good will and sympathy are no longer enough; amateur
+nursing, even when performed with the best intentions, may involve grave
+dangers for those who are seriously ill.
+
+On the other hand, although it is true that a little knowledge is a
+dangerous thing, it is no less true that total ignorance may be more
+dangerous still. For instance, in cases of incipient, slight, or chronic
+illness, and in certain emergencies a little knowledge may be safer far
+than no knowledge at all; and no one, surely, should be ignorant of the
+principles of hygiene.
+
+The American Red Cross, recognizing the part that women can and should
+play in preventing sickness and in building up the health and vigor of
+the nation, has added to its larger patriotic services this elementary
+course of instruction in hygiene and home care of the sick. The lessons
+are not intended to take the place of a nurse's training, and procedures
+requiring technical skill are necessarily omitted. The object of the
+book is to supply a little knowledge of sickness, which though limited
+may yet be safe. The book is also designed to set forth some general
+laws of health; to make possible earlier recognition of symptoms; to
+teach greater care in guarding against communicable disease; and to
+describe some elementary methods of caring for the sick, which, however
+simple, are essential to comfort, and sometimes indeed to ultimate
+recovery.
+
+
+FOR FURTHER READING
+
+A History of Nursing--Dock and Nutting, Volume I.
+
+The Life of Florence Nightingale--Cook.
+
+The Life of Pasteur--Vallery-Radot.
+
+The House on Henry Street--Wald.
+
+Public Health Nursing--Gardner, Part I, Chapters I-III.
+
+Origin and Growth of the Healing Art--Berdoe.
+
+Medical History from the Earliest Times--Withington.
+
+Under the Red Cross Flag--Boardman.
+
+Report on National Vitality--Fisher, (Bulletin 30 of the Committee of
+One Hundred on National Health. Government Printing Office, Washington).
+
+
+
+
+CHAPTER I
+
+CAUSES AND PREVENTION OF SICKNESS
+
+
+Diseases of two kinds have long been recognized: first, those
+transmitted directly or indirectly from person to person, like smallpox,
+measles, and typhoid fever; and second, diseases like heart disease and
+apoplexy, which are not so transmitted. These two classes are popularly
+called "catching" and "not catching;" the former are the infectious or
+communicable diseases, and the latter the non-infectious or
+non-communicable. The term contagious, formerly applied to diseases
+supposed to be spread only by direct contact, is no longer an accurate
+or useful term.
+
+
+THE COMMUNICABLE DISEASES
+
+The invention of the microscope, as we have seen, revealed the existence
+of innumerable little plants and animals, so small that even many
+millions crowded together are invisible to the naked eye. These tiny
+living creatures are called micro-organisms or germs. The plant forms
+are called bacteria (singular, bacterium), and the animal forms
+protozoa (singular, protozoön). The common belief that all or even most
+bacteria are harmful is quite unfounded. As a matter of fact, while not
+less than 1500 different kinds of micro-organisms or germs are known,
+only about 75 varieties are known to produce disease.
+
+Most bacteria belong to the class of micro-organisms called saprophytes,
+which find their food in dead organic matter, both animal and vegetable,
+and cannot flourish in living tissues. These saprophytes act upon the
+tissues of dead animals and vegetables, and resolve them into simpler
+substances, which are then ready to serve as nourishment for plants
+higher in the vegetable kingdom. Thus the processes which we know as
+fermentation and putrefaction are due to the action of saprophytes.
+Higher plants in turn furnish food for men and animals, and so the food
+supply is used over and over in different forms, making what is known as
+the _food cycle_. If it were not for bacterial activities vegetation
+would be robbed of its supply of nourishment, and plant life would
+speedily end; destruction of plant life would deprive the animal kingdom
+of food and thus all life would become extinct. The saprophytes are
+consequently essential to the existence of both animals and vegetables.
+
+There are, however, other organisms called _parasites_, which can exist
+in living tissues of animals or vegetables. The organisms at whose
+expense the parasites live are called their _hosts_. Parasites not only
+contribute nothing to their hosts, but generally harm them by producing
+poisonous substances or depriving them of food. Some parasites are able
+to lead a saprophytic existence also, but as a rule they live at the
+expense of animal or plant life. Pathogenic, or disease-producing, germs
+belong to the group of parasites. The pathogenic germs which find
+favorable soil in the body produce poisons called toxins. These poisons
+or toxins interfere with the bodily functions, and thus cause what we
+know as communicable disease. Communicable diseases are caused by
+specific germs only: that is, a certain disease cannot develop unless
+its particular germs are present; the germs of typhoid for instance, can
+cause typhoid fever only, and not tuberculosis or other disease.
+
+A number of diseases are caused by micro-organisms that are now well
+known. Chief among these diseases are colds, septicæmia (blood
+poisoning), influenza, pneumonia, diphtheria, typhoid fever,
+tuberculosis, whooping cough, Asiatic cholera, bubonic plague,
+meningitis, tetanus ("lock jaw"), leprosy, gonorrhœa, syphilis,
+relapsing fever, typhus fever, glanders, and anthrax. Micro-organisms
+not yet identified probably cause the communicable diseases whose origin
+is not known with certainty. These include infantile paralysis,
+smallpox, scarlet fever, measles, mumps, chicken-pox, Rocky Mountain
+spotted fever, yellow fever, hydrophobia (rabies), foot-and-mouth
+disease. We can hardly doubt that the intensive laboratory research now
+in progress will reveal in the near future the specific germs of these
+diseases also.
+
+
+STRUCTURE AND DEVELOPMENT OF PARASITES
+
+The group of parasites consists of two general classes, the vegetable,
+and the animal. In the former class belong the bacteria, and in the
+latter the protozoa. The two classes are not sharply differentiated, but
+in general the vegetable parasites are less highly organized than the
+animal.
+
+
+BACTERIA
+
+SHAPE.--Bacteria are composed of single cells and are consequently
+called unicellular organisms. Under the microscope individual cells are
+seen to differ in size, shape, and structure. In shape bacteria show
+three different types; the rod-shaped (bacillus), the spherical
+(coccus), and the spiral (spirillum). The organisms causing typhoid
+fever for example are a variety of bacilli, those causing pneumonia are
+cocci, while those causing Asiatic cholera are spirilla.
+
+[Illustration: FIG. 1.--BACILLI OF VARIOUS FORMS. (_Williams._)]
+
+SIZE.--Bacteria vary greatly in size. Average rod-shaped bacteria are
+about 1/25000 of an inch long, but there are undoubtedly organisms so
+small that they cannot be seen, even by means of the strongest
+microscopes we now possess.
+
+[Illustration: STAPHYLOCOCCI. STREPTOCOCCI. DIPLOCOCCI. TETRADS.
+SARCINÆ. FIG. 2.--(_Williams._)]
+
+MOTION.--The power of motion in certain species of bacteria is due to
+hair-like appendages called flagella. These flagella by a lashing
+movement somewhat resembling the action of oars enable the organisms to
+move through fluids.
+
+MULTIPLICATION.--After bacteria have fully developed, each cell divides
+into two equal parts; the process of division is called fission. Each
+of these two parts rapidly grows into a full-sized organism. Then
+fission again takes place, so that four bacteria replace the original
+one. In each of the four, fission occurs again, and so the process of
+multiplication continues. As bacteria develop they group themselves in
+characteristic ways. Some, like the streptococci, arrange themselves in
+chains; the diplococci, in pairs; the tetrads, in groups of four; others
+in packets called sarcinæ, and still others, the staphylococci, form
+masses supposed to resemble bunches of grapes.
+
+[Illustration: FIG. 3.--SPIRILLA OF VARIOUS FORMS. (_Williams._)]
+
+[Illustration: FIG. 4.--BACTERIA SHOWING FLAGELLA. (_Williams._)]
+
+Under favorable conditions fission occurs rapidly; in some types a new
+generation may appear as often as every 15 minutes. Enormous
+multiplication would result if nothing occurred to check the process.
+But in nature such increase never continues unhindered, and bacteria,
+acting upon their food substances, produce acids and other materials
+injurious to themselves. Furthermore, lack of proper food, moisture, or
+favorable temperature, and competition with other organisms tend to
+prevent their unrestricted growth and multiplication.
+
+[Illustration: FIG. 5.--BACTERIA WITH SPORES. (_Williams._)]
+
+SPORES.--Most bacteria die if conditions become unfavorable to their
+growth, but some enter into a resting stage. This stage is characterized
+by the development of round or oval glistening bodies called spores,
+which are of dense structure and possess an extraordinary power to
+withstand heat, chemicals, and unfavorable surroundings. Except in rare
+instances a single cell produces but one spore. As soon as favorable
+conditions of temperature, moisture, and food supply are restored, the
+spore develops into the active form of the germ; it may, however, remain
+dormant for months or years. Spore formation, however, occurs in only a
+very few varieties of pathogenic bacteria.
+
+DISTRIBUTION.--Bacteria are very widely distributed in nature; they are
+in fact found practically everywhere on the surface of the earth. They
+are present in plants and water and food; on fabrics and furniture,
+walls and floors; and they are found in great numbers on the skin, hair,
+many mucous surfaces, and other tissues of the body.
+
+
+PROTOZOA
+
+The protozoa are the lowest group of the animal kingdom. Like bacteria
+they are composed of single cells so small as to be visible only under
+the microscope. They play an important part in causing certain diseases
+of man, especially in the tropics. Among the well-known human diseases
+of protozoan origin are malaria, amoebic dysentery, and
+sleeping-sickness. Protozoa also cause several wide-spread and serious
+plagues of domestic animals.
+
+
+VISIBLE PARASITES
+
+A few diseases are caused by parasites large enough to be seen with the
+naked eye. One of the most important is hookworm disease. This disease
+is caused by a tiny worm which penetrates the victim's skin and
+ultimately finds its way into the intestine. Other diseases also are
+caused by parasitic worms, such as tapeworms, pinworms, and trichinæ.
+The latter are acquired as a result of eating infected meat,
+particularly infected pork that has not been thoroughly cooked.
+
+
+TRANSMISSION OF PATHOGENIC ORGANISMS
+
+Pathogenic or disease producing organisms need for their development
+food, moisture, darkness, and warmth, conditions that exist within the
+human body. When one or more of these factors is unfavorable,
+development of germs is checked; if unfavorable conditions are extreme
+or long continued, the organisms begin to die. It is difficult to say at
+exactly what moment they will die if deprived of moisture or exposed to
+extremes of temperature or other unfavorable conditions, just as it
+would be impossible to state at exactly what moment a collection of
+house plants would all be dead if water were withheld, or if the room
+temperature were greatly reduced.
+
+Most pathogenic organisms, however, do not flourish long outside the
+body, and owe their continued existence to a fairly direct transfer
+from person to person. They gain access to the body through mucous
+surfaces such as the respiratory and digestive tracts, and through
+breaks in the skin, such as cuts, abrasions, and the bites of certain
+insects. They leave the body chiefly in the nasal and mouth discharges,
+as in coughing, sneezing, and spitting, in the urine and bowel
+discharges, and in pus or "matter."
+
+[Illustration: FIG. 6. (_L. H. Wilder._)]
+
+The problem of controlling communicable diseases, consequently, lies in
+preventing the bodily discharges of one person from travelling directly
+into the body of another. If a person is not expelling pathogenic germs,
+it is clear that he cannot pass diseases on to others. But both
+pathogenic and harmless germs follow the same routes from person to
+person, so that safety as well as decency lies in preventing so far as
+possible all exchanges of bodily discharges.
+
+There are five routes by which the bodily discharges most frequently
+travel from one person to another. Four of these routes of infection are
+called public, because in most cases efforts of individuals alone are
+not sufficient to control them. The public routes are water, milk, food,
+and insects. The fifth, or private route, includes all means by which
+fresh discharges of one person are passed to another, as when nose and
+mouth discharges are carried in coughing, sneezing, and kissing, or when
+bowel and bladder discharges are carried by the hands. These five routes
+in a given case differ greatly in relative importance, but the fifth, or
+direct route plays an immense part, although its importance in causing
+sickness has only lately been recognized. It cannot be too strongly
+emphasized that the chief agent in the spread of human diseases is man
+himself, and the human hand is the great carrier of disease germs both
+to and from the body. If unclean hands could be kept away from the
+orifices of the body, particularly the mouth, many diseases would soon
+cease to exist.
+
+
+Defenses of the Body
+
+In view of all the dangers from disease-producing germs it may seem
+surprising that the human race has not long ago succumbed to its
+invisible enemies. But the body has various defenses by means of which
+it may prevent invasion, or successfully combat its enemies in case they
+do gain access.
+
+The unbroken skin is usually impassable to bacteria. Virulent organisms
+are often found upon the skin of perfectly healthy persons, where they
+appear to be harmless unless an abrasion occurs which affords entrance
+into the deeper tissues. Most bacteria breathed in with the air cling to
+the moist surfaces of the air-passages and never reach the lungs.
+
+Mucous membranes lining the mouth and other cavities of the body would
+prove favorable sites for the growth of bacteria if the mucus secreted
+by them were not frequently removed. The mouth of a healthy person may
+contain bacteria of many kinds, but the saliva has a slight disinfectant
+power and serves as a constant wash to the membranes. The normal gastric
+(stomach) juice is decidedly unfavorable to the growth of bacteria,
+although it does not always kill them; they often pass through the
+stomach and are found in large numbers in the intestines. Other bodily
+secretions, such as the tears and perspiration, tend to discourage
+bacterial growth.
+
+Tissues of the body vary greatly in their power to resist invading
+germs, so that the route by which germs enter influences the severity of
+their effects. Typhoid bacilli and the spirilla of Asiatic cholera when
+taken with food or water produce far more serious disturbances than when
+injected under the skin; infections from pus germs through an abrasion
+of the skin may result in a slight local disturbance, while the same
+amount introduced into a deeper wound might cause a fatal infection.
+Certain germs nourish in certain tissues only; even tuberculosis, which
+attacks practically all tissues, has its favorite locations.
+
+IMMUNITY.--In addition to its mechanical defenses against disease, the
+body shows a varying degree of _immunity_, or the power possessed by
+living organisms to resist infections. Immunity or resistance is the
+opposite of susceptibility. It is exceedingly variable, being greater or
+less in different people and under different conditions, but the exact
+ways in which it is brought about are still in many cases far from
+clear.
+
+Immunity may be _natural_ or _acquired_. By natural immunity is meant
+an inherited characteristic by which all individuals of a species are
+immune to a certain disease. The natural immunity of certain species of
+animals to the diseases of other animals is well known. Man is immune to
+many diseases of lower animals, and they in turn are immune to many
+diseases of man. Cattle, for instance, are immune to typhoid and yellow
+fever, while man shows high resistance to rinderpest and Texas fever;
+both, however, are susceptible to tuberculosis, to which goats are
+immune. There are all gradations of immunity within the same species.
+Moreover, certain individuals have a personal immunity against diseases
+to which others of the same race or species are susceptible.
+
+Immunity may be _acquired_ in several ways. It is commonly known that
+one attack of certain communicable diseases renders the individual
+immune for a varying length of time, and sometimes for life. Among these
+diseases are smallpox, measles, whooping-cough, scarlet fever, infantile
+paralysis, typhoid fever, chicken-pox, and mumps; erysipelas and
+pneumonia on the other hand appear to diminish resistance and to leave a
+person more susceptible to later attacks.
+
+Again, in some cases immunity may be artificially acquired by
+introducing certain substances into the body to increase its
+resistance. Examples of this method include the use of antitoxin as a
+protection against diphtheria, of sera in pneumonia and other
+infections, and vaccination against smallpox and typhoid fever whereby a
+slight form of the disease is artificially induced. Laboratory research
+goes on constantly, and doubtless many more substances will eventually
+be discovered that will reduce human misery as vaccines and antitoxin
+have already reduced it.
+
+Vaccination and inoculation have saved thousands of lives. Smallpox,
+once more prevalent than measles, was the scourge of Europe until
+vaccination was introduced. During the 18th century it was estimated
+that 60,000,000 people died of it, and at the beginning of the 19th
+century one-fifth of all children born died of smallpox before they were
+10 years old. In countries where vaccination is not practised the
+disease is as serious as ever; in Russia during the five years from
+1893-97, 275,502 persons died of smallpox, while in Germany where
+vaccination is compulsory, only 8 people died of it during the year
+1897. Death rates from diphtheria and typhoid fever have been greatly
+reduced by the use of antitoxin and antityphoid vaccine. Thus in New
+York State in 1894, before antitoxin was generally used, 99 out of every
+100,000 of the population died of diphtheria, while only 20 out of
+100,000 died of it in 1914. In 1911 a United States Army Division of
+more than 12,000 men camped at San Antonio, Texas, for four months. All
+of these men were vaccinated against typhoid fever and only a single
+case occurred during the summer, although conditions of camp life always
+tend to spread the disease.
+
+While many and various factors tend to lower resistance rather than to
+increase it, the idea that these factors act equally in all kinds of
+infection is erroneous.
+
+      "The principal causes which diminish resistance to
+      infection are: wet and cold, fatigue, insufficient or
+      unsuitable food, vitiated atmosphere, insufficient sleep
+      and rest, worry, and excesses of all kinds. The mechanism
+      by which these varying conditions lower our immunity must
+      receive our attention, for they are of the greatest
+      importance in preventive medicine. It is a matter of common
+      observation that exposure to wet and cold or sudden changes
+      of temperature, overwork, worry, stale air, poor food,
+      etc., make us more liable to contract certain diseases. The
+      tuberculosis propaganda that has been spread broadcast with
+      such energy and good effect has taught the value of fresh
+      air and sunshine, good food, and rest in increasing our
+      resistance to this infection.
+
+      "There is, however, a wrong impression abroad that because
+      a lowering of the general vitality favors certain diseases,
+      such as tuberculosis, common colds, pneumonia, septic and
+      other infections, it plays a similar rôle in all
+      communicable diseases. Many infections, such as smallpox,
+      measles, yellow fever, tetanus, whooping-cough, typhoid
+      fever, cholera, plague, scarlet fever, and other diseases,
+      have no particular relation whatever to bodily vigor. These
+      diseases often strike down the young and vigorous in the
+      prime of life. The most robust will succumb quickly to
+      tuberculosis if he receives a sufficient dose of the
+      virulent micro-organisms. A good physical condition does
+      not always temper the virulence of the disease; on the
+      contrary, many infections run a particularly severe course
+      in strong and healthy subjects, and, contrariwise, may be
+      mild and benign in the feeble. Physical weakness,
+      therefore, is not necessarily synonymous with increased
+      susceptibility to all infections, although true for some of
+      them. In other words, 'general debility' lowers resistance
+      in a specific, rather than in a general, sense."--(Rosenau:
+      Preventive Medicine and Hygiene, pp. 403 and 404.)
+
+
+CARRIERS
+
+Well persons who carry in their bodies pathogenic germs but who
+themselves have no symptoms of disease are called carriers. Thus typhoid
+carriers have typhoid bacilli in the intestinal tract, while they
+themselves show no symptoms of typhoid fever; diphtheria carriers have
+bacilli of diphtheria in the throat or nose, but have themselves no
+symptoms of diphtheria, and so on. It has now been proved that many
+patients harbor bacteria for weeks, months, or even years following an
+infection, and are dangerous distributors of disease; also, some
+healthy individuals without a history of illness harbor living bacteria
+which may infect susceptible persons in the usual ways. Transmission by
+healthy carriers goes far to explain the occurrence of diseases among
+persons who have apparently not been exposed. This explanation has
+greatly clarified the whole problem of the spread of communicable
+diseases. Carriers, unfortunately, exist in large numbers, and render
+the ultimate control of disease exceedingly difficult. They can usually
+be identified by bacteriological tests. To some extent they can be
+supervised; food handlers at least should be legally obliged to submit
+to physical examinations, and should be licensed only when proved free
+from communicable disease.
+
+Diseases are also spread by persons suffering from them in a form so
+mild or so unusual that they pass unrecognized. These persons are known
+as "missed" cases. Carriers of disease and "missed" cases go freely
+about the community, handling food, using common drinking cups,
+travelling in crowded street cars, standing in crowded shops; in various
+ways coming into close contact with other people, coughing and sneezing
+and kissing their friends no less often than normal individuals. It is
+consequently clear that the bodily discharges of supposedly normal
+persons may be hardly less a menace than those of persons known to be
+infected.
+
+Diseases that depend for transmission upon milk, water, food, and
+insects may be controlled by public action, that is, by specific
+measures taken by a large group of people in order to protect the
+individual. Such action constitutes _public sanitation_. There is,
+however, a large group of diseases, chiefly sputum-borne, that cannot be
+controlled except by individual action. Such individual action
+constitutes a large part of _personal hygiene_.
+
+The whole problem of controlling infections sounds simple, depending as
+it does for the most part upon unpolluted water, milk, and food,
+extermination of certain insects, and cleanliness in personal behaviour.
+In practice the problem is not so easy. Public sanitation has performed
+miracles in the past, and will do much in the future; behaviour,
+however, will continue to be influenced by many factors, social and
+economic as well as personal. Ignorance of the laws of health is an
+obstacle to progress, but in modern conditions even the instructed may
+be unable to control their ways of living and working. Indeed, such
+control is at present limited to the privileged few. On the ignorant and
+the poor, those least able to bear it, society loads the heaviest burden
+of sickness. Only when ignorance and poverty are abolished, as one day
+they will be, can the final stage be reached in the fight for public
+health.
+
+
+THE NON-COMMUNICABLE DISEASES
+
+In this group is included a great variety of maladies. Of some the
+causes are known, while in the case of others, origin, prevention, and
+remedy are still obscure. Here belong defects in structure of the body,
+both hereditary and acquired; insanity and other nervous diseases; new
+growths, like tumors and cancer; disturbances of bodily processes, as
+malnutrition and gout; and the important class of degenerative diseases,
+like arteriosclerosis, in which tissues become hardened and fibrous and
+hence less able to perform their normal functions.
+
+The degenerative diseases are playing a menacing part in national
+health. The average length of life in the United States has shown a
+marked increase it is true, during the last 40 years. But this gain
+represents chiefly the saving of life through prevention of communicable
+diseases, especially among babies and children; among people who have
+passed the 30th year on the other hand, death rates are actually
+increasing. This increase is most marked after the age of 45, and is
+caused chiefly by the increase of cancer, and of degenerative diseases
+of the heart, blood vessels, and kidneys. Degeneration of tissues is
+normally a condition typical of old age, and in aged persons it may
+occur in any tissue. There is no elixir of youth, and for old age there
+is no cure. But the important facts in this connection are that
+degenerative changes now occur prematurely, and that among a vast number
+of people, in various classes of society and various occupations, the
+vital organs show a marked tendency to break down after the age of 45.
+
+This condition is not inevitable. Before the beginning of the present
+war, death rates at all ages were decreasing in England, Sweden, and
+other European countries. In America also degenerative diseases can be
+checked or prevented to a large extent, and it is highly important that
+their causes should be generally understood.
+
+The two groups following include some of the probable causes:
+
+1. Conditions of life which result in continued overwork, and mental
+overwork in particular; worry, excitement, insufficient recreation and
+exercise, and other kinds of nervous strain typical of modern life,
+especially in cities.
+
+2. Irritating substances in the body, including poisonous substances
+resulting from infectious diseases, and from syphilis in particular;
+poisons from chronic infections, alcohol, and industrial poisons such
+as lead and other metals; overeating and improper eating, especially of
+meat and other proteins, and rich or highly seasoned food; faulty
+digestion, constipation, and imperfect elimination through the
+kidneys.--(See Dr. A. E. Shipley, in bulletin of the N. Y. City Dept. of
+Health, Feb., 1915.)
+
+The importance of early recognition cannot be overemphasized. In many of
+these troubles the symptoms are not pronounced, and the victims have no
+knowledge of their condition until they happen to be examined for life
+insurance, or until the disease is far advanced. And even when they
+realize that trouble exists, as for example constipation or overwork,
+most people absolutely fail to realize how serious the consequences may
+be. The first step toward remedy is periodic complete physical
+examination by a competent physician, in order to learn in time how to
+prevent these degenerative diseases, if present, from growing worse. The
+custom of undergoing an annual physical examination is becoming more
+common, and "such a course, conservatively estimated, would add 5 years
+to the average life of persons between 45 and 50."--(Winslow.)
+
+      "Recently, we have been making examinations of the
+      employees of whole institutions, large banks and other
+      industrial concerns in New York City, and we find almost
+      the same conditions there. Out of 2000 such examinations
+      among young men and women of an average age of 33, just in
+      the early prime of life, men and women supposedly picked
+      because of their especial fitness for work, only 3.14% were
+      found free of impairment or of habits of living which are
+      obviously leading to impairment. Of the remaining persons,
+      96.69% were unaware of impairment; 5.38% of the total
+      number examined were affected with chronic heart trouble;
+      13.10% with arteriosclerosis; 25.81% with high or low blood
+      pressure; 35.65% with sugar, casts or albumen in the urine;
+      12.77% with combination of both heart and kidney disease;
+      22.22% with decayed teeth or infected gums; 16.03% with
+      faulty vision uncorrected.... The fact of greatest import,
+      however, was that impairment, sufficiently serious to
+      justify the examiner in referring the examinee to his
+      family physician for medical treatment, was found in 59% of
+      the total number of cases, while 37.86% were on the road to
+      impairment because of the use of "too much alcohol," or
+      "too much tobacco," constipation, eye-strain, overweight,
+      diseased mouths, errors of diet, and so forth....
+
+      "And what is the cause of this appalling increase, in the
+      United States, of these and other degenerative diseases? I
+      believe it can be shown to the satisfaction of any
+      reasonable person that the increase is largely due to the
+      neglect of individual hygiene in United States....
+
+      "If a man were suddenly afflicted with smallpox or typhoid
+      fever or any other acute malady, he would lose no time in
+      getting expert advice and applying every known means to
+      save his life. But his life may be threatened just as
+      seriously, though possibly not so imminently, by
+      arteriosclerosis, heart disease, or Bright's disease, and
+      he will do nothing to prevent the encroachment of these
+      diseases until it is too late, but will continue to eat as
+      he pleases, drink as he pleases, smoke as he pleases, or
+      overwork, and worry himself into a premature
+      grave."--("Conservation of Life at Middle Age," Prof.
+      Irving Fisher, Am. Journal of Public Health, July, 1915.)
+
+Periodic physical examinations are as necessary for children as for
+adults, in order to detect physical defects. These defects are known to
+have such an immense bearing upon health that routine examinations of
+all children have become an integral part of the work of enlightened
+public schools.
+
+Prevention of degenerative disease, then, as well as of the enormous
+numbers of preventable accidents and injuries, depends in large measure
+upon proper living conditions and proper personal habits. The infectious
+diseases, according to Dr. Hill, cost us annually at least 10 billion
+dollars in addition to the loss of life, and he adds: "The infectious
+diseases in general radiate from and are kept going by women."--(Hill--
+New Public Health, p. 30.) Women, it is true, can prevent many of the
+infections, but they can do still more, for hygienic habits to be
+effective must be acquired early, and mothers and teachers, because they
+have practically the entire control of children, have the power to
+prevent many cases of degenerative as well as of communicable disease.
+
+
+EXERCISES
+
+1. Distinguish between communicable and non-communicable disease.
+
+2. Describe the part played by micro-organisms in causing disease.
+
+3. Describe the structure of bacteria and their method of
+multiplication.
+
+4. In what ways are pathogenic germs transmitted from person to person?
+
+5. Upon what preventive measures does the control of communicable
+diseases depend?
+
+6. What is meant by immunity?
+
+7. Against what diseases may immunity be acquired artificially? How has
+the practice of immunizing affected death rates from communicable
+diseases?
+
+8. What factors tend to lower resistance? Do they act equally in the
+case of all diseases?
+
+9. Define a carrier, and explain the importance of carriers in the
+spread of disease.
+
+10. Name some of the characteristics and causes of degenerative
+diseases.
+
+11. Whom do the degenerative diseases most commonly affect?
+
+12. Describe methods that should be employed to prevent degenerative
+diseases.
+
+
+FOR FURTHER READING
+
+The New Public Health--Hill, Chapters I-IX.
+
+Health and Disease--Roger I. Lee, Chapters XV-XXIV.
+
+Principles of Sanitary Science and the Public Health--Sedgwick, Chapters
+I, II, III.
+
+Scientific Features of Modern Medicine--Frederic S. Lee, Chapters II,
+IV-VI.
+
+Disease and Its Causes--Councilman, Chapter I.
+
+Preventive Medicine and Hygiene--Rosenau.
+
+Publications of the Life Extension Institute--25 West 45th Street, New
+York City.
+
+
+
+
+CHAPTER II
+
+HEALTH AND THE HOME
+
+
+Of all the considerations that determine health, heredity is the one
+unalterable factor. Although certain characteristics are obviously
+hereditary,--complexion, height, and mental and physical traits in great
+variety,--yet in the past heredity has been little understood. In
+consequence it has served too often as a scape goat for faults and
+failings not beyond an individual's control. Our first clear
+understanding of the principles underlying heredity resulted from
+experiments made by Mendel, an Austrian monk, during the last century,
+and it is now possible to predict with a high degree of accuracy the
+inheritance of certain characteristics.
+
+Many diseases, formerly considered hereditary because their actual
+causes were unknown, are now known to be communicable. Thus, it is now
+understood that tuberculosis is not hereditary, although little children
+may be infected by tuberculous parents. No germ diseases are inherited
+in the strict sense of the word; but a baby may be infected with
+syphilis before birth if his father or his mother has the disease.
+
+It is true, however, that certain tissue weaknesses of the body seem to
+be hereditary, and in consequence one family is more susceptible to
+digestive disorders, another to diseases of the lungs, a third to
+deafness, and so on. Moreover, general low vitality may be inherited. It
+should be emphasized, however, that hereditary weakness does not
+inevitably lead to disease. Many persons have succeeded in preventing
+the development of active disease by guarding against strain in
+directions where they are weak by inheritance.
+
+Of all tissue weaknesses that may be inherited, defects of the nervous
+system are the most serious. Nervous disorders of every degree of
+severity, from slight nervous instability even to insanity, may result
+when these tissues are defective; but it is now a recognized fact that
+nervous disorders in many cases can be prevented from developing.
+Feeblemindedness, another condition due to defective tissue, is known to
+be inherited in the majority of cases, and in all cases it is incurable.
+
+
+HYGIENE OF ENVIRONMENT AND PERSON
+
+By environment is meant everything outside the body that affects it;
+taken in its complete meaning the word might include everything that is
+or ever was in the whole universe. It is possible to consider here a few
+only of the many environmental and personal factors affecting the health
+of individuals.
+
+The home constitutes the important part of environment for most persons,
+and for children in particular, since they spend the greater part of
+their time in or about it, and get there the foundation on which their
+health in later years depends. For persons employed away from home,
+industrial and occupational hygiene is hardly less important; but those
+subjects are too extensive to be considered here.
+
+Most people live where they must, and few have any part in planning the
+construction of their own houses. In choosing a house, however, one
+should remember that rooms where sunshine never enters are unfit for
+continued occupation. For children in particular fresh air and sunshine
+are essential, and it may be economy in the end to pay a comparatively
+high rent for an apartment having sunshine during at least a part of the
+day. Ignorance and carelessness, unfortunately, can spoil the best
+living conditions, and sometimes even in the country fresh air and
+sunshine are excluded from sleeping and living rooms.
+
+VENTILATION.--Ventilation has a direct bearing on health, although,
+contrary to former belief, the actual amount of oxygen in the air is not
+ordinarily the most important factor; even badly ventilated rooms
+contain more than enough oxygen to support life. The factors of prime
+importance in ventilation are temperature, humidity, air movement, and
+the number of persons in a given space since the greater the distance
+from one another the less is the probability that diseases will be
+spread.
+
+Room temperature should not be above 70° F. and, except for the aged or
+sick, it is better to be between 60° and 65°. Some moisture in the air
+is desirable; the amount needed is from 50% to 55% of the total moisture
+that the air can hold at a given temperature. We have no apparatus to
+decrease humidity in the air of houses, and in summer we are obliged to
+endure humidity, if excessive, no matter how uncomfortable we may be.
+But in winter the air in most houses is too dry, so that the mucous
+membranes of the nose and throat often become irritated and susceptible
+to infection. Most heating systems, particularly in small buildings,
+make no provision for supplying moisture. Keeping water in open dishes
+on or near radiators is often recommended, and would greatly improve the
+condition of the air, if people remembered to keep the dishes filled.
+
+The following is a simple but effective device to increase humidity:
+Roll an ordinary desk blotter into a cone about 8 inches in diameter at
+the base, and keep it constantly submerged for about one inch in a dish
+of water. The water rises to the top of the blotter and a large surface
+for evaporation is thus afforded.
+
+[Illustration: FIG. 7.]
+
+Stagnant air is harmful. Air should be in constant though not
+necessarily perceptible motion. Air about the body, if motionless, acts
+like a warm moist blanket, preventing the passage of heat from the body.
+
+The three factors, heating, humidity, and air motion, must be considered
+together. Every person requires each hour about 3000 cubic feet of air,
+and the problem of heating and ventilating is that of providing this
+amount in gentle motion, at a temperature of about 65° F., and of
+humidity from 50-55%. Higher temperatures and stagnant air cause
+disinclination to work, headache, nausea, restlessness, or sleepiness,
+and if continued are likely to result in loss of appetite, and anemia.
+The tuberculosis movement has clearly shown the benefits both for the
+sick and the well of living in the open air, and has caused great and
+beneficial changes within a generation. The more time spent in the open
+air the better; since however most persons who work must spend the
+greater part of the day indoors, ventilation is a matter of great
+importance.
+
+Although fresh air enthusiasts are still too few, yet some go to the
+extreme and think that because cool air in motion is good, the colder
+the air and more violent the motion the better. On the contrary,
+chilling the whole body or a part of the body lowers resistance.
+Draughts of air have no bad effects upon persons in good health,
+particularly those accustomed to changes in temperature. But draughts
+are likely to be injurious to aged or sick persons and babies, by
+diminishing their resistance to such infections as common colds and
+pneumonia. It should be remembered that draughts or cold alone cannot
+cause colds; the specific germs must be present.
+
+LIGHTING.--Amount and direction of light are physiologically important.
+Defects of the eyes, too prolonged use, and insufficient light are the
+commonest causes of eye strain. Most eye defects can be relieved by
+glasses. Children's eyes should be examined upon entering school, and as
+often afterward as the oculist advises. Prolonged use causes fatigue of
+the eyes, especially when the illumination is poor; within limits, the
+amount of light needed depends on the nature of the work. Light should
+come from the left side of right handed people; never from the front.
+Light reflected from snow, sand, glazed white paper of books, or other
+bright surfaces is fatiguing from its intensity, and from the unusual
+angle at which it enters the eyes. Too much light is harmful, and
+probably causes some of the effects, such as nausea and headache,
+commonly attributed to poor ventilation.
+
+Almost all blindness is preventable, and blindness due to industrial
+accidents and processes is no exception to this rule. Surely no
+individual precautions or legal measures are too great in order to guard
+against this saddest of all physical defects.
+
+CLEANLINESS OF HOUSES.--A clean, well-cared for house is desirable from
+every point of view, but certain kinds of cleanliness affect health more
+than others.
+
+The most scrupulous care should be exercised wherever food is stored or
+prepared. The kitchen is in reality a laboratory; in it either
+intelligently or ignorantly are formed chemical compounds which have a
+far-reaching effect upon family health. From the standpoint of health no
+other room in the house is so important. It should be bright, airy, and
+easy to clean. In cleaning kitchen tables and woodwork water should not
+be allowed to soak into cracks and dark corners, carrying with it
+particles of food for the nourishment of bacteria and insects. Linoleum,
+if used to cover the floor, should be well fitted at the edges to
+prevent water from running underneath. There should be neither cracks
+nor crevices in wall or floor, and no dark corners or out-of-the-way
+cupboards in which dust, food particles, and moisture can accumulate.
+Such conditions not only attract mice and roaches, but furnish favorable
+soil for the development of moulds and fungi which by their growth
+affect food deleteriously. Waging a constant warfare against the
+development of bacteria constitutes a large part of good housekeeping.
+
+All cooking utensils should be thoroughly washed, scalded, and dried
+before they are put away; the use of carelessly washed dishes is bad.
+Enameled or agate ware which has begun to chip should be discarded.
+Dish-cloths and towels should be washed and boiled after using, and if
+possible dried in the sun.
+
+Every place in which food is kept should have constant care. The
+refrigerator is particularly important. Its linings should be
+water-tight, and the drain freely open at all times; otherwise the
+surrounding wood will become foul and saturated with drainings. At least
+once a week it should be entirely emptied and cleaned in the following
+way: The racks should be thoroughly washed in hot soapsuds to which a
+small amount of washing soda has been added, rinsed in boiling water,
+dried and placed in the sun and air. All parts of the refrigerator
+should be washed in the same manner, especially grooves and projections
+where food or dirt may lodge. The drainpipe should be flushed, the whole
+interior rinsed again with plain hot water, thoroughly dried with a
+clean cloth, and left to air for at least an hour. The drainage pan
+should be washed and scalded frequently. Food showing the slightest
+evidence of spoiling should be removed from the refrigerator at once.
+
+Even more attention should be paid to the hands of the cook. They should
+be washed always before handling food, and always after visiting the
+toilet, using the handkerchief, or otherwise coming in contact with
+nose, mouth, or other bodily secretions. Theoretically coughing and
+sneezing ought not to occur in the neighborhood of food, especially of
+food to be eaten raw; and persons with coughs, colds, or other
+communicable disease, however slight, ought not to handle food. If this
+rule were observed in practice, more persons would go hungry, but fewer
+would be sick.
+
+Thorough cleaning of rooms involves soap, water, sunshine, air, and
+elbow grease, just as it did before germs were discovered. Cleaning
+means actually removing dirt and dust, not merely stirring it up to
+settle again; consequently dry sweeping and dusting are ineffectual.
+Vacuum cleaning, and sweeping and dusting with damp or "dustless" mops
+and dusters are good. Deodorants and disinfectants do not take the place
+of ordinary cleanliness.
+
+Dust does not carry living disease germs to an appreciable extent; the
+fact is now well established that diseases formerly thought to be
+transmitted by dust or even supposed to travel directly through the air,
+are carried on tiny particles of moisture and mucus expelled in coughing
+and sneezing. This mode of transmission is called droplet or spray
+infection; it is one of the most active agents in spreading certain
+kinds of communicable diseases.
+
+Nevertheless dust in motion is harmful; it irritates the lining
+membranes of the nose, throat, bronchial tubes, and lungs, even causing
+tiny wounds through which disease germs enter. Thus tuberculosis is
+especially prevalent among stone cutters, felt workers, and others
+engaged in dusty trades. Metallic dust is especially harmful, because it
+is harder and sharper than dust from organic substances like wool and
+cotton. Furthermore, presence of dust indicates a low standard of
+cleanliness. People who tolerate it generally tolerate uncleanliness in
+other forms, more serious though less apparent.
+
+Cleaning would not be so great a problem if most houses were not
+littered with such dust catchers as carpets, so-called ornaments, carved
+and upholstered furniture, banners, draperies, and a vast collection of
+articles that can only be classified as Christmas presents. In actual
+practice things that are difficult or expensive to clean seldom are
+cleaned; carpets for example are considered unhygienic, not because they
+cannot be cleaned, but because they are not. William Morris' advice to
+exclude from houses all articles not known to be useful or believed to
+be beautiful would, if followed, add years to the lives of housekeepers.
+
+GARBAGE, has little bearing on health, except in so far as it affords a
+breeding place for flies. If it contains disease germs it may be
+dangerous, but statistics show that garbage handlers, although they can
+hardly be called especially careful, are not more subject to sickness
+than other men of their class. Garbage disposal is chiefly a question of
+preventing a public nuisance; it is a matter of cleanliness and public
+decency.
+
+INSECTS.--Flies, cockroaches, and other scavenging insects may carry
+disease germs on their feet and thus infect food on which they walk.
+Typhoid, cholera, dysentery, and other diseases have been carried by
+flies. Flies are always a menace, and should not be tolerated; moreover,
+the thought of their coming to food directly from manure piles and privy
+vaults is disgusting. Houses should be thoroughly screened in the fly
+season, but it is better to destroy the nuisance at its source. The
+chief breeding places of flies are garbage cans and manure piles. If
+the garbage can is water tight, closely covered, frequently emptied, and
+thoroughly cleaned, flies will not develop in it; about ten days must
+elapse from the time when the egg is laid until the insect is ready to
+fly. Fly traps to fit on the garbage can are useful. Manure should be
+screened and removed frequently, or it can be treated chemically.
+Methods for treating it are given in "Preventive Medicine and
+Hygiene."--Rosenau, p. 255, and in Bulletin No. 118, of the U. S. Dept.
+of Agriculture, July 14, 1914.
+
+[Illustration: FIG. 8.--A FLY WITH GERMS (GREATLY MAGNIFIED) ON ITS
+LEGS. (_U. S. Dept. Agri._)]
+
+Other diseases carried by insects are malaria and yellow fever, each by
+a special species of mosquito; typhus fever, by lice; and bubonic
+plague, by rat fleas. Various diseases less common in this country are
+carried by other insects. Even when mosquitoes are not carrying disease
+germs their bites may be harmful since they are often rubbed, especially
+by children, until the skin is broken, and various infections may enter
+through the wounds. Insects of every kind, rats, mice, and vermin should
+be excluded from houses.
+
+SEWAGE.--Discharges from the bowels and bladder contain various germs,
+and constitute one of the most important routes by which germs of
+typhoid fever, cholera and certain other diseases travel from person to
+person. Keeping sewage out of the water supply is consequently of great
+importance. Where a system of sewage disposal exists, the responsibility
+of making the system adequate and thus safeguarding public health rests
+upon the community as a whole. Communities ordinarily get just as much,
+or just as little typhoid fever as they are willing to endure.
+
+[Illustration: FIG. 9.--HOW A WELL MAY BE POLLUTED. (_From "The Human
+Mechanism."_ Copyright by Theodore Hough and William T. Sedgwick. Ginn
+and Company, publishers. Used by permission.)]
+
+In places having no system of drainage privies must be used. They can be
+made harmless, as army camps prove, but they require scrupulous care.
+Fecal matter must be prevented from draining into wells and other water
+supplies, and must be screened from flies. The privy should be located
+at a distance from the well. The minimum distance that is safe depends
+in each case upon the nature of the soil and the direction of the
+natural drainage. Even when the privy is situated below the well on
+sloping ground, drainage may still occur from the privy to the well;
+however, a well-made, properly located pit privy is safe unless it is
+near a limestone formation. The dry earth system is satisfactory in
+places having an efficient public scavenger system; in this system pails
+or cans are used to receive the discharges, which are then covered with
+sand, ashes, earth or, preferably, chloride of lime. The buckets are
+frequently emptied and the contents buried at least one foot below the
+surface of the ground. The objection to this method for more extended
+use is that proper care of the cans is a disagreeable duty of which most
+households soon tire.
+
+PERSONAL CLEANLINESS.--The main functions of the skin are three: to
+protect underlying tissues, to excrete waste matter, and to regulate
+bodily heat by checking or allowing the evaporation of perspiration.
+After perspiration has evaporated solid matter is left upon the skin,
+and oily matter also is deposited on it by the glands that keep the
+skin lubricated. Removing these and other materials at least once a day
+is desirable to improve the bodily tone and sense of well-being. Real
+cleanliness is impossible without frequent use of warm water and soap.
+
+Cold baths are stimulating, though not very efficacious for cleansing
+purposes. They are valuable tonics if properly used, but delicate or
+elderly persons should use them only by a physician's advice. Chilly
+feelings or depression following should be the signal for any person to
+discontinue cold bathing or swimming in cold water.
+
+Warm baths are soothing in their effects, and are appropriate at bed
+time, particularly for persons inclined to sleeplessness. Very hot
+baths, especially if prolonged, may be harmful, and should not be taken
+often.
+
+There is no clear connection between general cleanliness and disease.
+Frequent bathing does not protect a person from any particular disease,
+except in so far as bathing necessarily includes washing the hands. If
+typhoid germs for example have actually been swallowed, a clean bodily
+exterior is of no avail in preventing typhoid fever or in diminishing
+its severity. The same is true of other diseases.
+
+But it is impossible to emphasize unduly the importance of clean hands.
+Hands are prime offenders in distributing fresh bodily secretions, and
+germs both innocent and harmful. All health authorities agree on this
+point.
+
+      "Perhaps 90% of all infections are taken into the body
+      through the mouth. They reach the mouth in water, food,
+      fingers, dust, and upon the innumerable objects that are
+      sometimes placed in the mouth. The fact that the great
+      majority of infections are taken by way of the mouth gives
+      scientific direction to personal hygiene. Sanitary habits
+      demand that the hands should be washed after defecation and
+      again before eating, and fingers should be kept away from
+      the mouth and nose, and that no unnecessary objects should
+      be mouthed. All food and drink should be clean or
+      thoroughly cooked. These simple precautions alone would
+      prevent many a case of infection."--(Rosenau: Preventive
+      Medicine and Hygiene, p. 366.)
+
+As Dr. Chapin says:
+
+      "Probably the chief vehicle for the conveyance of nasal and
+      oral secretion from one to another is the fingers. If one
+      takes the trouble to watch for a short time his neighbors,
+      or even himself, unless he has been particularly trained in
+      such matters, he will be surprised to note the number of
+      times that the fingers go to the mouth and the nose. Not
+      only is the saliva made use of for a great variety of
+      purposes, and numberless articles are for one reason or
+      another placed in the mouth, but for no reason whatever,
+      and all unconsciously, the fingers are with great frequency
+      raised to the lips or the nose. Who can doubt that if the
+      salivary glands secreted indigo the fingers would
+      continually be stained a deep blue, and who can doubt that
+      if the nasal and oral secretions contain the germs of
+      disease these germs will be almost as constantly found upon
+      the fingers? All successful commerce is reciprocal, and in
+      this universal trade in human saliva the fingers not only
+      bring foreign secretions to the mouth of their owner, but
+      there exchanging them for his own, distribute the latter to
+      everything that the hand touches. This happens not once,
+      but scores and hundreds of times during the day's round of
+      the individual. The cook spreads his saliva on the muffins
+      and rolls, the waitress infects the glasses and spoons, the
+      moistened fingers of the peddler arrange his fruit, the
+      thumb of the milkman is in his measure, the reader moistens
+      the pages of his book, the conductor his transfer tickets,
+      the "lady" the fingers of her glove. Every one is busily
+      engaged in this distribution of saliva, so that the end of
+      each day finds this secretion freely distributed on the
+      doors, window sills, furniture and playthings in the home,
+      the straps of trolley cars, the rails and counter and desks
+      of shops and public buildings, and indeed upon everything
+      that the hands of man touch. What avails it if the
+      pathogens do die quickly? A fresh supply is furnished each
+      day."--(Chapin: The Sources and Modes of Infection, p.
+      188.)
+
+ORAL HYGIENE.--Cleanliness and proper care of the mouth and teeth can
+hardly be over emphasized. Their bearing upon health is direct. Long ago
+it was recognized that persons with decayed or missing teeth frequently
+suffered from dyspepsia, a natural result of inability to masticate
+properly, but only within recent years has it been realized that decayed
+teeth give rise to many other diseased conditions. Bacteria are
+constantly present in the mouth. If the mucus of the mouth is not
+removed, it forms a sticky coat upon the surfaces of the teeth and gums.
+In this bacteria collect, and pus or matter may also be formed, which,
+if carried by the blood to other parts of the body, may cause digestive
+troubles, rheumatism, and diseases of heart and kidneys. (See Dr. T. B.
+Hartzell, Health News, Oct., 1915, "The Importance of Mouth Hygiene and
+How to Practise it.")
+
+To keep the mouth and teeth healthy they must have:
+
+1. Proper use.
+
+2. Proper care.
+
+3. Proper treatment.
+
+1. Teeth, like other parts of the body, need exercise. Foods that
+require a considerable amount of chewing should be included in the diet.
+Such food is needed by children as soon as their first teeth have come,
+but care must be exercised to see that the food is actually chewed
+before it is swallowed.
+
+2. A good brush should be provided. The stiffness of the bristles should
+be regulated according to the individual. The brush should be
+thoroughly rinsed after using, and discarded as soon as it is worn.
+Dental floss is generally needed to remove particles that have lodged
+between the teeth.
+
+Brushing the teeth by passing the bristles across them is not
+efficacious. They should be brushed not across but with the cracks, as a
+good housewife sweeps a floor.
+
+      "In the light of recent investigation conducted by some of
+      the leading students of mouth hygiene, the most effective
+      way to use the toothbrush is to place the bristles of the
+      brush firmly against the teeth, applying firm pressure, as
+      though trying to force the bristles between the teeth,
+      using a slight rotary or scrubbing motion.... After a
+      little practice the user of this method will be surprised
+      at the results obtained. Care should be used to go over all
+      the surfaces of the teeth in this manner."--(See Dr. W. G.
+      Ebersole. "The Importance of Mouth Hygiene and How to
+      Practice it," Health News, Oct., 1915.)
+
+After brushing the teeth, the mouth should be rinsed by forcing lukewarm
+water about the teeth, using all the force that can be brought to bear
+by the cheeks, lips, and tongue.
+
+3. TREATMENT.--The teeth, including the first teeth of children, should
+be inspected by a competent dentist at least twice a year. Periodic
+cleansing by a dentist, and early attention to small cavities, may
+prevent serious ill health and impairment of the body, as well as the
+acute suffering generally accompanying treatment of advanced dental
+defects.
+
+CLOTHING.--Clothing was originally used for purposes of ornament. Desire
+for protection from cold and dampness came later. The amount of clothing
+required varies greatly according to individual needs and habits, but it
+is increasingly recognized that light clothing is best, provided that
+the wearer is really protected from cold. Clothing should be porous in
+order to allow ventilation of the body, supported so far as possible
+from the shoulders, and clean and well aired. Dampness favors the growth
+of germs which may cause irritation of the skin.
+
+Clothing should not constrict the body or hamper its movements. Perhaps
+the worst health menace for which clothing is to blame comes from the
+high heeled shoes on which many women prefer to limp through life. From
+the health standpoint shoes are of great importance. Bad shoes are
+responsible for many cases of flat feet, whose muscles have degenerated
+through non-use, and for much so-called "rheumatism," which is merely
+the protest of abused muscles. Bad shoes also, by distorting the feet,
+prevent comfortable walking, which is the only out-of-door exercise
+readily available for the vast majority of people; and still worse, the
+resulting unnatural position of the body sometimes has serious
+consequences by bringing injurious strains on other muscles and organs.
+
+FOOD.--Two distinct problems are encountered here: the problem of
+nutrition, and the problem of preventing sickness. Nutrition, or proper
+feeding, is a subject beyond the scope of this book; it is nevertheless
+one of the most important, if not the most important, factor in
+maintaining health. Food preparation and care of children, the two most
+important functions of the home, are unfortunately relegated to the
+least intelligent and least interested members of most households in
+which servants are employed.
+
+Most American families eat too much protein food, such as meat and eggs.
+Excess of protein probably leads to degeneration of tissues, and plays a
+part in causing the degenerative diseases already mentioned. Habit is
+important here as in other ways of living, but cereals and vegetables
+should in large measure make up the diet of sedentary persons and indeed
+of everyone in warm weather.
+
+The amount of food required in 24 hours depends on many factors: age,
+height, weight, occupation, season, and habit. Underweight and
+overweight are both abnormal conditions; probably the latter is the more
+easily remedied. Both require the advice of a physician. Rapid reduction
+of weight involves certain dangers, especially for persons with weak
+hearts.
+
+Food may cause sickness either because it is in itself harmful, or
+because it carries disease germs. Meat from diseased animals should be
+destroyed before it reaches the market, but bacterial activities in food
+originally wholesome may form in it poisonous substances.
+
+The chief diseases known to be carried by food, water, or milk are
+typhoid fever, paratyphoid, dysentery and other diarrhœal diseases,
+scarlet fever, diphtheria, septic sore throat, and tuberculosis. The
+sole problem here is to keep human and animal excretions out of food,
+water, and milk. Since thorough cooking kills disease germs, danger
+arises chiefly from raw foods. All fruits and vegetables eaten raw
+should first be thoroughly washed.
+
+Water is essential to health. At least three pints should be taken
+daily, the amount varying somewhat according to diet, exercise,
+temperature, and so forth. Most persons drink too little water.
+
+Cities and towns should of course have public supplies of pure water.
+Contamination of water, when it occurs, is caused chiefly by sewage
+from cesspools, privies, and drains. All well or spring water must be
+constantly watched and Boards of Health are always ready to examine
+samples of water and to report whether it is safe to drink. At the
+present time a porcelain filter is the only satisfactory kind for a
+household, but many domestic filters are so badly cared for that in
+actual practice they are worse than none. Danger from a filter
+containing an accumulation of impurities is greater than the danger from
+most ordinary water supplies. Boiling water for ten minutes kills all
+pathogenic germs, but this method is inconvenient on a large scale and
+is not practical for continued family use.
+
+Every effort should be made to insure a regular supply of pure water in
+every house. It is not satisfactory to have two kinds, one for drinking
+and one for other purposes, since mistakes are sure to be made,
+especially by children. Some families who use only bottled or filtered
+water for drinking purposes habitually run the risk involved in using
+impure water from the tap for cleaning the teeth.
+
+Freezing destroys most germs, but ice is not necessarily free from
+bacterial life, and should be used in drinking water only when known to
+be free from impurities. Neither does freezing milk or cream
+necessarily kill germs that may be contained in it.
+
+Raw milk plays so important a part in the spread of disease that its
+fitness for human consumption is open to serious question. Certified
+milk, where obtainable, is safe but expensive. Boiled milk is safe, but
+changed in taste and to some extent in quality. If milk is heated to
+142°-145° F. and kept at that temperature for 30 minutes all disease
+germs in it are killed. This process, called pasteurization, renders
+milk safe. The objection is sometimes made that continued use of
+pasteurized milk for infants causes scurvy, but in New York City where
+over 90 per cent. of the milk is pasteurized no increase in scurvy has
+been noticed, while a large diminution in deaths of infants from
+diarrhœal diseases has resulted, as in all cities where pasteurization
+is required.
+
+The following is a simple method for pasteurizing a quart bottle of
+milk. If the directions are exactly followed the milk will be
+pasteurized at the end of the process; no thermometer need be used. To
+prevent the bottle from breaking, it is first warmed by placing it for a
+few minutes in a pail of warm water.
+
+      "From the results of the experiments it was concluded that
+      any housewife can pasteurize a one quart bottle of milk by:
+
+      1. Boiling 2½ quarts of water in a large agate saucepan; or
+      better
+
+      2. Boiling 2 quarts of water in a 10 pound tin lard pail,
+      placing the slightly warmed bottle from the ice chest in
+      it, covering with a cloth and setting in a warm place. At
+      the end of one hour the bottle of milk should be removed
+      and chilled promptly. The water must be boiled in the
+      container in which the pasteurization is to be
+      done."--(Ruth Vories, in "Health News," Sept., 1916.)
+
+ELIMINATION.--Careful attention should be paid to elimination through
+the bowels and kidneys. Constipation is responsible for many common
+ailments; among them are headache, disinclination to work, irritable
+temper, and lowered resistance. If long continued, constipation becomes
+serious both from congestion and displacement of pelvic organs, and from
+absorption over a considerable time of even small amounts of the
+poisonous substances resulting from decomposition of food in the large
+intestine. The bowels can best be regulated by diet, water, exercise,
+and habit. The habitual use of cathartic and laxative drugs is most
+unwise, because they tend to aggravate the trouble. Moreover the
+habitual and continued use of injections and "internal baths" is
+harmful, and would not be considered necessary if bran and coarse flour
+and vegetables were substituted for concentrated foods. Greed, laziness,
+and lack of intelligence lead most persons suffering with constipation
+to prefer pills to the restraints demanded by hygienic living. The habit
+of evacuating the bowels at a regular time, if established in early
+childhood and rigidly adhered to, will prevent constipation among most
+healthy people. Any person who thinks drugs necessary should consult a
+physician, and be prepared to follow the régime he advises over a
+considerable period of time and at the cost of some self-denial.
+
+For healthy people, voiding urine presents no difficulty if a sufficient
+amount of water is taken; but some persons reduce the amount of liquid
+taken in order to escape the inconvenience of urination. This practice
+is harmful, and may involve insufficient cleansing of the entire system.
+If frequent urination disturbs sleep, liquids may be withheld during the
+evening; but the total amount of water taken in 24 hours should not be
+diminished.
+
+REST AND FATIGUE.--A fatigued person is a poisoned person. Muscular
+exertion burns the fuel constituents of the body, as we recognize by the
+greater heat generated within us during muscular exertion. Waste
+products, resulting from this burning process, accumulate if not
+removed, and clog the body in somewhat the same way that ashes and
+cinders clog a furnace. The fatigued person remains fatigued,
+consequently, until the accumulations of waste matter are removed by the
+normal action of the lungs, skin, and kidneys.
+
+Fatigue is caused by both mental and physical work, and when excessive,
+affects the nervous system most disastrously. The body can and should
+respond to occasional extra drafts on strength and endurance; its
+flexibility and power of adjusting to varying conditions may even be
+stimulated thereby. But even slight fatigue, if continued and especially
+if associated with anxiety or worry, has caused many nervous and mental
+breakdowns.
+
+Work carried beyond the point of normal fatigue requires a
+proportionately longer time for recovery. For example, if the point of
+fatigue has been reached by a certain finger muscle after 15
+contractions, and if half an hour is required to rest it completely, one
+might suppose that one hour would rest it after 30 contractions. This is
+not so, however; after 30 contractions 2 hours are required, or 4 times
+as much rest for twice the amount of work, if continued beyond the point
+of fatigue. Laboratory experiments and experience alike show that this
+principle holds true in other forms of fatigue. Thus the output of
+factories has been shown in many instances to be greater, other things
+being equal, when operatives work 8 hours a day than when they work
+longer. Excessive hours in any kind of work are the poorest economy.
+
+Fatigue is increased in direct proportion not only to muscular exertion
+but also to the amount of speed, complexity, responsibility, monotony,
+noise, and confusion involved in an occupation. Ability to bear fatigue
+differs greatly with different people, as ability varies to bear other
+kinds of strain. Rest at night and on Sunday, and the annual vacation
+should be enough to keep a person in good condition. If not, there is
+probably something wrong with the worker's health, the nature of his
+work, or his adaptation to his particular kind of work. This statement
+is not only true of persons regularly employed, but of those living at
+home, including children in school, women in "society," and especially
+mothers of families.
+
+SLEEP.--A sufficient amount of sleep is essential to health, but
+individual requirements vary widely. Each person should know and regard
+his own need, and children and young people should be obliged to go to
+bed early. Ability to sleep is largely habit; good habits should be
+formed and continued. Sleep-producing drugs should never be taken,
+except by a doctor's prescription.
+
+RECREATION.--Owing to the speed, complexity, and worry of modern life
+among all classes, and to the monotony of work in industry, recreation
+has become a matter of vital importance for everyone. Some muscular
+activity, preferably in the open air, is needed by every healthy person.
+Recreation should be as unlike the regular occupation as possible: going
+to the theatre, for example, is not the best exercise for sedentary
+workers employed all day in artificially lighted offices. The element of
+pleasure is essential. Hoisting dumb-bells purely from conscientious
+motives is seldom beneficial, and is generally soon abandoned.
+
+The part played by habit in matters of health is often overlooked.
+Although the body adjusts itself to widely varying conditions and even
+to unfavorable ones, the importance of forming desirable habits cannot
+be overemphasized. Sudden or radical changes in living, however,
+particularly among people no longer young, may play havoc. New and
+violent systems of exercise, weight reduction, and food fads forced on
+families by enthusiastic discoverers involve considerable risk.
+
+Many elements enter into health; in no single one is found hygienic
+salvation. Temptation always exists to emphasize one element at the
+expense of others. For instance, people who insist upon overventilating
+rooms regardless of others' comfort may themselves be utterly careless
+in regard to necessary sleep, and more than one fastidiously clean
+person has disregarded the highly unclean condition of constipation. To
+maintain sound health only a rational program will suffice: properly
+balanced work and play, sleep and food and all other elements must be
+included in due proportion. And over-anxious health seekers might well
+remember that health is not so much an end in itself, as a means to a
+happy and productive life; even in concern over health, it is possible
+for him that saveth his life to lose it.
+
+
+EXERCISES
+
+1. Explain the difference between an hereditary disease and hereditary
+susceptibility to a disease. How may hereditary susceptibility to a
+disease be combatted?
+
+2. What are the essentials of good ventilation?
+
+3. What is the proper temperature for a living room? What are the
+effects of higher temperatures? Of lower temperatures?
+
+4. Describe methods for maintaining household cleanliness.
+
+5. Discuss the importance from the point of view of health, of dust; of
+insects; of garbage; of sewage.
+
+6. What principles should guide one in deciding whether a certain water
+supply is safe to use for drinking purposes? What are the dangers of
+impure water? How can impure water be rendered safe?
+
+7. What diseases may be carried by milk? How can milk be rendered safe?
+
+8. Explain the health aspects of personal cleanliness.
+
+9. What care should be given the teeth and mouth? Why?
+
+10. What bad results frequently follow constipation? How should
+constipation be remedied?
+
+11. Name seven factors that are important in causing fatigue. Why is it
+uneconomical to continue work, either physical or mental, beyond the
+point of fatigue?
+
+12. What facilities for recreation, especially in the open air, does
+your community provide for little children? For school children? For
+working boys and girls? For grown people?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Introduction and Chapters I, III-V,
+VII-IX.
+
+How to Live--Fisher and Fisk, Chapters I, III-V.
+
+The Human Mechanism--Hough and Sedgwick, Chapters V, XXII-XXIX.
+
+Disease and Its Causes--Councilman, Chapters X, XII.
+
+Fatigue and Efficiency--Goldmark, Chapters II, III.
+
+Preventive Medicine and Hygiene--Rosenau.
+
+A Manual of Personal Hygiene--6th Edition, Edited by Walter L. Pyle.
+
+Four Epochs of a Woman's Life--Galbraith.
+
+Hygiene and Physical Culture for Women--Galbraith.
+
+The Home and Its Management--Kittredge.
+
+Exercise and Health--F. C. Smith, Supplement 24 to the Public Health
+Reports, Government Printing Office, Washington.
+
+The Sanitary Privy--Farmers' Bulletin 463, United States Department of
+Agriculture, Government Printing Office, Washington.
+
+Safe Disposal of Human Excreta at Unsewered Homes--Lumsden, Stiles and
+Freeman, Bulletin 68, Public Health Reports, Government Printing Office,
+Washington.
+
+The Disposal of Human Excreta and Sewage of the Country Home--New York
+State Department of Health, Albany.
+
+Milk and Its Relation to Public Health--Bulletin 56, Hygienic
+Laboratory, Government Printing Office, Washington.
+
+Milk and Its Relation to Health--New York State Department of Health,
+Albany.
+
+Other Publications of the United States Public Health Service and of the
+Departments of Health of the different states and cities.
+
+
+
+
+CHAPTER III
+
+BABIES AND THEIR CARE
+
+
+The principles of hygiene are fundamentally the same for young and old.
+The applications, however, differ at different ages. From the time when
+physical growth and development are complete until changes due to old
+age appear, an individual commonly has greater resistance than at other
+ages, and is able in consequence to endure unfavorable conditions of
+life with more success.
+
+Babies, on the other hand, are exceedingly sensitive to their
+environment. Surroundings that are even slightly unfavorable are likely
+to make babies sick. In order to remain healthy, they must have exactly
+the right kind of food, in the right quantities and at the right times;
+their sleep, exercise, and clothing must be carefully regulated; they
+must be protected from careless handling, from nervous strain, and above
+all, from the many kinds of infection to which they are peculiarly
+susceptible. The life of a baby fortunately can be controlled almost
+completely; when properly regulated it offers, therefore, an unequalled
+opportunity to see how hygienic principles work out in actual practice.
+
+The primitive mother's instinct to nourish and protect and succor her
+helpless child was the original form of nursing. Instinct alone,
+unfortunately, has never accomplished much in preserving health. The
+human race has now had an experience in the care of infants that extends
+over thousands of years. Yet today we are still, on the whole, less
+successful in keeping babies alive than we are in raising domestic
+animals; we still allow society to continue, like a modern Herod, in its
+ruthless career of slaughtering the innocents.
+
+About 14 babies out of every 100 born in the registration area[1] of the
+United States die before reaching the age of one year, while in some of
+our industrial cities as many as 25 out of every 100 born die before
+they are a year old. Most of these deaths are preventable. Thus, in a
+few American cities, the death rates have been so reduced that fewer
+than 10 babies out of every 100 die before completing the first year;
+while in Dunedin, New Zealand, as a result of the work of the Society
+for the Health of Women and Children, the infant death rate has been so
+reduced that in 1912 only about 4 out of every 100 babies died before
+they were a year old.
+
+While ignorant mothers, who may or may not be uneducated women, and
+contaminated milk, are as a matter of fact, chiefly responsible for our
+high infant death rates, yet as we have already seen, every factor in
+the environment has its effect upon a baby. This fact has led Sir Arthur
+Newsholme, an eminent English authority, to say:
+
+      "Infant Mortality is the most sensitive index we possess of
+      social welfare. If babies were well born and well cared
+      for, their mortality would be negligible. The infant death
+      rate measures the intelligence, health, and right living of
+      fathers and mothers, the standards of morals and sanitation
+      of communities and governments, the efficiency of
+      physicians, nurses, health officers, and educators."
+
+Care of the child should begin at the earliest possible moment: that is,
+nearly nine months before he is born. Care before birth, for want of a
+better name, is called prenatal care of the mother. Every woman who
+thinks that she is pregnant should put herself at once under the care of
+a competent physician, so that he can make the necessary examinations as
+early as possible. If she follows his advice in regard to hygiene and
+proper regulation of her life, she may be free from anxiety, and may
+justly expect that her delivery will be a safe and normal process.
+
+A demonstration of the value of prenatal care was recently made by the
+Boston District Nursing Association. During the year 1915 prenatal care
+was given to 751 expectant mothers in 5 wards of the city; each woman
+attended a pregnancy clinic, where she was under the care of an
+experienced obstetrician, and was visited at intervals by a nurse who
+kept careful watch of her general condition and gave necessary advice
+and encouragement. In consequence the death rate among the babies whose
+mothers had prenatal care was only half as great, through the whole
+first year of life, as the death rate of babies in the same wards whose
+mothers had not had prenatal care. Moreover, the rate of still-births
+was only half as great as the rate among the general population of
+Boston. If prenatal care can save so many lives, surely it ought to be
+available for every pregnant woman in the land, including even that
+generally neglected class of people who are neither very rich nor very
+poor.
+
+Each baby's birth should be recorded by the registrar of births, and
+parents should make sure that registration has been attended to in the
+city or town where they live. In some states birth registration is
+already obligatory, but in any case it is required by the child's own
+interest. For instance, in later life it may be necessary for him to
+prove the date and place of birth in order to establish, among other
+things, his right to vote and to inherit property, and to settle the
+question of his liability to military service. Moreover, complete and
+accurate birth registration is needed by every community because it is
+essential to such reforms as reducing infant mortality and abolishing
+child labor.
+
+
+GROWTH AND DEVELOPMENT
+
+Statements in regard to growth and development are based on observations
+of many children. It should be remembered that the following figures
+represent averages only, and that healthy children may vary from them
+considerably without giving cause for alarm.
+
+AVERAGE SIZE.--The average weight of a baby at birth is from 7 to 7½
+lbs. and the average length is about 20 inches, but it is not unusual
+for a child to weigh anywhere from 5 to 10 pounds at birth and to
+measure from 16 to 22 inches in length. During the first week of life a
+baby loses slightly in weight. After the first week a healthy baby
+should gain from 4 to 8 ounces a week until he is six months old; after
+that time the weekly gain is less. The weight at birth will usually
+double during the first five months, and treble during the first year.
+Consequently, a baby weighing 7 pounds at birth may be expected to weigh
+14 pounds when five months old, and 21 pounds when a year old. Weight is
+one of the most important indications of a baby's condition. He should
+be weighed every week during the first 6 months, once in two weeks
+during the second 6 months, and once a month throughout the 2nd year.
+
+MUSCULAR DEVELOPMENT.--A baby at birth is helpless, and during the first
+few months he has little muscular control. During the third month he
+ordinarily begins to lift his head, and he can usually hold it up
+without support by the time he is 3 months old; when 7 to 8 months old
+he sits erect and begins to play with toys. From this time a baby makes
+rapid progress; he attempts to stand on his feet, begins to creep, and
+by the time he is 14 months old he is usually able to stand alone, or
+even to walk a few steps. He is usually running about without difficulty
+when fifteen or sixteen months old.
+
+Babies should never be urged to walk or to bear their weight on their
+feet. If healthy they are generally eager to go about unaided, and like
+to investigate their surroundings without assistance. If walking is
+unusually delayed, a physician should be consulted.
+
+DEVELOPMENT OF SPECIAL SENSES.--A new-born baby is unable to
+distinguish objects, but the eyes are sensitive to light and need
+careful protection. Hearing, although undeveloped at birth, soon becomes
+acute; consequently the child should stay in a quiet room. When six or
+eight weeks old he notices objects, and at three months old he welcomes
+his mother when he is hungry. A month or two later he begins to
+distinguish between familiar and unfamiliar faces, and to show approval
+or disapproval.
+
+DEVELOPMENT OF SPEECH.--A baby six or seven months old begins
+consciously to utter sounds, and usually can say a few unconnected words
+by the time he is a year old. The average child, however, does not begin
+to form sentences of more than two or three words until he is about two
+years old.
+
+DEVELOPMENT OF TEETH.--The so-called milk teeth are twenty in number;
+they are followed by thirty-two permanent teeth. The two lower front
+teeth (central incisors) generally appear when a child is from five to
+nine months old, and in from one to three months later the four upper
+front teeth (upper incisors) appear. All the first or milk teeth should
+have come through by the time a child is two and a half years old, but
+wide variations occur both in the time and order of appearance and
+should occasion no uneasiness if the child seems well. Unusual
+conditions of any sort should be referred to the physician; it is a
+great mistake to attribute all illness at this time to teething.
+
+The first of the permanent teeth appear when a child is about six years
+old. Mothers sometimes mistake the first permanent molars for temporary
+teeth, a mistake that frequently leads to neglect and even extraction of
+highly important teeth. All but the last four molars, sometimes called
+wisdom teeth, should be through by the time a child is fifteen. The
+wisdom teeth may not appear before the 20th or even the 25th year.
+
+NORMAL EXCRETIONS.--A new-born baby should have one or two bowel
+movements during the first twenty-four hours; the first bowel movements
+are sticky and almost black in color. After the baby begins to nurse,
+three to four movements a day are not unusual, and throughout infancy
+and childhood as well as adult life there should be one or two
+evacuations of the bowels daily. The character of the stools is more
+important than the number. While the baby is taking milk only, the
+movements should be soft, yellow in color, and nearly odorless. Change
+in frequency of the movements, or appearance of undigested food or curds
+of milk in the stool, should be carefully noted and if continued,
+reported to a physician; they may be the first signs of serious
+digestive trouble.
+
+The urine of an infant should be odorless and colorless. It should be
+voided at least once during the first twenty-four hours, and much more
+frequently after the baby begins to nurse. Marked diminution in the
+amount of urine should be reported to a doctor.
+
+Efforts should be made early to develop habits of regularity in the
+evacuation of the bladder and bowels. If taken up regularly most
+children learn to use a chamber for bowel movements by the time they are
+three months old. Normal children, if properly trained, usually have no
+bladder discharge during the night after they are 18 months old, and
+they learn even earlier to indicate a desire to urinate during the day
+time.
+
+CLOTHING.--The amount and weight of a baby's clothing should depend upon
+the season; but garments worn next to the skin, except the diaper,
+should be wholly or partly of wool, the lightest weight in summer and
+heavier weight in winter. During the first few weeks a baby's abdomen
+should be supported by a flannel binder about six inches wide, applied
+snugly but not tightly enough to restrict either the abdomen or chest
+walls. It may be replaced later by a loosely fitting knitted band worn
+for warmth only. Such a band is especially necessary if there is
+tendency to diarrhœa, but in no case should it be discarded before
+the 18th month. All garments except the diaper and first flannel binder
+should hang from the shoulders, and should fit loosely but well.
+
+Clothing for babies should be of soft materials and should be simply
+made. Even the first clothes should not be very long. The weight of very
+long clothing is an unnecessary burden, and prevents free movements of
+the legs. At night an entire change of clothing should be made, and a
+nightgown of warmer material substituted for the petticoat and slip.
+Most children are dressed too warmly indoors, but in low temperatures
+they need to be well protected.
+
+Diapers should be soft and absorbent. It may be necessary to wash new
+diapers several times before using in order to make them soft enough.
+Care should be taken not to apply them too tightly, or in such a way as
+to cause pressure on the genitals. They should be changed during the day
+whenever wet or soiled, and at night when the baby is taken up to be
+fed. Proper care of diapers is highly important, however laborious. They
+should be well washed, boiled, and thoroughly dried before they are used
+a second time. Diapers that have been wet but not soiled should not be
+dried and used again before being washed. Much work can be saved if
+pads of loosely woven absorbent material are used inside the diaper to
+receive discharges. The pads can be burned, but even if washed the labor
+is less than washing full sized diapers. Like all other infant's
+garments, diapers should be washed with pure white soap and without
+starch. Waterproof material used to cover the diaper is almost sure to
+irritate the baby's skin, and is consequently harmful.
+
+SLEEP.--During his first few weeks a normal baby sleeps about
+nine-tenths of the time, and should be left undisturbed except for
+necessary care. He should sleep in a crib, bassinet or basket protected
+from light and drafts; in no circumstances should a baby sleep in the
+bed with his mother or any other person. Pillows are unnecessary for
+babies, and indeed for older children, but if used they should be thin
+and firm.
+
+The amount of sleep necessary gradually diminishes, but during all the
+years of growth a child needs more sleep than an adult. The amount of
+sleep required daily is approximately as follows:
+
+  First month                  18 to 20 hours
+  Second to sixth month        16 to 18 hours
+  Sixth month to one year      14 to 15 hours
+  One to two years             13 to 14 hours
+  Two to four years            11 to 12 hours
+
+After this time a child should sleep at least ten hours out of the
+twenty-four. During the first year a nap in the middle of the forenoon
+and another in the afternoon are desirable. A child who is inclined to
+sleep so long that his nap interferes with his night's sleep, should be
+waked from his nap, but at the same hour every day. When a child is a
+year old, one nap during the day is often sufficient, if he is doing
+well, but the habit of taking a nap at some time during the day should
+be continued through the fifth year if possible, or even later.
+
+Babies should not be rocked or otherwise coaxed to go to sleep; they
+should be made comfortable and then left alone. They learn to go to
+sleep by themselves as soon as they are convinced that sleep is expected
+of them, and that no unfounded objections on their part will be
+regarded. Continued inability to sleep normally usually indicates
+discomfort or poor general condition, and should be taken up with the
+doctor. Pacifiers and thumb-sucking should not be allowed, since they
+lead to changes in the shape of the jaw with resulting imperfect
+adjustment of the teeth. Soothing syrup and like medicines should never
+be given to a baby; death or permanent injury has resulted from their
+use. It is impossible to emphasize too strongly the danger of giving
+them even a single time.
+
+FRESH AIR.--All that has been said about the importance of fresh air
+for adults applies with even greater force to infants and children.
+During his first month especially a baby is susceptible to draughts;
+nevertheless, the room should be well ventilated and its temperature
+kept between 68° and 70° F. during the day, and at about 65° F. at
+night. Even in cold weather the room should be well aired two or three
+times a day; the baby should be removed to another room while the
+windows are open. After the baby is three or four months old the windows
+may be left open at night provided the outside temperature does not fall
+below freezing. A healthy baby two or three weeks old may be taken
+out-of-doors for a short time in mild weather; when he is three months
+old he may be taken out-of-doors even in winter on bright sunny days.
+The time spent out-of-doors should be gradually increased until the baby
+stays out the greater part of the day; but he should not be exposed to
+storms, wind, flying dust, dampness, extremes of temperature, or
+insects. The eyes should not be covered by veils, but they should be
+shielded from the direct rays of the sun at all times.
+
+DIET.--A baby, in order to thrive, must have suitable food, given at
+regular intervals. During the first few months of life no other food
+can take the place of mother's milk. Breast-fed babies are more robust
+than bottle-fed babies; more than this, they are less likely to contract
+infectious diseases or to suffer from digestive disorders. The number of
+bottle-fed babies who die every year is three times as great as the
+number of breast-fed babies who die. Many mothers do not understand the
+risk involved in weaning small babies; and so every year many little
+lives are lost, and lost needlessly. When poverty forces nursing mothers
+to wean their babies and seek work outside their homes, one can only say
+that a society which tolerates such a waste of infant life is indeed
+regardless of its own welfare.
+
+Special conditions, of course, may make it undesirable for a mother to
+nurse her baby. No one but the physician is competent to decide this;
+not even neighbors, grandmothers, other members of the family, or the
+mother herself. Where artificial feeding must be used, it should be
+carefully adapted to the individual child, and in consequence it must be
+prescribed by the doctor. Patent foods, notwithstanding the claims on
+their printed labels, should be used only under his advice.
+
+INTERVALS OF FEEDING.--Little milk is secreted during the first two days
+after the birth of a child. The baby should, nevertheless, be put to
+the breast as soon as he has had his first bath, if the mother is
+sufficiently rested. Always before and after nursing the mother's
+nipples should be washed in water that has been boiled. Nursing should
+be repeated at intervals of six hours during the first two days.
+
+The following schedule for the feeding of healthy babies is given by
+Holt in "Care and Feeding of Infants." (1917.)
+
+
+SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR
+
+  ------------------+--------+----------+----------+-----------+--------
+                    |        |          |          |           |
+                    |Interval|   Night  | No. of   | Quantity  |Quantity
+       Age          |between | feedings,| feedings,|  for one  | for 24
+                    |meals by|  6 p.m.  | in 24    |  feeding  | hours
+                    |  day   |    to    | hours    |           |
+                    |        |  6 a.m.  |          |           |
+  ------------------+--------+----------+----------+-----------+--------
+                    |  Hours |          |          |   Ounces  | Ounces
+  2d to 7th day     |    3   |     2    |     7    |    1-2    |  1-14
+  2d and 3d weeks   |    3   |     2    |     7    |    2-3½   | 14-24
+  4th to 6th week   |    3   |     2    |     7    |    3-4    | 21-28
+  7th week to 3 mos.|    3   |     2    |     7    |   3½-5    | 25-35
+  3 to 5 months     |    3   |     1    |     6    |   4½-6    | 27-36
+  5 to 7 months     |    3   |     1    |     6    |   5½-6½   | 33-39
+  7 to 12 months    |    4   |     1    |     5    |    7-8½   | 35-43
+  ------------------+--------+----------+----------+-----------+--------
+
+During the period when seven feedings are given in 24 hours the
+following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m.,
+6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when
+the number of feedings is reduced from seven to six. Food should be
+given on exact schedule time; the baby if asleep should be waked for
+any meal except the one due at 2 a.m.
+
+WATER.--Pure boiled water should be given regularly even to a young
+baby. He is often satisfied with a little warm water if he is fretful
+between the hours of nursing. Water may be given from a cup, a spoon, or
+a bottle; it is desirable, however, for the baby to learn to drink from
+a cup before the period of weaning begins.
+
+WEANING.--Ordinarily, a baby should be fed from the breast until he is
+seven months old, either exclusively or with the exception after the
+second month of one bottle-feeding in twenty-four hours. This exception
+will do the baby no harm and may be a great relief to his mother.
+Partial breast-feeding should continue if possible through the ninth
+month, but every baby should be entirely weaned by the time he is one
+year old. It may be necessary, if either the baby or the mother is not
+thriving, to change the food before the ninth month; but it is desirable
+not to make the change in hot weather. Healthy babies, it should be
+remembered, increase in weight constantly, and steady gain in weight is
+the best indication that a baby's food is suitable.
+
+NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy glass,
+cylindrical in shape, without angles or corners to make cleaning
+difficult. The number of bottles provided should be two or three more
+than the number of feedings given in 24 hours.
+
+Short black rubber nipples which slip over the neck of the bottles
+should be selected. They should be of such a shape that they can easily
+be turned inside out; a nipple turner costs little, and is well worth
+the price. Nipples should be discarded when they become soft or when the
+opening grows so large that the milk runs in a stream rather than drop
+by drop.
+
+As soon as the baby has finished his meal, the bottle should be removed
+from his mouth, rinsed in clear hot water, and left standing filled with
+cold water until a convenient time for boiling all the bottles to be
+used during the next 24 hours. Sufficient time must be allowed for the
+bottles to cool thoroughly between the time when they are boiled and the
+time when they are refilled. When it is time to boil the bottles they
+should be placed in an agate or other suitable kettle, covered with
+water, and boiled vigorously for three minutes. A cloth placed in the
+bottom of the kettle will help to prevent the bottles from breaking.
+After the bottles have been removed from the boiling water, they should
+be stoppered at once, either with rubber stoppers or plugs of sterile
+cotton. The stoppers, if used, should be boiled with the bottles;
+sterile cotton may be purchased by the package.
+
+An easy and satisfactory method to care for rubber nipples is the
+following: Provide as many nipples as the number of feedings given in 24
+hours, and another, if desired, to be used in case of accident; provide
+also two cups of ordinary white enamel, each one large enough to hold
+all the nipples at once. One cup should have a cover; the other should
+not. To avoid mistakes it is well to have the cups different in shape.
+As soon as each feeding is finished the nipple should be thoroughly
+cleansed under running water by scrubbing it inside and out with a
+nipple brush. The nipple thus cleansed is placed in the cup without a
+cover. When all the nipples have been used, cleansed, and collected in
+the uncovered cup, they are transferred into the other cup; water is
+added, the cup is covered and its contents are boiled for three minutes.
+The nipples remain covered in the boiled water until needed; they are
+removed one by one for the successive feedings. Care must be used in
+removing a nipple to take it by the rim, not to touch other nipples
+during the process and not to dip the fingers into the water. The best
+way is to remove them by means of a glass rod, which is boiled with the
+nipples and kept with them in the cup when not in use. There are
+several advantages of this method of caring for nipples: it is easy; it
+reduces to a minimum the necessary handling of the nipples after
+boiling; and it reduces the probability of using the wrong nipple, since
+boiled nipples are always in one kind of receptacle and used nipples in
+another. It also prevents the too common practice of continuing to keep
+nipples in a supposedly antiseptic solution long after the solution has
+become badly soiled.
+
+TABLES of diet for children over one year of age may be found in the
+Appendix, page 322.
+
+BATHING.--Usually the cord has separated and the navel has entirely
+healed by the time a baby is 10 days old. After this time a daily tub
+bath should be given; it should be given not less than one hour after
+feeding. The temperature of the room should be from 70-72°, measured by
+a thermometer placed in the part of the room where the bath is to take
+place. In order to avoid chilling or tiring the baby the bath should be
+given quickly, without confusion or interruption; success can be
+achieved by using even a moderate amount of foresight. Before undressing
+the baby everything to be used should be collected and placed within
+easy reach,--clean clothing, soft towels, 2 wash cloths, pure white
+soap, powder, absorbent cotton, etc. The bath tub should last of all be
+filled with water, and its temperature tested by means of a bath
+thermometer. The temperature of the water should be from 98° to 100°.
+After the baby is three months old slightly cooler water should be
+splashed over his chest, back, neck, and arms just after he is removed
+from the tub, and as he grows older the temperature of his cool splash
+can be reduced. Children who become accustomed to cool water in this way
+take kindly to their cold showers later.
+
+The baby's face should be washed first and dried carefully, while his
+body is still covered. Next the head should be washed; a little soap
+should be used, but it must on no account enter the eyes. Next the
+entire body should be soaped with the hand; and then the baby should be
+placed gently in the bath, his head and shoulders supported by the
+attendant's left hand and forearm. Care should be taken to rinse off all
+the soap. The baby should not stay in the tub more than 2 or 3 minutes;
+after he has been removed from the tub he should be wrapped at once in a
+soft bath towel. He should be dried gently but thoroughly by patting
+with soft, warm towels rather than by rubbing. Folds of the skin should
+be dried with special care. A little powder may be applied, but a baby
+who is kept both clean and dry will not need much powder, if any. The
+baby should next be quickly dressed, with as little turning and moving
+as possible. Clothing should be drawn on over the feet instead of over
+the head, and the petticoat should be placed inside the slip so that the
+two garments may go on simultaneously.
+
+EYES.--Secretion accumulating in the corners of a baby's eyes should be
+removed by means of a bit of absorbent cotton moistened in boiled water.
+The secretion should be wiped away gently; a different piece of cotton
+should be used for each eye, and a piece that has been used should not
+be put back into the water. Further than this, eyes in a normal
+condition do not need cleansing.
+
+Every person who handles a baby should be very sure that her hands are
+clean; she should be doubly sure before she touches his eyes, since a
+baby's eyes are peculiarly susceptible to infection from any source.
+More than a quarter of all totally blind persons in the United States
+became blind by infection of the eyes at birth. Blindness of the new
+born can be prevented in practically all cases if the doctor uses a
+preparation of silver in the baby's eyes immediately after birth. This
+treatment is effective and entirely safe.
+
+If at any time the eyelids look red or swollen, or if a drop of matter
+appears between the lids, the physician should be summoned at once.
+Total blindness may result if treatment is delayed even a few hours.
+
+MOUTH.--The mouth should be rinsed after feeding by giving the baby a
+teaspoonful of boiled water. Until the teeth come it does not require
+other cleansing, and attempts to clean it may injure the delicate
+membranes that line it. Indeed, except in an emergency, fingers should
+not be inserted into a baby's mouth. The teeth when they appear should
+be cleaned by means of a soft tooth-brush.
+
+NOSTRILS.--The nostrils need no cleaning other than removal of mucus
+that can easily be reached by means of a piece of cotton. If a little
+vaseline is placed in the nostrils on a small piece of absorbent cotton
+in the early morning, collections of mucus will usually be softened so
+that they can be removed easily at bath time.
+
+GENITAL ORGANS.--The genital organs of girl babies should be gently
+washed twice a day, using absorbent cotton, and tepid water. Treatment
+other than cleanliness is ordinarily unnecessary. Vaseline may be
+applied if the genitals are slightly reddened; any discharge or abnormal
+appearance should be reported to the doctor. In the case of boy babies
+the foreskin should be gently drawn back twice a week after immersion in
+the tub; after the parts have been gently washed with absorbent cotton,
+it should be drawn forward again. No force should be employed in
+retracting the foreskin; the physician should be consulted if it cannot
+be retracted easily.
+
+THE DEVELOPMENT OF HABITS.--During his first few months crying is a
+child's only means of expression, and he quickly learns to make
+effective use of his limited opportunities. It is important for the
+mother to distinguish between crying caused by pain, illness, or hunger,
+and crying caused by temper. These cries are more or less distinctive,
+but no one can be sure in every case just what a crying baby is
+attempting to express.
+
+A cry caused by hunger is fretful and often interrupted by sucking the
+thumb; it ceases when the child is fed. A cry caused by indigestion is
+similar; the child is relieved for a short time by feeding, but soon
+begins to cry again. If he has acute pain, such as earache, the cry is
+sharp, repeated at frequent intervals and accompanied by other symptoms
+of distress, such as restlessness, contraction of the features, and
+drawing up the legs. In serious illness the cry is usually feeble,
+fairly constant except when the child is asleep, and exaggerated by
+slight causes.
+
+A limited amount of crying is useful exercise for a baby, and should not
+distress his mother unduly. Moreover, crying may be merely the
+expression of a wish to be taken up, to be played with, carried about or
+otherwise amused, to be given a pacifier, or to be indulged in other bad
+habits. If not indulged in these ways he may cry from temper. The cry of
+temper is loud and violent, accompanied by vigorous kicking or by
+holding the body rigid. Proper treatment of the baby may prevent many
+months of discomfort, and spare him the formation of his first bad
+habit. All other possible causes for crying should be eliminated. If the
+child continues to cry when he is warm and dry and comfortable, "It
+should simply be allowed to cry it out. This often requires an hour and
+in extreme cases two or three hours. A second struggle will seldom last
+more than ten or fifteen minutes and a third will rarely be necessary"
+(Holt). Gas may form in the child's stomach during prolonged crying. It
+is consequently permissible to take him up after 15 minutes, and hold
+him erect; he generally expels gas at once, and immediately experiences
+relief. As soon as he is relieved, he should go back to his crib.
+
+EXERCISE.--Exercise is essential to the development of the body, but
+during the first few weeks warmth and quiet are so important that a baby
+should not be disturbed except for necessary care. His position,
+however, should be changed occasionally; if he lies on the same side
+constantly the soft bones of the head may become misshapen from
+pressure. As the baby grows older he needs more exercise, and he may be
+given an opportunity for it by removing his outer clothing and placing
+him on a bed in a warm room for a short time each day. Unnecessary
+handling is not good for a baby at any age.
+
+After he becomes more active, he may play on a mattress or thick blanket
+placed on the floor. The blanket should be covered with a washable pad
+or rubber cloth and clean sheet, and the whole should be surrounded by a
+fence at least two feet high. In such an enclosure a baby may safely be
+left to play if protected from draughts and cold. Elevated pens that can
+be folded when not in use are more convenient but more expensive than
+the home-made arrangement. As soon as a child begins to run about he
+takes ample exercise, and he may even need to be guarded from too great
+fatigue, especially toward bedtime. Games and play should be adapted to
+the age of the child and sufficiently varied to exercise all portions of
+the body; but they should not be too violent nor too prolonged. Some
+supervision of children's play is necessary, but they should be given as
+much freedom as possible and allowed to develop their own initiative.
+
+PLAY AND TOYS.--The desire for play does not develop until a child is
+about six months old. At this age toys that can be washed, such as those
+of hard or soft rubber, should be selected. A baby instinctively carries
+everything to his mouth,--first his thumb, then playthings, and later
+whatever he may find, no matter how unsuitable. For his safety and
+protection this habit should be overcome as soon as possible, and he
+must learn to put nothing in his mouth except food and drink. Relatives
+are nearly always tempted to give too many and too fragile toys; they
+merely teach a child to be destructive and constantly to expect
+something new. Toys are the first possessions of which a child is
+conscious, and through them many desirable qualities may be developed:
+neatness and order, gentleness and a feeling of protection toward the
+helpless doll or Teddy bear, and unselfishness in sharing special
+treasures with playmates. Later the child may be given pets and made
+responsible for their care; but animals should not be subjected to
+unintentional cruelties from small children.
+
+
+EXERCISES
+
+1. What two factors are chiefly responsible for the deaths of babies
+under a year old? What other factors contribute? In your city or town
+what is the number of deaths per 1000 births of babies under one year
+old?
+
+2. Why is birth registration important to an individual? to a
+community? Is it required by law in your city?
+
+3. What is the average weight of babies at birth? Describe the rate at
+which they should gain.
+
+4. At what age may a normal child be expected to sit erect? to stand? to
+walk? to speak? When should his first teeth appear? his permanent teeth?
+
+5. Describe normal bowel movements of a baby.
+
+6. How should a young baby be dressed?
+
+7. Describe a baby's bath and toilet.
+
+8. Describe the surroundings that are suitable for a baby.
+
+9. What is the best food for a healthy baby? Why?
+
+10. Describe in detail a good daily program for a healthy baby four
+months old.
+
+11. What habits are desirable for a baby to form, and how may he be
+trained so that he will form them?
+
+12. Name all the indications that would tell you when a baby was not
+thriving, and in each case tell what you would do about it.
+
+
+FOR FURTHER READING
+
+The Care and Feeding of Children--Holt.
+
+The Care and Feeding of the Baby--Truby King.
+
+The Baby's First Two Years--R. M. Smith.
+
+The Care and Feeding of Children--J. L. Morse.
+
+Preventive Medicine and Hygiene--Rosenau, Section III, Chapter II.
+
+Pamphlets:
+
+  Prenatal Care, Mrs. Max West.
+
+  Infant Care, Mrs. Max West.
+
+  Child Care, Mrs. Max West. Published by the Children's Bureau,
+  United States Department of Labor, Washington, D. C. (Free on
+  request.)
+
+The Care of the Baby--Supplement No. 10 to the Public Health Reports,
+1913, Government Printing Office, Washington, D. C.
+
+Your Baby: How to Keep It Well--New York State Department of Health,
+Albany.
+
+Publications of the American Association for the Study and Prevention of
+Infant Mortality--1211 Cathedral Street, Baltimore, Md. (Free on
+request.)
+
+Publications of the National Committee for the Prevention of
+Blindness--130 East 22d Street, New York City. (Free on request.)
+
+
+FOOTNOTES:
+
+  [1] An area including about two-thirds of the population of the United
+  States.
+
+
+
+
+CHAPTER IV
+
+INDICATIONS OF SICKNESS
+
+
+By indications of sickness we mean all evidences of deviation from a
+normal physical condition. They may be apparent only to the person in
+whom they occur, or to a second person only, or to both. These
+deviations, commonly called the symptoms of sickness, are always
+important to notice, whether the conditions they indicate are serious or
+not.
+
+Early symptoms of sickness are often slight; hence they easily pass
+unnoticed. Yet a slight trouble, easily checked in its early stages,
+may, if neglected, grow into a serious or even fatal disorder: just as a
+burning match, which anyone could extinguish instantly, may kindle a
+fire beyond the power of an entire city to control.
+
+It is important, then, to notice even slight symptoms of sickness,
+first, in order to determine the nature of the trouble, and second, in
+order to institute treatment as early as possible. It is, however,
+hardly less important to observe symptoms accurately during the entire
+course of an illness. A patient's progress can be determined only by
+careful comparison between present and past conditions.
+
+Many symptoms can be detected only by methods requiring scientific
+apparatus as well as the knowledge and skill of a physician, but very
+pronounced symptoms are generally evident to anyone. The neighbors do
+not need to be told when a person has advanced tuberculosis; neither is
+an expert required to see that something ails a man with a broken leg.
+Furthermore less pronounced symptoms may often be clearly seen by any
+observant person, even by those not specially trained. Accordingly it is
+important for every woman who has charge of others, sick or well, to
+form the habit of noticing unusual appearances of any kind. This habit
+is one that most people must take pains to acquire, because people
+generally see only the things that their own experience in life has
+taught them to see. An added difficulty is the fact that when illness
+begins it is not a trained observer, but the untrained sufferer or
+untrained member of his family who decides whether to send for the
+doctor and thus to set in motion the machinery for treatment and cure.
+
+All the training and experience of a physician are required in order to
+decide what symptoms indicate, and to prescribe proper remedies.
+Diagnosis, or the process of determining the nature of illness from the
+symptoms observed, is often exceedingly difficult; it must take into
+consideration not one symptom only but the presence or absence of a
+number of symptoms. Untrained persons who attempt to make diagnoses are
+frequently led astray by the fact that actual causes of trouble may be
+situated far from the places where symptoms are felt or observed. For
+instance, the real cause of headache may lie in a region far removed
+from the head; and so-called heart-burn, which is caused by disordered
+digestion, has nothing to do with the heart. Again, an early symptom of
+tuberculosis of the hip joint is pain under the knee; a mother is
+clearly not doing the best thing when she assumes that any pain in a
+joint means rheumatism, and therefore doses her suffering child with the
+medicine that "helped" his rheumatic grandfather. No untrained person is
+equipped to make a diagnosis, and still less to prescribe medicine or
+treatment.
+
+Symptoms, like all other forms of discomfort, tend to trouble a patient
+in proportion to the amount of attention that he gives them. Hence, in
+order to avoid calling his attention to them unnecessarily they should
+be observed so far as possible without his knowledge; when it is
+unavoidable for him to realize what is going on, observation should be
+made a matter of routine, so that his interest may not be especially
+excited. For instance, everyone who has seen the routine medical
+inspection of school children realizes how little attention the children
+themselves give to the process, apparently regarding it merely as one of
+the many inexplicable proceedings of grown people. On the other hand,
+children who know their symptoms are over-anxiously watched soon learn
+to watch themselves and to exaggerate every little ache and pain.
+
+Symptoms may be divided into two classes: first, objective symptoms, or
+those that can be noted by an observer, like cough, pulse rate, or color
+of the skin; and second, the subjective symptoms, which are apparent
+only to the person affected, like pain and fatigue. The success of any
+woman who cares for the sick depends to a large extent upon her
+quickness and accuracy in noticing and reporting these symptoms and
+their variations. It should be remembered that pronounced symptoms are
+not the only ones of importance: even slight symptoms that continue over
+an appreciable length of time may be of very great importance. A brief
+description of some important symptoms follows, in order to help persons
+without technical training to describe the symptoms as well as to
+observe them.
+
+
+OBJECTIVE SYMPTOMS
+
+TEMPERATURE.--Bodily heat is produced by slow burning of food materials,
+which goes on for the most part in actively working muscles and glands.
+Heat thus generated is distributed by the blood to all parts of the
+body, but the surface of the body is generally cooler than the interior.
+In health the body temperature varies only a few degrees, no matter how
+much the temperature of its surroundings varies; consequently a
+temperature is abnormal if it is higher or lower than the usual
+temperature of a healthy person.
+
+The temperature is taken by means of a clinical thermometer placed
+either in the mouth, the rectum, or the armpit (axilla).
+
+[Illustration: FIG. 10.--CLINICAL THERMOMETER.]
+
+To take the mouth temperature, first wash the thermometer, using cold
+water and absorbent cotton or clean soft cloth. Next shake it until the
+mercury thread registers 96° or below. It is well before purchasing a
+thermometer to see whether it can be shaken down easily. Next place the
+thermometer in the patient's mouth, with its bulb under his tongue; he
+must then keep his lips closed until it is removed. Leave the
+thermometer in his mouth for two minutes. Then remove the thermometer,
+read the temperature and record the result. Clean the thermometer at
+once, using first cold water and soap, and then alcohol, 70%.
+
+The mouth temperature of a healthy person is about 98.6° F. This
+statement holds true if the person has been sitting with his mouth shut
+for a little while before his temperature is taken; but a hot bath,
+breathing through the mouth, eating or drinking, and so forth may cause
+marked temporary changes.
+
+The temperature in the rectum generally varies less than the temperature
+in the mouth unless it is taken when the rectum contains fecal matter.
+The temperature should be taken by rectum in babies and young children,
+restless, drowsy, or delirious patients, patients who cannot be trusted
+to keep the thermometer under the tongue, mouth breathers, and in any
+patients who have difficulty in keeping the mouth shut. The temperature
+is normally about half a degree higher in the rectum than in the mouth.
+
+In order to take a temperature by rectum, adults generally find it more
+convenient to lie on the side and prefer, if they are able, to insert
+and hold the thermometer themselves; but the attendant should be
+certain that they can do so without breaking the thermometer. Rectal
+thermometers should be lubricated with oil or vaseline before using;
+they should be inserted about two inches, left in three minutes, and
+cleansed in the same way as the mouth thermometer. A thermometer used to
+take rectal temperatures should never be used in the mouth.
+
+In taking the temperature of a baby place him on his back, hold him
+firmly with his legs elevated, and carefully insert the bulb of the
+thermometer, well oiled, for about one inch. Keep the child quiet, and
+hold the thermometer in place three minutes. Great importance should not
+be attached to a slight fever of short duration. The temperature of a
+child is much more easily affected by slight causes than that of an
+adult, and rectal temperatures between 97.5° and 100.5° should not cause
+anxiety unless continued.
+
+Temperatures taken in the axilla are less accurate than those taken by
+mouth or rectum. Consequently the method is less often used. The axilla
+should first be wiped; then the thermometer should be inserted and held
+for 5 minutes by pressing the arm tightly against the chest wall. The
+temperature in the axilla is normally about half a degree lower than in
+the mouth.
+
+The temperature varies somewhat according to the time of day. It is not
+unusual for the mouth temperature of persons who are entirely healthy to
+be as low as 97° in the early morning, or as high as 99° in the late
+afternoon, and probably most people's temperatures vary as much as a
+degree during the twenty-four hours. Even greater variations that are
+not long continued have little if any significance in people who feel
+well.
+
+Decided variations either above or below normal are highly important
+symptoms. A temperature below 98° is called subnormal, and one above
+99.5° is called fever. The number of degrees of fever does not
+necessarily bear a direct relation to the severity of an illness. Thus,
+it does not follow that one person is twice as sick as another, because
+his temperature is twice as many degrees above normal. All symptoms,
+including variations in temperature, must be considered in connection
+with one another, and it is generally impossible to state the
+significance of any one symptom taken by itself.
+
+The temperature should be taken once or twice a day as a matter of
+routine in almost every form of illness, and oftener when the patient's
+condition requires it. Also it should be taken as a matter of routine
+whenever there is indication of beginning sickness; especially when
+there is headache, pain, sore throat, coated tongue, cough or cold,
+chill, vomiting, diarrhœa, or rash. It is not a good plan to take
+one's own temperature oftener than necessary, or indeed anyone's;
+certainly not a baby's, since frequent use of the thermometer may
+irritate the rectum.
+
+PULSE.--Each time the heart beats, blood is forced out from the heart
+into the arteries, thus causing an expansion of the arterial walls. This
+expansion, called the pulse, can be felt in some places where arteries
+lie close to the surface of the body. The character of the pulse beat
+and its rate, or the number of times the beat occurs each minute, give
+information about the heart and blood vessels; taken together they are
+perhaps more important than any other one symptom.
+
+[Illustration: FIG. 11.--TAKING THE PULSE AT THE WRIST. NOTE THE
+POSITION OF ARM. (_From "Elementary Nursing Procedures," California
+State Board of Health._)]
+
+The pulse rate varies much more than the temperature. It differs in
+different individuals and at different ages, and it often shows great
+temporary changes, especially during exercise or eating, or as a result
+of excitement, fear, or other emotion. Definite statements in regard to
+normal pulse rates are hard to make, because different individuals
+though in perfect health show marked variations; we generally say,
+however, that the pulse rate of a normal man at rest is about 72 a
+minute, and that of a normal woman is about 80 a minute. At birth the
+pulse is quickest; it may then be from 124 to 144. From the 6th to the
+12th month it may be from 105 to 115 a minute, and from 90 to 105
+between the 2d and 6th years. About the time of puberty it reaches the
+adult rate, and during old age it may be decidedly slower than the adult
+rate.
+
+What we chiefly want to know about the pulse is
+
+1. Its rate, or number of beats per minute,
+
+2. Its force,--whether weak or strong,
+
+3. Its rhythm,--whether regular or irregular.
+
+Much practice is necessary before the pulse rate can be counted with any
+degree of accuracy, and wide experience with both normal and abnormal
+pulses is required in order to judge its strength, rhythm, or other
+characteristics.
+
+The pulse may be felt most conveniently on the thumb side of the front
+of the wrist. The pulse should be counted while the patient is lying
+down, and the watch used must have a second hand. To count the pulse,
+one should place two or three fingers (not the thumb) on the patient's
+wrist, and after the pulse has been felt distinctly for a few beats, the
+exact time by the second hand of the watch should be noticed and the
+counting begun immediately. It is generally best to count for half a
+minute, multiply the result by two to get the rate for a whole minute,
+and then to repeat for another half minute. The two results should agree
+within two beats, if the patient is quiet. A greater variation than two
+beats may mean that the pulse rate is varying, but when it is counted
+by inexperienced persons the apparent difference is generally the result
+of inaccurate counting, and it may be necessary to count two or three
+times more. The force of the pulse varies also in different individuals;
+it is, however, important to notice when it grows stronger or weaker in
+the same person. Normally the pulse-beat is regular like the ticking of
+a clock; it is called irregular if a few rapid or slow beats are
+followed by others of a different rate. During sickness the pulse should
+be counted whenever the temperature is taken, or oftener; and the result
+should be written down at once. The pulse of a sick person often shows
+changes both in rate and character; these changes are generally
+important and should be noticed.
+
+RESPIRATION.--Variations in the rate and character of respiration or
+breathing should be noticed. The normal rate of respiration for an adult
+at rest is 16 to 20 each minute, but it may be much faster, especially
+during muscular exercise. In babies the rate is about 30 to 35 a minute,
+and 20 to 25 in little children. The respirations, especially of babies,
+can best be counted during sleep by placing the hand lightly on the
+chest or abdomen. Since the respiration rate is partly under a person's
+control, it is almost sure to alter if the patient knows it is being
+counted; hence when the patient is awake it is better to keep one's
+fingers on his wrist, to place his hand upon his chest, and then to
+count the rise and fall of the chest while apparently counting the
+pulse. Sometimes it is possible to count the respirations merely by
+watching the rise and fall of the nightgown or bed clothes. The
+respiration is usually counted for a full minute. A watch with a second
+hand must be used, and the result should be recorded immediately.
+
+In certain forms of sickness breathing may become rapid, especially if
+the lungs or air passages are affected. In addition to the rate anything
+unusual about the breathing should be noticed whether it seems difficult
+or painful; if noisy, whether the sound is like snoring, or wheezing, or
+sighing, and so on.
+
+GENERAL APPEARANCE.--Any unusual expression of the face should be noted;
+whether it is drawn, pinched, anxious, excited, or dull and stupid; and
+also, whether the face is thin, swollen, or puffy under the eyes. The
+condition and appearance of the skin are significant: the skin may be
+dry, moist and clammy, hot or cold; its color, and the color of the face
+especially, may be flushed or pale or slightly yellow or blue. A bluish
+tinge about the nose, tips of the fingers, or the feet should be
+specially noticed. Reddened or discolored areas on any part of the body
+may be important, and also eruptions, rashes, swellings, or sores. It
+should be noticed whether the abdomen is normal or whether it is
+distended and hard.
+
+Strength or weakness is indicated to some extent by the way the patient
+moves, and by his ability to walk, stand, sit, hold up his head, feed
+himself, or turn in bed without assistance. The position he habitually
+takes is sometimes significant; in heart affections, for instance, he
+may be unable to lie down, in pleurisy he ordinarily lies on the
+affected side, and during abdominal pain he generally draws the knees
+up.
+
+SPECIAL SENSES.--The special senses are frequently disturbed in
+sickness. The eyes may be blood-shot; the patient may be over-sensitive
+to light, or see spots floating before the eyes, or he may be unable to
+see at all. The pupils of the eyes may be unusually large or small, or
+one may be large while the other is small. Swelling, redness, or
+discharge from the eyes should be noticed. Hearing and touch and smell
+may be impaired; or they may be abnormally acute, and cause real
+suffering. Taste may be impaired, especially when the nose is affected
+or when the mouth is not clean. Discharge from the nose or ears should
+be reported. Not only discharge, but also trouble of any kind, such as
+pain, tenderness, or swelling, is important if situated in or near the
+ears.
+
+THE VOICE is often much altered in sickness. It may be weak, hoarse, or
+whispered. Speech may be clear or thick, or the ability to speak may be
+entirely lost; in extreme weakness speaking is generally difficult, and
+may be impossible. Moaning, groaning, and other unusual sounds should be
+noted. A loud, sharp cry at night with or without waking, if a repeated
+occurrence, may be an early symptom of some diseases of children.
+
+THE TONGUE in health is red and moist; when extended it is somewhat
+pointed and can be held steadily. In sickness it may be cracked, dry and
+parched, or if the patient is not properly cared for, it may be covered
+with white, yellow, or brown coating; in many exhausting illnesses it is
+flabby and trembling. In scarlet fever the tongue is often a vivid red
+color, and is then called strawberry tongue. The odor of the breath may
+be foul from decay or neglect of the teeth, from indigestion,
+constipation, nasal catarrh, or special diseases.
+
+THE THROAT and tonsils are sometimes red and swollen as in simple sore
+throat; or they may be covered by white patches.
+
+THE GUMS may be swollen, tender, or bleeding. A collection of sticky
+brownish material may appear on the teeth and gums of neglected
+patients.
+
+COUGH when present may be: dry, or accompanied by expectoration;
+painful, frequent, loud, or whooping; and worse by day or by night. The
+sputum may be yellow, white, gray, rusty, blood-streaked, dark, or
+frothy. The amount of sputum should be noticed as well as its
+appearance.
+
+APPETITE or absence of appetite should be noted, and also the amount of
+food actually eaten by a patient; the amount eaten is frequently not the
+same as the amount carried to him on a tray.
+
+If VOMITING occurs, the color, consistency, amount, and general
+appearance of the vomitus should be noted; if its appearance is unusual
+the vomitus should be saved for the doctor's inspection.
+
+EXCRETIONS.--The number of bowel movements is important, and also their
+character. The consistency of the feces may be hard, soft or fluid;
+their color may be any shade of brown, yellow or green, from black to
+clay color. They should be saved for the doctor to see if appearance or
+odor is unusual.
+
+THE URINE in health is clear, amber colored, and slightly acid. From 30
+to 50 ounces should be excreted in 24 hours; the amount varies, however,
+especially according to the amount of fluid taken. It is important to
+notice whether the urine is scanty or greatly increased in amount, dark
+or pale, clear or cloudy, and whether sediment is deposited after
+standing. It is essential that urine should be voided in sufficient
+amount; the necessity for watching its quantity is frequently overlooked
+in the home care of the sick. Frequency of urination should also be
+noted. Inability to urinate, particularly where the urine has previously
+been scanty, is serious if continued; it should be reported to the
+doctor without delay. Inability to control the bladder and bowels are
+also symptoms to be reported.
+
+LOSS OF WEIGHT is significant in both adults and children, and failure
+of babies and children to gain in weight is a danger signal.
+
+SLEEP.--The number of hours a patient sleeps should be noticed and
+recorded as accurately as possible. The word of the patient on this
+subject is not sufficient evidence. Character of sleep should also be
+noted, whether it is quiet or restless, and whether the patient sleeps
+lightly or is difficult to arouse.
+
+MENTAL CONDITIONS.--It is important to watch carefully the mental
+condition of a patient; whether, for example, he is normal, or
+depressed, irritable, restless, apathetic, dull, excited, wandering,
+delirious, or unconscious. Hasty judgment of mental conditions should
+be avoided, but close attention to them is necessary.
+
+
+SUBJECTIVE SYMPTOMS
+
+PAIN is the most important subjective symptom and should never be
+disregarded. Bodily pain does not occur in persons who are in all
+regards physically and mentally well; hence pain is a sign that
+something, small or great, is out of order.
+
+      "Of all symptoms pain is the one which interests patients
+      the most. We here emphasize the truth, too little
+      understood, that pain is an unpleasant sensation, nothing
+      more, and is _never_ imagined. Imagination may be its
+      cause, but the pain thus produced hurts just as truly as
+      pain produced by a real disease. Pain is only a phenomenon
+      of consciousness; it is always real, even that felt in a
+      dream. If the patient is too unconscious to feel it, there
+      simply is no pain, no matter how badly the person's body is
+      injured." (Emerson: Essentials of Medicine, p. 356.)
+
+One should remember that no possible method exists to measure the
+intensity of pain exactly, or to describe its quality accurately.
+Therefore in describing pain, it is best to use the patient's own
+language. Four points should especially be observed, (1) its location;
+(2) its character, which may be dull or sharp, stabbing, throbbing or
+continuous, slight or severe; (3) the time at which it is worst; certain
+diseases, for instance, are characterized by more severe pain at night;
+(4) it should be noticed whether the pain is relieved or increased by
+change of position, eating or drinking, heat or cold, or the like. Pain
+may be felt in a part far from the place where the trouble really lies;
+thus a dislocated shoulder causes pain in the elbow.
+
+Pain is always a danger signal, although the significance is not always
+so great as the sufferer thinks. The more attention a patient gives to
+his pain, the more severe it always becomes, therefore his attention
+should not be called to it unnecessarily. A good observer, however, can
+get much information by noticing the patient's expression, position,
+motions, etc., without constantly asking him how he feels. Although many
+persons overestimate pain, others persistently disregard it, either
+because they are unwilling to take the necessary measures to remedy it,
+or because they wish to appear heroic. Both courses of action are
+mistaken; everyone should realize the folly and danger of bearing pain
+if it is possible to remove the cause.
+
+Nausea, fatigue and malaise are other subjective symptoms; malaise is
+the name given to a general feeling of physical discomfort not
+restricted to any one part of the body. All three are abnormal when
+there is not apparent or sufficient cause.
+
+RECORDS.--An accurate record should be kept of the patient's symptoms,
+medicine, diet, treatment, etc., so that the doctor may have a
+continuous record, and so that another person taking charge temporarily
+may know just what has been done for the patient. The record must be
+written; otherwise details cannot be remembered exactly. It should be as
+simple and concise as possible; it is the place for facts, not for
+opinions, and if inaccurate it is worse than none. It is better not to
+keep the record in the patient's room, for the patient should not see
+his own record, nor hear its contents discussed. The doctor usually
+writes his orders on the record sheet itself, or on a separate sheet to
+be attached to the record for reference. Blank record forms can be
+purchased, but a form that is made at home is entirely satisfactory. An
+example of a daily record sheet follows.
+
+
+                                  RECORD
+
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+   Date |  Hour    |Tem.|Pulse|Resp.|   Diet and     |B.M.|Urine|Remarks
+        |          |    |     |     |   medicine     |    |     |
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+  1916  |          |    |     |     |                |    |     |
+  Jan. 1|4 p.m.    |100°| 76  | 24  |Medicine        |    |     |
+        |5 p.m.    |    |     |     |                | 1  |â„¥ vii|
+        |6 p.m.    |    |     |     |Supper:         |    |     |
+        |          |    |     |     | Baked potato,  |    |     |
+        |          |    |     |     | toast, fruit,  |    |     |
+        |          |    |     |     | tea.           |    |     |
+        |8 p.m.    |    |     |     |Medicine        |    |     |Sponge
+        |          |    |     |     |                |    |     |bath.
+        |9:30 p.m. |    |     |     |                |    |     |Asleep.
+  Jan. 2|3 a.m.    |    |     |     |                |    |â„¥ ix |
+        |8 a.m.    |99° | 74  | 22  |Medicine        |    |     |Patient
+        |          |    |     |     |                |    |     |slept
+        |          |    |     |     |                |    |     |most
+        |          |    |     |     |                |    |     |of the
+        |          |    |     |     |                |    |     |night.
+        |8:30 a.m. |    |     |     |Breakfast:      |    |     |
+        |          |    |     |     | Cereal, orange,|    |     |
+        |          |    |     |     | toast, coffee. |    |     |
+        |9:30 a.m. |    |     |     |Bath.           |    |     |
+        |11:30 a.m.|    |     |     |                |    |     |Sat up
+        |          |    |     |     |                |    |     |1 hour.
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+
+TUBERCULOSIS, CANCER, AND MENTAL ILLNESS.--As we have seen, early
+symptoms of sickness are always important; yet it seems worth while to
+mention particularly the early symptoms of tuberculosis, cancer, and
+mental disorders, because each of these diseases, though curable in
+many cases when taken in the early stages, is serious and often fatal
+if neglected. Certain facts relating to their cause and prevention
+should be known to everyone. Tuberculosis, long our greatest cause of
+death, is gradually growing less; but cancer and mental disease are now
+on the increase.
+
+TUBERCULOSIS.--Every year tuberculosis causes the death of about 150,000
+people in the United States. It is caused by the bacillus tuberculosis,
+a germ which may attack any tissue of the body, although it most
+frequently affects the lungs of grown people, and the bones and glands
+of children. The disease is not inherited, but susceptibility to it
+appears to be; it is readily communicated from person to person. The
+germ of tuberculosis is so widely distributed that probably few persons
+over 30 years of age have not been infected with it at some time,
+although the infection may have been too slight to be noticed. Indeed,
+most people have probably been infected many times, though without
+serious results.
+
+Tuberculosis is spread chiefly in two ways: (1) through any bodily
+discharges from infected persons, especially through the nose and mouth
+discharges; (2) through milk from infected cows. The ways by which the
+disease is spread indicate methods of prevention. Milk, especially for
+children, should either be pasteurized or should come from cows that
+have been tested and proved to be free from the disease. Other methods
+of prevention include avoiding any and all bodily discharges of infected
+persons, and increasing bodily resistance as far as possible. Good food,
+sufficient rest and fresh air are not only important preventives, but
+also the most efficacious means of cure. Persons who suffer from
+insufficient food, exposure, bad housing, long hours, and bad conditions
+of work are especially susceptible to tuberculosis, and thus it is
+rightly called a disease of poverty.
+
+Early symptoms of tuberculosis include cough, hoarseness, loss of
+appetite, pain in the side, loss of weight, getting tired easily,
+feeling run down, rise in temperature in the afternoon, night sweats,
+expectoration, and spitting blood. No one, nor even several, of these
+symptoms necessarily indicates the presence of tuberculosis; on the
+other hand, even the cough is not necessarily present when tuberculosis
+actually exists. When one or more of these symptoms appears and
+continues, a thorough examination should be made by a doctor;
+examination can do no harm, certainly, if tuberculosis is not found, and
+if it is, immediate treatment is of the greatest importance. No known
+drug or medicine is a cure for tuberculosis. Successful treatment
+depends on taking the disease in time and in following the doctor's
+advice unremittingly.
+
+CANCER.--The cause of cancer is not known. All the evidence, however,
+goes to show that it is neither communicable nor hereditary. Cancer may
+occur on the skin, stomach, or other organs; in women it most commonly
+occurs in the breast or uterus (womb). In both sexes it occurs most
+frequently after 40 years of age. No known medicine will cure cancer;
+salves and ointments have no effect. Radium and _x_-ray should not be
+relied upon if the cancer can be removed by operation. Safety consists
+in removing the growth entirely, and complete removal is possible only
+in the early stages.
+
+Early diagnosis is consequently of the greatest possible importance, and
+an examination can do no harm in any case. Warts and moles on the skin
+may develop into cancer, and should be removed if they show signs of
+irritation. Loss of appetite and weight, any disturbance of the stomach
+or intestines, and sores that refuse to heal should lead a person to
+consult a physician; the same is true of any lump in the breast, and of
+irregular or persistent bleeding from the uterus in women over forty.
+The fact that pain is not present in cancer until the late stages leads
+many persons to neglect the trouble until it is too far advanced for
+operation. Time is all-important; hope depends on operation in the early
+stages when there is a very great probability of permanent cure.
+
+MENTAL ILLNESS.--Insanity, like cancer, is increasing. Like both cancer
+and tuberculosis, hope lies in prevention and early treatment; and like
+them both, in its early symptoms it is too often unrecognized or
+neglected.
+
+Many people are surprised to learn that known, avoidable causes are
+responsible for the condition of about 50% of the insane patients now
+under treatment. Chief among these known causes is a communicable germ
+disease called syphilis, to which is due the disease called paresis, or
+"softening of the brain." About 25% of patients admitted to hospitals
+for the insane are there from the effects of habitual use of alcohol,
+even in "moderate" quantities. Other cases of insanity result from
+diseases of the heart, arteries, and kidneys, and still others have been
+traced to the poisons of tuberculosis, typhoid, diphtheria, and other
+communicable diseases. Prevention of insanity caused by these diseases
+depends upon prevention or complete cure of the diseases themselves.
+
+Still other causes of insanity are known. Hereditary nervous weakness
+may predispose to insanity, and for such persons, those whose nervous
+resistance is naturally not very great, the stress of living may prove
+too much. Mental breakdowns are rarely caused by overwork unless
+accompanied by worry or bad hygienic conditions, but they result not
+infrequently from bad mental habits.
+
+      "The average person, little realizes the danger of brooding
+      over slights, injuries, disappointments, or misfortunes, or
+      of an unnatural attitude towards his fellowmen, shown by
+      unusual sensitiveness or marked suspicion. Yet all these
+      unwholesome and painful trains of thought, may if persisted
+      in and unrelieved by healthy interests and activities, tend
+      towards insanity. Wholesome work relieved by periods of
+      rest and simple pleasures and an interest in the affairs of
+      others, are important preventives of unwholesome ways of
+      thinking. We should train ourselves not to brood, but to
+      honestly face personal difficulties."--(Why Should Anyone
+      Go Insane?, by Folks and Ellwood.)
+
+Prevention of insanity consequently depends chiefly upon avoiding
+alcohol and communicable diseases, especially syphilis; upon good
+hygiene, self-control, and avoidance of bad mental habits; and upon
+adopting a program of living and working that will not overtax one's
+nervous strength. Sleeplessness, unusual nervous fatigue following
+slight exertion, and diminished power to control the emotions, are among
+the danger signals. And when a person becomes unusually depressed or
+morose, excited or irritable, suspicious, unreasonable, or "queer," it
+is probable that expert medical advice should be obtained as quickly as
+possible.
+
+
+EXERCISES
+
+1. What is a symptom? Why are early symptoms especially important?
+
+2. Distinguish between objective and subjective symptoms.
+
+3. Tell all you can about normal and abnormal variations in the body
+temperature. What symptoms would lead you to take a person's
+temperature?
+
+4. Describe the method of taking temperatures.
+
+5. How should you cleanse a clinical thermometer? What are the dangers
+of neglecting to cleanse it properly?
+
+6. Describe both normal and abnormal pulse and respiration.
+
+7. Discuss the significance and importance of pain.
+
+8. Describe early symptoms of tuberculosis, cancer, and mental illness.
+What is the first step to be taken when any one of these symptoms
+appears?
+
+9. What symptoms of all those mentioned in this chapter did you notice
+in the last sick person with whom you had anything to do?
+
+10. What are the essentials of a good daily record? The following is an
+account that a mother gave of the first twenty-four hours of a child's
+illness. Make a chart for the patient, and include in it all the
+information the mother gave. Which do you consider more useful, your
+chart or the narrative?
+
+"Yesterday, October 10th, Johnny came home from school about half past
+three, and said he was too cold to play outdoors. He lay down and slept
+till about five, when he vomited a large amount of undigested food. I
+took his temperature and found that it was 103.8°, pulse 126, and
+respiration 28. At 10 that night his temperature was 102.5°, pulse 116,
+and respiration the same as before. The next morning at 8 he had a
+temperature of 100.6°, pulse 114, respiration 24. At noon his
+temperature was 101°, pulse 118, respiration 24; and at 4 o'clock his
+temperature was 100.6°, pulse 122, respiration 22. The doctor came at 6
+o'clock yesterday afternoon; according to his orders I put Johnny to
+bed, gave him half a tablespoonful of castor oil at 6.30, and a special
+gargle. His throat was red and sore and he seemed to feel very
+miserable. The doctor took a culture from the child's throat. At 8.15
+and again at 8.50 he had fluid bowel movements. At 9.30 he had a glass
+of milk, after which he slept until 6 a.m. when his bowels moved again
+and urine was passed. He passed eight ounces of urine at noon and four
+ounces at 3.30. He drank a glass of water at 6 this morning, and at 6.30
+I gave him a cup of hot broth. At 8 he had a glass of milk, but at 10 he
+refused everything but a glass of water. At 1.30 he had a large dish of
+ice cream. He had a cool sponge bath last night at 9, and a cleansing
+bath this morning at 8.45. This morning his throat was still sore but
+not so red, and I saw that he gargled every half hour when he was awake.
+This afternoon he seems brighter and asked for his harmonica, so his
+throat is probably more comfortable."
+
+
+FOR FURTHER READING
+
+Essentials of Medicine--Emerson, Chapters XVI, XVII.
+
+The Human Mechanism--Hough and Sedgwick, Chapter XII.
+
+Notes on Nursing--Florence Nightingale, Pages 105-136.
+
+Why Worry?--Walton.
+
+Those Nerves--Walton.
+
+Tuberculosis: Its Cause, Cure, and Prevention--Otis.
+
+Publications of the National Association for the Study and Prevention of
+Tuberculosis--105 East 22d Street, New York City. (Pamphlets free on
+request.)
+
+Publications of the National Committee for Mental Hygiene--50 Union
+Square, New York City. (Pamphlets free on request.)
+
+Publications of the Mental Hygiene Committee of the State Charities Aid
+Association--105 East 22d Street, New York City. (Pamphlets free on
+request.)
+
+Publications of The American Society for the Control of Cancer--25 West
+45th Street, New York City. (Pamphlets free on request.)
+
+
+
+
+CHAPTER V
+
+EQUIPMENT AND CARE OF THE SICK ROOM
+
+
+Adequate care of the sick consists to a large extent in rendering their
+physical and mental surroundings as favorable as possible. Obviously, a
+sick person, since his strength is already depleted, needs not only to
+have his resistance increased in all possible ways, but also to have all
+his remaining strength conserved by eliminating every unnecessary tax
+upon it. In sickness even slight fatigue, chill, or nervous strain,
+insufficient ventilation, or improper feeding, may become factors of
+immense importance. Nothing is trivial if it affects the welfare and
+comfort of a patient.
+
+Even when perfect provision for the care of the sick is out of the
+question, every effort should be made to insure as satisfactory
+arrangements as possible. Ideal conditions are seldom found except in
+buildings originally planned for the sick; yet in many houses a few
+simple changes will produce excellent results. Of course, it is not
+necessary in every case to adopt all the following suggestions. Common
+sense must be the guide. For instance, in illness that is slight and
+likely to be of short duration, a patient may be more distressed than
+benefited by radical changes in his surroundings. Except when certain
+essentials are concerned, great consideration should be given to a
+patient's preferences; yet on the other hand it is not reasonable to
+make an entire family miserable in order to gratify some slight whim.
+
+CHOICE OF A SICK ROOM.--A south or east exposure is generally best for a
+sick room. A south room may be undesirable in very hot weather, but
+sunshine during a part of the day is essential. The room should be
+quiet, near the bath room, and well removed from odors from the kitchen.
+It should be situated so that good ventilation is possible. It is
+desirable though not necessary for it to have more than one window; in
+summer the windows must be thoroughly screened. It should be possible to
+open the window without exposing the patient to a direct current of air,
+and to open the door without placing him in full view of all who pass
+through the hall.
+
+It is essential for the patient to have a room to himself. Unless he
+needs care or help or watching at night, not even the person caring for
+him should sleep in the room. Neither should the rest of the family
+keep their possessions in the sick room. Closets opening into the room,
+bureaus, and chiffoniers should be emptied of the belongings of other
+members of the family, to prevent people from tiptoeing into the sick
+room at all hours to remove garments. The sick room should for the time
+belong exclusively to the patient, and resulting inconvenience should be
+borne by well members of the family.
+
+Every possible precaution should be taken to exclude from a sick room
+unnecessary noises of all kinds; flapping curtains, squeaky doors and
+rocking chairs, heels without rubber, creaking corsets, noisy
+petticoats, ticking clocks, refractory bureau drawers, and rustling
+newspapers are among the everyday sounds that irritate the nerves of
+sick and well alike. Ordinary out-of-door noises do not usually disturb
+the sick, except when the country patient is brought to the city, or the
+reverse; but nearby and generally avoidable noise is the kind that
+distracts and harasses nervous patients.
+
+Whispering is an annoying sound and should not be allowed, either in the
+patient's room or just outside the door. Whatever the subject of
+conversation may be, the patient thinks that he is under discussion.
+Anything undesirable for him to hear should be settled well out of his
+hearing, and in speaking to him there is no possible objection to an
+ordinary well modulated voice.
+
+Usually a person's own room is more restful and less disturbing than a
+strange place, but if it serves as a work room as well as a bed room, it
+may easily be the worst place during sickness. The sight of a desk piled
+high with papers or a basket overflowing with accumulations of family
+mending may actually delay recovery; even the room itself may constantly
+suggest work, and work necessarily left undone. The essential thing to
+remember is that mental rest is no less important than physical, and
+every effort should be made to secure them both.
+
+FURNISHING.--Superfluous articles add to the care of a sick room, and in
+consequence they should be removed at the outset. All the furnishings
+that remain should be easy to clean, but it is not necessary for a sick
+room to look bare and desolate.
+
+The woodwork as in any other room should have a hard finish, and angles
+and corners that harbor dust should be as few as possible. Hard wood
+floors without cracks are best from the point of view of cleanliness and
+convenience. A few light, washable rugs make the best floor covering,
+but very small rugs on highly polished floors slide easily and are
+decidedly dangerous. Carpets diminish noise, but are objectionable from
+every other point of view.
+
+In furnishing houses people ought to realize more frequently than they
+do how greatly nervous fatigue may be increased by ill chosen wall
+coverings. Plain papers or tinted walls are best for bed rooms and the
+color should not be harsh or striking; soft gray, green, or buff is
+good. The design is no less important than the color; a design that on
+casual inspection appears quite harmless may become an instrument of
+torture to a person unable to escape from it for a single hour. Weak or
+nervous patients sometimes become quite exhausted from attempting to
+follow an intricate pattern, or from counting over and over a design
+that is frequently repeated on the wall. If the patient sees grotesque
+faces and figures in the design the paper is more objectionable still.
+
+Necessary furniture includes the bed, which will be discussed in detail
+later, a small table to stand by the head of the bed, a dresser, two
+chairs, and a wall thermometer. If the patient is able to sit up three
+chairs are needed, of which one should be an armchair with a high back.
+No rocking chair should be allowed in the room unless the patient
+himself prefers to sit in one; no one else should be allowed to rock in
+the room, since the motion is almost always annoying to patients.
+Elaborate, carved, or upholstered furniture is unsuitable in a sick
+room, but if it must be used it should have washable covers.
+
+Other desirable articles of furniture are a couch, screen, foot-stool
+and a second, larger table. In few cases, if any, is anything further
+really necessary, although patients frequently desire special articles
+to which there can be no objection.
+
+Most ornaments add much work and little beauty, and have no place in a
+sick-room. No heavy unwashable curtains or hangings should be allowed,
+but simple washable curtains and clean white covers for the tables and
+dresser are desirable. Pictures, if suitable, give much pleasure, but
+must be used with discretion. It goes without saying that the subjects
+should be pleasant, but not everyone realizes that complicated subjects
+are undesirable and that pictures of people or things in motion should
+be avoided; patients are sometimes worried to see motion that is forever
+incomplete.
+
+Flowers give great pleasure to the sick by adding color and variety and
+interest to their surroundings. They should be carefully tended and
+given fresh water daily. Fading flowers and forlorn plants should be
+removed from the sick room, and those having strong, heavy odors should
+not even be admitted. They do not need to be very many or very
+expensive; indeed, a potted plant or a few cut flowers are often more
+acceptable than the great masses of costly flowers that are daily
+brought to the private wards of hospitals.
+
+VENTILATION.--A patient needs fresh air certainly as much as a well
+person, and probably even more. His room should be thoroughly ventilated
+night and day. A fireplace makes the problem easier, but in most cases
+an open window is the main dependence. It should be possible to open
+windows at the top as well as at the bottom, and the patient may be
+protected from a direct draught by a screen, or by a sheet stretched
+along the side of the bed and fastened at the head and foot by tying it
+around the posts.
+
+Ventilating a room without subjecting the patient to draughts is not
+always easy. One method is to insert a board three or four inches high
+under the lower sash so that air is admitted between the two sashes.
+Another way to ventilate without causing a draught is to remove one or
+two panes of glass and tack cheese cloth over the opening; or to tack
+cheese cloth to the lower edge of the upper window casing and to the
+upper edge of the upper sash, after the sash has been lowered about a
+foot. Once or twice a day the room should be thoroughly aired by opening
+windows and doors until the air has been completely changed. The
+patient, including his head, must be well-covered during the process.
+An electric fan is useful in summer, but it should not be close enough
+to the bed for the patient to feel air blowing upon him.
+
+HEATING.--Great care should be taken to maintain a suitable temperature
+in the sick-room, and for this purpose a thermometer in the room is a
+necessity. Between 65° and 68° is generally the best temperature, and
+hot water bags and extra covers may be given if the patient is chilly.
+During a bath or other treatment in which the patient is more or less
+exposed the temperature should be 70°. The temperature at night may be
+lower; how low will depend largely on the patient's condition and on
+what must be done for him during the night. Hot water, steam heat, or
+electricity is best for the sick room. Gas or oil stoves should never be
+used except in emergencies, and then for a short time only.
+
+LIGHTING.--Sunlight is one of the most powerful disinfectants, and for
+this reason if for no other it is needed in every sick room. Sunless
+rooms, moreover, even if they were wholesome, are too depressing to a
+patient's spirits for use except perhaps in hot summer days. Ordinary
+well-regulated light is best in a sick room, and except in a few
+diseases, especially those in which the eyes are affected, it is
+undesirable to darken the room or to encourage in any way an appearance
+of gloom. The patient's eyes, however, should be protected from bright
+lights shining directly upon them; in this connection it is well to
+remember that lights and their reflections strike differently upon the
+eyes of a person lying down from the way in which they strike the eyes
+of persons sitting or standing, and a light that seems agreeable to the
+attendant may therefore be painful to the patient.
+
+Almost all persons sleep best in dark rooms, and in most cases it is
+undesirable for a sick room to be lighted at night. The attendant,
+however, must be able to see what she is doing and generally needs a
+shaded candle, small night light, or electric flash. It should be
+possible to see the patient clearly in case of need, otherwise serious
+changes in his condition occurring in the night may pass unnoticed.
+
+A reading lamp on the bedside table is desirable for patients allowed to
+read, but reading in bed even with a well-regulated light is fatiguing,
+and should not be continued for long uninterrupted periods. A pocket
+flash light is safer than matches and a candle for patients who wish to
+consult their watches in the night; indeed, matches in the hands of
+patients always involve risk. Some patients find twilight a time of
+great depression. In such a case it had best be shortened by drawing
+the shades early, turning on the lights, and remembering not to leave
+him alone.
+
+CLEANING.--The sick-room should be kept thoroughly clean at all times,
+and the less dust stirred up in doing so the better. Dry sweeping or
+dusting should not be allowed. Ordinary brooms should be dampened or
+covered with damp cloths, and dust cloths should be dampened also; but
+dustless mops and dusters are still better. Vacuum cleaning is very
+desirable; the noise, which is its only disadvantage, is not a serious
+objection in most cases. The cleaning of rooms after a communicable
+disease will be considered later.
+
+A sick room must be kept tidy as well as clean. The effect of order is
+quieting, but it should be maintained whether the effect upon the
+patient is apparent or not. Food and medicine should not be kept in the
+sick-room, and all used dishes, tumblers, soiled linen, etc., should be
+removed at once. Unnecessary articles should not be found in the room at
+any time; every necessary article should be kept in its place, and its
+place should be a good one.
+
+Maintaining order in the room does not mean that patients should be made
+uncomfortable. All patients, especially old people, want certain
+possessions within reach, and their wishes should be considered in spite
+of the fact that the æsthetic effect is generally far from good. For
+instance, a perfectly smooth bed is undesirable if in order to make it
+smooth the patient must be tucked in so tightly that he is
+uncomfortable. And it would be a mistake to remove an old man's
+newspapers before he has read them, even if he persists in strewing them
+all over the floor.
+
+THE ATTENDANT.--One person and one person only should carry the entire
+responsibility for the patient. She should plan for him as well as care
+for him, should see the doctor and take the doctor's orders. Confusion
+and innumerable mistakes result when several members of the family
+attempt to do the talking and directing.
+
+The attendant should wear washable dresses with sleeves that can be
+rolled up, washable aprons, and shoes with rubber heels. All her
+clothing should be comfortable. She should be neat in appearance,
+scrupulously clean in person, and should keep her finger nails short and
+smooth. Jewelry, especially rings and chains that rattle, and finery of
+any sort are all out of place in a sick-room.
+
+The attendant must learn that her own sleep, her diet, and her
+out-of-door exercise are essential to the patient's well-being hardly
+less than to her own. An amateur nurse often considers that going
+without food and sleep is a proof of her devotion. In a passion of
+self-sacrifice she neglects herself utterly for the first few days, and
+as a consequence is quite useless at a later period when her services
+may be most needed. An exhausted, sleepy nurse, trained or untrained, is
+wholly unfit to be trusted with medicines and doctor's orders, to note
+changes in the patient's condition, or to give him kindly attention.
+Efficiency and fatigue have never pulled together since the world began,
+and no one can do good work when suffering from lack of sleep and rest.
+
+The person, then, who genuinely wishes to give her patient the best
+possible care should not make a martyr of herself. She should go out of
+doors daily; both fresh air and occasional absence from the patient are
+essential to her physical and mental well-being. Moreover, she will be
+showing her patient the greatest kindness in the long run if during her
+recreation time she thinks of him as little as possible. Indeed, she
+need not consider herself inhuman if she has a thoroughly good time.
+
+On the other hand, a person who is responsible for the care of a patient
+must be made to realize that she and she only is ultimately responsible
+during the entire 24 hours of every day. Being responsible for a patient
+does not mean that she should be with him every minute, or do everything
+herself: it does mean that she should plan so effectively that
+everything necessary is done, either by herself or by another competent
+person. When she goes away for even half an hour, she should appoint
+someone else to be responsible in her place and to her when she comes
+back. She must consequently make very clear just what she wants done. If
+there is medicine, nourishment, or treatment to be given, she can easily
+make a list, with the time for each, and ask that each item be crossed
+off the list as soon as the work has been done. She should not forget to
+ask for the list when she returns.
+
+What is really needed is a little executive ability. As Florence
+Nightingale said:
+
+      "It is impossible in a book to teach a person in charge of
+      the sick how to _manage_, as it is to teach her how to
+      nurse. Circumstances must vary with each different case.
+      But it is possible to press upon her to think for herself.
+      Now what does happen during my absence? I am obliged to be
+      away on Tuesday. But fresh air, or punctuality is not less
+      important to my patient on Tuesday than it was on Monday.
+      Or: At 10 p.m. I am never with my patient; but quiet is of
+      no less consequence to him at 10 than it was at 5 minutes
+      to 10. Curious as it may seem, this very obvious
+      consideration occurs comparatively to few, or, if it does
+      occur, it is only to cause the devoted friend or nurse to
+      be absent fewer hours, or even fewer minutes from her
+      patient--not to arrange so as that no minute and no hour
+      shall be for her patient without the essentials of her
+      nursing."--(Notes on Nursing.)
+
+It is exceedingly difficult to care for members of one's own family or
+to be cared for by them. Too much or too little is almost invariably
+expected by one person or the other, and where great affection is
+involved not only is the strain increased on both sides, but often harm
+results from too great unselfishness on either side or both. But
+sometimes the reverse is true, and then one should remember that normal
+behavior may be impossible for the sick. During weakness and pain,
+irritability and unreasonableness are as characteristic as other
+symptoms, and it is as foolish to demand a normal mental state from a
+sick person as it would be to demand a normal temperature. For a
+cheerful, reasonable, and unselfish patient--and there are surprisingly
+many--one should be devoutly thankful, but patience and pity should be
+given no less to those whose tortured nerves cause suffering to others
+as well as to themselves.
+
+Every woman who cares for the sick should remember that she is the
+patient's chief if not his only link with the normal world, and that his
+plight is pitiful indeed if she is complaining or irritable or
+unwilling. Anyone who cares for the sick should remember also that she
+is necessarily in a most intimate relation with the patient, and that
+such enforced intimacy calls for extra consideration on her part, and
+for the most scrupulous respect for confidential matters. It is
+inexcusable even for members of the patient's family to discuss with one
+another the patient's private concerns, or his queer or unreasonable or
+annoying ways. During sickness the skeletons in most people's mental
+closets walk forth, and anyone who misuses special opportunities to know
+intimate affairs can only be classed with eavesdroppers and village
+gossips.
+
+
+EXERCISES
+
+1. What are the essentials of a good sick room as to:
+
+  (_a_) Situation and exposure.
+  (_b_) Lighting and heating.
+  (_c_) Furnishing.
+  (_d_) Ventilation.
+
+2. How may a sick room be ventilated without exposing the patient to
+draughts?
+
+3. How should the bed be placed in relation to doors, windows, and
+walls?
+
+4. How should a sick room be cleaned?
+
+5. What in general are the duties of the attendant?
+
+6. Make a plan of your own bedroom, and show what changes, if any, would
+be desirable if it were to be used as a sick room.
+
+
+FOR FURTHER READING
+
+Notes on Nursing--Florence Nightingale, Pages 1-63, 84-105.
+
+
+
+
+CHAPTER VI
+
+BEDS AND BEDMAKING
+
+
+The common saying that the best bed for an invalid is his own bed
+contains an element of truth. Taking from a patient his own accustomed
+bed, even when a better is substituted, sometimes disturbs him greatly
+and makes him feel that he is indeed very ill. Nevertheless, a suitable
+bed is essential to the proper care of a helpless person, and no patient
+should continue to use an unsuitable one, unless his illness is slight
+and also likely to be of very short duration.
+
+Besides being comfortable, a bed suitable for the sick must be clean and
+easy to keep in a sanitary condition. The springs should be firm, and
+the mattress should be elastic and should give an even support without
+lumps and hollows. The bed covers should be clean, light, and warm; the
+pillows should be sufficient in number not only to make the head and
+shoulders comfortable, but also any other part of the body in need of
+support. Moreover, the bed should be so placed and of such a kind that
+the work of caring for the patient may be rendered as easy for the
+attendant as possible. In every household at least one bed suitable for
+a sick person should be available in case of need.
+
+BEDSTEADS.--Beds of white enameled iron, brass, or brass and iron
+combined are most easily kept clean, and are the best in every way. The
+frame should be strong enough to stand firmly, yet not so heavy that it
+is hard to move. It should have as few angles as possible, and all its
+joints should be smooth and well finished. The springs should be made of
+wire stretched tightly on a metal frame that fits smoothly into the head
+and foot pieces. Large castors should be used; they may be removed from
+the foot if the bed moves too easily.
+
+A bed to be used in sickness should have the following
+dimensions--length, 6 ft. 6 in., height 24 to 26 inches, width, 36
+inches. If a bed is either too high or too low the labor of lifting and
+moving the patient is greatly increased. If the bed is too narrow the
+patient is insecure. If the bed is too wide, its center is difficult or
+impossible to reach without leaning or kneeling upon it; and if too
+short, it will prove uncomfortable for a tall person. A bed that is too
+low may be raised on four heavy boxes of the same height; or still
+better, upon heavy wooden blocks which any carpenter can easily make,
+and which are well worth a little trouble to obtain. In the top of each
+block a hollow should be made into which the leg of the bed will fit
+after the castor has been removed. A broad firm stool or a low chair may
+be provided for a patient who has difficulty in getting in and out of a
+high bed.
+
+Beds with complicated attachments for moving patients are not
+recommended for family use. They are expensive, likely to get out of
+order, seldom needed, and generally unsatisfactory. In some surgical
+cases a bed with a firm, flat surface is necessary. Such a surface may
+be secured by placing between the mattress and springs two boards
+slightly separated, or one wide board with holes bored in it to afford
+ventilation.
+
+Wooden beds are undesirable: they are difficult to keep clean, they
+readily absorb moisture and odors, they cannot well be disinfected, and
+their solid frames prevent a free circulation of air. Moreover, it is
+almost impossible to render fit for use again a wooden bed into which
+vermin have once made their way. Folding beds and lounges even of the
+best type are unhygienic, usually too low for the patient's comfort, and
+often insecure.
+
+A bedstead should be wiped frequently with a damp cloth; if it is of
+enameled iron it may be washed with soap and water. The springs may be
+cleansed with a stiff brush dipped in kerosene oil. Excessive use of
+water upon the springs is likely to make them rust.
+
+MATTRESSES.--Various substances are used in the manufacture of
+mattresses, but nothing has yet been found that is as satisfactory as
+curled hair. It is light and clean and elastic, it does not readily
+absorb odors, and it is easily renovated. Although hair is more costly
+than other materials, a hair mattress may be used almost indefinitely if
+it is occasionally made over.
+
+Felt or cotton mattresses are firm, but heavy, difficult to keep clean,
+and likely to absorb odors. A useful mattress made from straw is
+sometimes found in country districts. Such a bed is thoroughly hygienic,
+for the worn straw may be burned and the tick washed and refilled with
+clean straw; but straw beds are generally hard and lumpy. The least
+desirable of all mattresses is the old fashioned feather bed, and it
+should never be used if a better can by any possibility be obtained; but
+a feather bed should not be arbitrarily taken away from an old person
+accustomed to its use, unless his welfare is really at stake.
+
+A mattress made in two sections is unnecessary for a single bed; indeed,
+a mattress made in one piece is more easily kept in place if the
+patient is restless. A good quality of blue and white ticking makes a
+serviceable cover for both mattress and pillows since its color is not
+likely to run.
+
+CARE OF THE MATTRESS.--A mattress should be brushed frequently with a
+whisk broom, especially around the tufts and edges. If a patient is long
+confined to bed, a fresh one should occasionally be substituted so that
+the regular mattress may be removed, well brushed, beaten with a carpet
+beater, and left exposed to the sun and air for a day or two. A mattress
+that is badly soiled should be sent to a cleaner and made over; it
+cannot be cleaned properly at home. It is generally possible to remove
+blood stains, if they have not soaked through the ticking, by applying a
+thick cream made from raw starch and cold water. When the starch becomes
+dry it should be brushed away, and the application should be repeated
+until the stain has disappeared. For the best results the starch should
+be applied before the stain is dry.
+
+PILLOWS.--One patient can use an almost unlimited number of feather
+pillows. Some should be soft and others firm, some large and some small;
+but pillows that are very large and thick are less useful than a greater
+number of smaller ones. It is well to have several small pillows of
+varying size and thickness to support different parts of the body.
+
+Hair pillows are often acceptable in warm weather, and they are also
+desirable for patients with high fever or excessive perspiration. Rubber
+air pillows are a convenience in traveling and add much to the comfort
+of a patient when he first goes out in a carriage or motor car, but air
+pillows are not sufficiently durable for general use.
+
+If a pillow tick becomes soiled, the feathers may be transferred to a
+clean tick by making an opening about six inches long in the end of each
+pillow, sewing the ticks together, and then shaking the feathers from
+one tick to the other. The soiled tick can then be washed. If the
+feathers themselves have become soiled they should be renovated by a
+cleaner. Pillows, like mattresses, should be frequently brushed, sunned,
+and aired. They should not be held in the mouth while a clean
+pillow-case is adjusted.
+
+PROTECTION OF THE MATTRESS AND PILLOWS.--In all cases of sickness the
+mattress must be adequately protected. Neglect is inexcusable and may
+cause expense and trouble as well as discomfort to the patient.
+
+The following may be used to protect the mattress or pillows: large
+quilted pads, small pads of cotton batting covered with old muslin or
+cheese cloth, slip covers for the mattress, rubber sheets and
+pillow-cases, old blankets and quilts that may be washed easily. Heavy
+wrapping paper, builders' paper, and newspapers serve well in
+emergencies, or for a short time.
+
+RUBBER SHEETS AND PILLOW-CASES.--Soft rubber cloth, single or double
+faced, is most frequently used when it is necessary to protect the bed
+from discharges. It may be purchased by the yard. Rubber sheets should
+not be used unless they are really necessary. They are hot and
+uncomfortable, and increase the tendency to perspire. When used, a
+rubber sheet should be 1 yard wide or wide enough to reach from the
+lower edge of the pillows down to the patient's knees, and long enough
+so that it can be tucked in securely on both sides of the bed. Rubber
+sheets may be cleaned by laying them on a flat surface and washing on
+both sides with soap and water, using a small brush if necessary. After
+rinsing they should be wiped, and when thoroughly dry they should be
+rolled rather than folded, to prevent the rubber from breaking.
+
+Rubber pillow-cases are used for a patient who perspires profusely, or
+who has a discharge of any kind from the head or neck, and also when
+substances which may wet or stain the pillow are applied to the head.
+They should be put on next to the pillow, securely fastened with tapes,
+snap hooks, or buttons, and covered with the regular pillow slip.
+
+Rubber sheets and pillow-cases are not durable. They should be used
+carefully, and frequently examined for holes or worn places by holding
+them up to the light. Even a pin hole near the center may render a
+rubber sheet or pillow-case as useless as a sieve.
+
+SHEETS.--Sheets of ample proportions are necessary for comfort, and
+important for sanitary reasons as well. For a bed of the dimensions
+mentioned in this lesson sheets should be three yards long, and two
+yards wide. A safe rule for any bed is to have the sheets one yard
+longer and one yard wider than the mattress. A sheet of these dimensions
+is large enough to be tucked under the sides and foot of the mattress,
+while at least twelve inches are left to fold over the blankets at the
+top. Cotton sheets are as good as linen for general use, or even better,
+and are far less expensive.
+
+DRAW SHEETS are used to cover rubber sheets, and to protect beds when
+the rubbers are not used. In hospitals special draw sheets are usually
+provided, but an ordinary sheet folded answers every purpose. New and
+expensive sheets should not be used for draw sheets, since they are
+more likely than other sheets to become stained. Draw sheets should be
+wide enough to extend about four inches beyond the rubber sheet at the
+top and bottom.
+
+PILLOW COVERS.--Pillow covers are generally made of cotton, but persons
+who can afford the cost frequently prefer linen, especially in hot
+weather. Unless fastened with buttons or tapes, a pillow case should be
+several inches longer than its pillow. It should be wide enough to slip
+on easily, but not so wide that it wrinkles or allows the pillow to
+turn. If it is too small the pillow will become hard and uncomfortable.
+These small things, unimportant as they are to the well, may cause much
+discomfort to a restless or nervous patient.
+
+BLANKETS.--All wool blankets are both light and warm, and are
+consequently the most comfortable bed covering. But unless they can be
+dry cleaned frequently, it is better to select blankets made from one
+part wool and two parts cotton. Blankets containing equal parts of wool
+and cotton are warmer, but are more injured by washing. Very light
+blankets of wool or outing flannel are useful in summer. Double blankets
+should always be cut in two and bound at the ends, since single blankets
+are easier than double blankets to handle and wash. Patients are
+frequently too warmly covered by day. Too much warmth is enervating, it
+causes the patient to perspire, and makes him restless and more
+susceptible to draughts and to changes of temperature. Two light
+blankets are warmer and more comfortable than one heavy blanket.
+
+COMFORTERS AND QUILTS.--Heavy cotton comforters are burdensome without
+being correspondingly warm. Eiderdown quilts or those padded with wool
+are good for a patient who sleeps out of doors, or whose room is kept at
+a low temperature. Bed covers that cannot be laundered readily should be
+protected by basting on both sides of the top a wide piece of muslin or
+linen, which can be removed and washed.
+
+COUNTERPANES.--White dimity counterpanes are desirable, since they are
+light in weight, easily laundered, and inexpensive. A heavy counterpane
+is uncomfortable at any time, and still more uncomfortable in sickness.
+If a light spread is not available, a sheet makes a good substitute. A
+counterpane should be wide enough to cover the sheets and blankets at
+the sides when the bed is open, and long enough to protect the bedding
+at the top and bottom.
+
+
+BED MAKING
+
+All methods of making beds for the sick are based upon a few underlying
+principles. The aim in every case is to obtain the following results
+with the least expenditure of time and labor: first, to secure comfort
+for the patient, and to eliminate all causes of friction, irritation, or
+pressure upon his skin; next to keep the covers firmly in place, so
+that the bed will not easily become disarranged; then to protect the
+mattress, and last, to secure as good an appearance as possible.
+
+[Illustration: FIG. 12.--THE DRAW SHEET IN PLACE. (_From "Elementary
+Nursing Procedures," California State Board of Health._)]
+
+TO MAKE AN UNOCCUPIED BED, proceed as follows: remove the pillows and
+covers one at a time, and place them on chairs, near an open window if
+possible. Brush the mattress and then set it up on its ends to air, or
+turn it back over the foot board. Wipe the bedstead with a damp cloth.
+Replace the mattress after it has aired, turning it from side to side
+and from end to end on alternate days. Cover the mattress, unless it is
+enclosed in a slip cover, with a white quilted pad or an old blanket,
+and then spread the lower sheet over the mattress, so that the middle
+fold of the sheet lies upon the center of the mattress in a straight
+line from the head of the bed to the foot. Tuck the sheet under, first
+at the top and then at the bottom, drawing it so that it is firm and
+tight. If the sheet is of proper length tuck fourteen or sixteen inches
+under at the top, but take care to cover the mattress at the foot also.
+Next tuck the sheet under at the side, folding its corners to make a
+neat finish like an envelope. Place the rubber sheet, if it must be
+used, across the bed, with its upper edge where the lower edge of the
+pillows will come. A draw sheet somewhat wider than the rubber sheet is
+needed next; an ordinary sheet, folded once the long way of the sheet,
+may be used, with the fold toward the head of the bed. Tuck both rubber
+and draw sheet securely under the mattress at the side. In some cases
+the rubber sheet may be placed next to the mattress, and covered by the
+mattress pad and lower sheet. Place the draw sheet as directed, whether
+the rubber is used or not. After the lower, rubber, and draw sheets have
+been adjusted on one side of the bed, go to the opposite side, draw them
+over smoothly, and tuck them under the mattress as tightly as possible.
+
+Next spread the upper sheet over the bed so that its upper edge reaches
+to the upper edge of the mattress, and its middle crease lies over the
+middle line of the mattress, and place it right side down, so that the
+smooth side of the hem will be uppermost when the sheet is turned over
+the blankets. Place the blankets so that their upper edges lie a little
+higher than the place where the lower edge of the pillow will come, and
+tuck them in firmly at the bottom and sides. If the blankets are not
+long enough to tuck in at the foot, place the lower blanket as directed
+and the upper blanket five or six inches lower than the first. When
+tucked in, the upper blanket holds the lower one in place fairly well.
+Place the counterpane evenly and smoothly, tuck it under at the foot,
+turn its corners neatly, turn its upper edge under the upper edge of the
+blankets and fold the upper sheet down over the whole. Last of all,
+shake the pillows and place them neatly on the bed.
+
+[Illustration: FIG. 13.--THE CLOSED BED. (_From "Elementary Nursing
+Procedures," California State Board of Health._)]
+
+Practice is necessary before it is possible to make a bed quickly and
+well, and a certain amount of proficiency in making an unoccupied bed
+should be acquired before undertaking to make a bed with a patient in
+it. One should learn to work in an orderly way, without confusion,
+unnecessary motion, or jarring of the bed.
+
+TO CHANGE A PATIENT'S PILLOWS.--Stand preferably on the right side of
+the bed and slip the left arm under the patient's shoulders, supporting
+his head in the hollow of the arm. Raise him slightly and remove the
+pillows one at a time with the right hand, drawing them outward on the
+left side of the bed. Place a small pillow under his head. Shake the
+pillows, change the cases if necessary, and replace them on the left
+side of the bed, ready to be drawn back into position. Raise the patient
+as before, remove the small pillow and draw the others into place. It is
+sometimes better to hold the patient on the upper pillow while removing
+and replacing the under one.
+
+LIFTING A PATIENT IN BED.--Patients tend to slip down toward the foot of
+the bed, and they should be raised if unable to help themselves. To
+raise the patient, instruct him to flex his knees and to press his feet
+firmly upon the bed; place one arm under his shoulders, as when
+changing pillows, the other arm under the thighs, and lift him upward
+without jerking. The lifting can be done more easily by two people, and
+with less discomfort to the patient: if he is entirely helpless two
+people are necessary. Two people should proceed as follows: Let _A_
+place her left arm under the patient's head and shoulders as before, her
+right arm under the small of his back; let _B_ place her right arm also
+under the small of his back and her left arm under his thighs, and at a
+signal let them lift together. In this way the weight is so evenly
+distributed that a heavy person can be lifted without great difficulty.
+
+TO TURN A PATIENT IN BED.--A patient may be turned toward or away from
+you. In turning a patient toward you, place one hand over his farther
+shoulder and the other over his hip, and turn him toward you. Then flex
+his knees slightly. To turn a patient from you, pass one hand as far as
+possible under the shoulders, and the other as far as possible under the
+thighs. Then raising the patient slightly, draw him back toward you,
+turning him at the same time, and then flex the knees. Lastly place a
+pillow firmly against his back to support it.
+
+TO CHANGE THE SHEETS WHILE THE PATIENT IS IN BED proceed as follows:
+First collect the fresh linen and place it conveniently near the bed.
+Then draw the bedclothes from beneath the mattress, raising the mattress
+meanwhile with one hand to prevent jarring the bed. Remove first the
+spread and then the upper blanket if there are two, fold each once and
+place it on a chair. Hold the remaining blanket in place with one hand,
+while with the other you draw the upper sheet out from under it; then
+fold the edges of the blanket up over the patient to keep them out of
+the way. The upper sheet, unless soiled, may be folded once and used
+again as a draw sheet. Next remove all the pillows, unless the patient
+prefers to keep one. Then move the patient toward one side of the bed
+and turn him on his side so that he faces the edge nearest him. Roll the
+draw sheet and rubber sheet together if both are to be removed, or
+separately if the rubber sheet is to remain on the bed; then roll the
+bottom sheet throughout its entire length, and bring the three sheets,
+all rolled as flat and as tightly as possible, close to the patient's
+back. Pleat about half of the fresh lower sheet lengthwise and place the
+pleated portion as close as possible to the rolled soiled sheets. Tuck
+in the other half of the fresh sheet at the top, bottom and side, draw
+the rubber sheet if it is to be replaced back over the fresh lower
+sheet, arrange the fresh draw sheet in place, tuck it in at the side,
+and roll its free portion close to the patient's back. The fresh side of
+the bed is then ready for the patient. Lift his feet back over the
+rolled sheets keeping his knees flexed, then turn him back over the
+rolled sheets on to the fresh smooth part, remove the soiled sheets and
+arrange the fresh ones in place on the side where the patient has just
+been lying. Be careful to keep him well covered with the blanket. After
+the lower sheets are in place and firmly tucked in, spread above the
+blanket the fresh upper sheet, and over the sheet spread the second
+blanket. Hold the sheet and blanket in place with one hand while using
+the other hand to draw out the first blanket from beneath the sheet. In
+this way the patient is constantly covered by a blanket. Place the
+blanket just removed above the other and finish the bed according to the
+directions given for an unoccupied bed, using special care, however not
+to draw the covers too tightly over the patient's feet.
+
+[Illustration: FIG. 14.--CHANGING THE DRAW SHEET. (_From Pope "Home Care
+of the Sick," American School of Home Economics, Chicago._)]
+
+TO MOVE A PATIENT FROM ONE BED TO ANOTHER.--On the fresh bed have the
+lower sheets in place but not the upper covers. Place the two beds close
+together side by side, and draw one mattress a little over the place
+where the two sides meet. Loosen the draw sheet under the patient, roll
+it on both sides close to the body and draw him gently over by means of
+this sheet, moving his shoulders at the same time. If the beds are
+unequal in height, use firm pillows or folded blankets to make an
+inclined plane.
+
+[Illustration: FIG. 15.--CHANGING A PATIENT FROM ONE BED TO ANOTHER.
+(_From Pope "Home Care of the Sick," American School of Home Economics,
+Chicago._)]
+
+If the beds differ greatly in height and indeed in most cases, it is
+better to carry the patient from one bed to the other. At least two
+people are needed; one alone should never attempt to carry anyone
+heavier than a small child. One method for lifting is as follows: Let
+two bearers, _A_ and _B_ stand on the same side of the bed. If the
+patient is to be moved into the right side of the fresh bed let both
+bearers stand on the right side of the occupied bed; if he is to go into
+the left side of the fresh bed, let them both stand on the left side of
+the occupied bed. Let _A_ place one arm under the patient's shoulders
+and her other under the small of his back, while _B_ places one arm
+under his hips and the other just below his knees. Draw the patient to
+the edge of the bed, instruct him to place his arms about the shoulders
+of _A_ and to hold the body rigid, and then lift together at a given
+signal, keeping his weight well up on the chests of the bearers.
+
+Whenever a patient must be turned, lifted, carried, or moved in any way,
+let him know beforehand just what you intend to do so that he may not be
+startled, and also that he may coöperate if possible. Grasp him firmly
+but gently, avoid pinching the skin, and move him steadily and
+smoothly, avoiding jerks and false starts. Do not attempt alone more
+than your strength is amply sufficient to accomplish, and endeavor at
+all times to handle the sick with the utmost gentleness and
+consideration.
+
+
+EXERCISES
+
+1. Describe a bedstead and mattress suitable for a sick person's use,
+and tell why they are to be preferred.
+
+2. How should the bedstead be cared for? the mattress? the pillows?
+
+3. How should a mattress and pillows be protected?
+
+4. Describe in detail the bed covers that are desirable for use in
+sickness.
+
+5. Name the results that a good method of bedmaking aims to secure.
+
+6. Describe the method of making an unoccupied bed.
+
+7. How should one change the pillows of a helpless patient?
+
+8. Describe the way in which you would lift and turn a patient in bed.
+
+9. Describe the method of changing sheets and remaking a bed while the
+patient is in it.
+
+10. Why are beds and bedmaking considered so important in the care of
+the sick?
+
+
+FOR FURTHER READING
+
+Notes on Nursing--Florence Nightingale, Pages 79-84.
+
+
+
+
+CHAPTER VII
+
+BATHS AND BATHING
+
+
+Bathing is necessary in sickness no less than in health. It stimulates
+and equalizes the circulation, is soothing in feverish conditions, is
+refreshing to most people, and by affording a certain amount of exercise
+it lessens the fatigue of lying in bed. Moreover, without frequent
+bathing it is impossible to keep the skin in good condition, since
+scales of dead skin, oily matter, and solid substances left by
+perspiration collect on the surface of the body when a person is lying
+still in bed as well as when he is leading an active life. The common
+belief that sick people are likely to catch cold from bathing is quite
+unfounded; every patient, unless his condition is such that the doctor
+orders otherwise, should have one complete cleansing bath each day. In
+addition to the regular cleansing bath other kinds are often prescribed
+as medical treatment.
+
+
+CLEANSING BATHS
+
+A _tub bath_ if allowed by a patient's condition, is the most
+satisfactory kind, but special precautions must be taken to guard her
+from fatigue and chill. The bath room and everything to be used should
+be made ready before she leaves her bed. Necessary clothing and toilet
+articles should be collected and arranged conveniently, a chair covered
+with a blanket and also a bath mat should be placed beside the tub, and
+the temperature of the bath room should be regulated so that it is about
+70° F., or a little lower if the room is likely to become overheated as
+the bath proceeds. The bath water should be drawn last. Its temperature,
+tested by a thermometer, should be between 96° and 100° at the
+beginning, and may be increased if desirable.
+
+If the patient is weak, wash and dry her face, neck, and ears, and if
+necessary cut the finger and toe nails before she leaves the bed, in any
+case before she enters the tub. As soon as the patient has left the bed,
+strip it and leave it to air; then assist her into the bath room and
+help her carefully into the tub. Do not allow her to stay in the water
+more than ten minutes at most, and stop the bath at once if she shows
+the slightest sign of faintness, dizziness, exhaustion, difficult
+breathing, marked change of color, or other unusual symptom. Indeed, if
+the patient is weak or her reaction to the bath uncertain, as when she
+takes her first tub bath after an illness, someone should always be
+within call to help the attendant in case of need. A faint, heavy
+patient in a bath tub is an impossible load for one person to handle.
+
+While the patient is in the tub, soap her well, brush her finger and toe
+nails, rinse, and rub her to stimulate the circulation. Then help her
+from the tub, seat her in the chair, draw the blanket closely about her
+from neck to feet, dry her with warm towels, exposing the body as little
+as possible, and, if she is to return to bed, put on a fresh night gown,
+and wrapper and slippers. Next place the lower sheet, the draw sheet,
+and one pillow on the bed as quickly as possible, help the patient into
+bed, keeping her well covered with a blanket, and finish making the bed.
+If she seems chilly, give a hot water bag and hot drink and leave the
+blanket next her in place. After the patient has been made comfortable,
+clean the tub and put the bath room in order.
+
+Even patients supposedly able to take tub baths without assistance
+should not lock the bath room door nor be left alone a long time.
+
+BED BATH.--Practice is essential in order to give a bed bath skillfully.
+The aim is to make the patient thoroughly clean and thoroughly dry,
+without chilling, fatiguing, or exposing her, without making the bed
+damp, and without unnecessary haste or delay. One method of giving a
+bed bath follows, but any method that accomplishes these aims is likely
+to be satisfactory.
+
+First see that the room is about 70° F. and likely to remain so, and
+exclude draughts. Collect everything to be used, including a blanket to
+cover the patient, an old blanket or large bath towel to protect the
+bed, at least two other towels, one a bath towel and the other a face
+towel, two wash cloths, soap, nail brush, powder, alcohol, comb and
+brush, nail file, scissors, etc.; fresh bed and personal linen; a large
+basin containing water at 105°, a jug of hotter water, and a slop jar.
+Remove the upper bed clothes except one blanket, which should cover the
+patient constantly during the bath, and spread them where they will air;
+remove all the pillows but one, and place the bath blanket under the
+patient as the under sheet is placed in bed making. If a bath blanket is
+not used, keep the bath towel under the part that is being bathed by
+moving the towel from place to place.
+
+Next remove the night gown in the following way: Let the patient lie on
+her back, with her knees flexed; draw the gown up as far as possible,
+then raise or get her to raise her hips so that the gown may be drawn up
+above the waist. Next raise her head and shoulders with one arm and draw
+the night gown up to the neck with the other; remove one sleeve, draw
+the gown over the head and then off the other arm.
+
+[Illustration: FIG. 16.--WASHING A PATIENT WITHOUT EXPOSURE. (_Sanders
+"Modern Methods in Nursing."_)]
+
+The patient is now ready for the bath. Wet the wash cloth thoroughly,
+but hold it gathered in the hand so that it will not drip. Wash the
+face, neck, and ears first, dry them thoroughly, and next, using the
+second wash cloth, wash the arms and hands, chest and abdomen, giving
+particular attention to the armpits and navel. Raise the blanket
+slightly with one hand to keep it from becoming damp, but expose the
+patient as little as possible; the arms and legs need not remain covered
+while being washed. Dry each part thoroughly before washing the next.
+Next turn the patient on her side and wash the back, the buttocks, and
+upper part of the thighs; give special attention to the fold between the
+buttocks. Then turn the patient on her back, and wash the thighs, legs,
+and feet. If it is important to move the patient as little as possible,
+leave the back until last so that the under sheet may be changed without
+turning her again. Cut the toe nails if necessary before washing, and
+clean them carefully afterward. Unless there is a reason to the
+contrary, wash the hands and the feet in the basin, first protecting the
+bed with a towel, newspaper, or clean wrapping paper. Be sure to clean
+well between the toes, and to dry the feet thoroughly; they may need
+some friction. Throughout the bath empty and refill the basin as
+necessary.
+
+Wash the genital region last. Let the patient lie upon her back with
+knees flexed and separated, or upon one side with the knees flexed and
+one slightly raised. Patients who are able may take this part of the
+bath themselves with whatever assistance may be necessary. The
+attendant, however, must either do it herself or make sure that the
+patient does it thoroughly. To neglect a helpless patient is always
+unkind, and no less unkind when the motive is a mistaken sense of
+modesty. If discharge from the genitals is present use absorbent cotton,
+or clean, soft old cloth to wash the parts, and burn it afterward. It is
+sometimes desirable to place the patient on a bedpan and rinse the parts
+by a gentle stream of warm water poured from a jug. After the attendant
+has completed this part of the bath she should wash her own hands
+thoroughly.
+
+After the bath rub the patient with alcohol. If a complete alcohol rub
+is impossible, at least rub the points where pressure comes, especially
+the back. After the rub apply a little toilet powder if the patient
+desires it. When the toilet is complete remove the bath blanket, remake
+the bed and put the room in order.
+
+CARE OF THE MOUTH AND TEETH.--In sickness the mouth and teeth require
+more than ordinary attention; indeed, the condition of a patient's mouth
+is a fair index to the quality of the care she is receiving. If the
+patient can brush her own teeth she should do so in the morning, at
+night, and after meals. At those times the attendant, without waiting to
+be asked, should bring her a towel, tooth-brush, cup of tepid water,
+tooth paste or powder, and a small basin or dish to receive the used
+water. The process is generally more thorough when the patient does it
+herself, and even a patient unable to sit up can brush her teeth
+successfully if the nurse holds the powder and cup of water, and
+provides a basin shallow enough for the patient to use by turning her
+head to one side.
+
+[Illustration: FIG. 17.--THE NURSE ASSISTING THE PATIENT IN BRUSHING THE
+TEETH. (_From "Elementary Nursing Procedures," California State Board of
+Health._)]
+
+The attendant must cleanse the mouth of a patient who is unable to do it
+herself. If this cleansing is neglected, a dark tenacious substance
+collects upon the teeth and gums, composed chiefly of food particles,
+bacteria, mouth secretions, and worn out cells of the mucous membrane.
+Once formed it is difficult to remove, hence the mouths of all patients
+and especially those who have fever, must receive proper care from the
+very beginning of illness. Cotton swabs are convenient for cleansing the
+mouth; they are made by winding a small piece of absorbent cotton upon a
+match or wooden tooth-pick.
+
+To cleanse the mouth of a helpless patient, take to the bedside the
+mouth wash prescribed by the doctor, a towel to protect the bedclothes,
+several swabs, and a receptacle for used swabs; the latter should be a
+strong paper bag or several thicknesses of newspaper. Clean the tongue,
+gums, teeth, and spaces between the teeth gently but thoroughly, using
+especial care if the gums are tender. Dip only clean swabs in the
+solution, discard each one after using it once, and burn it afterward.
+Let the patient rinse her mouth after cleansing it if she is strong
+enough. If the mouth is very dry, encourage her to drink more water.
+Notify the doctor if the gums and tongue crack or bleed since he may
+wish to order a special mouth wash. Cold cream or boracic ointment may
+be used if the lips are dry and cracked.
+
+False teeth should be thoroughly brushed and cleansed, and kept in cold
+water if taken out during the night.
+
+CARE OF THE HAIR.--Long hair, if neglected, becomes tangled and matted
+in a surprisingly short time. Unless the patient is actually in a dying
+condition she is not too sick to have it properly attended to at least
+once a day. Before combing the hair protect the pillow with a towel;
+then part the hair in the middle from the forehead to the nape of the
+neck, and draw it to either side. Begin to comb at the ends, holding the
+strand of hair firmly in one hand placed between the head and the comb;
+in this way tangles can be removed without hurting. After combing and
+brushing the hair, braid it in two braids, beginning near the ears; draw
+it as tightly or loosely near the head as the patient prefers, but
+remember that tight braids mean fewer tangles. If the hair is heavy or
+badly tangled the patient may be too much fatigued to have it all combed
+at one time; in this case braid the part that has been finished and
+complete the work later.
+
+TO WASH THE HAIR OF A BED PATIENT.--The hair of a patient can be
+successfully washed in bed if sufficient care is taken not to chill or
+tire the patient, or to wet the bed. The following articles are needed:
+one small jug of strong soap suds made by dissolving a pure soap in hot
+water, one large jug of hot water at about 112° F., one jug of cold
+water, a slop jar or foot tub, one long rubber sheet or piece of enamel
+cloth, and several towels including at least one bath towel. Let the
+patient lie as near the edge of the bed as possible. Roll one small
+towel lengthwise, place it below the hair at the back of the neck, bring
+it up above the ears to the forehead and pin tightly, in order to catch
+water that might wet the face and neck. Next make a kind of trough of
+the large rubber by rolling its long edges inward for a few inches.
+Place this across the bed under the patient's head so that her neck
+rests on the lower roll. Raise by means of pillows the end of the rubber
+trough that lies toward the middle of the bed, in order to prevent water
+from running into the bed or collecting under the patient's head. Let
+the other end of the rubber extend over the edge of the bed down into
+the slop jar or foot tub, which may be placed on a chair or stool. Then
+wash the hair and scalp with the soap solution, and rinse them
+thoroughly with water from the large jug. Squeeze as much water as
+possible from the hair, remove the rubber and substitute a heavy bath
+towel, and rub and fan the hair until dry. A shampoo in bed is tiring.
+Do not attempt it unless the patient is strong enough to stand not only
+the shampoo itself, but also a complete change of bed clothing, which
+will almost certainly be necessary if the attendant has been careless or
+clumsy in the slightest degree.
+
+HOT FOOT BATHS properly speaking are medical treatment, but they are
+taken by many persons to relieve colds, headache, or insomnia. Let the
+patient sit, well wrapped, with her feet in water at about 105°, and
+then increase the temperature gradually by adding hotter water. Take
+care to add hot water slowly and not to pour it directly upon the
+patient's feet or ankles; otherwise she may be scalded. Mustard may be
+added to the bath water in the proportion of one tablespoonful of
+mustard to each gallon of water. If mustard is to be used make it into a
+smooth paste with cold water, thin the paste with warm water, and when
+thin enough to pour easily add it to the bath water and stir well. The
+bath may continue for 10 to 20 minutes, and the feet should be dried
+afterward without friction. The patient should go to bed at once; she
+should not wander about, clearing away her foot bath, doing forgotten
+things, getting herself chilled, and losing all the good effects.
+
+A foot bath may be given easily to a patient in bed. Bring to the
+bedside a blanket, a towel, the tub filled with water, and something
+with which to protect the bed; this may be a rubber sheet, bath towel,
+old blanket folded, or several thick clean newspapers. Loosen the upper
+covers at the foot of the bed, fold them back above the patient's knees,
+and cover her legs and feet with the extra blanket making it overlap the
+bed clothing so that it will not slip. Flex the patient's knees, put the
+bed protector under her feet, place the tub on the side of the bed,
+raise the legs and feet with one hand and arm, and slide the tub into
+place with the other, raising the elbow in such a way that it keeps the
+blanket out of the water. Lower the feet slowly into the water, fold the
+towel, and place it over the edge of the tub in order to protect the
+patient's knees from the cold rim; then tuck the blanket closely about
+the tub and legs and proceed as before. After the bath use the towel,
+unless it is wet, to receive the feet when they are withdrawn from the
+tub. Remove the tub, dry the feet thoroughly, cover them warmly, and
+remake the bed.
+
+COOL SPONGE BATH.--For feverish patients doctors often order cool sponge
+baths. In order to give a cool sponge bath, first protect the bed
+thoroughly, but leave the patient uncovered except for a towel laid over
+the hips. Use cool water, or cool water and alcohol, and have the wash
+cloth as wet as it can be without dripping. Bathe the body without
+friction, using long, light strokes, and leave each part wet until the
+bath has been completed. Do not use soap. Sponge in this way the arms,
+legs, chest, and back, but not the abdomen, for ten to twenty minutes,
+giving special attention to the neck and inner side of the arms and
+legs, because in those places large blood vessels lie nearer the surface
+of the body. After finishing the bath dry the body by patting it gently
+with towels.
+
+Take the patient's pulse occasionally during the bath, and stop the bath
+at once if the patient's pulse grows weaker, if she shivers violently,
+or if her face, fingers, or toes turn a bluish color. Babies react
+rapidly to cool sponging; for a baby use tepid water, sponge for five
+minutes only, and watch the child closely during the bath.
+
+
+EXERCISES
+
+1. What may a bath be expected to accomplish in addition to cleansing?
+
+2. In giving a tub bath, what precautions should be taken to avoid
+chilling the patient? to avoid tiring the patient?
+
+3. What symptoms would lead you to think that a tub bath was not
+agreeing with a patient? What should you do in such a case?
+
+4. Name six essentials of a skillfully given bed bath.
+
+5. What preparations should be made and what articles assembled before
+beginning a bed bath?
+
+6. Describe the method of bathing a patient in bed.
+
+7. What care should the mouth and teeth of every sick person receive?
+How should such care be given to a patient who is helpless?
+
+8. Describe the daily care of a patient's hair, and tell how a shampoo
+may be given to a patient in bed.
+
+9. How should you give a mustard foot bath to a patient in bed?
+
+10. When and how should you give a cool sponge bath?
+
+
+FOR FURTHER READING
+
+The Human Mechanism--Hough and Sedgwick, Chapter XI.
+
+
+
+
+CHAPTER VIII
+
+APPLIANCES AND METHODS FOR THE SICK-ROOM
+
+
+Patients who are confined to bed even for a few days often suffer
+acutely from muscular tension, from pressure, and from fatigue due to
+lack of exercise. Indeed, many a sick person is surprised to find that
+the bed which had seemed so infinitely desirable can change into a place
+of torment after a few short days of illness. "Bed-weariness" is hard to
+bear in any case of illness, but it is doubly hard for persons who are
+really helpless.
+
+Unless the patient is an experienced sufferer he often has no idea what
+should be done to make him comfortable; while an equally inexperienced
+helper, though full of good will, is often discouraged to find that the
+arrangement she had thought perfect soon fails to satisfy her restless
+patient. But if she is willing to devote thought and ingenuity to
+removing small annoyances, she can do many things to alleviate his
+misery.
+
+BED SORES, or pressure sores, are caused by continued pressure upon the
+skin. The weight of the body, or of a part of the body, if it comes for
+a long time upon one place finally interferes with the circulation in
+the tissues on which the part rests, and consequently interferes with
+the nutrition of the affected part. Any tissue to which the blood is not
+bringing all its necessary food supply tends to lose its tone, to become
+weak, and if the condition persists, to break down altogether.
+
+The direct cause of bed sores then is pressure, and pressure is
+aggravated by moisture, wrinkles in the bed clothes, crumbs or other
+hard particles, lack of cleanliness, friction of any kind, or by rough,
+careless handling. Bed sores occur most often over bony prominences,
+such as the end of the spine, elbows, heels, shoulders, hips, ankles,
+and knees, but they may form anywhere, even on the ears or back of the
+head. They are more likely to appear on thin, aged, or depleted
+patients. These painful and serious sores can be prevented almost always
+by faithful care. When they occur, they result in the great majority of
+cases purely from negligence, and a person who knows the danger and yet
+through carelessness allows one to develop upon a patient may justly
+feel herself disgraced.
+
+Prevention of bed sores depends upon keeping the skin dry and clean and
+upon relieving pressure by special devices and by turning the patient
+frequently. The parts where pressure comes should be washed at least
+twice daily with warm water and soap, rubbed frequently with alcohol to
+improve the circulation and to keep up the tone of the skin, and
+powdered with a little good toilet powder. Much powder is likely to do
+harm by collecting in hard, irritating particles. The bed should be kept
+constantly dry and smooth, and free from crumbs, lumps, wrinkles, or
+other inequalities. Prolonged pressure should be relieved by turning the
+patient often,--once every waking hour is not too often if the body is
+emaciated,--and by pillows, pads, and rings.
+
+Small pillows or thick pads of cotton should be placed under the
+patient's back and shoulders, between the knees and ankles when he lies
+on his side, and in other places where sores are likely to develop.
+Rubber rings are useful, but few patients like them for a long time.
+They should not be inflated more than necessary to raise the affected
+part from the bed; if much inflated, they are uncomfortable and may do
+harm. The ring may be covered with a muslin pillow case, or it may be
+wound smoothly with long strips of bandage or old muslin. Ordinary
+cotton batting wound with strips of muslin may be made into rings and
+used to remove pressure from heels, elbows, or other parts. These cotton
+rings are less heating than pads, and give better support.
+
+The first sign of a bed sore is either redness of the skin or a dark
+discoloration like a bruise. Every point where a bed sore may form
+should be inspected daily. If the slightest symptom of a sore appears,
+the patient must not lie on the affected part, and every effort should
+be made to keep the skin from breaking; vigorous rubbing at this stage
+is dangerous, and will by no means make up for previous neglect. The
+condition should be reported to the doctor at once. If in spite of all
+efforts the skin does break, a peculiarly difficult kind of open wound
+results which must be treated and dressed according to the doctor's
+directions.
+
+DEVICES TO GIVE SUPPORT.--The variety and number of pillows one patient
+can use is almost unlimited. A weak patient when lying on his side
+should have his back supported by a pillow. When he lies on his back a
+pillow should be placed under his knees to lessen muscular tension, and
+if he may be raised in bed, several pillows are needed to support him
+comfortably. A back rest is useful for a patient who can sit up in bed.
+Satisfactory back rests of several types can be purchased, or one may be
+improvised from a straight chair placed on the bed bottom side up, so
+that its legs lie against the head of the bed and its back forms an
+inclined plane. Back rest and chair alike should be covered by several
+pillows to make them comfortable, and other pillows should be used to
+support the patient's arms.
+
+A person who is sitting up in bed always tends to slip down toward the
+foot. This tendency may be corrected by using a foot rest, knee pad, or
+pillow. A hard pillow may be placed in the bed at the foot for the
+patient to brace his feet against; or a short board, well padded, may be
+arranged as follows for the feet to rest against: Fasten ropes to the
+board, as the ropes of a swing are fastened to the seat; set the padded
+board on edge at a convenient point below the patient's feet, and hold
+it in place by tying the ropes of the "swing" to the head of the bed. A
+pillow may be used in the same way, either at the feet or under the
+knees, by folding it over a long strip of muslin, the ends of which are
+then tied to the sides of the bed, brought up to the head, and there
+tied to prevent slipping. A cylindrical cushion six or eight inches in
+diameter and as long as an ordinary pillow, stuffed with firm material,
+may also be used for this purpose. It should be held in place by strips
+of strong muslin or ticking sewed to the ends of the cushion and tied to
+the head of the bed. The cushion should have a washable cover.
+
+[Illustration: FIG. 18.--SHOWING FOOT-SLING FOR SUPPORTING PATIENT IN
+THE UPRIGHT POSITION. (_Sanders "Modern Methods in Nursing."_)]
+
+Supports called _bed cradles_ are used to keep the weight of the bed
+covers from sensitive parts of the body, generally the feet or abdomen.
+They are semi-circular pieces of wood or iron fastened together so that
+they will stand up. A satisfactory cradle may be improvised as follows:
+Cut a barrel hoop in two, cross the halves at right angles and tie them
+together firmly; place the cradle over the affected part under the bed
+clothes. A smaller cradle may be made by taking sections that are less
+than half of the barrel hoop. If used for one foot only, the cradle
+should be small enough not to interfere with the motion of the other
+foot; if used for both feet, it should be large enough to allow some
+freedom of motion. Since the cradle leaves an air space, the feet should
+be wrapped in a piece of soft flannel. A cradle used for the protection
+of the abdomen should extend a little beyond the body on each side.
+
+[Illustration: FIG. 19.--ADJUSTABLE BED REST.]
+
+Adjustable tables are convenient for patients who are able to sit up in
+bed. These tables are supported on one side only so that they may extend
+over the bed. Another kind of bedside table has short legs and stands
+directly on the bed. Such a table can easily be made at home from a wide
+board with supports six or eight inches high nailed to each end. A lap
+board supported by heavy books may serve for temporary use. Indeed,
+home-made substitutes are often as good as expensive apparatus or even
+better. If sick-room appliances must be bought, it is well to remember
+that simple standard designs are best. Complicated apparatus is soon out
+of order, and is generally a trial both to the patient and to those who
+must adjust it. Persons taking care of chronic patients may often obtain
+valuable suggestions in regard to appliances by consulting a visiting
+nurse or the superintendent of the local hospital.
+
+[Illustration: FIG. 20.--ADJUSTABLE TABLE.]
+
+BEDPANS are utensils to receive bowel and bladder discharges of patients
+lying in bed. Enamel bedpans are better than porcelain, although more
+expensive. The shape known as the "Perfection" is best for general use.
+A "slipper" bedpan, although harder to clean and ordinarily less
+comfortable, may be preferable if it is especially difficult or
+undesirable to raise the patient. The square or douche pan is preferred
+by some people, and is especially useful when the quantity of discharge
+is large, as after an injection.
+
+When a patient asks for the bedpan it should be brought if possible
+without a moment's delay, not only because no other form of neglect
+makes a patient realize her helplessness more acutely, but also because
+the desire to use it often passes quickly and delay may encourage the
+habit of constipation. If the patient does not ask for the bedpan, the
+attendant should offer it at suitable times. Bedpans should be warmed
+before use. An easy way to warm one is to let hot water run over it; the
+outside should afterward be dried.
+
+To place the bedpan, first flex the patient's knees and push the night
+gown up; place one hand under the patient's hips, raise them slightly,
+and with the other hand slip the pan into place. If the patient is
+entirely helpless two persons are needed to lift her. Place a pad or
+folded cloth between the patient's back and the pan; then lower the
+patient gently. Before removing the pan, bring toilet paper, water and
+two pieces of soft old muslin or gauze. A patient, if able, prefers to
+use the toilet paper without assistance; her hands should afterward be
+thoroughly washed. If she is unable, the attendant must do everything
+needed. After the patient has been cleaned as thoroughly as possible
+with paper raise her hips with one hand and then remove the pan; it is
+important to raise her first because the skin often adheres and may be
+injured if the pan is suddenly pulled away; carelessness in managing the
+bedpan has caused more than one bed sore. Then remove the pan with one
+hand and cover at once. Turn the patient, if helpless, on her side, wash
+the parts with one piece of old muslin, thoroughly dry them with the
+other, and either burn or thoroughly wash both pieces afterward.
+
+Empty the bedpan and clean it at once; ordinarily one can clean it
+without wetting or soiling the hands. Use cold water first, removing all
+adhering solid particles with a tightly rolled piece of toilet paper. Do
+not use a brush for this purpose. After using cold water, rinse the pan
+thoroughly in hot water, and at least once a day wash it well in hot
+soapsuds. Directions for disinfecting the pan will be given later, but
+remember that a properly kept pan needs no deodorant solution. Glass
+urinals should be provided for men, and kept clean in the same way.
+Contents of both bedpan and urinal should always be carefully inspected;
+neither should be emptied in the dark.
+
+
+DAILY ROUTINE IN THE SICK-ROOM
+
+Obviously the routine of a patient's day must vary according to her
+condition, her preferences, and the amount of time the attendant has to
+give her. The temperature, pulse, and respiration must be taken and all
+medicine, nourishment, and treatment given at the exact times ordered,
+but the attendant should learn whether or not the doctor wishes her to
+wake the patient for food or treatment. Good management in the sick-room
+depends upon foresight and planning, and therefore it is well to keep in
+mind the following suggestions:
+
+Vitality is lowest in the early morning, hence baths and treatments,
+especially if they are fatiguing or painful, should if possible be left
+until after breakfast. Patients often wake early and wait, weak and
+miserable, for the day to begin. A hot drink at this time may give
+relief and enable the patient to sleep again. Even though breakfast time
+is near, nourishment should be given as soon as the patient wakes. She
+may not admit that she is hungry, but her nourishment should not be
+delayed until the family breakfast is ready, or still worse, finished.
+
+Before breakfast the bedpan should be offered, the patient's face and
+hands should be washed, her teeth brushed, her hair tidied, the bed
+straightened, and the room put in order. These services should require a
+few minutes only. The room if properly arranged at bed time needs only a
+little attention now unless untidy work has gone on during the night;
+disorder in a sick-room is as unnecessary in the early morning as at any
+other time.
+
+After the patient has finished her breakfast she may rest, or if
+allowed, read her mail or the newspaper while the attendant prepares for
+her day's work; about an hour after breakfast the patient should be
+bathed, unless she prefers her bath in the evening. After the bath some
+form of light nourishment should be given, even to a patient who has
+regular meals. If a patient is able to sit up in a chair, the best time
+for her to do so is generally just after the bath and toilet have been
+completed; but if she feels tired she had better wait until afternoon.
+The bed room can be better aired and cleaned if it is possible to take
+her into another room; and she herself generally profits by a change of
+scene.
+
+The doctor should definitely state when and for how long a patient may
+sit up for the first time after an illness, and an amateur who may be
+ignorant of the dangers involved should not assume the responsibility of
+deciding. When a patient is to sit up for the first time, put on her
+stockings, slippers, and wrapper before she leaves the bed. Arrange an
+arm chair with pillows in the seat and at the back, bring it close to
+the bedside and cover it with a large blanket unfolded. The chair may
+face either the head or the foot of the bed. Help the patient to a
+sitting position on the extreme edge of the bed, with her feet hanging
+down. Next, standing in front of her and supporting her well, let her
+slip down until she stands upon her feet, then let her turn, and gently
+lower her into the chair. See that the patient while sitting up is
+warmly covered, and that her foot-stool, pillows, etc., are adjusted
+comfortably. Move her chair so that the outlook may be as interesting as
+possible, and at least a little different from the view from the bed.
+Most patients like to look out of the window; children and old people
+enjoy it particularly.
+
+If the patient shows signs of fatigue, she should go back to bed even
+before the appointed time. To help her back to bed, reverse the process
+of helping her out. A footstool may be needed if the bed is high, or
+two people to lift her if she is weak or heavy. When a patient is in bed
+no one should ever sit on the bed, lean against it, use it as a table
+for folding linen, making pads, etc., take hold of the bed posts in
+passing, or touch the bed unnecessarily in any way.
+
+The best time for visitors is the last of the morning or the early
+afternoon. A judicious visitor may do an immense amount of good,
+especially to a chronic patient; indeed, she may be the only ray of
+light in a dark day. Subjects of conversation should be pleasant, but
+not too stimulating or exciting. The visitor should be prepared to carry
+the burden of the conversation, to drop topics skillfully that seem to
+involve fatigue or excitement, and either to go or to stop talking if
+the patient seems tired. Visitors should remember to talk naturally and
+cheerfully on ordinary topics, and to avoid excessive sympathy and
+labored attempts to cheer the patient. They should also remember that
+few patients bear well even the mildest forms of teasing. The patient's
+room is not the place to discuss personal or family troubles; yet it is
+only too often chosen for such purposes, probably because the complainer
+knows that in it an audience is always to be found.
+
+Visitors not belonging to the family should not be present in the
+sick-room during treatment of any kind, unless their help is required;
+neither, as a rule, should they stay during the patient's meals. A
+member of the family may stay with advantage if the patient tires of
+eating alone, but casual visitors almost invariably offend by undue
+urging if the patient's appetite is poor, or by facetious remarks if it
+is good.
+
+Ordinarily only one visitor should be admitted at a time, since a weak
+patient may be tired merely by looking from one to another. If it is
+desirable to limit the call, the attendant should tell the visitor
+beforehand how long to stay, or arrange a signal for the visit to end.
+To announce baldly in the sick-room that the patient is tired and the
+visitor must go, will only elicit aggrieved protests from both. In
+illness lasting only a day or two all visitors should be discouraged;
+during colds, because they are communicable; during general fatigue,
+headaches, digestive upsets, and painful menstruation, because rest and
+quiet are highly desirable. Visitors at such times too frequently give
+injudicious sympathy, and may actually delay the recovery of patients
+who enjoy playing the rôle of interesting invalid.
+
+The time when a trustworthy visitor is present may be the best time for
+the attendant to rest. The patient should be told when the attendant is
+going, and approximately when she will return. It is a mistake to slip
+away while the patient sleeps; she seldom fails to wake before the time
+scheduled and to resent the desertion. Surprises of any kind, pleasant
+or unpleasant, are seldom good for patients.
+
+Toward the end of the afternoon the patient is probably tired,
+especially if she has not slept during the day. When fever is present
+her headache and restlessness increase as the day goes on, but it should
+be remembered that uncomfortable beds and too heavy covers cause much of
+the restlessness attributed to fever. Rubbing the back and legs with
+alcohol, giving a tepid sponge bath, remaking the bed or changing her
+position may help to soothe her.
+
+The evening should be kept free from excitement, and every possible
+effort should be made to encourage sleep. It is a mistake to think that
+a better night results from keeping a sleepy patient awake all the
+evening; sick people should sleep when they can. Just before bedtime the
+attendant should prepare her own cot, and then make the following
+preparations for the patient to sleep: wash the patient's face and hands
+or give a sponge bath if it is desired, brush the hair, change the night
+gown, brush crumbs from the bed, tighten the sheets or remake the bed if
+necessary, rub the back and other pressure points with alcohol, shake
+the pillows, give liquid nourishment, preferably hot, cleanse the mouth,
+and give the bedpan. See that the patient's feet are warm, the bed
+covers right, the room ventilated properly and in good order, and the
+light extinguished or arranged for the night. If the patient is inclined
+to be wakeful a hot foot bath may help her, or sponging the entire
+length of the spine for fifteen minutes, using very hot water and long
+downward quiet strokes. No conversation should be encouraged during
+preparations for the night. Patients in bed all day often lose the habit
+of sleeping at the regular time, and lie awake far into the night from a
+vague feeling that someone else is coming or something further is to be
+done for them. Consequently last of all ask the patient if she wants
+anything more; if not, say good-night, go out and stay out, at least
+until she has had a chance to go to sleep. She is thus helped to realize
+that nothing further is likely to happen, and that it is time to go to
+sleep.
+
+Toward morning the patient grows weaker. More bed covers will probably
+be needed, and they may often be added without waking her. Night at the
+best is a dreary time for the sick. Pain and weariness and
+discouragement are less bearable in the darkness; nervous fears and
+morbid fancies defy control. Never is kindness more needed or more
+appreciated than it is by those who lie awake and watch for the morning.
+
+
+EXERCISES
+
+1. Name all the causes, direct and indirect, of pressure sores.
+
+2. Why are pressure sores generally more serious than injuries of equal
+extent to the skin of a well person?
+
+3. Where are pressure sores most likely to occur and what are their
+symptoms?
+
+4. What measures should be employed to prevent pressure sores?
+
+5. Describe ways to support a person lying down in bed.
+
+6. Describe ways to support a person sitting up in bed.
+
+7. How may the weight of the bedclothes be removed from any particular
+part of the body?
+
+8. How should a bedpan be cared for?
+
+9. Describe in detail a day's routine either of yourself the last time
+you were ill in bed, or of another patient personally known to you.
+Could the plan of the day have been improved, and if so, in what ways?
+
+
+
+
+CHAPTER IX
+
+FEEDING THE SICK
+
+
+Substances used for food are generally grouped into three classes,
+called the three nutrients. The nutrients are: first, the proteids or
+nitrogenous substances, which are found in meat, fish, eggs, milk,
+cheese, peas, beans, etc.; second, the carbohydrates, which include
+sugars and starch; and third, the fats, which are found in butter, oil,
+the fat of meat, etc. In addition to the nutrients, water and certain
+mineral salts are essential to life, while some indigestible material
+like the fibre of vegetables is needed to give bulk and to stimulate the
+action of the intestines.
+
+The nutrients furnish the body with materials for growth, and for repair
+of tissues worn out by use; they also furnish fuel substances from which
+the body obtains its heat and its energy. All three nutrients can serve
+as fuel, but the proteids alone can furnish materials for growth and
+repair of tissues. In order to be used by the body for any purpose,
+nutrients must first go through a series of complicated changes known as
+digestion, which renders them soluble so that they can soak through the
+walls of the intestine.
+
+
+THE DIGESTIVE PROCESS
+
+Digestion begins in the mouth. There the food is crushed and its fibres
+separated by the teeth, it is moistened by the saliva, and substances in
+the saliva begin a chemical action upon the starch. Chewing should be
+sufficient to reduce the food to a soft mass well moistened with saliva.
+Slow eating is desirable, but the emphasis should be placed on thorough
+chewing. For instance, long intervals between bites are of no special
+benefit if mouthfuls of food are washed down by swallows of water.
+
+After it has been swallowed, the food passes into the stomach and
+remains there for a variable length of time, while it undergoes further
+preparation for absorption. It is moved about by the contraction of the
+muscular walls of the stomach, so that it becomes mixed with the stomach
+juices and more thoroughly softened. Some digestion of proteids goes on
+in the stomach, and a little absorption through the walls.
+
+Little by little the food is discharged from the stomach into the small
+intestine, and the most important part of digestion then begins. It is
+acted upon chemically by a fluid flowing into the intestine from an
+organ called the pancreas; this pancreatic juice acts upon all three
+nutrients and is of great importance in the digestive process. The bile
+and other juices that flow into the intestine perform important
+functions also.
+
+The food masses are moved along by rhythmic contractions of the
+intestine, and absorption goes on when the food has been so changed that
+it can soak through the intestinal walls into the blood and lymph
+vessels. The small intestine is about 20 feet long, and consequently
+affords a large surface for absorption, as does also the large
+intestine, into which the small intestine opens. The blood and lymph
+carry the digested food substances to all parts of the body, and thus
+the different tissues are provided with the materials they need for
+growth, repair, and energy. Excess of food substances may be stored as
+fat or expelled from the body.
+
+As the blood and lymph go through the tissues they take from the tissues
+the refuse, or the part that remains after the fuel substances have been
+consumed. This refuse from the tissues may be likened to the ashes from
+a furnace; it is finally eliminated from the body through the kidneys
+and lungs, and to some extent through the skin and bowels. The part of
+the food that is not digested of course never soaks through the
+intestinal walls; it merely passes through the small and large
+intestines and is finally expelled as feces or bowel movements. The
+characteristic odor of fecal matter results from the action of bacteria
+upon it while in the large intestine.
+
+It must be remembered that the body is not nourished merely by
+swallowing food: in order to nourish the body food must also be
+digested, absorbed, and made use of by the tissues. Many factors may
+operate both in health and in sickness to render food indigestible. It
+may be originally unsuited to the human digestive apparatus, or spoiled,
+or poor in quality, or badly cooked. But even when wholesome in itself
+it may be ill-adapted to a particular person at a particular time; thus
+it may be too great in amount, or eaten at improper hours. Moreover a
+person's own idiosyncrasy or manner of living or fatigue or illness may
+render it especially indigestible for him.
+
+Experiments have shown that pain, fear, worry, and other unpleasant
+emotions actually stop the action of the digestive juices and check
+muscular contractions of the small intestine. Furthermore, even the
+absence of pleasant anticipation of food has been shown to delay
+digestion for hours. Thus scientific knowledge confirms our common
+experience that such mental states seriously interfere with digestion.
+The converse is also true. Agreeable taste and odor of food, or even
+pleasurable thought of it, start the secretion of digestive fluids. It
+is a common saying that the mouth waters at the prospect of inviting
+food, but it is less well known that appetizing food does actually start
+the stomach juices also. A person who understands the physiological
+effect that the emotions have upon digestion is in a far better frame of
+mind to cope successfully with the difficulties of feeding the sick than
+one who considers sick persons' likes and dislikes entirely irrational.
+
+
+FEEDING THE SICK
+
+Nourishing the sick is not always an easy problem, but its importance
+can hardly be overestimated. Indeed, proper feeding in many illnesses
+makes the difference between life and death. The actual amount of
+nourishment needed in sickness is often less than in health, but it may
+be just as great, or even greater if the illness causes increased tissue
+waste. Yet the digestive process of a sick person must be rendered as
+little laborious as possible, all foods ordinarily difficult to digest
+must be eliminated, certain others must be withheld or restricted
+according to the nature of the sickness, and in addition one may have to
+deal with an appetite that is capricious, diminished, or totally absent.
+
+Diet for the sick is often a part of medical treatment; in such cases
+the doctor will prescribe special diets and his orders must be carefully
+carried out. Except for special diets, food for the sick is generally
+divided into four classes: first, liquid or fluid diet; second,
+semi-solid diet; third, light or convalescent diet; and lastly, full
+diet. These diets are not very sharply distinguished.
+
+LIQUID DIET generally includes milk, eggnog, albumen water, broths,
+soup, beef juice, thin gruel, and beverages. Liquid diet makes least
+demand upon the digestive powers, because it consists of food already
+dissolved and therefore nearer the condition in which it can be
+absorbed. Moreover, it is less likely than other foods to contain excess
+of fat, improperly cooked starches, and other indigestible material.
+Liquids must be given at regular intervals and at shorter intervals than
+solid foods; 6 to 8 ounces every two or three hours is not too much if
+the patient can take it. The doctor usually specifies the amount and the
+interval. Some patients will take more nourishment at one time if the
+interval is slightly increased.
+
+SEMI-SOLID DIET includes all fluids and in addition soft milk toast,
+soft cooked eggs, well cooked cereal, custards, ice cream and ices,
+junket, and gelatine jellies. Liquid or semi-solid diet is commonly
+given in acute fevers because digestive juices and other fluids of the
+body are then diminished, and also because their digestion places a
+minimum of work upon a system already burdened with bacterial poisons.
+
+LIGHT OR CONVALESCENT DIET generally means a simple mixed diet. In
+addition to the articles in the two preceding diets it includes oysters,
+chicken, baked potatoes, most fruits except bananas, simple desserts,
+white fish, and other meats and vegetables added judiciously until full
+diet is reached. Fried foods should not be included.
+
+FULL DIET means an unrestricted menu, but even from full diets
+especially indigestible foods should be excluded. The principles of
+feeding sedentary persons as described in manuals of dietetics apply to
+patients who are obliged to be inactive although not really ill, as for
+example, a patient suffering from a broken leg. Ordinarily in such
+cases, as in other kinds of illness, the appetite is greatly diminished,
+but a word of warning should be given against overfeeding patients whose
+meals are their chief interest. Such patients are only too likely to
+interpret full diet as anything they desire in any quantity at any time
+of day or night, and then to attribute their discomfort and irritability
+to their illness rather than to overeating.
+
+Constipation is especially stubborn in sickness, since the patient is
+deprived of his usual exercise and variety of food. So far as possible
+the bowels should be regulated by diet. Laxative foods include most
+vegetables with a large amount of fibre, coarse cereals and flour, oils
+and fats, and most fruits and fruit juices. Unfortunately many laxative
+foods are difficult for sick persons to digest and must therefore be
+used with caution. A glass of hot or cold water or orange juice an hour
+before breakfast may be helpful, and at bed time hot lemonade, oranges,
+prunes, figs, or other fruit if allowed.
+
+It is essential for patients to drink water freely, and it should be
+given between meals and also between liquid nourishments. Persons
+inexperienced in the care of the sick frequently make the mistake of
+bringing water only when a patient asks for it.
+
+Many acute illnesses begin with fever, headache, sore throat, and
+especially among children with vomiting, diarrhœa, and other digestive
+disturbances. In such cases all food should be withheld until the doctor
+comes, but boiled water, hot or cold, should be given freely. Efforts to
+tempt the appetite are then mistaken; few people are injured and many
+are benefited by omitting food even for 24 hours at the beginning of an
+acute illness, and with few exceptions a doctor can be found in a
+shorter time.
+
+SERVING FOOD FOR THE SICK.--Food for the sick should always be most
+carefully prepared and of the best quality, and in addition it should be
+as inviting, as varied, and as well served as possible. Neglect in these
+respects is inexcusable. Even slight carelessness in preparing or
+serving food may arouse disgust and thus banish permanently some
+valuable article from the dietary.
+
+Trays, dishes, tray cloths, and napkins for the patient must be
+absolutely clean and as attractive as possible. Cracked or chipped
+dishes should not be used. Individual sets of dishes for the sick may be
+purchased, and their convenience makes them well worth their price.
+Paper napkins may be used in many cases to save laundry work; clean
+white paper is always superior to soiled linen.
+
+Before the tray is brought to the bedside, everything should be arranged
+so that the patient can eat in comfort. It is bad management to let the
+soup cool while the patient's pillows and table are being adjusted. In
+setting the tray great care should be devoted to placing the articles
+conveniently, and to the appearance and garnishing of the food. Careful
+serving requires more thought, but little if any more actual time than
+slovenly serving. Dishes should not be so full that food is spilled in
+transit; hot dishes should be covered; hot dishes should reach the
+patient hot, and cold dishes cold. Liquid nourishment in a glass or cup
+should be served on a small tray or plate covered with a doily. Neither
+glass nor cup should be held by the rim.
+
+It is not uncommon to overload trays and to serve everything at once in
+order to save steps, but a patient is ordinarily more interested in a
+meal that is served in courses unless very long intervals elapse
+between. Moreover, if the meal is served in courses he is not tempted to
+eat dessert first and then to refuse the rest of the meal. If food is
+given sufficiently often it is safer to err on the side of serving too
+little at a time rather than too much, since the sight of large amounts
+of food is often disgusting.
+
+The patient's likes and dislikes should be considered as far as
+possible, but most patients should not be consulted about their menus
+beforehand. Great variety in one meal is not necessary; it should be
+introduced by varying successive meals. An article that has been
+especially disliked should not be served a second time, unless it can be
+disguised beyond a possibility of detection. An article of food to which
+a patient objects should be removed at once; one may appear disappointed
+if it seems wise, but should never argue. When patients persistently
+refuse necessary nourishment a difficult situation is presented;
+persuasion and every form of ingenuity must be used, and the doctor's
+coöperation enlisted. When, for example, a strict milk diet is ordered
+for a patient who announces that he never takes milk in any
+circumstances the situation may seem hopeless but it is not necessarily
+so.
+
+TO FEED A HELPLESS PATIENT.--Helpless and weak patients must be assisted
+to eat or drink. A napkin should first be placed under the patient's
+chin. The attendant should place her hand under the pillow, raise the
+head slightly, and hold the glass to his lips with her other hand. An
+ordinary tumbler can be used by a patient lying down if it is not more
+than a quarter full, or a special feeding cup may be purchased. Bent
+glass tubes may be used for cool liquids; they should be washed
+immediately after use. A child who can sit up sometimes takes more
+nourishment if it is given through a soda water straw.
+
+If the patient must be fed with a spoon care should be taken that the
+liquid is not too hot, but the attendant should not blow upon it to cool
+it. It should be given from the point of a spoon placed at right angles
+to the lips, and plenty of time between mouthfuls should be allowed. A
+swallow should not be given at the moment when the patient is drawing
+the breath in. Great patience is required if a helpless person is to be
+fed acceptably. The attendant should sit by the bedside rather than
+stand, should present at least the appearance of having unlimited time,
+and should endeavor not to deprive the patient in any way of the
+satisfaction he may derive from his nourishment.
+
+
+EXERCISES
+
+1. What needs of the body do food substances supply?
+
+2. Give an outline of the digestive process.
+
+3. Describe the effect of different mental states upon digestion, and
+give examples of the ways by which a knowledge of these effects may be
+utilized in feeding patients.
+
+4. Why is the problem of nourishing the body of especial importance in
+sickness?
+
+5. Name the four ordinary classes of diet for the sick, and mention all
+the articles you can belonging to each class.
+
+6. Why is constipation a common ailment among patients confined to bed,
+and what attempts should be made to overcome it by the diet?
+
+7. Why is it necessary for sick persons to drink water freely, and what
+efforts should the attendant make to encourage them to do so?
+
+8. Describe the proper serving of a patient's tray.
+
+9. How should helpless patients be assisted to eat?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Chapter II.
+
+The Human Mechanism--Hough and Sedgwick, Chapters VIII, XIII, XIX.
+
+Notes on Nursing--Florence Nightingale, Pages 63-79.
+
+How to Live--Fisher and Fisk, Chapter II.
+
+Bodily Changes in Pain, Hunger, Fear and Rage--Cannon, Chapter I.
+
+Food for the Invalid and the Convalescent--Winifred S. Gibbs.
+
+Practical Dietetics--Pattee, Chapters IV, V.
+
+Feeding the Family--Rose.
+
+Diet in Health and Disease--Friedenwald and Ruhrah.
+
+Feeding Children from Two to Seven Years Old--New York City Department
+of Health.
+
+American Red Cross Text Book on Home Dietetics--Ada Z. Fish.
+
+Emergency Cooking--Pamphlet 708, American Red Cross.
+
+War Diet in the Home--Pamphlet 706, American Red Cross.
+
+Red Cross Conservation Food Course for Children and Special
+Classes--Pamphlet 705, American Red Cross.
+
+
+
+
+CHAPTER X
+
+MEDICINES AND OTHER REMEDIES
+
+
+ACTION OF DRUGS.--Modern medical practice increasingly emphasizes diet,
+baths, exercises, and other hygienic measures in the treatment of
+sickness. Drugs are given far less than they were a generation ago; yet
+medicines are still the most familiar of all remedies, and the most
+abused by those who persist in treating themselves. Misuse of medicine
+even by intelligent people is astonishingly common.
+
+Problems of sickness and health would be enormously clarified if the
+uses and limitations of drugs were more generally understood. Many
+people still believe that every disease can be cured by a drug if only
+the doctor is clever or lucky enough to think of the right one to give.
+Such beliefs result naturally enough from centuries of faith in charms
+and magic, and occasionally are confirmed by remarkable cures apparently
+brought about by drugs, but really pure coincidence or the result of
+suggestion.
+
+It is a fact that a few medicines are known which if rightly used
+actually do cure certain diseases. An example of their action is the
+curative effect of quinine in malaria. Such medicines, unfortunately,
+are few. In the great majority of cases medicines do not cure disease;
+their beneficial action is ordinarily indirect and is due to their power
+either to increase or to check certain processes within the body.
+
+It is here that the abuse of drugs comes in. Disordered bodily processes
+give rise to symptoms of disease; and it is the symptoms of disease, not
+the disease itself, that trouble the patient. A patient with typhoid,
+for example, is not conscious of the toxins in his blood, but of
+headache, weakness, and fever; the man with eyestrain is not aware of an
+imperfectly shaped lens, but of headache and indigestion. What the
+patient wants is to have his symptoms relieved; in some cases they can
+be controlled by drugs, and the sufferer then considers himself cured.
+But the original condition persists: it may in the meantime be
+improving, but it may on the other hand be growing worse.
+
+Not infrequently it is best to check symptoms, and to check them by
+means of drugs. When they should be checked, only a thoroughly trained
+physician is qualified to decide. The question is not one for amateurs,
+since the whole practice of medicine, including the prescription of
+drugs, constantly becomes more nearly an exact science. People should
+obtain and follow expert advice in regard to health as they would in
+regard to other affairs of life. The constant self-dosing practised by
+thousands of people is harmful and unintelligent; it is, however, no
+less irrational to go to the other extreme and refuse to take medicine
+prescribed by a competent doctor.
+
+AMATEUR DOSING.--Amateur dosing either of oneself or of others is
+dangerous in more ways than one. In the first place, time is lost.
+Moreover, symptoms are characteristic; checking or altering them
+increases the difficulty of finding the real trouble. The man with
+eyestrain who takes one drug to stop his headache and another to "cure"
+his stomach, is simply delaying the time when properly adjusted glasses
+will relieve both. In this case the result may not be serious; but such
+a loss of time in finding the trouble and beginning proper treatment
+might prove fatal in the case of tuberculosis.
+
+Another objection to amateur prescription of medicine is the fact that
+most drugs have more than one effect. In addition to their main action
+they have others, subordinate or ordinarily less marked. These minor
+effects may be serious in some cases. Many headache remedies, for
+example, affect the heart; a dose that is harmless for a normal person
+may be strong enough to injure seriously a person with a weak heart. A
+doctor, and a doctor only, is competent to decide when and in what
+quantity medicines will be beneficial, because he alone understands both
+the condition of the patient and all the possible effects of the drug.
+
+In no circumstances should medicine prescribed for one person be taken
+by another. This rule seems obvious enough; yet every day people pass on
+their pet remedies to friends. Some medicines deteriorate after
+standing, and others grow stronger; nevertheless, medicine supposed to
+have cured a cough or a tonic supposed to have strengthened some member
+of the family after an attack of grippe is cheerfully administered
+months later to another member of the family, who, to make matters
+worse, may differ in age, strength, and probably in the nature of his
+sickness. Drugs are expensive, and it is considered economical to use
+them up; measured by lost time and impaired health such practices may be
+anything but thrifty.
+
+Cathartics, tonics, and various drugs to relieve pain and sleeplessness
+are among the remedies most commonly taken without medical advice.
+Enough has already been said about constipation to indicate proper
+hygienic treatment, but another warning should be given against
+habitual use of cathartics. Many of these drugs are irritating; even
+when not irritating, they are harmful, since the body depends more and
+more upon the drug to do for it what it should be enabled to do for
+itself, by remedying the original cause of the trouble. Licorice powder,
+cascara, saline cathartics such as Seidlitz powders and Rochelle Salts
+and some others are harmless for occasional use, if occasional is not
+too liberally interpreted.
+
+Tonics are poor substitutes for proper diet, rest, and fresh air. Using
+them may be likened to beating a tired horse; the horse goes faster, but
+he is not really stronger. In some emergencies the horse must go faster
+and there is nothing to do but beat him, and in some cases the tonic
+should be given; these, however, are cases for a doctor to decide.
+People persist in taking tonics because they are unwilling or unable to
+rest, or otherwise to change their ways of living.
+
+Medicines to stop pain or to induce sleep are probably the most
+pernicious of all self-prescribed remedies, for they add to other
+dangers the possibility of forming drug habits. These habits are so
+insidious and so powerful that it is not safe to take habit-forming
+drugs even once except by a doctor's direction. In short periods of time
+strong people, apparently firm in will and character, have acquired
+habits from supposedly moderate use of drugs like morphine, cocaine, and
+alcohol. No one, no matter how sure of his own self-control, can afford
+to run so grave a risk.
+
+PATENT REMEDIES.--Objections to self dosing in general apply even more
+strongly to using patent medicines. The ingredients of patent medicines
+are ordinarily unknown, so that using them is unintelligent at best.
+Sometimes they contain habit-forming or other harmful drugs. In other
+cases the ingredients are innocent enough, but totally unable to bring
+about the results claimed for them. The old story about a powerful
+remedy discovered by accident and thus unknown to the medical profession
+deceives only the ignorant or credulous; with our present knowledge of
+chemistry and physiology powerful remedies are not discovered in that
+way.
+
+Even to these comparatively harmless patent preparations there are two
+serious objections. One is the loss of time, during which the patient
+may grow worse. The other is that money is obtained under false
+pretenses; fraud is a common element in the success of patent remedies.
+One of the least harmful, a substance called "Murine" may be taken as an
+example[2]. This substance was widely advertised at one time as a
+"positive cure for sore eyes." Analysis showed it to be a solution of
+borax, which cost about five cents a gallon to prepare. It sold for one
+dollar an ounce, or at the rate of $128.00 a gallon. Although it could
+not bring about the wonderful cures advertised, it was practically
+harmless, and buyers of "Murine" must have been injured chiefly in
+pocket. But with "cancer cures" and "consumption cures" it is a
+different story. Early treatment of these diseases is essential to
+recovery; delay in many cases means robbing the sufferer of his only
+chance of life. No drugs are now known that will cure these diseases,
+and it seems incredible that anyone should be willing to practise such
+cruel deception upon ignorant people merely for the sake of making
+money.
+
+ADMINISTRATION OF MEDICINE.--Medicines may be introduced into the body
+in a number of ways. In the majority of cases they are swallowed and
+finally carried to the tissues by the blood just as digested food is
+carried.
+
+Except in rare emergencies no medicine should be given to a sick person
+without the doctor's order. The prescribed dose should be accurately
+measured in a medicine glass having a scale to show the number of
+teaspoonfuls. When measuring medicine, think only of what you are doing;
+neither talk nor listen to conversation. First read the label on the
+bottle. Next, shake the bottle, if the medicine is liquid, in order to
+mix the contents thoroughly. Then remove the cork with the second and
+third fingers, and hold it between them while pouring, thus keeping the
+cork clean and protecting the contents of the bottle. Hold the medicine
+glass on a level with the eyes, and in the other hand hold the bottle,
+with the side bearing the label uppermost to avoid soiling it; pour out
+the dose, measuring exactly, wipe the bottle, replace the cork, and
+again read the label on the bottle.
+
+Most medicines should be diluted with a little water. Pills and capsules
+should not be presented to patients in the attendant's fingers, but on a
+saucer or teaspoon. Acids and medicines containing iron should be taken
+through a glass tube kept for medicine exclusively. Tubes and glasses
+should be washed at once after use, and neither they nor the bottles
+should stay in the patient's room. If a dose is omitted for any reason,
+do not increase the next dose; give the regular dose at the next regular
+time.
+
+Serious mistakes in giving or taking drugs are far too common, and no
+precautions are too great to guard against them. Never use medicine from
+a box or bottle that has no label. Never take or give another person a
+medicine selected in the dark, even though you have positive knowledge
+that there is no other bottle or box of medicine in the whole house; in
+just such circumstances the fatal mistakes occur.
+
+A few things can be done to make medicines more palatable. The water
+used to dilute the dose and to be taken after it should be very cold.
+Holding the nose is helpful. A piece of cracker, a peppermint, or a
+slice of lemon or orange, if allowed, may be taken afterward. Giving
+disagreeable medicine in ordinary food, as lemon juice, orange juice, or
+milk, and giving bitter powders in jam or jelly, is unwise because it
+sometimes results in life long dislike for a useful article of diet.
+Where food is given directly after the dose to take away its taste, the
+association of dislike seems to be formed less frequently.
+
+The taste of castor oil is so disgusting that it often causes vomiting,
+but if skillfully given the oil need not be tasted by a patient who is
+willing to coöperate. Its way of sticking to the tongue and teeth
+constitutes the chief difficulty; the object therefore is to prevent it
+from sticking by swallowing the dose all at once. To administer the oil,
+wet the inside of a medicine glass or large spoon with very cold water,
+and leave a little water in the bottom. Pour the required dose in slowly
+and cover it with more cold water. Let the patient hold in his hand
+something to take away the taste,--cracker, bread, peppermint, or
+whatever is allowed; for castor oil water is not very effectual. Then
+direct him to hold his nose, open his mouth, and hold his breath;
+caution him to let the oil run down without swallowing until all has
+been taken, and afterward to chew the cracker, continuing to hold his
+nose until he has swallowed the cracker. When the patient understands
+and is ready, pour the dose in quickly as far back as possible, taking
+care not to spill the last drop on the lips. This process may seem
+unduly troublesome, but when castor oil is needed it is badly needed and
+efforts to make it stay down are worth while. The following method also
+effectually disguises the taste of castor oil: place in a glass a
+teaspoonful of baking soda, add the prescribed dose of oil and then the
+juice of half a lemon. Mix all together thoroughly and let the patient
+take the mixture while it is effervescing. This method may be used
+unless the patient is not allowed soda and lemon juice. Castor oil may
+be bought in capsules, but on account of their size many people find the
+capsules impossible to swallow.
+
+SUPPOSITORIES.--Sometimes medicines are given through the rectum. For
+this purpose they are combined with cocoa butter or other material, and
+made into small cones called suppositories. They melt at a low
+temperature and should be kept on ice until needed. A suppository
+should be lubricated with vaseline, and inserted very gently as far as
+the finger can be introduced, while the patient is lying on the back or
+left side.
+
+ENEMATA.--An injection of a fluid into the rectum is called an enema.
+(Plural, enemas, or enemata.) Enemas are generally used to cause
+evacuation of the bowels.
+
+For a simple purgative enema one of the following is generally used:
+plain water; or a solution of common salt in the proportion of one
+teaspoonful of salt to one pint of water; or soap suds made with a white
+soap such as castile or ivory. Unless otherwise ordered the temperature
+of the enema should be between 105° and 110° F.
+
+To give an enema, one should proceed as follows: First protect the bed
+by placing under the patient's hips a rubber sheet, covered by a draw
+sheet or large towel. Let the patient lie on the back, with the knees
+flexed and head low. Bring to the bedside a commode or bedpan, and
+lastly the solution contained in a fountain syringe having a long rubber
+tube, stopcock and short hard rubber nozzle. The bag of the syringe may
+be hung on the bed post or elsewhere, but it should not be more than
+three feet at most above the patient's head. Lubricate the nozzle with
+vaseline either from a tube, or removed from a jar by means of a piece
+of toilet paper; never dip the nozzle itself into a vaseline jar. Let
+the solution flow into the bedpan until it runs warm and smoothly; a
+jerky flow means presence of air bubbles which cause pain if injected
+into the bowels. Unless the patient is able to do it herself, gently
+insert the nozzle, and at the same time start the flow. Force must not
+be used in inserting the nozzle, and the flow should be gentle; if the
+solution goes in rapidly the patient may be unable to retain it. If
+there is a desire to expel the enema as soon as the injection has begun,
+shut off the current and wait a minute, meanwhile making gentle pressure
+upon the patient's abdomen with one hand; then lower the bag a little
+and begin again. A grown person should take from two to four pints, and
+a child from one to two pints. After the enema is finished give the
+bedpan immediately; the enema will, however, be more effective if
+retained a few minutes. The bedpan should be given and removed according
+to the directions on page 176. Sometimes an enema is expelled with such
+violence that it soils the upper sheet; to protect the covers a rubber
+sheet may be spread over the patient's knees and legs. Since an enema
+sometimes causes nausea or faintness, a patient should be watched
+constantly during the process.
+
+To give an enema to a baby one may use a small syringe having a soft
+rubber bulb with a nozzle directly attached, or the ordinary fountain
+syringe with the small, hard rubber tip designed for infants. The enema
+should be given in a warm room free from draughts, and the baby must be
+warmly covered throughout the process. First cover the lap with a pad or
+folded blanket. Upon the blanket place a warmed rubber sheet, and over
+the rubber a warm diaper. Hold the baby on your lap, so that he lies on
+his back with his knees drawn up. Hold his feet or legs firmly in your
+left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that
+all the air is expelled from the syringe, and then proceed as already
+directed. A baby will take from two or three ounces up to half a pint or
+even more, according to the size of the child. After the injection is
+finished place a small vessel under the baby's hips, and hold it until
+the fluid has been expelled, keeping the child well covered all the
+time.
+
+After being used, the nozzle of a fountain syringe should be washed with
+soap and water, boiled, dried and put away in a clean place. Inserting
+the nozzle into the bag of the syringe immediately after withdrawing it
+from the rectum is a filthy but not uncommon practice. The syringe
+should be kept clean inside and out; it should be washed in hot
+soapsuds, rinsed in clean hot water, drained, and when thoroughly dry
+wrapped in a clean towel or tissue paper. The ordinary fountain syringe
+hanging for months by a dirty string on a hook in the bath room is an
+unpleasant and generally an unclean object.
+
+SPRAYS AND GARGLES.--Several other methods of administering medicines
+are occasionally employed. Some remedies may be applied directly to the
+throat by gargles, and to the nose and throat by sprays. The throat may
+be cleansed by gargling with a solution of a teaspoonful of baking soda
+or common salt in a glass of warm water. Nose sprays should not be used
+except under medical advice, and it is well to remember that if the
+mouth washes, gargles, and sprays advertised to be disinfectants were
+really strong enough to kill germs, they would be too harsh for common
+or continued use. The nozzles of nose and throat sprays should be boiled
+immediately after use. A surprising number of families who have
+progressed far beyond common drinking cups and towels, continue to use a
+common nose spray without even washing the nozzle. Children while they
+are well should be taught to gargle the throat; a child with a sore
+throat and an aching head is in a poor condition to learn anything.
+
+INHALATION or breathing in, is another method used to introduce drugs
+into the membranes of the nose, throat, and lungs. Smelling salts are an
+example of substances used for inhalation; they are used to stimulate
+persons who are faint. They should not be placed close to the nostrils,
+nor used at all when the patient is totally unconscious.
+
+Inhalations of steam are often used in asthma, croup, and bronchitis.
+Special croup kettles are made for the purpose, but an ordinary pitcher
+half full of boiling water may be used instead. The patient's head
+should be held closely over the pitcher, and a towel should be adjusted
+around the top covering the patient's nose and mouth, but admitting just
+enough air to make it possible for him to breathe. If a drug is ordered
+it should be added to the water.
+
+INUNCTION, or rubbing a substance into the skin, is sometimes ordered
+for delicate babies and children. After the skin of the abdomen has been
+washed with warm soapy water and thoroughly dried, the substance
+ordered, generally olive oil or cod liver oil, should be applied by
+means of a circular movement of the palm of the hand. The oil should be
+warm and the rubbing continued until it is absorbed.
+
+Ointments are also applied by inunction. A small quantity at a time
+should be rubbed in, using a circular motion. If an ointment is ordered
+to be applied where the skin is broken, the ointment should be spread
+upon gauze and applied without friction. Liniments are rubbed in in the
+same way as ointments. In many cases rubbing accomplishes more than the
+ointment or liniment itself, so that this part of the treatment must not
+be slighted.
+
+HOUSEHOLD MEDICINE CUPBOARD.--In every household a small cupboard is
+needed for medical and surgical supplies. Glass shelves are desirable,
+because they show when dirty and are easily cleaned, but a wooden
+cupboard can easily be lined with clean paper or white enamel cloth held
+in place with thumb tacks. Dirty, stained shelves should not be
+tolerated. The cupboard should be kept locked and the key put well out
+of the reach of children. In the cupboard should be kept medicines in
+daily use; they should not be paraded on family dinner tables.
+
+Poisonous drugs should have rough glass bottles and conspicuous labels.
+All medicine bottles should be kept well corked, since evaporation may
+take place and the remaining solution, by becoming stronger, may be
+dangerous to use in the ordinary amount. Pills and tablets sometimes
+deteriorate by standing, and may become so hard that they pass through
+the stomach and intestines without dissolving. It is best to buy drugs
+and surgical supplies in small quantities; when it is cheaper to buy
+more at a time the druggist should be asked whether they will
+deteriorate or not.
+
+Almost every family needs to keep on hand some cathartics, some
+disinfectants, some material for first aid, and a few simple appliances.
+Most families have certain other needs peculiar to themselves, and for
+those who live at a distance from drug stores a greater quantity and
+variety may be required. Elaborate equipment and extensive supplies of
+medicines are neither economical nor necessary for household use.
+
+Castor oil, Rochelle or other laxative salts, and two grain cascara
+tablets ordinarily constitute a sufficient supply of cathartics. The
+dose of castor oil is one or two teaspoonfuls for a baby up to a
+tablespoonful for an adult. Rochelle salts and seltzer aperient are
+given dissolved in water; the ordinary dose is from one to four
+teaspoonfuls. Seidlitz powders come in two packets, one white and one
+blue. The contents of the packets should first be dissolved in separate
+glasses each filled about a quarter full of water. One solution should
+then be poured into the other and the mixture taken while it is
+effervescing. Cascara tablets are generally given in one to ten grain
+doses.
+
+A small bottle of tincture of iodine and one of 70% alcohol should be
+kept for disinfecting. Neither one is for internal use. The iodine is
+used to disinfect small wounds and abrasions of the skin. It is applied
+with cotton swabs and several swabs should be made and kept on hand in a
+box or envelope. Alcohol is used to disinfect thermometers and other
+instruments that cannot be boiled, for rubbing, and may also be used for
+disinfecting the skin. A 90% solution is sometimes used for rubbing; it
+need not be bought until needed. Denatured and wood alcohol are poisons
+and should be used in households only in spirit lamps; they are not safe
+for other purposes.
+
+First aid materials may include two gauze bandages two and one-half
+inches wide and two bandages one inch wide, one American Red Cross First
+Aid Outfit, a small package of absorbent cotton, a roll of old muslin, a
+package of adhesive plaster one inch wide, boracic ointment, picric acid
+gauze or other application for burns, safety pins, and a pair of
+scissors.
+
+For use in cases of fainting or exhaustion it is well to keep aromatic
+spirits of ammonia on hand. Its bottle should have a rubber stopper. The
+dose is one-half to one teaspoonful, in a quarter to half a glass of
+water. Hot coffee and tea are also good stimulants, but the time
+necessary to prepare them makes it desirable to have aromatic ammonia
+on hand. Household or ordinary ammonia must not be used as a substitute.
+
+Olive oil, mustard, and baking soda may be brought from the kitchen when
+needed. It is assumed that vaseline, cold cream, hand lotion, talcum
+powder, and other toilet preparations will also be available.
+
+Only a few appliances are necessary. Among them are a medicine glass, a
+teaspoon, clinical thermometer, hot water bag, fountain syringe, and an
+alcohol lamp in houses without gas or electric stoves. It is better not
+to buy other appliances until they are needed, particularly rubber goods
+since they deteriorate rapidly.
+
+
+EXERCISES
+
+1. Why is it dangerous for persons without medical training to prescribe
+medicines? What is the especial danger of dosing oneself?
+
+2. What is meant by a habit-forming drug? Name all you can, and tell why
+they are peculiarly dangerous.
+
+3. What are the special objections to patent medicines?
+
+4. What precautions should be taken in order to administer medicine
+accurately? What precautions to avoid giving wrong medicines?
+
+5. How may some disagreeable medicines be made more palatable?
+
+6. Tell how to prepare and give a soapsuds enema.
+
+7. How should a fountain syringe be cared for? a throat spray?
+
+8. Describe methods for giving steam inhalations.
+
+9. Describe the equipment and care of a household medicine cupboard.
+
+10. What drugs is it well for a family to keep on hand? What appliances?
+What materials for first aid?
+
+11. How many drugs in addition to those prescribed by a physician have
+you or your family on hand at the present time? How many do you consider
+really necessary? Are any of these medicines used to remedy troubles
+that might be cured by sufficient attention to rest, exercise, diet, and
+fresh air?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Chapter VI.
+
+How to Live--Fisher and Fisk, Supplementary Notes, Sections IV, V.
+
+Scientific Features of Modern Medicine--Frederic S. Lee, Chapters III,
+VIII.
+
+The Human Mechanism--Hough and Sedgwick, Chapter XX.
+
+The Conquest of Nerves--Courtney.
+
+Primitive Psychotherapy and Quackery--Lawrence, Chapters I-V.
+
+Nostrums and Quackery--American Medical Association. (See especially
+"Cancer Cures" and "Consumption Cures.")
+
+
+FOOTNOTES:
+
+  [2] See "Nostrums and Quackery," p. 445.
+
+
+
+
+CHAPTER XI
+
+APPLICATION OF HEAT, COLD, AND COUNTER-IRRITANTS
+
+
+INFLAMMATION.--A process called inflammation sometimes occurs in tissues
+that have been injured or invaded by bacteria. Although painful, it is
+nevertheless one of the reparative processes of the body, and therefore
+beneficial. Common examples of inflammation are boils, sore throat, and
+the swollen, painful condition resulting from sprains and fractures.
+Characteristic symptoms of inflammation are heat, redness, swelling, and
+pain.
+
+When a tissue has been invaded by bacteria, nearby blood vessels dilate,
+thus bringing an increased supply of blood to the affected part. This
+extra supply serves to wash away the offending substance, and at the
+same time it brings more white blood corpuscles, one function of which
+is to destroy bacteria. From the increased supply of blood the affected
+part becomes red and hot, and so much blood may come that the vessels
+further on are unable to carry it away fast enough. Some of the fluid
+part of the blood is then forced out into the tissues, and the part
+becomes swollen. Distension of the tissues and pressure on the nerve
+endings cause pain, and the injured part now exhibits the characteristic
+symptoms of inflammation.
+
+[Illustration: FIG. 21.--"THE HISTORY OF A BOIL." This figure represents
+a cross-section of normal skin. Note the surface layer, or cuticle, and
+the "true skin," or cutis. In the cutis one sees that the blood
+capillaries are just wide enough for the blood-cells to pass through "in
+single file." The skin has just been pricked by a dirty pin. On the
+point of this pin were several poisonous germs which were deposited at
+_a_. (_From Emerson's "Essentials of Medicine."_)]
+
+[Illustration: FIG. 22.--"THE HISTORY OF A BOIL" (continued). The poison
+from these germs diffuses through the cutis. The capillaries dilate. The
+leucocytes force their way through the walls of the capillaries and
+travel towards these germs. Note the dumb-bell shape of the leucocytes
+as they pass through the minute holes in the capillary walls, and their
+pseudopods as they travel towards their common destination, attracted by
+the poison from the germs. The skin in this region is now swollen, red,
+hot, and painful. (_From Emerson's "Essentials of Medicine."_)]
+
+At this point, if the injury begins to heal or the bacterial infection
+to yield, the extra blood supply is gradually carried off, the blood
+vessels resume their normal size, and the tissues return to their usual
+condition. If, however, the infection does not yield so quickly, more
+and more white blood corpuscles assemble and pass through the walls of
+the tiny blood vessels into the tissues. Here the struggle continues.
+Some bacteria and some white blood corpuscles are killed, and substances
+are formed which liquify these dead cells and also some cells of the
+surrounding tissues. The resulting fluid is called pus or matter, and in
+the case of a boil we then say it has come to a head. If the infection
+occurs near a cavity or near the surface of the body, the pus may escape
+by breaking through at the point of least resistance, and may carry most
+of the poisons along with it. If the pus finds no outlet it may be
+gradually absorbed by the blood stream, and healing may result without
+discharging. On the other hand, the germs may make their way into the
+circulation, thus causing the serious condition known as blood
+poisoning.
+
+[Illustration: FIG. 23.--"THE HISTORY OF A BOIL" (continued). The
+migration of leucocytes has continued until now they form a dense mass
+surrounding the germs. The poison of the germs has killed all the
+leucocytes and also all the cutis immediately around them, and now
+digestive fluids from the dead leucocytes is turning the whole dead mass
+into liquid pus. The boil has "come to a head." There is a little lump
+on the skin and through its thin covering of cuticle can be seen the
+yellow pus. (_From Emerson's "Essentials of Medicine."_)]
+
+Inflammation may be treated by means of hot applications, cold
+applications, or counter-irritants. The effect of heat is to dilate the
+vessels and hence to increase the flow of blood to the injured part.
+This increased blood supply makes the reparative process go on more
+vigorously, and also makes it possible for the accumulated fluid to be
+more rapidly carried away. Moist heat softens the tissues so that pus,
+if formed, can escape more easily.
+
+[Illustration: FIG. 24.--"THE HISTORY OF A BOIL" (concluded). The boil
+has finally ruptured. The liquid pus has escaped carrying with it the
+germs and most of their poisons; the migration of leucocytes has
+stopped; the capillaries are returning to normal size and now new tissue
+will grow and fill up this hole. (_From Emerson's "Essentials of
+Medicine."_)]
+
+Cold acts in just the opposite way. It decreases the size of the blood
+vessels so that less blood comes to cause pain and swelling; at the same
+time it diminishes the number of white blood corpuscles and the
+nutritive substance brought by the blood. The nature and location of the
+infection determine whether heat or cold is to be preferred.
+
+Counter-irritants, of which mustard is an example, have a complicated
+action. A counter-irritant affects the blood circulation of the place to
+which it is applied, and at the same time it irritates the superficial
+nerves, which in turn stimulate other more distant nerves. The latter
+nerves control the circulation in tissues not adjoining those to which
+the counter-irritant is applied, and thus it is possible for a mustard
+paste, for example, if applied at one point to bring about changes in
+the blood supply of another part of the body. The mechanism by which
+counter-irritation is brought about is an intricate nervous process
+called reflex action.
+
+
+HOT APPLICATIONS
+
+In applying either moist or dry heat the danger of burning or scalding a
+patient must be constantly kept in mind. This danger is always great,
+but it is especially great when the skin is tender like that of babies,
+children, and old people, or when the vitality is low as in cases of
+chronic or exhausting illness. Unfortunately accidents in applying heat
+are not uncommon; a moment's carelessness may cause serious injury and
+prolonged suffering.
+
+DRY HEAT.--Hot water bags are used to apply dry heat. They should be
+filled not more than two-thirds full of hot water, but the water must
+not be so hot that there is the slightest possibility of scalding the
+patient if the bag should leak. Boiling water should never be used.
+Before the stopper is screwed on, expel the air by squeezing the bag or
+by resting it upon a flat surface until the water reaches the top. After
+closing the bag make sure that both bag and stopper are in order, by
+noting whether leakage occurs when the bag is inverted and pressed
+moderately. Before it is placed near the patient the bag should be dried
+and entirely covered with a towel or canton flannel bag.
+
+Strong bottles, jugs, and jars, if they can be securely stoppered, may
+be used sometimes instead of hot water bags. The same precautions are
+necessary. Bricks, flat irons, or thick flannel bags containing salt or
+sand may be heated in the oven and used in the same way. Salt and sand
+retain heat for a long time, but are correspondingly slow to heat;
+therefore one bag should be heating in the oven while the other is in
+use. Their effect on the skin must be no less carefully watched than the
+effects of other hot applications.
+
+Hot dry flannel may be used without fear of burning a patient, and it
+sometimes yields sufficient warmth to relieve pain, particularly
+abdominal pain of babies. After it has been heated on a radiator or in
+an oven, it should be applied quickly and covered closely with another
+flannel to prevent escape of heat.
+
+Dry heat can be applied conveniently by an electric pad. The part to be
+heated may be wrapped in flannel or placed directly above or below the
+pad. The pad should be carefully watched to see that the switch is not
+accidentally turned, as it is possible for the pad to become hot enough
+to burn the patient or to set fire to the bed covers.
+
+MOIST HEAT.--To apply moist heat poultices or fomentations (stupes) are
+used.
+
+_Poultices_ may be made of various heat-retaining substances, but
+flaxseed meal is generally used. The poultices when ready should be
+applied without delay, therefore all preparations should be made in
+advance. To prepare a poultice, first provide a piece of gauze or thin
+old muslin about two inches wider than you wish the poultice to be when
+finished, and about two inches more than twice as long. In a shallow
+saucepan boil water, varying in amount according to the size of the
+poultice desired; about equal parts of water and meal will be needed.
+When the water is boiling briskly add the meal gradually, beating
+constantly with a spatula or knife. The poultice is done when the
+mixture coheres and is thick enough to drop from the spatula leaving it
+clean. Quickly spread a layer of the hot flaxseed from a quarter to half
+an inch thick on one-half of the muslin, leaving a margin on three sides
+of about an inch (Fig. 25). Fold in the margins of the cloth (Fig. 26)
+and then bring the other half of the cloth over the flaxseed so that the
+top of the poultice is covered. Tuck the free end of the upper half of
+the cloth under the turned in edges of the long sides.
+
+[Illustration: FIG. 25.--Turn the edges of the muslin over the flaxseed
+by folding first on the line _AA'_, and then on the lines _BB'_ and
+_CC'_.]
+
+[Illustration: FIG. 26.--Fold on the line _EE'_, bringing _FF'_ up over
+the flaxseed and tucking it under at _D_ and _D'_.]
+
+Carry the poultice on a hot plate, or rolled in a newspaper or hot
+towel. Test it carefully with the back of the hand, apply it to the skin
+gradually, cover it with cotton batting, oiled muslin, or several
+thicknesses of flannel, and keep it in place with a bandage or towel.
+Remove it as soon as it has become cold, and unless the skin is much
+reddened apply a fresh poultice. If the skin is much reddened, anoint it
+with vaseline or sweet oil, wrap it warmly, and apply the next poultice
+as soon as the appearance of the skin is normal.
+
+_Stupes_ or _hot fomentations_ are cloths, preferably of flannel or
+flannelette, wrung out of boiling water and applied to the skin. Each
+stupe should be three or four times as large as the area to be covered.
+Two are needed, so that one may be prepared before removing the other.
+To prevent escape of heat and moisture the stupe should be covered after
+it has been applied, first with a piece of rubber cloth or oiled silk or
+muslin, and next with several thicknesses of flannel, or cotton batting
+made into a pad. The whole should be kept in place with a bandage or
+towel used as a binder. The doctor will tell how often the stupes are to
+be applied, but if the skin becomes irritated they must be stopped until
+its appearance is again normal.
+
+[Illustration: FIG. 27.--WRINGING STUPE. (_From "Elementary Nursing
+Procedures," California State Board of Health._)]
+
+Great care must be taken in applying fomentations. They do little good
+unless very hot, but if applied too hot the patient is likely to be
+scalded. They must be wrung as dry as possible; but it is difficult to
+wring them without scalding the hands unless stupe wringers are used.
+Stupe wringers are heavy pieces of cloth, like roller towels or pieces
+of ticking, long enough to extend over opposite sides of the basin in
+which the stupe is to be boiled, and wide enough to hold the stupe
+easily. The wringer should be placed in the basin with the stupe
+arranged upon it. Boiling water should then be added, or the water,
+stupe, and wringer may be boiled together in the basin. After the stupe
+is ready, the wringer with the stupe upon it should be removed from the
+water by grasping the dry ends of the wringer. Then the ends should be
+twisted in opposite directions until the stupe inside is as dry as
+possible. Wringing is made easier if the wringer has wide hems into
+which sticks such as pieces of broom handles are inserted. By twisting
+the sticks in opposite directions the stupe may be wrung out easily.
+
+
+COLD APPLICATIONS
+
+DRY COLD.--Cold, like heat, may be used either dry or moist. Bags of
+rubber or of Japanese paper filled with small pieces of ice are used to
+apply dry cold. When weight is to be avoided, the bag should not be
+completely filled. After the bag has been filled and the air has been
+expelled, it should be stoppered securely and wrapped in a towel or
+piece of flannel, since it is possible for an uncovered ice bag to
+freeze the skin. Ice bags are easily punctured, and care should be taken
+not to bring pressure upon them especially when filled with sharp pieces
+of ice. An ice bag not in use should be thoroughly dry inside and out;
+it should be put away with enough absorbent cotton inside to keep the
+surfaces from adhering. Bags of Japanese paper are less costly than
+rubber, but less durable. To close them one should roll the top over and
+then tie it tightly with string.
+
+MOIST COLD.--Cold compresses for the head are often used for patients
+with fever or headache; they sometimes quiet a patient who is restless.
+An old handkerchief or piece of soft linen folded with the raw edges
+inside may be used as a compress. It should be large enough to cover the
+forehead. Two compresses at least should be provided, and a large piece
+of ice in a basin. One compress should be wrung so that it will not
+drip, and then applied to the head. The other meanwhile should be placed
+on the ice to cool. As soon as the first compress becomes warm, the
+second should be applied in its place.
+
+_Cold Compresses for the Eyes._--Soft material should be selected for
+eye compresses. Each one should be cut only a little larger than the eye
+and should fit neatly over it. Several compresses should be placed on a
+block of ice while one is applied to the eye, and every few minutes the
+compress should be changed. If there is discharge from the eye, each
+compress should be used but once; when used, they should be collected in
+a paper and afterward burned. Separate compresses should be used if both
+eyes are being treated. Definite directions in regard to changing
+compresses and the length of time the applications should be continued
+are generally given by the physician.
+
+
+COUNTER-IRRITANTS
+
+To some extent all hot applications are counter-irritants, but mustard
+pastes, mustard leaves, and the mustard foot-bath already described are
+the counter-irritants most commonly used.
+
+_Mustard Paste._--To make a mustard paste, mix dry mustard with flour,
+using for adults one part of mustard and six of flour to make a weak
+paste; increase the proportion of mustard up to equal parts of mustard
+and flour, according to the strength required. Use a smaller proportion
+of mustard for children; one part of mustard with from 6 to 10 parts of
+flour is generally enough. Add to the mustard and flour enough tepid
+water to make a paste, which must be absolutely free from lumps. Do not
+use hot water for this purpose, because it destroys some of the active
+properties of the mustard. Spread the paste on thin muslin, apply it to
+the skin, and remove it as soon as the skin is reddened so that its
+color resembles that of a strong sun-burn. If the skin is especially
+sensitive, mix a little sweet oil or vaseline with the paste.
+
+_Mustard leaves_ should be dipped in tepid water and may then be applied
+to the skin directly, but if specially sensitive, the skin should be
+protected by thin muslin or gauze. The leaf should remain until the skin
+is well reddened; a few minutes are generally sufficient.
+
+Care must be taken not to leave either a mustard leaf or a paste in
+place long enough to blister the skin. After the application has been
+removed; the part should be protected by a soft cloth until redness
+disappears. Vaseline or sweet oil should be applied to the skin if it is
+greatly irritated.
+
+Other counter-irritants in common use are iodine, turpentine, ammonia,
+kerosene, camphorated oil, capsicum vaseline, and various liniments.
+Tincture of iodine may be diluted with alcohol for especially sensitive
+skins; it sometimes causes blisters, and should not be applied more than
+once a day at most. Ammonia and turpentine cause blisters; they should
+not be used as counter-irritants except by a doctor's order, and then
+only after exact directions have been obtained. Turpentine and kerosene
+are inflammable and hence dangerous to use. It should be remembered that
+the action of all counter-irritants is physiologically the same, so that
+no advantage is obtained from the use of dangerous substances like
+kerosene and turpentine.
+
+
+EXERCISES
+
+1. What are the causes and symptoms of inflammation?
+
+2. Describe the process of inflammation.
+
+3. What is the effect of heat on an inflamed area? of cold?
+
+4. What are the dangers from hot applications, and how may they be
+guarded against?
+
+5. How should you fill a hot water bag? How should you cover it?
+
+6. Describe the method of preparing and applying a flaxseed poultice.
+
+7. Tell how to prepare and apply fomentations.
+
+8. How should you apply cold compresses to the head? to the eyes?
+
+9. How should you make a mustard paste for a baby six months old? for a
+grown person only slightly ill? for a feeble old person with a sensitive
+skin?
+
+
+FOR FURTHER READING
+
+Essentials of Medicine--Emerson, Chapter I.
+
+The Human Mechanism--Hough and Sedgwick, Chapter IX.
+
+
+
+
+CHAPTER XII
+
+CARE OF PATIENTS WITH COMMUNICABLE DISEASES
+
+
+The first chapter of this book described the ways in which communicable
+diseases are carried from person to person, and also some principles
+underlying methods of prevention. This chapter aims to show how these
+principles apply in the actual care of patients whose diseases are
+transmissible. In order to apply them intelligently, it is necessary to
+keep in mind certain facts in regard to the transmission of infections.
+A brief summary of these facts follows.
+
+Disease germs are present in the bodies of persons suffering from
+communicable disease, but they may also exist in the bodies of persons
+in good health; if present in the body, they may leave it in any bodily
+discharge. While every kind of germ does not leave the body by all the
+different routes, it is nevertheless true that most germs expelled from
+the body are carried in discharges from the nose, throat, bladder or
+bowels. Germ-laden discharges of an infected person may be distributed
+to other persons by water, milk and other foods, by certain insects, by
+unclean hands, by common drinking cups, towels, handkerchiefs, and
+similar articles, and directly by nose and throat spray. After they have
+been thus conveyed to other persons, the germs make their entrance into
+the body of their new victims through the digestive tract, through the
+nose, throat, and other mucous membranes, or through breaks in the skin.
+Prevention of communicable diseases, therefore, depends upon the measure
+of success attained in blocking the transit of germs from person to
+person; but methods of prevention, though easy to understand, are
+unfortunately sometimes difficult to carry out. In order to carry them
+out effectively one must devote to the problem great accuracy,
+unremitting care, considerable intelligence, and a highly developed
+conscience.
+
+Care of a patient suffering from transmissible disease is adequate only
+when it accomplishes two definite results. One result, which concerns
+the patient primarily, is to bring about his recovery as rapidly and as
+surely as possible; the other result, which concerns the community
+rather than the individual, is to make it impossible for the patient to
+infect others with his disease. In every case of communicable disease,
+from a slight cold in the head up to serious cases of pneumonia or
+typhoid fever, both the patient and the community must be constantly
+safe-guarded.
+
+INCUBATION PERIOD.--The interval between the moment when pathogenic
+germs enter the body, and the time when symptoms first appear and the
+patient begins to feel ill, is called the incubation period. Incubation
+periods vary according to the disease from a few hours to two or three
+weeks. The length of the period also varies somewhat in different cases
+of the same disease.
+
+CARE OF PATIENTS WITH COLDS OR OTHER SLIGHT INFECTIONS.--The usual
+symptoms of infectious diseases include fever, chill, sore throat, nasal
+discharge, cough, headache, vomiting and other digestive disturbances,
+and a general feeling of being sick all over. When one or more of these
+symptoms appear, unless they are very slight, a doctor should be sent
+for. The patient, whether child or grown person, should go to bed in a
+room alone and should stay in bed at least as long as the fever and
+symptoms of cold in the head continue, in order to protect others as
+well as himself. Persons in active life, it is true, are not always able
+to go to bed during colds; but there is no doubt that ultimately they
+would save time by doing so. It is especially necessary for children to
+remain in bed when suffering from colds, not only to insure their own
+well-being but also to protect others, since children are notably
+careless in regard to coughing, sneezing, and borrowing handkerchiefs.
+The patient needs mental rest as well as physical, and should not be
+allowed to work in bed.
+
+The patient's nose and throat discharges should be received only in
+material that can be burned, like old linen or muslin, gauze, or paper
+napkins. As soon as they are soiled these handkerchief substitutes
+should be placed in strong paper bags and afterward burned. Soiled
+handkerchiefs lurking under pillows or in other parts of the bed may
+infect other people or re-infect the patient. Handkerchiefs that may not
+be burned should be placed as soon as soiled in a covered receptacle
+filled with cold water containing a little washing soda; when several
+have been collected they should be boiled in the same covered receptacle
+for 20 minutes. After boiling they may go to the regular laundry.
+
+The patient's diet at first should be liquid or semi-solid. Large
+amounts of nourishment are not necessary during the first day or two,
+especially if the illness is likely to be short, but water should be
+taken as freely as possible. Cold drinks are generally acceptable during
+the feverish stage, but lemonade and other acids should be used with
+caution, since they sometimes irritate a sore throat. When the active
+symptoms have subsided the patient will need more food than usual, and a
+liberal, nourishing diet for a few days will do much to prevent the
+weakness and depressed vitality that often follow colds, tonsilitis, and
+other comparatively slight infections.
+
+The bowels should be carefully regulated, and a mild cathartic is often
+beneficial at the outset.
+
+Even during slight illness a patient should receive the daily care
+already described, and should be made as comfortable as possible. As in
+any illness, sponging and alcohol rubs are refreshing. An ice bag or
+cold compress may relieve headache, and hot applications or a cold
+compress on the throat are often soothing. The throat may be gargled
+with a solution of one teaspoonful of common salt dissolved in a pint of
+boiled water. If the patient perspires profusely he should be rubbed
+with a towel until dry, and provided with fresh warm, night clothes. An
+alcohol rub may well follow. It is most unwise for a patient who is
+perspiring freely to get up in a cold room and attend to himself.
+
+Common colds are far more serious than they are usually supposed to be.
+
+      "More people suffer from common colds than from any other
+      single ailment.... Could the sum total of suffering,
+      inconvenience, sequelæ, and economic loss resulting from
+      common colds be obtained, it would at once promote these
+      infections from the trivial into the rank of the serious
+      diseases.... Colds are contracted from other persons having
+      colds, just as diphtheria is contracted from diphtheria.
+      Arctic explorers exposed to all the conditions ordinarily
+      supposed to produce colds do not suffer from these ailments
+      until they return to civilization and become infected by
+      contact with their fellowmen.... While common colds are
+      never fatal, the complications and sequelæ are serious.
+      These are rheumatic fever, pneumonia, sinusitis, nephritis,
+      and a depressed vitality which favors other infections and
+      hastens the progress of organic diseases.
+
+      "Common colds are perhaps most contagious during the early
+      stages. If persons isolate themselves by remaining in bed
+      during the first three days of a cold, they would not only
+      benefit themselves, but would largely prevent the spread of
+      the infection. The contagiousness and severity of colds
+      differ in different epidemics and in different seasons of
+      the year, depending upon the particular micro-organism
+      involved and other factors not well understood.
+
+      "PREVENTION.--The prevention of colds consists, first in
+      avoiding the infection, and, secondly, in guarding against
+      the predisposing causes. Contact should be avoided with
+      persons who have colds, especially in street cars, offices,
+      and other poorly ventilated spaces where the risk of
+      persons coughing or sneezing directly in one's face is
+      imminent. Contact with the infection may further be guarded
+      against by a careful self-education in sanitary habits and
+      cleanliness, based upon the modern conception of contact
+      infection.
+
+      "Colds, like other diseases conveyed in the secretions from
+      the nose and mouth, are often conveyed by direct and
+      indirect contact through lack of hygienic cleanliness and a
+      disregard of sanitary habits. Kissing, the common drinking
+      cup, the roller towel, pipes, toys, pencils, fingers, food,
+      and other objects contaminated with the fresh secretions
+      will transmit the disease."--("Preventive Medicine and
+      Hygiene," Rosenau.)
+
+CARE DURING MORE SERIOUS INFECTIONS.--When a patient is suffering from
+serious transmissible disease, he needs the most skillful care
+available, and for the sake of others he must be strictly isolated or
+quarantined. By isolating or quarantining a patient is meant making such
+arrangements that germs expelled by the patient are necessarily
+destroyed before they can enter the body of another person. Isolation,
+therefore, includes disinfection, and while methods vary according to
+the nature of the particular disease, yet the principles given below are
+applicable in most cases.
+
+The first essential is that the patient should have a room to himself.
+No one except those caring for him should enter the sick-room for any
+purpose whatever; visitors should be rigidly excluded. At the outset all
+unnecessary articles should be removed from the sick-room, and it
+should be possible to boil, burn, scrub, or otherwise thoroughly clean
+everything allowed to remain. The windows should be screened in summer,
+and flies must be excluded. Fresh air is especially needed by patients
+with communicable diseases, and ventilation of the room must be adequate
+both day and night. Foul odors plainly indicate that the patient or
+something in the room is not clean. The remedy is obvious and deodorants
+are quite unnecessary if the patient and the room are properly cared
+for. It is highly desirable to reserve a bath room for the exclusive use
+of the patient and his attendant and also to reserve a room adjoining
+the patient's room for the exclusive use of the attendant. When it is
+impossible, as it often is, to give up so much space, each family must
+make the best arrangement it can to separate the patient and his
+attendant from the rest of the family.
+
+The attendant must remember that her ten fingers are the ten most active
+agents in distributing the communicable diseases. After handling the
+patient or anything that the patient has touched, and whenever she
+leaves the patient's room, she must scrub her hands thoroughly with warm
+water, soap, and a nail brush. She should not soil her hands
+unnecessarily, even though she intends to scrub them later. She must
+remember for her own protection to keep her hands away from her mouth
+and face, and to cleanse them with special care just before eating. If
+disinfection is needed in addition to the scrubbing, she must use
+conscientiously whatever solution the doctor orders.
+
+At the same time that she is caring for a patient with a communicable
+disease, the attendant ought not to care for children or other members
+of the family, she ought not to prepare food, and she ought not to
+handle dishes or utensils used by other persons. Every day, however,
+many women are doing just these things, and it is true that in many
+instances no bad results are observed. Yet if any arrangement to insure
+safety can possibly be made, it is inexcusable to run the risk of
+spreading diseases which kill thousands of persons every year and injure
+many more for life.
+
+When home conditions render adequate care and strict isolation of the
+patient impossible, hospital care should be seriously considered. No
+personal or sentimental objections should be allowed to influence the
+decision, if removing the patient to a hospital is necessary to
+safeguard his welfare or the welfare of the family. Hospital care should
+be considered especially for patients with typhoid fever, because
+untrained persons cannot safely care for patients so seriously ill.
+Since a patient with typhoid needs skilled care, and since he greatly
+endangers other persons, most authorities consider hospital care
+essential unless the patient can have the continuous services of a
+trained nurse and almost ideal home conditions. Many cases of typhoid,
+it is true, are successfully nursed at home in extremely adverse
+conditions by visiting nurses; yet in few kinds of sickness is
+continuous care by a graduate nurse more necessary to protect the
+community as well as to safeguard the patient himself.
+
+Members of a family in which there is typhoid should be immunized if the
+doctor advises it. This process, which is performed by the doctor, in
+the majority of cases renders a person immune to typhoid fever for three
+or four years.
+
+The question of home or institutional care for persons with tuberculosis
+must also be carefully considered. In some cases tuberculosis may be
+cared for at home with comparative safety, and in some other cases the
+risk is not very great if the patient is intelligent, careful, and well
+supervised. But everyone should face the fact that all cases of
+tuberculosis of the lungs involve some risk to others in the family, and
+most cases involve great risk. The danger to children is greater than to
+adults. Most tuberculosis infections, it is now believed, are acquired
+in childhood. The bad results of an infection acquired in childhood may
+not show themselves for years, since the germs may remain inactive until
+the person's resistance is lowered by some unfavorable condition.
+
+THE CHILDREN'S DISEASES.--The so-called children's diseases are probably
+the most familiar and the least regarded of all those belonging to the
+communicable group. Most persons, it is true, realize that scarlet fever
+is serious; everyone should also realize that measles and whooping-cough
+are serious. For example, in the State of New York during the year 1916,
+more children died from each of these diseases than from scarlet fever:
+in that year 745, or four times the number that died of scarlet fever,
+lost their lives from whooping-cough, while 913 died of measles. If
+diseases that kill hundreds of children every year are not serious, one
+is at a loss to know what a serious disease is.
+
+Some parents even expose children unnecessarily to these infections on
+the fatalistic theory that they must have the diseases sometime, and
+therefore the sooner the better. Nothing could be more mistaken; the
+diseases are not inevitable, and there is no advantage whatever in
+having them if escape is possible. Moreover, serious as the children's
+diseases are in themselves, their after-effects may be even more
+serious. At this very moment hundreds of people are going through
+life handicapped by weakened hearts or kidneys, by defective sight or
+hearing, merely because their parents considered the children's diseases
+necessary. The common belief that children should have these diseases as
+early as possible is also erroneous, since statistics show that the
+younger the child the more likely is the disease to prove fatal.
+
+Every mother should realize that the children's diseases are most
+infectious in the early stages. Early symptoms include fever, sore
+throat, and nasal discharge, and the trouble at first often resembles a
+severe cold. During this stage the diseases are most easily
+communicated. Measles in particular is generally not recognized until
+its most infectious stage has passed. The moral to be drawn is that sore
+throats, coughs, and colds should never be regarded lightly, and that
+their spread should be prevented by all possible means.
+
+The accompanying table taken from the regulations of the New York State
+Department of Health, gives symptoms of communicable diseases among
+children, and rules for isolation and exclusion from school.
+
+  NEW YORK STATE DEPARTMENT OF HEALTH
+  COMMUNICABLE DISEASES AMONG CHILDREN
+  RULES FOR ISOLATION AND EXCLUSION FROM SCHOOL
+
+  HERMAN M. BIGGS, M.D.
+  Commissioner
+
+  Issued by the
+  Division of Public Health Education
+
+  =======================================================================
+     DISEASE   |      PRINCIPAL SIGNS         |         METHOD OF       |
+               |       AND SYMPTOMS           |         INFECTION       |
+  -------------+------------------------------+-------------------------+
+  CHICKENPOX   | Rarely begins with fever.    | Contact with discharges |
+               | Rash appears on second day   | from nose and throat of |
+               | as small pimples, which in   | a patient.              |
+               | about a day become filled    |                         |
+               | with clear fluid. This fluid |                         |
+               | becomes yellow colored, a    |                         |
+               | crust forms and the scab     |                         |
+               | falls off in about 14 days.  |                         |
+               | Successive crops of papules  |                         |
+               | appear until tenth day.      |                         |
+  -------------+------------------------------+-------------------------+
+  DIPHTHERIA   | Onset may be rapid or        | Contact with discharges |
+               | gradual. The back of the     | from nose and throat,   |
+               | throat, tonsils, or palate   | occasionally by         |
+               | may show patches. The most   | drinking infected milk. |
+               | pronounced symptom is sore   |                         |
+               | throat. There may be hardly  |                         |
+               | any symptoms at all.         |                         |
+  -------------+------------------------------+-------------------------+
+  MEASLES      | Begins like cold in the      | Contact with discharges |
+               | head, with running nose,     | from nose and throat    |
+               | sneezing, inflamed and       | of a patient.           |
+               | watery eyes and fever.       |                         |
+               | Mulberry-tinted spots appear |                         |
+               | about the third day; rash    |                         |
+               | first seen behind the ears,  |                         |
+               | on forehead and face. The    |                         |
+               | rash varies with heat; may   |                         |
+               | almost disappear if the air  |                         |
+               | is cold, and come out again, |                         |
+               | with warmth.                 |                         |
+  -------------+------------------------------+-------------------------+
+  MEASLES      | Illness usually slight.      | Same as above.          |
+  (LIBERTY)    | Onset sudden. Lymph nodes in |                         |
+               | back of neck enlarged. Rash  |                         |
+               | often first thing noticed;   |                         |
+               | no cold in head. Usually     |                         |
+               | have fever, sore throat, and |                         |
+               | the eyes may be inflamed.    |                         |
+               | Rash sometimes resembles     |                         |
+               | measles and scarlet fever,   |                         |
+               | variable.                    |                         |
+  -------------+------------------------------+-------------------------+
+  MUMPS        | Onset may be sudden,         | Same as above.          |
+               | beginning with sickness and  |                         |
+               | fever, and pain about the    |                         |
+               | angle of the jaw. The        |                         |
+               | parotid glands become        |                         |
+               | swollen and tender. Opening  |                         |
+               | the mouth is accompanied by  |                         |
+               | pain.                        |                         |
+  -------------+------------------------------+-------------------------+
+  POLIOMYELITIS| Onset sudden, fever,         | Contact with discharge  |
+               | excitable, pain on bending   | from nose, throat or    |
+               | neck forward, pain on being  | bowels of a patient     |
+               | handled, headache, vomiting. | or carrier.             |
+               | Sometimes sudden development |                         |
+               | of weakness of one or more   |                         |
+               | muscle groups.               |                         |
+  -------------+------------------------------+-------------------------+
+  SCARLET      | The onset is usually sudden, | Discharges from nose    |
+  FEVER        | with headache, fever, sore   | and mouth, suppurating  |
+               | throat, and often vomiting.  | glands or ears of a     |
+               | Usually within twenty-four   | patient.                |
+               | hours the rash appears as    | Milk may convey         |
+               | fine, evenly diffused, and   | infection.              |
+               | bright red dots under skin.  |                         |
+               | The rash is seen first on    |                         |
+               | the neck and upper part of   |                         |
+               | chest, and lasts three to    |                         |
+               | ten days, when it fades and  |                         |
+               | the skin peels in scales,    |                         |
+               | flakes, or even large        |                         |
+               | pieces.                      |                         |
+  -------------+------------------------------+-------------------------+
+  SMALLPOX     | Onset sudden usually with    | All discharges of a     |
+               | fever and severe backache.   | patient and particles   |
+               | About third day upon         | of skin or scabs.       |
+               | subsidence of constitutional |                         |
+               | symptoms red shot-like       |                         |
+               | pimples, felt below the      |                         |
+               | skin, and seen first about   |                         |
+               | the face and wrists most on  |                         |
+               | exposed surfaces, develop.   |                         |
+               | They form little blisters    |                         |
+               | and after two days more      |                         |
+               | become filled with yellowish |                         |
+               | matter. Scabs form which     |                         |
+               | begin to fall off about the  |                         |
+               | fourteenth day.              |                         |
+  -------------+------------------------------+-------------------------+
+  SORE THROAT, | Begins with sore throat and  | Discharges from nose    |
+  ACUTE,       | weakness. Throat diffusely   | and mouth of a          |
+  SEPTIC       | reddened and may show        | patient.                |
+               | patches like diphtheria.     |                         |
+  -------------+------------------------------+-------------------------+
+  WHOOPING     | Begins with cough which is   | Discharges from nose    |
+  COUGH        | worse at night. Symptoms may | and mouth of a          |
+               | at first be very mild.       | patient.                |
+               | Characteristic "whooping"    |                         |
+               | cough develops in about 2    |                         |
+               | weeks, and the spasm of      |                         |
+               | coughing sometimes ends with |                         |
+               | vomiting.                    |                         |
+  =======================================================================
+  ===============================================================
+               |             EXCLUSION FROM SCHOOL              |
+               |-------+-------------------+--------------------+
+               |       | OTHER CHILDREN    |    OTHER SCHOOL    |
+               |       |    OF SAME        |     CHILDREN       |
+    DISEASE    |       |   HOUSEHOLD       | ESPECIALLY EXPOSED |
+               |       +--------+----------+--------+-----------+
+               |Patient|        |          |        |           |
+               |       | Non-   |          | Non-   |           |
+               |       | immunes|Immunes[3]| immunes| Immunes[3]|
+               |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  CHICKENPOX   |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  DIPHTHERIA   |  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  -------------+-------+--------+----------+--------+-----------+
+  MEASLES      |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  MEASLES      |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  (LIBERTY)    |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  MUMPS        |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  POLIOMYELITIS|  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  -------------+-------+--------+----------+--------+-----------+
+  SCARLET      |  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  FEVER        |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  SMALLPOX     |  Yes  |   Yes  |    Yes   |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  SORE THROAT, |  Yes  |   No   |    No    |   No   |    No     |
+  ACUTE,       |       |        |          |        |           |
+  SEPTIC       |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  WHOOPING     |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  COUGH        |       |        |          |        |           |
+  ===============================================================
+  ================================================================================
+              |               DURATION OF EXCLUSION FROM DATE OF ONSET           |
+              +--------------+------------+-------------------------+------------+
+              |              |  PATIENT   |      PATIENT REMAINS    |            |
+              |              |  GOES TO   |        ISOLATED AT      |            |
+              |              |  HOSPITAL  |           HOME          |            |
+    DISEASE   |              +------------+------------+------------+            |
+              |  PATIENT     | Other      | Other      | Children   |  Children  |
+              |              | children   | children   | who leave  |  exposed   |
+              |              | of         | who        | household  |  at        |
+              |              | the same   | remain at  | as soon as |  school    |
+              |              | household  | home       | disease is |            |
+              |              |            |            | discovered |            |
+  ------------+--------------+------------+------------+------------+------------+
+  CHICKENPOX  | Until all    | Exclude if non-immune until          |Exclude     |
+              | scabs are    | 21st day after child last            |from        |
+              | shed and     | saw patient.                         |school if   |
+              | disinfection |                                      |non-immune  |
+              | of person;   |                                      |during      |
+              | at least     |                                      |11th to 22d |
+              | 12 days.     |                                      |days after  |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  DIPHTHERIA  |Until         | Until two cultures at least 24       |            |
+              |patient is    | hours apart are reported             |            |
+              |recovered     | negative. Those showing              |            |
+              |and has two   | diphtheria bacilli should not        |            |
+              |cultures      | necessarily be immunized             |            |
+              |from throat   | unless symptoms appear.              |            |
+              |and nose which|                                      |            |
+              |contain no    |                                      |            |
+              |diphtheria    |                                      |            |
+              |bacilli;      |                                      |            |
+              |cultures not  |                                      |            |
+              |to be taken   |                                      |            |
+              |until 9 days  |                                      |            |
+              |from date of  |                                      |            |
+              |onset.        |                                      |            |
+              |Disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ------------+--------------+--------------------------------------+------------+
+  MEASLES     | Until        | Exclude non-immunes until            |If          |
+              | recovery and | 15th day after child last            |non-immune  |
+              | disinfection | saw patient.                         |exclude     |
+              | of person;   |                                      |from school |
+              | at least 7   |                                      |during 8th  |
+              | days from    |                                      |to 15th     |
+              | onset.       |                                      |day after   |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  MEASLES     | Until        | Exclude if non-immune until          |Exclude from|
+  (LIBERTY)   | recovery and | 22d day after child last             |school if   |
+              | disinfection | saw patient.                         |non-immune  |
+              | of person;   |                                      |during 11th |
+              | at least 8   |                                      |to 22d days |
+              | days.        |                                      |after       |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  MUMPS       |Two weeks     | Exclude 15th to 22d day after        |Exclude     |
+              |after onset   | child last saw patient.              |from 15th   |
+              |and one week  |                                      |to 22d day  |
+              |after         |                                      |after child |
+              |disappearance |                                      |last saw    |
+              |of swelling   |                                      |patient.    |
+              |and after     |                                      |            |
+              |disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ------------+--------------+------------+------------+------------+------------+
+  POLIO-      | Until        | 14 days    | Until 14   | 14 days    |            |
+  MYELITIS    | patient is   | from time  | days       | from time  |            |
+              | recovered.   | child      | after      | child      |            |
+              | Disinfection | last saw   | quarantine | last       |            |
+              | of person at | patient.   | raised.    | saw        |            |
+              | least 21     |            |            | patient.   |            |
+              | days.        |            |            |            |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SCARLET     |At least 30   | Seven days | Until      | Seven      |            |
+  FEVER       |days and until| from time  | seven days | days from  |            |
+              |discharges    | child      | after      | time       |            |
+              |have ceased   | last saw   | quarantine | child      |            |
+              |and           | patient.   | raised.    | last saw   |            |
+              |disinfection  |            |            | patient.   |            |
+              |of person.    |            |            |            |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SMALLPOX    |Recovery and  |Exclude if  |Exclude if  |Exclude if  |Exclude 20  |
+              |disinfection  |non-immune  |non-immune  |non-immune  |days unless |
+              |of person     |until 21st  |until 20    |until 21st  |they have   |
+              |at least 14   |day after   |days after  |day after   |been        |
+              |days.         |child last  |quarantine  |child last  |successfully|
+              |              |saw patient,|has been    |saw patient,|vaccinated  |
+              |              |or 7 days   |raised or   |or 7 days   |within 1    |
+              |              |after       |7 days after|after       |year in     |
+              |              |successful  |successful  |successful  |which       |
+              |              |vaccination |vaccination |vaccination |case they   |
+              |              |and         |and         |and         |may return  |
+              |              |disinfection|disinfection|disinfection|at once.    |
+              |              |of person.  |of person.  |of person.  |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SORE THROAT,|Until         |                                      |            |
+  ACUTE,      |recovery.     |                                      |            |
+  SEPTIC      |              |                                      |            |
+  ------------+--------------+--------------------------------------+------------+
+  WHOOPING    |Eight weeks   | Fourteen days provided no cough      |            |
+  COUGH       |or until 1    | develops.                            |            |
+              |week after    |                                      |            |
+              |last          |                                      |            |
+              |characteristic|                                      |            |
+              |cough and     |                                      |            |
+              |disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ================================================================================
+  =================================================================
+     DISEASE   |                  Remarks                         |
+               |                                                  |
+  -------------+--------------------------------------------------+
+  CHICKENPOX   | A mild disease and seldom any after effects.     |
+  -------------+--------------------------------------------------+
+  DIPHTHERIA   | Very dangerous, both during attack and from      |
+               | after effects. When diphtheria occurs in a       |
+               | school all children suffering from sore throat   |
+               | should be excluded and the health officer        |
+               | notified. The medical school inspector or        |
+               | health officer should take cultures from all     |
+               | inflamed throats and noses. There is great       |
+               | variation of type, and mild cases are often      |
+               | not recognized, but are as infectious as         |
+               | severe cases. There is frequently no immunity    |
+               | from further attacks.                            |
+  -------------+--------------------------------------------------+
+  MEASLES      | After effects often severe. Period of greatest   |
+               | risk of infection three days, before and after   |
+               | the rash appears. Great variation in type        |
+               | of disease. Dangerous in children under 2        |
+               | years of age. During an outbreak all children    |
+               | having a temperature over 99°F. should           |
+               | be sent home and the health officer notified.    |
+  -------------+--------------------------------------------------+
+  MEASLES      | After effects slight. Regulations strict,        |
+  (LIBERTY)    | because frequently confused with scarlet fever.  |
+  -------------+--------------------------------------------------+
+  MUMPS        | Seldom leaves after effects. Very infectious.    |
+               | Inflammation of genital organs of male or        |
+               | female may occur.                                |
+  -------------+--------------------------------------------------+
+  POLIOMYELITIS| Disease is most communicable in the early        |
+               | stages. After effect is paralysis of certain     |
+               | muscle groups, transitory or permanent.          |
+               | Death is due usually to paralysis of             |
+               | respiratory muscles.                             |
+  -------------+--------------------------------------------------+
+  SCARLET      | Dangerous both during attack and from after      |
+  FEVER        | effects. Great variation in type of disease.     |
+               | Slight attacks are as infectious as severe       |
+               | ones. Many mild cases not diagnosed and          |
+               | many concealed. A second attack is rare.         |
+               | When scarlet fever occurs in a school, all       |
+               | cases of sore throat should be sent home and     |
+               | health officer notified. Most fatal in           |
+               | children under ten years.                        |
+  -------------+--------------------------------------------------+
+  SMALLPOX     | Peculiarly infectious. When smallpox occurs      |
+               | in connection with a school or with any of       |
+               | the children's homes all persons exposed         |
+               | must be vaccinated or quarantined for a          |
+               | period of 20 days. Cases of modified smallpox    |
+               | in vaccinated persons, may be, and often         |
+               | are, so slight as to escape detection. Fact      |
+               | of existence of disease may be concealed.        |
+               | Mild or modified smallpox is as infectious as    |
+               | severe type.                                     |
+  -------------+--------------------------------------------------+
+  SORE THROAT, | Often leads to serious results, affections of    |
+  ACUTE,       | heart, kidneys, etc. Very apt to occur in        |
+  SEPTIC       | epidemics due to milk contaminated by a          |
+               | patient suffering from the disease.              |
+  -------------+--------------------------------------------------+
+  WHOOPING     | After effects often very severe and disease      |
+  COUGH        | causes great debility. Relapses are apt to       |
+               | occur. Second attack rare. Specially             |
+               | infectious for first week or two. If a child     |
+               | vomits after a paroxysm of coughing, it is       |
+               | probably suffering from whooping cough.          |
+               | Great variation in type of disease. Often        |
+               | fatal in young children.                         |
+  =================================================================
+
+  [3] Immunes are those who have had the diseases or in smallpox, who
+  have been successfully vaccinated within a year.
+
+  DISINFECTION: The cleansing and disinfection of the person includes
+  washing the entire body and the hair with soap and water; thorough
+  brushing of the teeth; rinsing the mouth; gargling the throat, and
+  douching and spraying the nose with an antiseptic solution; and
+  finally, a complete change of clothing (or a change of underwear and
+  a thorough shaking and brushing of the outer garments out of doors
+  before these are put on again). (_Facing p. 247_)
+
+It may be added that the ways by which poliomyelitis, or infantile
+paralysis, is spread are not definitely known at the time of writing.
+We are justified, however, in believing that investigation now in
+progress will make exact information available in the near future.
+
+      "The weight of present opinion inclines to the view that
+      poliomyelitis is exclusively a human disease, and is spread
+      by personal contact, whatever other causes may be found to
+      contribute to its spread. In personal contact we mean to
+      include all the usual opportunities, direct or indirect,
+      immediate or intermediate, for the transference of body
+      discharges from person to person, having in mind as a
+      possibility that the infection may occur through
+      contaminated food.
+
+      "The incubation period has not been definitely established
+      in human beings. The information at hand indicates that it
+      is less than two weeks, and probably in the great majority
+      of cases between 3 and 8 days."--(Report of Special
+      Committee on Infantile Paralysis, American Journal of
+      Public Health, November 1916.)
+
+
+DISINFECTION
+
+Specific directions for disinfecting in every kind of communicable
+disease would be too extended to be given here. In each case the
+attendant should learn from the doctor just how that particular disease
+is communicated, just what discharges, utensils, linen, etc., need to be
+disinfected, and just what disinfectants he prefers to have used. The
+following general methods are now in use, but it must be remembered that
+from time to time new methods are devised and new disinfectants are
+discovered.
+
+CARE OF NOSE AND THROAT DISCHARGES.--The care of handkerchiefs has
+already been described on page 239. Cloths or cotton used to wipe the
+eyes or to receive any other bodily discharge including vomitus, should
+be collected in the same way and burned. Everyone should be taught in
+early childhood to cover the nose and mouth with a handkerchief during
+coughing and sneezing; if the patient has not already learned to do so
+he must be taught now. If the amount of expectoration is great,
+waterproof receptacles should be provided, which should be burned with
+their contents.
+
+CARE OF DISCHARGES FROM THE BOWELS AND BLADDER.--At the present time the
+following preparations are commonly used to disinfect stools and urine:
+5% solution of carbolic acid; chloride of lime solution, made freshly
+whenever needed by mixing thoroughly ½ pound of chloride of lime with
+one gallon of water; and unslaked lime to which is added _hot_ water.
+The amount of carbolic solution used should be about equal in bulk to
+the amount of material to be disinfected; the chloride of lime solution
+should be at least twice, and the unslaked lime at least one-eighth the
+bulk. Fecal masses should be broken up so that the disinfectant may
+reach every part; they may be stirred with tightly twisted toilet paper,
+which should be left in the bedpan and disinfected with the stools. If
+these substances are used, disinfection is considered complete at the
+end of an hour, and the contents of the bedpan may then be emptied into
+the toilet with safety. It may be necessary to provide two bedpans so
+that one may be available for use while the contents of the other is
+being disinfected. Bedpans and urinals should be boiled daily and kept
+thoroughly clean at all times.
+
+In places having no sewerage system, disinfected discharges may be
+emptied into a trench situated at a distance from the well, and then
+covered with earth. As an extra precaution, the disinfected discharges
+may be mixed with sawdust or kerosene and burned in the trench.
+Directions for installing a sanitary privy may be found in Bulletin 68
+of the United States Public Health Service.
+
+BATH WATER and water that has been used for cleansing the teeth and
+mouth may be disinfected in the same way as urine, or it may be emptied
+into a suitable receptacle and boiled ten minutes.
+
+CARE OF THE HANDS.--Disinfectants for the hands should be used in
+addition to scrubbing with soap and water, not as a substitute. The
+hands may be disinfected after scrubbing by soaking them for three
+minutes in one of the following solutions: alcohol 70%, carbolic acid
+solution 2½%, or a solution made by adding one teaspoonful of lysol or
+of creolin to a pint of water. These disinfectants are poisons if taken
+internally; the bottles must be carefully labeled and kept in a safe
+place. It is a good plan to wear rubber gloves when handling infective
+material; the gloves should afterward be boiled for ten minutes.
+
+CARE OF UTENSILS.--A sufficient number of dishes, spoons, tumblers,
+basins, etc. must be reserved for the patient's exclusive use; these
+utensils must be washed separately and dried with towels not used for
+other dishes. Mistakes frequently occur by which other persons use the
+patient's dishes, and in consequence his dishes should not be kept in
+the cupboard with other dishes; if no other safe place can be found,
+they had better stay in the patient's room covered with a clean cloth or
+napkin. The dishes should be scalded daily and at the termination of the
+illness they must be boiled briskly for ten minutes before they are
+returned to general use. Food left on the patient's tray should be
+burned; it should not be eaten by any one else, nor placed in the pantry
+or refrigerator with other food.
+
+CARE OF LINEN.--A satisfactory way to disinfect towels, night gowns, bed
+linen, etc. is to place the articles immediately in a wash boiler filled
+with cold water to which a little washing soda has been added, and then
+to boil them in the same water for twenty minutes; they can afterward
+go safely into the regular laundry. The boiling may be done once a day;
+articles soiled in the meantime may be left to soak in the cold water
+and soda.
+
+DISINFECTION OF THE PERSON.--"The cleansing and disinfection of the
+person includes washing the entire body and the hair with soap and
+water; thorough brushing of the teeth; rinsing the mouth; gargling the
+throat, and douching and spraying the nose with an antiseptic solution;
+and finally, a complete change of clothing (or a change of underwear)
+and a thorough shaking and brushing of the outer garments out-of-doors
+before these are put on again."--(New York State Department of Health.)
+
+TERMINATION OF QUARANTINE.--After the patient has recovered, he and the
+attendant should, if the doctor thinks it necessary, disinfect
+themselves as directed above before they mingle again with other people.
+The exact time when it is safe for a person to come out of quarantine
+and resume ordinary life varies in different diseases. Moreover, opinion
+differs in regard to quarantine periods for the same diseases, so that
+the regulations of Boards of Health in different cities show wide
+variations. It is of course impossible to say at just what moment every
+patient, or even the majority of patients, will stop expelling germs.
+Quarantine periods are intended to protect the community as completely
+as possible without causing unnecessary hardship to individuals. In any
+given case, the local regulations should be strictly observed but
+release from quarantine is not a guarantee that the patient is not still
+discharging germs, and extreme care should still be taken to prevent the
+spread of saliva and other discharges.
+
+TERMINAL DISINFECTION.--A room that has been occupied by a patient with
+a communicable disease should be thoroughly cleaned at the termination
+of the illness. Dishes, utensils, bed linen, etc. should be cared for in
+the ways already described. The floor, bedstead, and other furniture
+should be washed with hot water, soap, and washing soda. The walls,
+windows, etc., should be wiped with a cloth wrung out of hot water, soap
+suds, and soda. The mattress, unless badly soiled with discharges,
+should be scrubbed with the same solution and a stiff brush, and left
+out-of-doors in the sunshine for a day or two, or until dry. If badly
+soiled, it is best to destroy the mattress unless the Board of Health
+has facilities for steam sterilization. Ordinary washing is all that is
+generally required for blankets, but if badly soiled they should be
+sterilized by steam or burned. The room should then be thoroughly
+sunned and aired for a day or two, with the windows wide open both day
+and night. Sunning and airing are among the most important measures in
+disinfecting a room, and should not be slighted. If there has been gross
+pollution, as when a careless consumptive persists in spitting on the
+floor and walls, it may be necessary to remove the old paint and paper
+and have the room done over. The room may safely be occupied after all
+these measures have been taken.
+
+FUMIGATION.--Many Boards of Health have abandoned fumigation after
+communicable diseases, except after those which like typhus and yellow
+fever, are carried by vermin or insects. Dry formaldehyde gas, which was
+formerly used for fumigation, has a violent effect on mucous membranes,
+but its power to kill bacteria, even on surfaces, appears to be weak,
+while its penetrating power is not sufficient to disinfect bedding,
+carpets, upholstered furniture, and other fabrics. Since fumigation is
+costly, troublesome, and ineffectual there seems to be no good reason
+for using it. Moreover, its use gives a false sense of security, so that
+really effective measures like sunning, airing, and scrubbing are likely
+to be neglected.
+
+Theory and practice of disinfection, it is clear, have radically
+changed in recent years. Modern knowledge requires concurrent
+disinfection, or the destruction of germs from the moment when symptoms
+are first noticed; all the time, day and night, this disinfection must
+go on with unremitting care. Today wet sheets are not hung in doorways
+nor are chemicals left about in open dishes to disinfect quite harmless
+air, but scrupulous cleanliness at all stages of disease is recognized
+as one of the most important measures, if not the most important
+measure, in disinfection.
+
+
+EXERCISES
+
+1. Summarize the ways in which infectious diseases are spread.
+
+2. What is meant by the incubation period? State the length of the
+incubation period in measles; Liberty measles; whooping-cough; scarlet
+fever; chicken-pox; diphtheria; mumps; typhoid fever.
+
+3. Name some of the early symptoms common to most infectious diseases.
+If such symptoms appear, what should be done while waiting for the
+doctor to come?
+
+4. Discuss the importance, prevention, and treatment of common colds.
+
+5. What measures should be taken to isolate a patient who is suffering
+from a communicable disease?
+
+6. What special care should the attendant of a patient with a
+communicable disease give to her own clothing and person?
+
+7. Why are the children's diseases more serious in reality than they are
+commonly supposed to be?
+
+8. Describe the symptoms of each of the following: Measles, scarlet
+fever, chicken-pox, mumps, whooping-cough, and diphtheria.
+
+9. How should bowel and bladder discharges be disinfected?
+
+10. How should dishes and other utensils be disinfected?
+
+11. How should linen be disinfected?
+
+12. Describe measures necessary for concurrent disinfection.
+
+13. Describe measures necessary for terminal disinfection.
+
+
+FOR FURTHER READING
+
+Preventive Medicine and Hygiene--Rosenau.
+
+The New Public Health--Hill, Chapters VII-XVII.
+
+Essentials of Medicine--Emerson, Chapters XII-XV.
+
+Health and Disease--Roger I. Lee, Chapter X-XIV.
+
+Disease and Its Causes--Councilman, Chapters V-IX.
+
+Publications of the New York State Department of Health, Albany,
+entitled: The Teacher and Communicable Disease; A Method for the Control
+of Communicable Diseases in Schools; Regulations and Instructions for
+Cleansing and Disinfection; The Conduct of an Isolation Period for
+Communicable Disease in a Home; Tuberculosis; Typhoid Fever; Scarlet
+Fever; Measles; Whooping-cough; Diphtheria; Poliomyelitis, Acute
+Anterior (Infantile Paralysis); Smallpox; Septic Sore Throat; Venereal
+Diseases. (Any of the above pamphlets will be sent upon receipt of a
+three cent stamp.)
+
+
+
+
+CHAPTER XIII
+
+COMMON AILMENTS AND EMERGENCIES
+
+
+This chapter describes a few home treatments for the relief of slight
+ailments and injuries, together with some measures that may be employed
+in emergencies. For more extended instructions in these subjects the
+student should consult the Red Cross Text-book on First Aid.
+
+
+CONDITIONS IN WHICH THE NERVOUS SYSTEM IS INVOLVED
+
+HEADACHE.--Headache is not a disease in itself, but a symptom common to
+many different disorders. Among the abnormal conditions often causing
+headaches are fatigue, eyestrain, indigestion, constipation, neuralgia,
+rheumatism, anæmia, acute infections, and other disorders. Treatment
+should consist in finding the cause and removing it if possible; clearly
+no one remedy can cure so many different causes. A physician should be
+consulted if headaches are of frequent occurrence, but in many cases
+rest and attention to other hygienic requirements are all that is
+needed. During an attack of headache a hot foot bath may give relief, or
+a mustard paste or cold applications on the back of the neck, or an ice
+bag or cold compress on the forehead.
+
+SLEEPLESSNESS, like headache, has many possible causes, and effective
+treatment consists in finding and removing them. Pain or discomfort of
+any kind, fatigue, overwork, and worry are common causes. Sleeplessness
+easily becomes a habit that may persist after its cause has been
+removed; hence a person who has formed the habit of sleeplessness should
+patiently strive to break the old habit and to substitute a better. A
+careful hygienic régime is essential for the patient, exercise in the
+open air, and cultivation of a hopeful and tranquil spirit. The diet
+should be liberal, but light and unstimulating; tea and coffee should be
+omitted, certainly during the latter part of the day. The patient should
+spend rather a dull evening, avoiding excitement and mental exertion
+that is difficult, even though pleasurable. He should retire early. A
+hot tub or foot bath, and a hot drink at bed time may help to produce
+sleep. The bedroom should be dark, cool, and well ventilated, the bed
+comfortable and the covers light but warm. The patient should be told
+that rest is the most important thing for him, and that he should not
+try too hard to sleep nor worry if unsuccessful. The patient should try
+to banish from his mind, at bed time, thoughts that are distressing, and
+even those that are especially interesting. By using patience and
+persistence most persons can regain the power of sleeping even when
+habits of sleeplessness have been long established.
+
+FAINTING is a partial or total loss of consciousness due to a diminished
+supply of blood in the brain. It may follow bleeding, exhaustion from
+heat, fatigue from prolonged standing and the like, or strong emotional
+disturbance, like fear or surprise. Fainting is less common than it
+formerly was; it now occurs most frequently among persons suffering from
+anæmia, heart weakness, or special susceptibility.
+
+Symptoms of fainting are pale face, cold perspiration, rapid, feeble
+pulse, and shallow, sighing respiration. Treatment consists in removing
+the patient into cool, fresh air, applying cold water to the face and
+keeping the head low. For a person who feels faint but has not lost
+consciousness, this treatment will probably prove sufficient; if,
+however, he becomes unconscious, place him so that the head is lower
+than the body, loosen the clothing, especially the clothing about the
+neck, apply cold water to the face and chest, and see that fresh air is
+plentiful. When the patient is sufficiently conscious to swallow, give a
+teaspoonful of aromatic spirits of ammonia in half a glass of water and
+keep him quiet until he has entirely recovered.
+
+A person who is unconscious from any cause always requires immediate
+attention. In emergency work elevate the patient's head if his face is
+flushed, and keep it low if his face is pale. Do not try to arouse an
+unconscious patient by shaking him and calling to him, in the first
+place because it is useless to do so, and in the second, because
+consciousness will return spontaneously if his condition improves.
+
+CONVULSIONS.--In every case of convulsions a doctor is needed at the
+earliest possible moment. Convulsions in adults are very serious; in
+babies and small children although serious they are less alarming, since
+they may follow comparatively slight disturbances, particularly
+disturbances of digestion.
+
+Treatment for babies and children with convulsions consists first in
+keeping the child as quiet as possible, and next in measures to draw
+blood from the brain toward the surface of the body. The child should
+first be undressed, moving him as little as possible, and put to bed
+between warm blankets. Cold should be applied to his head by a compress
+or ice bag, and hot water bag should be placed near his feet. An enema
+should then be given. A warm tub bath is sometimes used to apply heat,
+if the convulsion has not subsided by the time the child is undressed.
+If the bath is given the temperature of the water should not be above
+106°, and should be tested by a thermometer. If no thermometer is
+available, the water should be tested with the elbow rather than the
+hand, and cold water should be added if it feels uncomfortably warm.
+There is great danger of scalding a child during the excitement
+inevitably caused by a convulsion.
+
+Although haste is needed when a child has convulsions, yet quiet is
+essential, since the slightest movement tends to increase the
+convulsions or to start them again. As soon as the convulsions are over
+the child should be removed from the bath and put to bed between warm
+blankets. Even after the symptoms have completely subsided, the greatest
+care should be taken to keep the child quiet. He should be handled and
+disturbed as little as possible. The bath should be repeated if
+convulsions begin again. The doctor, when he comes, will probably order
+a dose of castor oil; and therefore, if it is impossible to obtain a
+doctor at once, the dose should be given.
+
+SHOCK (in the medical sense of the word) or _collapse_, is a serious
+condition in which a patient's vitality and all his bodily processes are
+profoundly depressed. Generally shock occurs only after a severe injury
+or a long exhausting illness. Since, however, some persons are
+peculiarly susceptible to it, the possibility of shock must be kept in
+mind in treating even slight injuries. The probability of shock is
+somewhat increased if patients are allowed to see their own wounds.
+Injured persons should always sit or lie down while wounds, however
+slight, are dressed.
+
+Symptoms of shock are pallor, pinched, anxious expression, dilated
+pupils, cold clammy skin, feeble breathing, and rapid, weak pulse. The
+patient may be mentally normal, or irrational, or unconscious, but more
+frequently he appears stupid, and though conscious, he pays no attention
+to what is going on. Unfortunately this condition is sometimes mistaken
+for sleepiness, and he is left alone to sleep just when active measures
+are most needed.
+
+If a patient shows any symptom of shock the doctor should be summoned
+immediately, but no time should be lost in beginning treatment, since
+the condition may be critical. It should be remembered, however, that
+panic and confusion may alarm a patient who is conscious, and thus
+increase the shock. The patient should be covered warmly, and undressed
+under blankets, without exposure or avoidable moving. His head should be
+low, and as quickly as possible hot water bags should be placed near but
+not upon him. If the patient is conscious and able to swallow he should
+be given hot coffee or aromatic spirits of ammonia, one teaspoonful in
+half a glass of water. The legs and arms should be rubbed from the
+extremities toward the heart, but care should be taken to avoid touching
+or moving injured parts. The patient should stay in bed, warmly covered
+and closely watched for some time after he has apparently recovered.
+
+Helping a patient into bed is not necessarily the first thing to be done
+in every case of sudden illness. Great harm may be done by the
+injudicious moving of injured persons, and often it is safer to make a
+person comfortable with pillows and blankets where he happens to be,
+certainly until a sufficient number of people can be found to lift him
+properly. Clothing should be removed carefully, and one should not
+hesitate to cut it away if undressing is painful or necessitates much
+moving.
+
+STIMULANTS, in emergency work, are frequently misused. They should not
+be given when the head has been injured, when bleeding is profuse, or
+when the face is red and the pulse strong. Neither should attempts be
+made to give fluids of any kind to patients not sufficiently conscious
+to swallow. Safe stimulants to use are black coffee, tea, or aromatic
+spirits of ammonia. Alcoholic liquors should not be given unless
+prescribed by a physician.
+
+SUNSTROKE AND HEAT EXHAUSTION are both caused by excessive heat either
+indoors or out, but they differ both in symptoms and in treatment.
+
+Sunstroke or heat stroke, usually begins with acute pain in the head,
+followed almost immediately by loss of consciousness. The skin is dry
+and very hot, the face is red or purple, the pupils are dilated, the
+breathing is difficult, the pulse is slow, and the temperature high.
+
+Treatment consists in sending for the doctor, removing the patient to a
+cool place, undressing him and applying cold, especially to the head and
+spine, or still better, placing him in a very cold bath. The body should
+be rubbed constantly in the direction of the heart. Stimulants should
+not be given.
+
+Symptoms of heat exhaustion, on the other hand, resemble those of shock.
+The doctor should be summoned, and the patient should be removed to a
+cool and quiet place, where he should stay warmly covered in a reclining
+position. Stimulants should be given, hot water bags applied, and the
+other measures for treating shock should be employed.
+
+
+CONDITIONS IN WHICH THE DIGESTIVE TRACT IS AFFECTED
+
+NAUSEA AND VOMITING are frequently caused by injudicious eating,
+especially when a person is worried or fatigued. A doctor should be
+consulted if either one occurs often, or if vomiting is accompanied by
+pain, prostration, diarrhœa, fever, or other acute symptoms. A person
+who is nauseated should lie down in a cool, quiet place. Hot
+fomentations may be applied to the abdomen, or a mustard paste over the
+stomach. Soda mints or a teaspoonful of baking soda may be given
+dissolved in hot water, and unless diarrhœa is present a Seidlitz
+powder or other saline cathartic may be given. A large quantity of warm
+water may be given to wash out the stomach; it is more effectual if salt
+or mustard is added, in the proportion of one teaspoonful to a glass of
+water.
+
+HICCOUGH, which is usually caused by digestive disturbances, is not
+serious in healthy people, and can generally be stopped by holding the
+breath, or by drinking water. If these measures are not effectual, salt
+or mustard in water as already described or a teaspoonful of the syrup
+of ipecac, may be given to produce vomiting. If the hiccough still
+continues, medical advice should be obtained.
+
+DIARRHÅ’A is ordinarily caused by an infection, or by an offending
+substance in the intestines. The offending substance should be removed
+before attempts are made to check the diarrhœa. When a baby has diarrhœa
+four things should be done--all food should be withheld; boiled water
+should be given freely; bowel movements should be saved for the doctor
+to see; and unless a doctor can be found immediately, castor oil should
+be given, from one-half to one teaspoonful according to the age of the
+child. Similar treatment should be given to older children. Adults
+should take one tablespoonful of castor oil and drink boiled water
+freely, but they should take no food until the doctor comes.
+
+CONSTIPATION has been discussed on pages 193 and 52.
+
+COLIC is a sharp, intermittent pain in the abdominal region; it is
+caused in many instances by indigestion or chilling. The following
+remedies may relieve it: a hot water bag, an emetic, as salt or mustard
+in luke-warm water, a Seidlitz powder or other saline cathartic, soda
+mints, or a teaspoonful of syrup of ginger in hot water. Unless it feels
+sore or tender, the abdomen may be rubbed up, on the right side, across,
+just below the waist, and down, on the left side. Babies may be given a
+few teaspoonfuls of warm water, or an enema of salt and water.
+
+Colic may be serious. The doctor should be summoned at once if the
+patient seems exhausted, if the pain is severe, if pain is increased
+rather than relieved by pressure, if the abdomen feels sore, especially
+on the right side, or if sharp abdominal pain is accompanied by fever,
+vomiting, and stubborn constipation. If the above-mentioned symptoms are
+present, no food, drink, or medicine should be given until the doctor
+comes.
+
+
+CONDITIONS IN WHICH THE EYES OR EARS ARE AFFECTED
+
+STYES generally accompany eyestrain or poor general health. The cause
+should be found and treated; and especial attention should be given to
+correcting eyestrain, indigestion, and constipation. Hot applications
+may be used, but if pus gathers, the stye should be treated by a
+physician.
+
+FOREIGN BODIES IN THE EYE may sometimes be removed by blowing the nose
+violently, by yawning several times, or by drawing the upper lid down
+over the lower. The eye should not be rubbed. If it proves impossible to
+dislodge the object by these methods or by others similar, the patient's
+eyelid should be turned back in the following way: Let the patient sit
+with his head back in a low chair placed in a good light, and stand
+behind him holding his head between your side and upper arm. In this
+position the patient's head is held firmly while both of the operator's
+hands are free. Next draw down the lower lid, and remove the object, if
+visible, on the corner of a clean handkerchief. To turn back the upper
+lid, grasp the eyelashes firmly, draw the lid down, out, and then up
+over a match or pencil placed across the middle line of the lid and held
+in your other hand. Then wipe the object carefully away if it is
+visible.
+
+Irritation that persists after the foreign body has been removed may be
+relieved by a cold compress continued for an hour or more, or by a drop
+or two of castor oil placed under the lid. If attempts to remove the
+foreign body prove unsuccessful, if the injury is severe, or if
+irritation continues after several hours, apply a cold compress, bandage
+it firmly so that the eyeball is kept at rest, and seek the aid of a
+physician.
+
+DISORDERS AFFECTING THE EARS.--Permanent deafness may result from
+neglecting disorders of the ears. Ear-ache, discharge from the ear,
+swelling in or about it, pain or tenderness behind it, all require
+medical attention and no time should be lost in securing it. To relieve
+pain the patient may lie with the ear on an ice bag, but nothing
+whatever should be put into the ear before the doctor comes, except when
+an insect has entered the ear, and causes acute distress by the noise of
+its beating wings. If such an accident has occurred, the patient should
+lie on the unaffected side, and warm sweet oil should be dropped very
+gently into the affected ear by means of a medicine dropper. The insect
+generally drowns in the oil and floats to the opening of the ear canal.
+After it has been removed, the patient should lie on the affected side
+so that the oil may drain out of the ear.
+
+No attempts should be made to remove foreign bodies from the ear or
+nose, unless they can be reached easily with the fingers. Hair pins,
+crochet hooks and similar instruments should never be used for this
+purpose. It is best for a doctor to remove foreign objects because
+unskillful attempts are likely to move them further in.
+
+
+CONDITIONS IN WHICH THE SKIN IS AFFECTED
+
+PRICKLY-HEAT, which affects babies and children more often than adults,
+is an eruption caused by heat and moisture, and aggravated by flannel
+underwear. It may be prevented by keeping the skin dry and cool, and it
+may be relieved by bathing the skin with alcohol and water, about one
+part of alcohol to three of water, and by using after the bath a powder
+made of two parts of starch to one of boracic acid, or any good talcum
+powder.
+
+INSECT BITES AND STINGS.--The sting, if still in the wound, should first
+be removed, and then ammonia should be applied, since the poison is
+generally acid. Applications of cold water, alcohol and water, or wet
+salt may relieve the subsequent burning and itching, but ammonia is
+generally most effective.
+
+IVY POISONING may be treated by applying cloths wet in a strong solution
+of baking soda or of boracic acid, or by applications of carbolized
+vaseline or ichthyol. Severe cases should have medical attention.
+Scratching and rubbing seem to spread the inflammation, and special care
+should be taken not to rub the face or eyes with infected hands.
+Susceptible people should avoid the plant if possible.
+
+
+OTHER EMERGENCIES
+
+CHILLS may be the result of infection or of exposure to cold. An early
+diagnosis of the trouble is so desirable that it is well to send for a
+doctor even when symptoms are not severe. If a person has a chill his
+temperature should be taken at once; fever and chill together probably
+indicate invasion by bacteria. When chills follow exposure to cold the
+patient should go to bed between warm blankets, his body should be
+briskly rubbed, and hot water bags and a hot drink should be given. If
+he prefers, he may take a hot bath before going to bed.
+
+CROUP is caused by a spasmodic closure of the larynx so that breathing
+is impeded. The child who develops croup may have a slight cold, but
+frequently shows no symptoms until he wakes in the night with a hoarse
+ringing cough and difficult breathing. True croup, though often
+distressing, is seldom serious, even when the symptoms are so severe
+that the child appears to be partly suffocated. An emetic should be
+given at once, preferably syrup of ipecac, one teaspoonful followed by
+warm water, or ten drops every 15 minutes until the child vomits freely.
+Hot fomentations may be applied to the throat and chest in order to
+hasten relaxation of the muscular spasm, and water should be kept
+boiling near the bed in a teakettle or uncovered saucepan. The child
+should stay in a warm room during the following day.
+
+Whenever a child develops a croupy cough his throat should be examined.
+A physician should be summoned if the throat is red and especially if
+the redness is associated with rise in temperature. Cases of diphtheria
+have been overlooked by neglecting such symptoms.
+
+
+BLEEDING
+
+In the vast majority of cases, bleeding can be stopped by elevating the
+injured part and applying pressure over the wound. One should, however,
+remember that loss of blood is not the only danger presented by an open
+wound, for pus-producing germs, if they make their entrance, may cause
+an infection which may be as serious as the bleeding itself. Hence in
+dealing with open wounds of any sort one should always keep in mind the
+danger of infection as well as the danger from loss of blood.
+
+TREATMENT OF SLIGHT WOUNDS.--Loss of blood from slight wounds is seldom
+so serious as the danger of infection; therefore small cuts, pin pricks,
+scratches, etc. should be encouraged to bleed by pressure near the wound
+in order to expel the germs that may have entered. After the wound has
+bled a little, tincture of iodine should be applied by means of a cotton
+swab both to the wound itself and also to the surrounding skin.
+
+After the wound has thus been disinfected it should be covered with a
+sterile dressing; a sterile or aseptic dressing is material in which all
+bacterial life has been destroyed. Gauze from a First Aid dressing or
+from a packet of sterile gauze should be used for this compress, or
+gauze may be cut from a sterile bandage. The compress serves two
+purposes: it protects the wound from infection, and if applied with
+pressure it checks further bleeding.
+
+The compress should be securely bandaged in place, or its edges may be
+fastened with adhesive plaster or collodion. Neither of the two latter
+should cover the wound itself. The outside bandage may be changed when
+soiled, but the compress itself should not be disturbed until the wound
+has healed. It is a mistake to dress wounds oftener than necessary,
+since handling them always increases the chance of introducing germs.
+Most children, like Tom Sawyer, delight in wounds, but they should be
+prevented if possible both from inspecting and from exhibiting them.
+
+If heat, swelling, redness, or pain develop in a wound after a day or
+two, a doctor should be consulted; and not a minute should be lost if
+the patient has a chill or if red streaks appear extending from the
+wound in the general direction of the heart. Until the doctor comes the
+wounded part should be elevated and covered with cold applications wet
+in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint
+of water.
+
+Several points should be remembered in dressing wounds. In the first
+place the mouth, which is full of germs, is not a good place for cut
+fingers. Moreover, wounds should not be touched by anything, especially
+the fingers, either washed or unwashed, nor should the scissors, fingers
+or other object be allowed to touch the surface of the dressing that is
+to be placed directly upon a wound. Unless they contain gross dirt
+wounds should not be washed with water, since washing introduces another
+chance of infection and accomplishes nothing except a tidy appearance,
+which is not essential. Furthermore, it should be remembered that
+exposure to the air will not infect a wound, and therefore time should
+be taken to find a suitable dressing. When a sterile dressing is quite
+impossible to obtain, the cleanest material available should be used;
+one of the best substitutes for a sterile dressing is the inner surface
+of a handkerchief or napkin that has not previously been unfolded since
+it was ironed. It is a common mistake to tie up a wound in the first
+article presented, which is usually a generous by-stander's soiled
+handkerchief. The same precautions in regard to cleanliness should be
+taken in dressing wounds that are known to be contaminated, since even
+into an infected wound it is possible to introduce more germs and more
+virulent ones.
+
+NOSEBLEED usually stops of itself, but if it is obstinate the patient
+should sit erect with the head back, and cold compresses should be
+placed on the nose and at the back of the neck. Pressure should be made
+on the upper lip by means of the fingers, or by a firm roll of paper or
+cotton placed under the upper lip. Salt or vinegar in water, a
+teaspoonful of either one to a cup of water, may be snuffed up the nose.
+The treatment should be continued for ten or fifteen minutes, or until
+bleeding stops; if the bleeding persists a doctor is needed.
+
+PROFUSE MENSTRUATION should be treated by keeping the patient quiet in
+bed with the head low and the feet slightly elevated. "Any marked
+increase, whether by amount, duration, or shortening of the interval
+between the periods ought to receive attention and be brought to the
+physician's notice" (Latimer). Painful menstruation may be relieved by
+rest in bed, mental as well as physical, by hot drinks and by the
+application of heat. Rest, and hygienic living persistently practised,
+will relieve most menstrual abnormalities. The common practice of using
+patent remedies and alcoholic liquors for disordered menstruation cannot
+be too strongly condemned.
+
+
+OTHER INJURIES
+
+SPRAINS.--A sprain is caused by twisting, stretching, or tearing the
+tissues about a joint. The first sharp pain comes from the injury to
+the tissues; subsequent pain is caused by the pressure of accumulated
+fluid. The other symptoms are those characteristic of inflammation.
+
+When a sprain is slight, the affected part should be elevated and kept
+at rest for the first twenty-four hours. Either heat or cold should be
+applied, or heat and cold alternately; a good treatment is to soak the
+part in hot water and afterward to allow cold water to run upon it from
+the tap. Gentle rubbing with a circular motion helps to reduce the
+swelling. If the joint must be used it should be bandaged tightly.
+
+Injuries to joints should never be neglected; and severe sprains always
+require medical attention, since in addition to the sprain a bone may be
+broken. A severely sprained joint should be elevated, treated with hot
+or cold applications, and kept at rest until it has been examined by a
+physician.
+
+BRUISES.--Bruises need no attention unless they are extensive or
+painful. The skin should be kept clean and if possible unbroken, since
+injured tissues are less resistant to infection than tissues in their
+normal state. Applications of cold water or of equal parts of cold water
+and alcohol may relieve the pain, but cold should not be used upon
+bruises that are extensive. A compress bandaged tightly in place may
+help to prevent swelling and discoloration.
+
+BURNS AND SCALDS.--Injuries from dry heat are called burns, and those
+from moist heat are called scalds. Both are painful, and both are
+dangerous if extensive or deep. Burns and scalds require medical
+attention if the injured area is extensive, if a large blister is
+formed, if the skin is destroyed or charred, and if symptoms of shock
+appear. Shock often follows burns or scalds even when the injury is
+comparatively slight.
+
+Treatment of slight burns, where the skin is reddened but not destroyed,
+has for its main object the exclusion of air. One of the following may
+be applied: dry baking soda, or baking soda made into a paste with
+water, picric acid gauze moistened in water, boracic acid ointment,
+vaseline, sweet oil, or castor oil; if none of these is obtainable,
+lard, cream, the white of an egg or unsalted butter may be used. Old
+muslin or linen bandaged lightly in place, should be used to cover the
+burn.
+
+The same treatment is used for sunburn, and also for small burns where
+blisters form. A blister, if it forms, should not be punctured; but if
+it is accidentally broken the skin of the blister should not be removed.
+It should be remembered that a broken blister is an open wound, and
+therefore liable to infection.
+
+BRUSH BURN is a name given to injuries where the surface of the skin
+has been removed. They include the scraped arms and legs which are
+common accidents in childhood. In order to dress a brush burn, particles
+of dirt should first be removed preferably by means of forceps that have
+been boiled, and the surrounding skin should then be cleansed with soap
+and water. The injured part should next be flushed with sterile salt
+solution, made by boiling water five minutes and adding to it salt in
+the proportion of one teaspoonful to a pint of water. If the dirt is
+difficult to remove a soap compress should be applied. To prepare the
+compress several thicknesses of gauze or muslin should be boiled in a
+strong solution of castile or green soap for ten minutes. The compress
+should remain in place several hours, and may be repeated if necessary.
+After the wound has been thoroughly cleansed, it should be dressed with
+old muslin that has been saturated in castor oil or spread with boracic
+ointment.
+
+
+EXERCISES
+
+1. Name some common causes of headache and of sleeplessness, and outline
+rational treatment for each of these disorders.
+
+2. Describe symptoms and treatment of shock; of fainting; of convulsions
+in children.
+
+3. Describe the treatment of all disturbances of the digestive tract
+mentioned in this book.
+
+4. What should be done if a foreign body has entered the eye? if one has
+entered the ear? What should be done for a person who has a stye? for a
+person with pain in or near the ear?
+
+5. How would you treat a sprain?
+
+6. Describe treatment for burns and scalds.
+
+7. Distinguish between heat stroke and heat prostration, and tell what
+treatment should be given in each case.
+
+8. What are the two principal dangers from slight wounds, and how should
+one guard against them? Show how you would dress a small cut.
+
+9. What should you do for a person with nose bleed?
+
+
+FOR FURTHER READING
+
+American National Red Cross Text Book on First Aid--Lynch.
+
+Immediate Care of the Injured--Morrow.
+
+Prompt Aid to the Injured--Doty.
+
+
+
+
+CHAPTER XIV
+
+SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS, CHRONICS, AND THE
+AGED
+
+
+In many cases of sickness institutional care has marked advantages. It
+may be the only solution when adequate provision for the sick is
+impossible at home; and it is often a necessity when a patient requires
+special equipment or apparatus, expert nursing, and medical attention
+within reach both day and night.
+
+On the other hand, it would not be desirable even if it were possible
+for all sick persons to be cared for in institutions. Care at home when
+it is adequate may be more successful than equally skillful care given
+elsewhere, since the sick quite as much as the well are injured by long
+separation from normal family life. Most children, because they need the
+attention of their own mothers, most convalescent and chronic patients,
+and most aged persons are cared for at home; and in the great majority
+of cases no better place for them could be found. Since patients of
+these four groups have needs peculiar to themselves, some special
+points in caring for them are considered in this chapter.
+
+
+CHILDREN
+
+Ability to observe quickly and accurately is seldom more needed than it
+is by a woman who cares for children. No one expects babies to explain
+their troubles, but people forget that small children are unable to
+describe their physical sensations with any degree of accuracy, although
+discomfort or sickness may show itself in all degrees of ill temper and
+bad conduct. For these exhibitions many a suffering child has been
+punished, where an older and more articulate person would have received
+considerate attention.
+
+Children, like babies, have a low resistance to disease. Moreover, they
+react quickly both to favorable and to unfavorable surroundings. Hence
+slight causes sometimes produce pronounced or even violent symptoms in
+children without giving cause for great anxiety, although the same
+symptoms if exhibited by adults, might indicate critical illness. On the
+other hand the recuperative power of children is high, and their
+recoveries are sometimes surprisingly rapid. It is a mistake, when a
+child has completely recovered from an acute but brief illness, to
+coddle him for weeks afterward merely because a grown person in similar
+circumstances would have failed to regain his strength.
+
+When a child is sick in bed, especial efforts should be made to insure
+adequate ventilation without chilling him. Children always lose heat
+rapidly because the body surface is proportionately large; when they are
+ill, therefore, it is especially necessary to keep them well covered, to
+see that their hands and feet are warm, and to avoid chilling them
+during their baths. But overheating must also be avoided, since all
+children, sick or well, who are too warmly dressed or who stay in rooms
+that are too warm, become weak and irritable and more susceptible than
+others to colds and other respiratory disorders. The child's skin should
+be kept clean and dry, but he should not be disturbed nor handled
+unnecessarily.
+
+Sick children require very simple food at short intervals. Variety is
+not so necessary for a child as for an adult, unless the child has been
+allowed to form bad habits of eating. Sick children should not be
+indulged unnecessarily, either in regard to their food or in other ways.
+However, attempts made during an illness to change the habits of a badly
+trained child are unwise because usually unsuccessful; parents who sow
+the wind by neglecting to train their children when they are in good
+health may as well make up their minds to reap a veritable whirlwind
+when the children are ill. Even when children are well trained it is
+difficult and sometimes impossible to prevent them from forming bad
+habits during sickness. Yet the labor of training a child reaps perhaps
+at no other time a richer reward than it does when the child is ill, and
+his recovery might be seriously impeded by unwillingness to accept
+necessary food, medicine, or treatment.
+
+PHYSICAL DEFECTS are faults in the structure of the body; adenoid
+growths, imperfect eyes, abnormally curved spines, and defective teeth
+are examples. Most physical defects can be cured in childhood by
+treatment or by slight operations. If untreated they frequently lead to
+sickness or to serious impairment of the body, and if neglected until
+adult life their injurious consequences are generally beyond remedy,
+even when the defects themselves can be repaired.
+
+Some indications of common physical defects are given below; they ought
+to be more generally known than they are. If a child exhibits one or
+more of the symptoms mentioned, he ought to be given a complete physical
+examination by a competent physician, and treatment, if needed, should
+begin without delay. The idea that children will outgrow these defects
+without treatment is erroneous. Better, however, than waiting until
+symptoms appear is the modern way of giving every child a physical
+examination at stated intervals, a practice already common in public
+schools where effective health work is carried on.
+
+EYESTRAIN frequently comes from imperfections in the shape of the eye;
+these imperfections can almost always be corrected by glasses. When a
+child is suffering from eyestrain, the eyes themselves may show
+indications of trouble; they may be blood-shot, the lids may itch or be
+crusted or inflamed, or styes may appear. In other cases the symptoms of
+eyestrain have no apparent connection with the eyes; such symptoms are
+headache, nausea, vomiting, indigestion, fatigue, irritability, poor
+scholarship, and nervous exhaustion. If a child shows any of these
+symptoms, or if he rubs his eyes, frowns, squints, wrinkles his
+forehead, sits bent over his book, or develops round shoulders, there is
+sufficient reason for having his eyes examined by an oculist.
+Examination by an optician should not be considered sufficient.
+
+ENLARGED TONSILS AND ADENOIDS.--The tonsils are masses of spongy tissue
+situated at the back of the mouth, on either side of the opening into
+the throat. If enlarged they may seriously interfere with breathing, and
+if diseased they frequently harbor the germs causing many acute
+infections, as well as germs of rheumatism and most of the heart
+disease originating in early life. Therefore the tonsils ought to be
+removed if they are diseased or greatly enlarged, but there is
+ordinarily no good reason for removing normal tonsils.
+
+Adenoids are situated at the back of the nose, and like the tonsils are
+composed of spongy tissue. Adenoids sometimes become so enlarged that
+they interfere with the passage of air through the nose, thus
+predisposing to catarrh, colds, and other respiratory diseases, to high
+palate with irregular teeth, to inflammation of the middle ear leading
+to deafness, to diminished mental activity, and to general poor health.
+
+If a child breathes through his mouth, if he snores at night, keeps his
+mouth open and has a dull, apathetic expression, his nose and throat
+should be examined, and if advisable his tonsils and adenoids should be
+removed.
+
+DEFECTIVE HEARING.--Permanent deafness among children in the great
+majority of cases comes from trouble in the throat or nose; hence the
+most effective measure to prevent deafness is to make sure that every
+child's nose, throat, and mouth are in a normal condition. Sensitive or
+timid children try to hide infirmities of any kind, but deaf children
+seem peculiarly unable to explain their difficulties. "No one," says
+Cornell, "has ever recorded that a small child complained of inability
+to hear." A child's ears should be examined if he breathes through his
+mouth, if he stoops habitually, if he is persistently inattentive, or if
+he is vague or stupid in carrying out directions. A child who appears
+normal at times and inattentive or stupid at other times should also be
+examined, since he may be deaf in one ear.
+
+Temporary deafness may come from accumulated wax in the ear. The wax
+should be removed by a doctor; inexpert attempts are likely to cause
+serious injury to the ear drum. Intermittent deafness may be caused by
+enlarged tonsils and adenoids. Children thus affected are not
+infrequently punished for seeming disobedience. Such children are
+especially liable to street accidents.
+
+DEFECTIVE TEETH have been considered on page 44.
+
+POSTURE.--In childhood the bones are soft and yield with comparative
+ease to continued strains; hence they often become deformed by bad
+positions assumed in sitting, standing, or in using the body in other
+ways. The postures habitually assumed by a child should be noticed and
+good postures should be insisted upon. But it is not enough to admonish
+him. The various causes tending to encourage bad positions should be
+corrected; among them are insufficient illumination of books and work,
+defective eyesight or hearing, obstructions in breathing, muscular
+weakness, and low general vitality. Children should have their chairs
+and tables suited to their size for their work both at home and in
+school.
+
+[Illustration: FIG. 28.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 29.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 30.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 31.--INCORRECT AND CORRECT STANDING POSTURES. (_From
+Cornell, "Health and Medical Inspection of School Children," F. A. Davis
+Co., Philadelphia._)]
+
+The adjustable chairs and desks now used in schools are a marked
+improvement upon the school furniture which has caused so many
+deformities in the past.
+
+[Illustration: FIG. 32.--ROUND SHOULDERS. (_Goldthwait, from Pyle's
+"Personal Hygiene."_)]
+
+One of the serious deformities caused by habitual faulty posture is
+curvature of the spine. A curvature not only injures a child's
+appearance and thus handicaps him in later life, but it brings strains
+and pressure upon the organs of the chest and abdomen which may
+seriously impair his health. As curvatures often pass unnoticed in their
+early stages, every child should be inspected occasionally when all his
+clothing has been removed, to see whether the weight is borne evenly on
+both feet, whether the development of the two sides is uniform, and
+whether the head and shoulders are properly carried. It should be
+noticed when the child stands, whether one shoulder is higher than the
+other, whether one shoulder blade projects more than the other, whether
+one hip is higher than the other, and whether one hand is lower than the
+other when the arms are hanging at the sides. The child should walk
+both toward and away from the observer, who should notice whether the
+child uses the two sides of his body in the same way, and whether he
+drags or shuffles his feet or has other abnormalities of gait.
+
+[Illustration: FIG. 33.--LATERAL CURVATURE. (_From Bancroft's "Posture
+of School Children." The Macmillan Co., New York._)]
+
+[Illustration: FIG. 34.--"WING SHOULDER BLADES IN FORWARD SHOULDERS.
+(_From Bancroft's "Posture of School Children." The Macmillan Co., New
+York._)]
+
+If abnormalities are found, a physician should be consulted. Often
+corrective exercises are all that is needed, and no one should put
+braces of any kind upon a child unless they have been prescribed by a
+physician. No attempt should be made to correct the common tendency of
+children to toe in or "walk pigeon-toed." Toeing-in is a natural manner
+of walking during the formative period and tends to strengthen the arch
+of the foot, while toeing-out tends to weaken the arch and to cause flat
+foot or broken arches.
+
+PREDISPOSITION TO NERVOUSNESS.--Heredity plays an important rôle in the
+predisposition to nervousness, so that children of nervous parents are
+particularly likely to show nervous instability. It is, however,
+difficult to say in a given case how much of his nervousness a child
+inherits and how much he acquires by imitating the irritability, the
+out-breaks of temper, and the other evidences of imperfect emotional
+control displayed by his nervously disposed parents. On the other hand,
+even children of nervous predisposition sometimes overcome their defects
+to some extent by imitating parents who have acquired self-control.
+
+Children predisposed to nervousness should be watched with special care,
+but they should not be allowed to realize that they are the objects of
+unusual solicitude. They need the most favorable surroundings that can
+be obtained, and their general health should be maintained at the
+highest possible level. Any condition that lowers vitality tends to
+increase their troubles; nervousness may be caused among children of
+good inheritance, and increased among others, by poor nutrition, lack of
+exercise and play out-of-doors, fatigue, loss of sleep, eyestrain,
+adenoid growths, and the poisons of infectious diseases.
+
+It is characteristic of many nervous children that they are too easily
+stimulated; they may be excitable, restless, unnaturally quick in
+moving, over-sensitive to pain and discomfort, easily fatigued,
+irritable in temper, and unable to control the emotions. They frequently
+make involuntary motions like grimacing and winking the eyes. Children
+of low nervous tone, however, are not necessarily excitable. A nervous
+child may be muscularly weak, awkward in gait, listless, dull, clumsy,
+forgetful, and inattentive. Such children often suffer from cold hands
+and feet and from profuse perspiration.
+
+Much can be done for these unfortunate children by removing the cause of
+their troubles if possible, by giving them simple and wholesome
+surroundings, by suiting their occupations to their strength, by
+eliminating mental strain, particularly during the adolescent period,
+and by training them to control their minds as well as their bodies.
+
+      "In addition to the hardening of the body, the education of
+      the child should include measures which increase the
+      resistance of the child against pain and discomforts of
+      various sorts. Every child, therefore, should undergo a
+      gradual process of 'psychic hardening' and be taught to
+      bear with equanimity the pain and discomfort to which
+      everyone sooner or later cannot help but be exposed. What I
+      have said about clothing, cold baths, walking in all
+      weather and at all temperatures, play and exercise in the
+      open air, has a bearing on this point, for a child who has
+      formed good habits in these various directions will have
+      learned many lessons in the steeling of his mind to bear
+      pain and to ignore small discomforts."--(Barker:
+      "Principles of Mental Hygiene Applied to the Management of
+      Children Predisposed to Nervousness.")
+
+
+CONVALESCENT PATIENTS
+
+After serious or prolonged illness the vitality is generally low and all
+bodily processes are likely to be depressed. During convalescence,
+therefore, the digestion is feeble, the muscles are weak so that fatigue
+follows slight exertion, and the sluggish condition of the circulation
+renders the patient especially sensitive to cold. Since the nervous
+system also becomes depressed and irritable, a convalescent patient is
+easily excited, easily discouraged, and quickly fatigued by mental
+effort. He finds the simplest decisions hard to make, and his emotions
+difficult to control; indeed, many a patient who has borne acute pain
+with unflinching courage becomes peevish at this stage, weeps easily,
+and expects more expression of sympathy than is good for him. Some
+persons naturally make quick recoveries, while others recuperate
+slowly. A long and tedious convalescence, it should be remembered, is
+the patient's misfortune rather than his fault.
+
+In restoring a convalescent patient to normal living it is imperative to
+proceed slowly. Food should be increased gradually both in variety and
+in amount; but the patient's appetite is not always a safe guide, and it
+may need to be encouraged or to be restrained. Both mental and physical
+exertion should begin only under careful supervision, and should
+increase by slow degrees. The patient should sleep as much as possible,
+should take long intervals of rest, and should continue no occupation to
+the point of fatigue. A patient who has been ill in a hospital or who
+has had at home the exclusive services of a nurse or an attendant, often
+finds the period following his return or following the nurse's departure
+an exceedingly difficult transition. The family should not expect or
+allow him to resume too many duties at a time when the mere acts of
+bathing and dressing may demand all the strength he has. Many
+convalescents are obliged, or think they are obliged, to take up regular
+work again before their strength is fully restored. There is generally
+no economy in so doing; indeed, time is saved in the end by waiting
+until recovery is complete before undertaking full work.
+
+Important as it is to build up the patient's physical strength, it is
+hardly less important to direct his thoughts away from himself and his
+sickness, and to help him renew his interest in normal living. During
+his illness he has of necessity relied upon the judgment and support of
+other persons, and his pain and discomfort have forced him to think
+constantly of himself and his many needs. The habit of sickness is
+readily broken by some persons, particularly by those whose nervous
+exhaustion has not been great and whose interests outside themselves are
+naturally keen. But the sick point of view has remarkable tenacity, and
+other patients, unless circumstances or deliberate efforts redirect
+their thoughts, will look upon themselves as invalids to the end of
+time.
+
+Hopefulness promotes health, while discouragement, apprehension, and
+unhappiness lower the tone of the whole system. Hence set backs,
+failures, delays, and relapses should not be dwelt upon, but signs of
+progress should be mentioned; judiciously however, since overdone
+attempts to cheer a patient seldom fail to have the opposite effect. If
+objects or situations that suggest undesirable thoughts are eliminated,
+the less often those thoughts tend to recur. Therefore, in order to
+break the habit of sickness, old thoughts must be gradually banished
+and new ones must be substituted. Sick-room appliances should be put out
+of sight as soon as they are no longer needed, and the patient may
+profit by moving into a different bed room. A few days spent away from
+home as soon as his strength permits often prove effective in breaking
+up sickness associations; the patient is generally encouraged when he
+finds that he can sleep in a different bed, endure some fatigue, and
+exist without daily visits from the doctor. Even a day spent at a
+different house in the same town sometimes directs the patient's
+thoughts into fresh channels. Gradually, but as quickly as safety
+allows, he should take his place in the normal family life and cease to
+be treated as an exception.
+
+Merely eliminating associations with sickness, however, is not enough;
+and exhorting a patient to forget himself and to become interested in
+something seldom accomplishes anything, especially if he is so depleted
+by illness that the thought of everyday activities suggests only
+weariness and pain. A person so weak that he is thoroughly fatigued by
+dressing himself should not be expected to view with enthusiasm the
+prospect of a full day's work. Much, however, may be accomplished by
+providing something that the patient really likes to do, and deliberate
+efforts must be made to stimulate his interest in some occupation,
+however simple it may be.
+
+Occupations for invalids are more than a means to pass away the time;
+they are also of distinct curative value. The patient's interest is not
+always easy to arouse, and some ingenuity may be needed in the
+beginning; sometimes interest is best aroused by working at some
+handicraft in his presence, and finally offering, as a favor, to teach
+him to do it also. His interest in any occupation is invariably
+increased if a well person not only directs but shares in the work.
+
+Care should be taken to select occupations suited to the patient's
+physical condition, to his age, tastes, and mental development. Two or
+three occupations are better than one, so that he may change from one to
+another before any one becomes tedious. Work requiring fine motions,
+close attention, or concentrated thought should be used for short
+periods, only, and no work should be continued to the point of fatigue.
+The patient should not be allowed to feel that he must finish a certain
+amount in a certain time. Even poor work is better than none, and a
+patient should always be encouraged by judicious praise.
+
+Games and puzzles are useful to some extent, but an aimless occupation
+is not so beneficial as one which has a tangible product, particularly
+a product that is useful as well as beautiful. Occupations frequently
+possible for invalids and convalescents include knitting, crocheting,
+many kinds of needle work, clay modeling, basketry, stenciling, weaving,
+book-binding, metal work, and photography. Manuals are now available
+giving directions for these and many other handicrafts. Sick children
+often enjoy collecting stamps, post marks, and other objects, making
+scrap books, sewing, weaving, knitting, paper folding, and various other
+kindergarten occupations.
+
+
+CHRONIC PATIENTS
+
+The whole field of caring for the sick offers nowhere greater
+opportunity for fine and finished work than it offers in the case of
+chronic invalids. It is an achievement of which an artist might be proud
+to make a chronic patient comfortable in body, happy in mind, and
+agreeable to others. Moreover, since success can never be attained by
+one who wearies in well doing, the care given to a chronic invalid tests
+not only the attendant's skill but also her moral and spiritual quality.
+
+Care of a chronic patient has for its aims maintaining the patient's
+health, rendering him as happy and comfortable in mind and body as it is
+possible for him to be, and providing whatever special treatment and
+attention his case requires. In order to maintain his health constant
+attention must be given to diet, to hygiene of the sick room, and indeed
+to all his surroundings. In many chronic illnesses, such as rheumatism
+and kidney disease, the diet is prescribed by the doctor; in every case
+care should be taken that the patient is not overfed or underfed, that
+the food is suited to his digestive powers, that foods causing
+flatulence are eliminated, particularly if the patient's trouble is
+heart disease, and not the least important requirement, that he derive
+as much pleasure from his food as possible.
+
+The regular daily care of the patient and of his room, already described
+in this book, should be scrupulously carried out, and no less
+scrupulously during the tenth year than it was during the tenth day.
+Cleanliness in every detail is absolutely essential to the patient's
+welfare; no one is more unpleasant either to himself or to others than a
+chronic patient who is neglected. Patients who are constantly in bed, it
+should be remembered, and paralyzed patients in particular, are
+peculiarly susceptible to pressure sores. If a patient is able, it is
+extremely important for him to sit up in a chair part of the day.
+Sitting up should never be omitted because it involves the expenditure
+of time and trouble for the attendant.
+
+It is often said that for most people some personal experience of
+sickness is beneficial; it can safely be said, however, that no one
+benefits from spending any considerable portion of his life in a state
+of helplessness and suffering. Behavior and character itself are
+determined by influences constantly coming into the mind from daily
+surroundings and associations with other people: one who recalls this
+fact needs only a moment's reflection to realize how ill adapted to
+healthy development of mind and character are the limited lives of the
+sick. Especially unfortunate is the situation of chronic invalids, shut
+off as they are from the objective interests and activities of normal
+life, deprived of all practice in making the salutary small adjustments
+and sacrifices required in every day living with other people, and
+self-centered as they necessarily tend to become from the inevitable
+focusing of attention upon their own discomforts and pain.
+
+On the whole, a surprisingly large number of invalids successfully
+resist the disintegrating effects of sickness upon character. But it is
+nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a
+few but debases many." A selfish invalid has more than once destroyed
+the happiness of an entire family, or spoiled the life of one member of
+it by monopolizing her whole time and attention. Families should
+remember that their injudicious sacrifices seldom bring enduring
+happiness or contentment to the patient himself; indeed, in the long run
+such sacrifices generally injure him even more than they injure his
+victims. Clearly much must and should be sacrificed by members of a
+family to the needs of an invalid; but in general it may be said that a
+sacrifice is injudicious if it relieves the patient of activity or
+responsibility that he can support without injury, if it makes him more
+dependent in mind or body, if it results in restricting his attention to
+himself and his affairs, or if it increases his tendency to make demands
+on others.
+
+Purposeful activity of some sort and the necessity for contributing to
+the welfare of others are essential parts of a wholesome life. If these
+essentials are entirely eliminated from the life of an invalid, the
+patient's greatest needs are probably left unsatisfied, even though the
+physical care he receives may be perfect in every detail. All that was
+said in regard to occupations for invalids applies with particular force
+to occupations for chronic patients, since however valuable manual
+occupations may be as a means to bring about recovery, they are still
+more valuable in furnishing interest and purpose in a life whose only
+prospect is a succession of weary, useless years. Handicapped patients
+sometimes learn occupations that yield a financial return, and ability
+to earn even a little stimulates self respect and mental health, whether
+the money is needed or not. The important point, however, is that the
+finished product should have a recognized use.
+
+In addition to enabling the patient to make things with his hands, a way
+should be found if possible by which he may contribute to the group of
+people with whom he lives. If a way can be discovered for him to do so,
+the opportunity should not be denied him nor should his service fail to
+be noted and appreciated, even if it is nothing more than telling a
+story to a restless child.
+
+
+CARE OF THE AGED
+
+At the end of life, as at its beginning, every individual especially
+needs the interest and protection of his own family. In ordinary
+circumstances neither a baby nor an aged person can be cared for so
+fittingly or so successfully in any other place as he can be in his own
+home.
+
+With advancing years is to be expected a general slowing down of all the
+powers. In old age both body and mind show characteristic changes, and
+particularly changes causing lowered resistance and diminished vigor. If
+the manner of living is adapted to these changes, both happiness and
+usefulness may be prolonged. But so gradually do the changes often come
+that they may escape notice for a long time, and the younger generation
+in looking back sometimes realizes with regret how much earlier measures
+might have been taken to prolong the usefulness and to mitigate the
+discomforts of aged parents and friends.
+
+Old people are keenly sensitive to cold, since the circulation gradually
+becomes less vigorous and they take little exercise. Keeping them warm
+both in bed and out adds more perhaps to their comfort than any other
+one measure. They should have warm underclothing and soft shawls and
+other extra wraps. A real service will be rendered by the person who
+invents a suitable and dignified wrap for old or feeble men, who dislike
+the informality of sweaters and feel disgraced by shawls. Old persons
+should and can be kept warm in bed, by providing them with hot water
+bags, with warm night clothes including stockings, by using woollen or
+outing flannel sheets if necessary, and by providing a sufficient number
+of light but warm bed covers. It is not always understood that many
+covers do not remedy the deficiencies of a thin mattress. If a thick
+mattress or two thin mattresses cannot be provided, a thick comforter or
+even many layers of newspaper should be placed between the mattress and
+the springs, and another thick comforter should be placed between the
+mattress and the lower sheet. Rubbing the body with warm olive oil often
+affords great comfort, by improving the circulation and thus increasing
+the sensation of warmth, and also by relieving the tendency of the skin
+to become dry and cracked. Poor circulation at night may cause cramps in
+the muscles of the legs; the cramps can usually be relieved by warmth
+and gentle rubbing.
+
+Old people frequently wish their rooms to be very hot, both by day and
+by night, even as hot as 80° or 85°, but if it is possible to keep them
+warm in any other way the temperature of the room should be kept at 70°.
+Well ventilated rooms are highly important for old people as for all
+others of low resistance, and it is entirely possible for their rooms to
+be warm and yet well ventilated. Aged persons should be carefully
+guarded from chill, exposure, crowds, and infected persons. Like little
+children they are peculiarly susceptible to the respiratory diseases,
+which cause many of the deaths commonly attributed to old age.
+
+Digestion usually becomes weaker than in earlier years, and less food is
+needed. It should be simple, hot, and divided into four or five meals
+rather than three. Old people often wake at an early hour, and hot
+nourishment will prevent them from growing weak and faint while waiting
+for the family breakfast. Both constipation and looseness of the bowels
+are common ailments in old age. So far as possible the bowels should be
+regulated by means of diet; but muscular weakness resulting in inability
+to control the bowels should not be mistaken for and treated as
+diarrhœa.
+
+It is unwise for old people to undertake unaccustomed or sudden muscular
+exertion, since the muscular system including the heart muscle grows
+weak and is generally unable to endure great strain. The bones,
+moreover, grow brittle and heal with difficulty if broken, so that
+persons of advanced years no matter how active should avoid walking on
+icy pavements, climbing on chairs to reach high shelves, and placing
+themselves in other insecure positions. Assistance must be tactfully
+given, however, as active old people are inclined to resent it. On the
+other hand, old people should be encouraged to continue moderate and
+safe activities, and to take regular exercises suited to their strength.
+Although increasing muscular weakness tends to make most old people
+indolent, it is far better for them both in mind and in body to remain
+as active as they can without danger of too great fatigue. At all
+events, they should be prevented if possible from becoming bedridden.
+
+Since in old age sight, hearing, and other special senses become less
+acute, one should remember that an old person may not notice the odor of
+escaping gas, the light of a smouldering match, or the sound of an
+approaching motor car, and that he must be specially guarded from such
+dangers of every day life. On account of their dulled perceptions old
+people are sometimes unjustly considered to be less intelligent than
+they really are. Young people moreover should be told, if an aged person
+is untidy and careless in personal habits, that the apparent negligence
+is caused by dulled perceptions and diminished muscular control for
+which old people are no more responsible than they are for failing
+eyesight or for inability to hear.
+
+Families should also realize that changes in mind and character are
+beyond an aged person's control and that they should not be made the
+cause for remonstrance or arguing. Just as the arteries harden with
+advancing years, as the bones become brittle and as other tissues become
+less flexible, so changes are likely to occur in the nervous system. It
+is not surprising when the brain substance like other tissues is
+becoming less flexible, that the powers of attention should weaken,
+that memory for recent events should diminish, or that other mental
+powers should fail. Changes in disposition are not uncommon: previously
+controlled persons sometimes become querulous and exacting, while
+excitable and irritable persons become more placid. With most old people
+emotions become less intense; feeble old people hardly realize great joy
+or great sorrow, and seldom look forward to death with apprehension.
+
+Among the most important changes that occur in the nervous system is its
+gradual loss in power to respond to new demands. New habits are
+difficult or impossible to form, and old habits are hard to break.
+Attempts to break the habits of a life time are therefore dangerous, and
+radical changes in old people's ways of living are attended by risk as
+well as by unhappiness. Such loss of adaptability in the nervous system
+makes it increasingly difficult for old people to assimilate new ideas
+and to understand new points of view. The feeling that the world is
+strange and that the next generation has gone on without them accounts
+for the tragic loneliness of many old people. Clearly it is for those
+who are younger and more flexible to bridge the gulf between the
+generations by their understanding and their sympathy.
+
+Physical care to whatever extent it is needed should be given to all old
+people as soon as they are unable to care for themselves, and thought
+should be given to adapting their surroundings and ways of living to
+their strength and needs, just as they should be adapted to the strength
+and needs of chronic patients. But a warning should be given against
+managing old people too much. It is hard for people who have managed
+their own lives successfully for many years to be managed, even for
+their own good. Indeed, it is questionable kindness to deprive old
+people of all freedom of action, even if following their own
+inclinations occasionally has disastrous results. Few persons would wish
+to prolong their lives if long life involved being thwarted in every
+desire, and sometimes real kindness consists in allowing old people to
+do certain things that are not good for them. Keeping them warm and
+letting them do as they please will go far to make old people happy.
+
+Many of the changes in old age reverse the developing process of
+childhood. In youth and age extremes meet, and the care of the aged
+presents certain marked similarities to the care of little children.
+Both require simple food, occupations suited to their strength, and
+protection from infections, from fatigue, and from nervous strain; both
+are dependent, more or less helpless, and for their happiness both need
+the affectionate care of their own families. But in one respect their
+needs are fundamentally different. In childhood formation of proper
+habits is all important, and in caring for children the future effect of
+every word and act must be taken into consideration. Old people, on the
+other hand, since they live largely in the past and their habits are
+irrevocably formed, may be indulged without harm in ways that would
+demoralize a child; with a clear conscience one may make them happy in
+ways both great and small. This difference makes possible one of the
+greatest pleasures that come to one who cares for the helpless and the
+sick, for of all enduring satisfactions few are greater than the power
+to fill with comfort and happiness the closing days of life.
+
+
+EXERCISES
+
+1. What is meant by a physical defect? Name some of the most common
+defects.
+
+2. Name some permanent injuries to the body caused by defective teeth;
+by diseased or enlarged tonsils and adenoids; by faulty posture.
+
+3. Describe some common symptoms of eye strain in children; of enlarged
+tonsils and adenoids; of deafness.
+
+4. Name several possible causes of round shoulders, and explain why
+urging a round-shouldered child to hold himself erect is seldom enough
+to make him correct his posture.
+
+5. What measures should be taken to overcome nervousness in children?
+
+6. Describe in detail the health work carried on in the public schools
+of your city or town. Considering the important part played by
+uncorrected physical defects in causing permanent physical disability
+among adults, do you think in the long run it is cheaper or more
+expensive for a community to spend money in protecting the health of
+school children?
+
+7. Discuss the particular needs of convalescent and of chronic patients.
+
+8. Explain the effect of activity upon recovery, and explain why it is
+desirable for invalids to have occupation.
+
+9. What special needs should be provided for in caring for old people?
+
+
+FOR FURTHER READING
+
+Invalid Occupations--Tracy.
+
+Occupation Therapy--Dunton.
+
+Handicrafts for the Handicapped--Hall and Buck.
+
+When Mother Lets Us Make Toys--Rich.
+
+Amusements for Convalescent Children--New York State Department of
+Health, Albany.
+
+Essentials of Medicine--Emerson, Chapter IX.
+
+Civics and Health--Allen.
+
+How to Live--Fisher and Fisk, Chapter III, Section II; and Supplementary
+Notes, Section III.
+
+Health Work in the Schools--Hoag and Terman.
+
+Medical Inspection of Schools--Gulick and Ayres.
+
+The Hygiene of the Child--Terman.
+
+Posture of School Children--Bancroft.
+
+
+
+
+CHAPTER XV
+
+QUESTIONS FOR REVIEW
+
+
+I. Show how you would:
+
+    1. Make an unoccupied bed. (Notice the number of minutes it takes
+       you to do it well.)
+
+    2. Remove all the covers from an unoccupied bed and leave the bed to
+       air.
+
+    3. Open a bed to receive a patient.
+
+II. Show how you would:
+
+    1. Change all the linen and remake an occupied bed. (How long did
+       it take you?)
+
+    2. Turn a patient from his back to his side, and the reverse.
+
+    3. Remove, shake, and readjust a patient's pillows.
+
+    4. Move a patient from one bed to another.
+
+    5. Prepare a weak patient to sit up in a chair, and assist him from
+       the bed to the chair.
+
+    6. Assist a weak patient from the chair to the bed.
+
+    7. Arrange pillows and back rest for a patient to sit up in bed; and
+       also how you would remove the pillows and back rest.
+
+III. Show how you would:
+
+    1. Lift a patient who has slipped down toward the foot of the bed,
+       and show what you would do to prevent him from slipping down.
+
+    2. Prevent bed covers from resting upon a sensitive foot, leg,
+       abdomen, or arm.
+
+    3. Describe and demonstrate every device you would use and every
+       thing you would do to prevent pressure sores.
+
+    4. Arrange pillows to support the arms of a person sitting up in
+       bed.
+
+    5. Arrange a table or a substitute for a table to support the book
+       or work of a patient sitting up in bed.
+
+    6. Arrange the light for a patient who is allowed to read in bed.
+
+IV.
+
+    1. Assemble all the articles you would use in giving a bed bath.
+       (How long did it take you?)
+
+    2. Show how to give a complete bed bath. (How long did it take you?
+       Did you have to stop the bath to fetch anything you had
+       forgotten?)
+
+    3. What special care would you give to the mouth and teeth? to the
+       finger and toe nails? to the hair? to badly tangled hair? How
+       would you cleanse the mouth of a helpless patient?
+
+    4. Show how to shampoo the hair of a bed patient.
+
+    5. Show how you would give a bath to a baby.
+
+    6. Show everything that you would do to prepare a patient for the
+       night.
+
+V.
+
+    1. Show how to take the temperature, pulse, and respiration.
+
+    2. Show how to cleanse a clinical thermometer.
+
+    3. Show how to give a foot bath (_a_) to a patient out of bed, (_b_)
+       to a patient in bed.
+
+    4. Show how you would give a cool sponge bath to a feverish patient.
+
+    5. Show how to give, remove, and cleanse a bed-pan.
+
+    6. Show how to fill and apply a hot water bag; an ice bag.
+
+    7. Show how to prepare and apply a mustard paste; a mustard leaf; a
+       flaxseed poultice; hot fomentations; cold compresses.
+
+    8. Show how to measure and administer a fluid medicine; pills or
+       tablets.
+
+    9. Show how to prepare and administer a salt and water enema to a
+       grown person; to a baby.
+
+   10. Show how to prepare steam inhalations.
+
+   11. Show how to apply an ointment; a liniment.
+
+VI.
+
+    1. Show how you would feed a helpless patient who is lying down.
+
+    2. Show how you would feed a patient who is able to sit up but
+       unable to use his hands.
+
+    3. Prepare a liquid nourishment tray.
+
+    4. Set a tray for light diet; for full diet.
+
+    5. Show how to place a tray for a patient unable to sit up but able
+       to feed himself; for a patient sitting up in bed.
+
+    6. What personal care should be given a patient just before meals?
+       just after meals?
+
+    7. How would you modify the diet of a patient inclined to
+       constipation? to diarrhœa?
+
+VII.
+
+    1. Describe effective household methods for removing dust.
+
+    2. Demonstrate the cleaning of a refrigerator.
+
+    3. Show how to ventilate a sick room while protecting the patient
+       from direct draughts.
+
+    4. Show how to clean a sick room with a minimum of disturbance to
+       the patient.
+
+    5. Explain how a patient with communicable disease should be
+       isolated.
+
+    6. Demonstrate the daily care of a room occupied by a patient with
+       communicable disease.
+
+    7. Explain methods of concurrent disinfection.
+
+    8. Explain methods of terminal disinfection.
+
+    9. Tell how the following should be disinfected: discharges from the
+       nose, throat, eyes, ears, bowels, bladder, wounds, and sores; bed
+       and personal linen; blankets; mattresses; dishes; utensils,
+       especially bedpans and urinals; clothing and person of the
+       attendant, especially the hands; furniture, rugs, and woodwork.
+
+VIII.
+
+    1. Name some of the most obvious symptoms of sickness.
+
+    2. Name some symptoms that would lead you to take a patient to a
+       doctor; to send for a doctor; to send for a doctor in haste.
+
+    3. Name some symptoms that are dangerous to neglect even though the
+       patient feels fairly well.
+
+    4. What are some of the symptoms of physical defects in children?
+       Name some conditions that are frequently caused by unremedied
+       defects.
+
+    5. Name some diseases commonly ushered in by symptoms resembling
+       those of a cold in the head.
+
+    6. What symptoms would lead you to isolate a patient?
+
+    7. Give as many illustrations as you can of the part played by good
+       and bad habits in determining health and sickness.
+
+IX.
+
+    1. How would you dress a cut? a burn? a sprain?
+
+    2. What would you do for a person suffering from colic? nausea?
+       diarrhœa? chill?
+
+    3. What are the symptoms of shock? heat stroke? heat prostration?
+       What treatment would you give in each case?
+
+    4. What would you do for a fainting person? for a person suffering
+       from nose bleed? from earache? from a cinder in the eye?
+
+    5. What course of action would you advise for a person troubled with
+       sleeplessness? frequent headaches? excessive irritability?
+       unusual depression of spirits? unfounded suspicions of other
+       persons' motives? a tendency to have the feelings hurt easily?
+       inability to control the emotions?
+
+X.
+
+    1. Why is it better to prevent sickness than to cure it?
+
+    2. Name the essentials of good hygienic conditions for babies, for
+       children, for grown people, for the aged.
+
+    3. How much of the sickness in the United States is preventable?
+
+    4. If part of the sickness is preventable, why is it not prevented?
+
+    5. What constitutes adequate care of the sick?
+
+    6. What proportion of the young men in your community who were
+       drafted have been rejected for physical disability? How many were
+       rejected for disabilities that might have been prevented?
+
+XI. (Answers to the following questions can generally be obtained from
+local health officers.)
+
+    1. What are the duties and powers of your local board of health?
+
+    2. How much did your city or town spend per person last year on
+       health protection? How does this amount compare with the amount
+       spent per person for police protection? for fire protection?
+
+    3. Who inspects the water supply in your town? the milk supply? the
+       food supply?
+
+    4. In your city, what was the number of deaths per 100,000 of the
+       population from tuberculosis each year for the last five years?
+       from typhoid fever?
+
+    5. Is there a tuberculosis sanitarium in your city or county? Are
+       nurses employed to supervise tuberculosis patients who remain at
+       home?
+
+    6. What provision does your community make for patients suffering
+       from other communicable diseases?
+
+    7. What measures are taken in your community to instruct school
+       children in matters of health? to instruct grown persons?
+
+    8. How does your community provide medical and nursing care for
+       persons unable to pay part or all of the cost of such service?
+
+XII. Explain why the following common beliefs are erroneous or
+unfounded:
+
+    1. That a damp cellar causes diphtheria.
+
+    2. That night air is harmful.
+
+    3. That one should "stuff a cold" and "starve a fever."
+
+    4. That almost everyone needs a tonic in the spring.
+
+    5. That the health of one's family would be endangered if a
+       tuberculosis hospital were placed on the next block.
+
+    6. That clearing up the back yard will protect the children of a
+       family from infantile paralysis.
+
+    7. That odorless and tasteless water is necessarily free from
+       harmful germs.
+
+    8. That all children should have the children's diseases, and have
+       them as early as possible.
+
+    9. That boils are a benefit to the system by removing impurities
+       from the blood.
+
+   10. That tomatoes cause cancer.
+
+   11. That consumption is inherited.
+
+   12. That dirt breeds disease.
+
+   13. That diseases come up drains.
+
+   14. That if a teaspoonful of medicine does you good, a tablespoonful
+       will do you more good.
+
+   15. That instinct teaches a mother how to care for her baby.
+
+   16. That low heeled shoes, though suitable for boys and men, cause
+       broken arches in women and girls.
+
+   17. That in one's own case, the rule that everyone needs regular
+       meals, regular hours of sleep, and daily exercise out of doors,
+       may be safely violated.
+
+
+
+
+APPENDIX
+
+
+The New York City Department of Health has kindly permitted us to
+include the following circulars of information issued by the Division of
+Child Hygiene.
+
+
+DEPARTMENT OF HEALTH THE CITY OF NEW YORK
+
+INSTRUCTIONS TO PARENTS REGARDING THE CARE OF THE MOUTH AND TEETH.
+
+The physical examination of school children shows that in many instances
+the teeth are in a decayed and unhealthy condition.
+
+Decayed teeth cause an unclean mouth. Toothache and disease of the gums
+may result.
+
+Neglect of the first teeth is a frequent cause of decay of the second
+teeth.
+
+If a child has decayed teeth, it cannot properly chew its food.
+Improperly chewed food and an unclean mouth cause bad digestion, and
+consequently poor general health.
+
+If a child is not in good health, it cannot keep up with its studies in
+school. It is more likely to contract any contagious disease, and it has
+not the proper chance to grow into a robust, healthy adult.
+
+If the child's teeth are decayed, it should be taken to a dentist at
+once.
+
+The teeth should be brushed after each meal, using a tooth brush and
+tooth powder.
+
+The following tooth powder is recommended:
+
+  2 oz. powdered precipitated chalk.
+  ½ oz. powdered Castile soap,
+  1 dram powdered orris root.
+  Thoroughly mix.
+
+This prescription can be filled by any druggist at a cost not to exceed
+fifteen cents.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+Instructions to Parents Regarding the Care of the Nose
+
+The physical examination of school children shows that in many instances
+they breathe through the mouth because they cannot breathe properly or
+sufficiently through the nose.
+
+This may be due to bad habits in regard to keeping the nose clean, or,
+in a majority of instances, to a growth which is known as "adenoids" and
+which stops up the back of the nose. In either case, the air is not
+breathed through the nose, and the child becomes what is known as a
+"mouth breather."
+
+Constant breathing through the mouth causes the child to become pale,
+restless in its sleep and dull in its actions. The child often speaks as
+though it had a cold in the head. Frequently there is an almost constant
+discharge from the nose.
+
+Mouth breathing renders a child especially liable to contract
+tuberculosis and other infectious diseases; in fact, the child has very
+little resistance to disease of any kind.
+
+Every child should be given a handkerchief, and be taught to thoroughly
+blow the nose several times each day. If, after doing this regularly,
+the child is still unable to breathe properly through the nose, it is
+probable that an adenoid growth is present. Such children should be
+taken to the family physician or to a dispensary for further advice and
+treatment.
+
+Do not wait too long in the hope that the child will outgrow the
+condition, for the effect of adenoid growths persisting throughout
+childhood may injure the person for life.
+
+Have your child's throat and nose examined one month after measles,
+scarlet fever, or diphtheria.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+Instructions to Parents on the Care of Children's Hair and Scalp
+
+Children affected with vermin of the head are excluded from school. The
+following directions will cure the condition:
+
+Mix one-half pint of sweet oil and one-half pint of kerosene oil. Shake
+the mixture well and saturate the hair with the mixture. Then wrap the
+head in a large bath towel or rubber cap so that the head is entirely
+covered; the head must remain covered from six to eight hours.
+
+(Tincture of larkspur may be used instead of oil mixture. The directions
+for use are the same.)
+
+After removing the towel, the head should be shampooed as follows:
+
+To two quarts of warm water add one teaspoonful of sodium carbonate
+(washing soda). Wet the hair with this solution and then apply Castile
+soap and rub the head thoroughly about ten minutes. Wash the soap out of
+the hair with repeated washings of clear warm water. Dry the hair
+thoroughly.
+
+Nits: If the head is shampooed regularly each week as above described,
+it will cure and prevent the condition of "nits."
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+DIET FOR CHILD FROM 12TH TO 18TH MONTH
+
+FIRST MEAL--ON RISING.
+
+(1) 1 to 2 ounces juice of a sweet orange
+
+or
+
+Pulp of 6 stewed prunes
+
+or
+
+1 ounce pineapple juice.
+
+(2) 8 ounces milk with either zwieback, or toasted biscuits or stale
+toasted bread.
+
+Note: Fruit must be given either ½ hour before or ½ hour after milk.
+
+SECOND MEAL--DURING FORENOON.
+
+Milk alone or with zwieback.
+
+NOON MEAL.
+
+(1) 6 ounces soup
+
+or
+
+3 ounces beef juice.
+
+Note: Soup may be made of chicken, beef or mutton.
+
+(2) Stale bread may be added to the above.
+
+FOURTH MEAL--AFTERNOON.
+
+Milk or toasted bread and milk.
+
+EVENING MEAL.
+
+(1) 4 ounces thick gruel mixed with 4 ounces top half milk.
+
+Taken with zwieback.
+
+Note: Gruel may be made of oatmeal, farina, barley, hominy, wheatena, or
+rice.
+
+(2) Apple sauce
+
+or
+
+Prune jelly.
+
+Total milk in 24 hours, 1 to 1¼ quarts.
+
+Note: 8 ounces is equal to a half pint.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+DIET FOR CHILD FROM 18TH TO 24TH MONTH
+
+BREAKFAST.
+
+(1) Juice of one sweet orange
+
+or
+
+Pulp of six stewed prunes
+
+or
+
+Pineapple juice (fresh or bottled) 1 ounce.
+
+(2) A cereal such as cream of wheat, oatmeal, farina, or hominy
+preparations with top milk (top 16 ounces) sweetened or salted. A glass
+of milk, bread and butter.
+
+Note: If constipated give the fruit ½ hour before breakfast with water;
+if not, they may be given during the forenoon.
+
+Raw fruit juice must be given either ½ hour before or ½ hour after milk.
+
+FORENOON.
+
+A glass of milk with two toasted biscuits or zwieback or graham
+crackers.
+
+DINNER.
+
+(1) Broth or soup made of beef, mutton, or chicken, and thickened with
+peas, farina, sago or rice
+
+or
+
+Beef juice with stale bread crumbs; or clear vegetable soup with yolk of
+egg
+
+or
+
+Egg soft boiled, with bread crumbs, or the egg poached, with a glass of
+milk.
+
+(2) Dessert: apple sauce, prune pulp, with stale lady-fingers or graham
+wafers
+
+or
+
+Plain puddings: rice, bread, tapioca, blanc-mange, junket or baked
+custard.
+
+SUPPER.
+
+Glass of milk, warm or cold; zwieback and custard or stewed fruit.
+
+Total milk in 24 hours, 1½ quarts.
+
+
+DEPARTMENT OF HEALTH
+
+CITY OF NEW YORK
+
+DIET FOR CHILD FROM TWO TO THREE YEARS
+
+BREAKFAST.
+
+(1) Juice of 1 sweet orange
+
+or
+
+Pulp of 6 stewed prunes
+
+or
+
+1 ounce pineapple juice (fresh or bottled)
+
+or
+
+Apple sauce.
+
+(2) A cereal such as oatmeal, farina, cream of wheat, hominy or rice,
+slightly sweetened or salted as preferred, with the addition of top milk
+(top 16 ounces)
+
+or
+
+A soft boiled or poached egg with stale bread or toast.
+
+(3) A glass of milk.
+
+Note: If constipated give the fruit ½ hour before breakfast with water;
+if not, they may be given during the forenoon.
+
+Milk and raw fruit juice must not be given at same meal.
+
+DINNER.
+
+(1) Broth or soup made of chicken, mutton or beef, thickened with
+arrowroot, split peas, rice, or with addition of the yolk of an egg or
+toast squares.
+
+(2) Scraped beef or white meat of chicken, or broiled fish (small
+amount)
+
+or
+
+Mashed or baked potatoes with fresh peas or spinach or carrots.
+
+(3) Dessert: apple sauce, baked apple, rice pudding, junket or custard.
+
+SUPPER.
+
+(1) A cereal or egg (if egg is not taken with breakfast) with stale
+bread or toast
+
+or
+
+Bread and milk or bread and cocoa or bread and custard.
+
+(2) Stewed fruit.
+
+
+DEPARTMENT OF HEALTH
+
+CITY OF NEW YORK
+
+DIET FOR CHILD FROM THREE TO SIX YEARS
+
+BREAKFAST.
+
+(1) Fruits: an orange, apple, pear or stewed prunes.
+
+(2) Cereal: oatmeal, hominy, rice or wheat preparations, well cooked and
+salted, with thin cream and sugar
+
+or
+
+Egg: soft boiled, poached, omelet or scrambled.
+
+(3) Milk or cocoa.
+
+DINNER.
+
+(1) Soup: beef, chicken or mutton.
+
+(2) Meat: chicken or beefsteak or roast beef or lamb chops or fish.
+
+(3) Vegetables: spinach or carrots or string beans, peas, cauliflower
+tops, mashed or baked potatoes, beets or lettuce (without vinegar)
+
+Macaroni, spaghetti.
+
+Bread and butter--not fresh bread or rolls.
+
+(4) Dessert: custard, rice or bread or tapioca pudding, ice cream (once
+a week) cornstarch pudding (chocolate or other flavor) stewed prunes or
+baked apple.
+
+SUPPER.
+
+(1) Milk toast or graham crackers and milk
+
+or
+
+A thick soup, as pea, or cream of celery with bread and butter
+
+or
+
+A cereal and thin cream with bread and butter.
+
+(2) Stewed fruit; custard or plain pudding; jam or jelly.
+
+
+
+
+GLOSSARY
+
+(For complete definitions of the following words the student is referred
+to general and scientific dictionaries)
+
+
+A
+
+ANTISEPTIC.--A substance which prevents or hinders the growth of
+micro-organisms.
+
+ANTITOXIN.--A substance that neutralizes the action of a toxin.
+
+ASEPTIC.--Free from living germs.
+
+AXILLA.--The armpit.
+
+
+B
+
+BACILLUS (pl. bacilli).--A rod-shaped or elongated bacterium.
+
+BACTERIAL.--Relating to bacteria.
+
+BACTERICIDE.--An agent having the power to destroy bacteria.
+
+BACTERIOLOGICAL.--Relating to bacteriology.
+
+BACTERIOLOGY.--The science dealing with microorganisms.
+
+BACTERIUM (pl. bacteria).--A unicellular vegetable micro-organism.
+
+
+C
+
+CARRIER.--An apparently healthy person who harbors pathogenic germs in
+his body.
+
+COCCUS (pl. cocci).--A bacterium of spherical or nearly spherical shape.
+
+COUNTER-IRRITANT.--A substance or agent which if applied to the skin
+causes irritation and thereby relieves an abnormal condition in another
+part of the body.
+
+
+D
+
+DEGENERATION.--A deterioration in cells or tissues of the body so that
+they become less able to perform their proper functions.
+
+DEGENERATIVE.--Pertaining to degeneration.
+
+DEODORANT.--An agent that destroys odors.
+
+DIGESTIVE TRACT.--The entire alimentary canal, including the mouth,
+Å“sophagus, stomach, and the small and large intestines.
+
+DIPLOCOCCUS.--A form of coccus in which two individuals remain attached
+after cell division has taken place.
+
+DISINFECT.--To destroy the germs of disease.
+
+DISINFECTANT.--An agent that destroys the germs of disease.
+
+DISINFECTION.--The process of destroying the germs of disease.
+
+
+E
+
+EMETIC.--A substance used to induce vomiting.
+
+ENEMA.--An injection of fluid into the rectum.
+
+
+F
+
+FECAL.--Pertaining to feces.
+
+FECES.--Matter discharged from the bowels; bowel movement.
+
+FERMENTATION.--Decomposition produced in an organic substance by the
+action of certain living agents.
+
+FISSION.--The process by which a cell divides into two parts.
+
+FLAGELLUM (pl. flagella).--A long hair-like appendage, by the action of
+which certain micro-organisms are enabled to move.
+
+FLEX.--To bend at a joint.
+
+FOMENTATION.--See _Stupe_.
+
+
+G
+
+GASTRIC JUICE.--The fluid secreted by the glands of the stomach.
+
+GERM.--A minute unicellular organism, either animal or vegetable; a
+micro-organism; a microbe.
+
+GERMICIDE.--An agent having the power to kill germs.
+
+
+H
+
+HOST.--An animal or plant in or upon which another organism lives.
+
+
+I
+
+IMMUNE.--Not susceptible to a particular disease; also, a person who is
+not susceptible to a particular disease.
+
+IMMUNITY.--The state in which an individual is not susceptible to a
+particular disease.
+
+IMMUNIZE.--To render immune.
+
+INCUBATION.--The interval between exposure to an infectious disease and
+the first appearance of symptoms.
+
+INFECT.--To communicate disease germs.
+
+INFECTION.--An agent by which disease may be communicated from one
+individual to another; also, an infectious disease.
+
+INOCULATE.--To introduce any biological product directly into the
+tissues of the body.
+
+INOCULATION.--The process of inoculating.
+
+INTESTINAL TRACT.--The small and large intestines.
+
+
+M
+
+MICROBE.--See _Germ_.
+
+MICRO-ORGANISM.--See _Germ_.
+
+MUCUS.--The substance secreted by mucous membranes.
+
+MUCOUS MEMBRANES.--The membranes lining certain cavities of the body,
+especially the digestive and respiratory tracts.
+
+
+N
+
+NUTRIENT.--One of several chemical groups to which the essential
+constituents of food belong.
+
+
+O
+
+ORGANIC.--Derived from or relating to an organism.
+
+ORGANISM.--An individual that is or has been alive.
+
+
+P
+
+PARASITE.--An individual that lives in or upon another individual.
+
+PASTEURIZATION.--The process of pasteurizing.
+
+PASTEURIZE.--To subject milk to a temperature of 142°-145° Fahrenheit
+for thirty minutes.
+
+PATHOGENIC.--Disease-producing.
+
+PERTUSSIS.--Whooping-cough.
+
+PROTEID.--One of the complex nitrogenous substances constituting the
+essential parts of animal and vegetable tissues.
+
+PROTOZOÖN (pl. protozoa).--An animal organism composed of a single cell.
+
+PUS.--The fluid product of inflammation; matter.
+
+PUTREFACTION.--Decomposition of nitrogenous organic matter brought about
+by micro-organisms and accompanied by a foul odor.
+
+
+R
+
+RESISTANCE.--See _Immunity_.
+
+RESPIRATORY TRACT.--The air passages, including the nose, mouth, larynx,
+trachea, bronchial tubes, and lungs.
+
+
+S
+
+SAPROPHYTE.--A vegetable organism that lives on decaying organic matter.
+
+SARCINA.--Literally, a bundle. Applied to bacteria grouped in bundles or
+packets.
+
+SEPTIC.--Putrefying or decomposing; infected by pus-producing bacteria.
+
+SEQUELA.--A disease or unhealthy condition following another disease or
+unhealthy condition.
+
+SERUM.--The fluid which separates from the clot after blood has
+coagulated; especially, that containing an antitoxin.
+
+SEWAGE.--Any substance containing urine or fecal matter; also, the
+substance which passes through sewers.
+
+SPIRILLUM (pl. spirilla).--A variety of bacteria having spirally twisted
+cells.
+
+SPORE.--A resting stage, characterized by great resistance, into which
+certain germs enter when conditions become unfavorable for their growth.
+
+SPUTUM.--Spit; expectoration.
+
+STAPHYLOCOCCUS.--A variety of bacteria that group themselves in masses
+resembling bunches of grapes.
+
+STERILE.--Free from living germs; aseptic.
+
+STERILIZATION.--The process of rendering sterile.
+
+STERILIZE.--To render sterile.
+
+STREPTOCOCCUS.--A variety of bacteria that arrange themselves in chains.
+
+STUPE.--A cloth wrung out of hot water and applied to the surface of the
+body.
+
+SUSCEPTIBLE.--Lacking resistance to a disease.
+
+SUSCEPTIBILITY.--The condition in which resistance to a disease is low.
+
+
+T
+
+TETRAD.--A variety of bacteria that arrange themselves in groups of
+four.
+
+TISSUE.--A collection of cells having the same function.
+
+TOXIN.--A poison produced by the action of micro-organisms.
+
+
+U
+
+UNICELLULAR.--Composed of a single cell.
+
+UTERUS.--The womb.
+
+
+V
+
+VACCINATE.--To inoculate with a poison in order to bring about immunity
+to a disease.
+
+VACCINE.--Any substance which if introduced into the body causes the
+formation of protective substances.
+
+VOMITUS.--Vomited substances.
+
+
+
+
+INDEX
+
+
+A
+
+  Abdomen, 68
+
+  Abdominal binder, 68
+
+  Action of drugs, 200
+
+  Adenoids, 284
+
+  Aged, care of, 303
+
+  Ailments and emergencies, 257
+
+  Air, 72
+
+  Alcohol, 160
+
+  Appliances,
+    bed cradles, 173
+    bedpans, 176
+    rubber utensils, 138
+
+  Applications, local, 220
+    cold, dry, 231
+    cold, moist, 235
+    hot, dry, 225
+      bricks, 226
+      flannel, 226
+      salt or sand, 226
+      water bags, 225
+    hot, moist, 227
+      fomentations, 229
+      poultices, 227
+      stupes, 229
+
+  Attendant, 127
+
+
+B
+
+  Bacteria, 1, 4, 5
+    bacilli, 5
+    coccus, 4
+    effects produced by, 3
+    entrance into the body, 9
+    food of, 2
+    immunity, 13
+    in food, 19
+    in water, 19
+    methods of study, 1
+    motion, 5
+    origin of communicable diseases, 3
+    parasites, 3, 8
+    saprophytes, 2
+    shape, 4
+    spirillum, 4
+    spores, 7
+    structure and development, 4
+    where found, 8
+
+  Bacteriology, 1
+
+  Baths, 42, 154
+    bed, 156
+    cleansing, 171
+    cold tub, 97, 171
+    daily, 24
+    foot, 165
+      mustard, 165
+    hot, 97
+    infant's, 78
+    sitz, 176
+    tub, 154
+
+  Bed cradles, 173
+
+  Bedmaking, 132
+
+  Bedpan, 176
+
+  Bed-rooms, care of, 84
+
+  Beds, 132
+    care of, 134
+    dimensions, 133
+    rubber pillow cases, 138
+    rubber sheets, 138
+    selection of, 132
+    wooden, 132
+
+  Bed sores, 169
+
+  Birth registration, 63
+
+  Blankets, 140
+
+  Bleeding, 272
+
+  Blindness, 33
+
+  Breast feeding, 73
+
+  Bruises, 276
+
+  Brush burn, 278
+
+  Burns, 277, 278
+
+
+C
+
+  Cancer, 111
+
+  Carriers, 17
+
+  Charts, 10, 246
+
+  Chickenpox, 236
+
+  Childhood, see Infancy, 60
+
+  Children, care of, 280
+    with adenoids, 284
+    with defective hearing, 285
+    with defective teeth, 286
+    with enlarged tonsils, 284
+    with eyestrain, 284
+    with incorrect posture, 286
+    with physical defects, 283
+    with predisposition to nervousness, 292
+
+  Chills, 270
+
+  Chronic patients, care of, 299
+
+  Circulars of information, 318
+    Department of Health, City of New York, 318
+      care of hair and scalp, 321
+      care of mouth and teeth, 318
+      care of nose, 320
+      diet of child twelfth to eighteenth month, 322
+      diet of child eighteenth to twenty-fourth month, 323
+      diet of child two to three years, 324
+      diet of child three to six years, 325
+
+  Cleaning room, 126
+
+  Cleanliness, personal, 41
+
+  Clothing, 47
+    disinfection of, 95
+    of infants, 68
+
+  Coccus, 4
+
+  Cold applications, 220
+
+  Cold, prevention of common, 241
+
+  Colic, 266
+
+  Compresses, cold, 232
+
+  Constipation, 52, 193, 266
+
+  Convalescents, care of, 294
+
+  Convulsions, 260
+
+  Counter irritants, 233
+
+  Croup, 271
+
+
+D
+
+  Degenerative diseases, 20, 24
+
+  Development of child, 64
+
+  Diaper, 69
+
+  Diarrhœa, 266
+
+  Diphtheria, 245
+
+  Disinfectants, 251
+
+  Disinfection, 248
+
+  Drainage, 40
+
+  Draughts, 32
+
+  Dust, effect upon health, 36
+
+
+E
+
+  Ear, disorders affecting, 268
+
+  Emergencies, 257
+
+  Enemata, 210
+    directions for giving, 210
+    for baby, 212
+
+  Environment, 29
+
+  Eruptive diseases, 236
+
+  Excreta, disinfection of, 249
+
+  Excretions, 52
+
+  Expectoration, 249
+
+  Eye, ailments, 267
+    compresses for, 232
+    foreign bodies in, 267
+
+  Eyestrain, 284
+
+
+F
+
+  Fainting, 259
+
+  Fatigue, 53, 106, 181
+
+  Feeding of infants, 73
+
+  Filtration of water, 50
+
+  Flies, as carriers of disease germs, 38
+
+  Floors, 120
+
+  Fomentations, 229
+
+  Food, 35, 48, 188
+    classification of, 48
+    for children, 78
+    for infants, 72
+
+  Foot bath, 165
+
+  Fumigation, 254
+
+  Furniture, 120
+
+
+G
+
+  Garbage, 37
+
+  Glossary, 326-330
+
+  Growth of child, 64
+
+
+H
+
+  Habits, 82
+
+  Hair, care of, 163
+
+  Handkerchiefs, 239
+
+  Hands, 11, 12, 43, 250
+
+  Headache, 257
+
+  Heat, application of, 220
+    exhaustion, 264
+
+  Heating, 54
+
+  Heredity, 27
+
+  Hiccough, 265
+
+  House, cleanliness of, 33
+
+  Humidity, 31
+
+  Hygiene, oral, 44
+    personal, 19, 28
+
+
+I
+
+  Immunity, 13
+
+  Infancy (and childhood), hygiene of, 60
+    air, fresh, 72
+    baths, 78
+    care of eyes, 80
+      of mouth, 81
+      of nostrils, 81
+      of genital organs, 81
+    clothing, 68
+    cry, significance of, 82
+    diet, 74
+    mother's milk, danger of substitutes, 72
+      water, 75
+      weaning, 75
+    excretions, 67
+    exercise, 83
+    growth and development, 64, 65
+      length at birth, 64
+        increase, 65
+      muscular development, 64
+      special senses, 66
+      speech, 66
+      teeth, 66
+      weight at birth, 64
+        increase, 65
+    habits, 82
+    mortality, 61
+    nursing bottles, 75
+      nipples, 75
+    play, 84
+    pulse, 96
+    respiration, 99
+    sleep, 70
+    toys, 85
+
+  Infection, 1, 43
+
+  Inflammation, 220
+
+  Inhalation, 213
+
+  Insects, 38, 270
+
+  Insect bites and stings, 270
+
+  Inunction, 214
+
+  Isolation, duration of, 247
+
+  Ivy poisoning, 270
+
+
+K
+
+  Kitchens, 34
+
+
+L
+
+  Light, 33, 124
+
+  Linen, 251
+
+  Lysol, 251
+
+
+M
+
+  Malaise, 106
+
+  Mattress, 135
+    care of, 136
+
+  Measles, 246
+
+  Medicines and remedies, 200
+    action of drugs, 200
+    amateur dosing, 202
+    enemata, 210
+    inhalation, 213
+    inunction, 214
+    patent remedies, 205
+    sprays and gargles, 213
+    suppositories, 209
+
+  Medicines, administration of, 206
+
+  Menstruation, profuse, 275
+
+  Mental condition, 104-112
+
+  Microorganisms, 9
+
+  Milk, 51
+    pasteurization, 51
+
+  Mouth, care of, 160
+    wash, 182
+
+  Mustard paste, 233
+    leaves, 233
+
+
+N
+
+  Nausea, 265
+
+  Nipple, bottle, 77
+    care of, 77
+
+  Non-communicable diseases, 20
+
+  Nosebleed, 274
+
+
+P
+
+  Pain, 105
+
+  Parasites, 3, 4, 8
+
+  Patent remedies, 205
+
+  Patient, care of,
+      with communicable disease, 236
+      with colds and slight infections, 238
+      with more serious infections, 242
+    changing sheet, 147
+    changing, 146
+    lifting, 146
+    mouth, 160
+    moving, 152
+
+  Personal hygiene, 19
+
+  Pillows, 137
+    covers, 138, 140
+
+  Poisonous drugs, 215
+
+  Posture, 286
+
+  Poultices, 227, 228
+
+  Prenatal care, 62
+
+  Prickly heat, 269
+
+  Protozoa, 8
+
+  Public agencies, 107
+
+  Public sanitation, 19
+
+  Pulse, 96
+
+  Purification of water, 50
+
+
+Q
+
+  Quarantine, termination of, 252
+
+
+R
+
+  Records, 107
+
+  Recreation, 55
+
+  Rectum, 93
+
+  Respiration, 99
+
+  Rest, 53
+
+  Rooms, 27
+
+
+S
+
+  Saprophytes, 2
+
+  Scalds, 277
+
+  Scarlet fever, 246
+
+  Sewage, 39
+
+  Sheets, 137, 138, 142
+
+  Shock, 261
+
+  Sick-room, model, 118
+
+  Sleep, 55, 70
+
+  Sleeplessness, 258
+
+  Small-pox, 246
+
+  Special senses in sickness, 101
+
+  Spores, 7
+
+  Sprains, 275
+
+  Sprays and gargles, 213
+
+  Stimulants, in emergency work, 263
+
+  Stupes, 229
+
+  Styes, 267
+
+  Sunstroke, 264
+
+  Suppositories, 209
+
+  Symptoms, 88
+
+
+T
+
+  Teeth, 45, 160
+    defective, 286
+    treatment, 46
+
+  Temperature, 92
+    method of taking, 92
+    normal, 95
+
+  Temperature of baths, 79, 155
+    of house, 30, 124
+    sponging for, 177
+    variations, 114, 206
+
+  Thermometer, clinical, care of, 92
+
+  Tonsils, enlarged, 284
+
+  Tuberculosis, 27-107
+
+
+U
+
+  Urine, 103
+
+
+V
+
+  Vaccination, 13, 25
+
+  Ventilation, 29, 123
+
+  Vomiting, 265
+
+
+W
+
+  Water, 49
+    filtration, 50
+
+  Weaning, 75
+
+  Weight, 65
+    loss of, 64
+
+  Whooping cough, 246
+
+  Wounds, 272
+
+
+
+
+[Transcriber's Note:
+
+
+Punctuation errors (e.g. missing period at end of sentence, missing
+quotation marks, etc.) and letters printed upside down have been
+corrected without note. Except where noted, inconsistencies in
+hyphenation, capitalization, and spelling (e.g. travelling and
+traveling) have not been changed. The original index had numerous
+errors, such as references to terms that do not appear in the text.
+Except where noted below, it has been left as printed.
+
+The following corrections were made:
+
+p. viii: Records, 105. to Records, 107. (under Chapter IV)
+
+p. ix: Care of the Patients with Communicable Diseases to Care of
+Patients with Communicable Diseases (under Chapter XII)
+
+p. ix: Care of liver, 251. to Care of linen, 251. (under Chapter XII)
+
+p. 15: innoculation to inoculation (Vaccination and inoculation have
+saved thousands of lives.)
+
+p. 16: principle to principal (principal causes which diminish
+resistance), to match cited text
+
+p. 37: gerns to germs (through which disease germs)
+
+p. 40: From "_The Human Mechanism_." to _From "The Human Mechanism."_
+(to match format of other captions)
+
+p. 41: perferably to preferably (preferably, chloride of lime.)
+
+p. 77: runnnig to running (thoroughly cleansed under running water)
+
+p. 82: symptons to symptoms (other symptoms of distress)
+
+p. 96: thay to they (taken together they are)
+
+p. 108: 8:30 to 8:30 a.m.
+
+p. 111: develope to develop (may develop into cancer)
+
+p. 115: missing degree symbol added (At noon his temperature was 101°)
+
+p. 132: illnes to illness (unless his illness is slight)
+
+p. 136: servicable to serviceable (makes a serviceable cover)
+
+p. 150: paitent to patient (ready for the patient.)
+
+p. 150-151: removed duplication of text in captions for Fig. 14 and Fig.
+15 (CHANGING THE DRAW SHEET, and CHANGING A PATIENT FROM ONE BED TO
+ANOTHER)
+
+p. 161: erroneous italics removed from "patient" and "her" (even a
+patient unable to sit up can brush her teeth)
+
+p. 167: added missing "bath" (to give a cool sponge bath)
+
+p. 175: ahould to should (the protection of the abdomen should)
+
+p. 177: expecially to especially (if it is especially difficult or
+undesirable)
+
+p. 177: patients' to patient's (between the patient's back and the pan;)
+
+p. 178: deoderant to deodorant (a properly kept pan needs no deodorant)
+
+p. 183: invarably to invariably (casual visitors almost invariably
+offend)
+
+p. 189: nurtients to nutrients (pancreatic juice acts upon all three
+nutrients)
+
+p. 195: solied to soiled (is always superior to soiled linen.)
+
+p. 205: appy to apply (apply even more strongly to using patent
+medicines.)
+
+p. 211: 166 to 176 (the directions on page 176.)
+
+p. 216: selzer to seltzer (seltzer aperient)
+
+p. 226: slighest to slightest (there is the slightest possibility of
+scalding)
+
+p. 227: accidently to accidentally (see that the switch is not
+accidentally)
+
+p. 228: cohers to coheres (when the mixture coheres)
+
+p. 229: annoint to anoint (anoint it with vaseline)
+
+p. 233: dicharge to discharge (If there is discharge from the eye,)
+
+p. 242: chould to should (visitors should be rigidly)
+
+p. 245: himelf to himself (safeguard the patient himself.)
+
+Table between pp. 246-247: diappearance to disappearance (Two weeks
+after onset and one week after disappearance)
+
+Table between pp. 246-247: pa-patient to patient (after child last saw
+patient.)
+
+p. 250: If to It (It may be necessary to provide two bedpans)
+
+p. 266: 216 to 193 (discussed on pages 193 and 52.)
+
+p. 280: etter to better (no better place)
+
+p. 300: attenom, to attention (constant attention must be given)
+
+p. 300: rotion to room, (hygiene of the sick room,)
+
+p. 301: salutory to salutary (making the salutary small adjustments)
+
+p. 308: querelous to querulous (sometimes become querulous)
+
+p. 329: Putrifying to Putrefying (Putrefying or decomposing)
+
+p. 331: bed-cradles to bed cradles (Index sub-entry, under "Appliances")
+
+p. 331: Bed-cradles to Bed cradles (Index entry)
+
+p. 331: Bed-sores to Bed sores (Index entry)
+
+p. 331: Brushburn to Brush burn (Index entry)
+
+p. 332: Foot-bath to Foot bath (Index entry)
+
+p. 333: Microörganisms to Microorganisms (Index entry)
+
+p. 333: Pre-natal to Prenatal (Index entry)
+
+p. 334: oss to loss (Index entry for "Weight, loss of")
+
+A fold-out table was facing p. 247 in the original book. For the plain
+text versions, it has been split into several smaller tables, with the
+"DISEASE" column repeated in each section. In the third section,
+"POLIOMYELITIS" has been hyphenated (POLIO-MYELITIS) to save space.
+
+The footnote pertaining to the table is immediately after it, not at the
+end of the chapter as usual.]
+
+
+
+
+*** END OF THE PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***
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+<div style='text-align:center; font-size:1.2em; font-weight:bold;'>The Project Gutenberg eBook of American Red Cross Text-Book on Home
+Hygiene and Care of the Sick, by Jane A. Delano and Anne Hervey Strong and American Red Cross</div>
+<div style='display:block; margin:1em 0'>
+This eBook is for the use of anyone anywhere in the United States and
+most other parts of the world at no cost and with almost no restrictions
+whatsoever. You may copy it, give it away or re-use it under the terms
+of the Project Gutenberg License included with this eBook or online
+at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you
+are not located in the United States, you will have to check the laws of the
+country where you are located before using this eBook.
+</div>
+<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: American Red Cross Text-Book on Home Hygiene and Care of the Sick</div>
+<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Author: Jane A. Delano<br />
+Anne Hervey Strong<br />
+American Red Cross</div>
+<div style='display:block;margin:1em 0'>Release Date: May 4, 2010 [eBook #32250]<br />
+[Most recently updated: April 20, 2021]</div>
+<div style='display:block;margin:1em 0'>Language: English</div>
+<div style='display:block;margin:1em 0'>Character set encoding: UTF-8</div>
+<div style='display:block; margin-left:2em; text-indent:-2em'>Produced by: Heiko Evermann, Fox in the Stars, S.D., and the Online Distributed Proofreading Team</div>
+<div style='margin-top:2em;margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***</div>
+
+<div class="figcenter" style="width: 316px;">
+<img class="border" src="images/cover.jpg" width="316" height="500" alt="" title="" />
+</div>
+
+<h1 class="intro">
+<span class="sm">AMERICAN RED CROSS TEXT-BOOK</span><br />
+<span class="wee">ON</span><br />
+<span class="med">HOME CARE OF THE SICK</span></h1>
+
+<div class="figcenter" style="width: 75px;">
+<img src="images/med-line-thin.png" width="75" height="1" alt="" title="" />
+</div>
+
+<p class="center lg">DELANO</p>
+
+<div class="tp">
+<h1>
+<span class="sm">AMERICAN RED CROSS<br />
+TEXT-BOOK</span><br />
+<span class="wee">ON</span><br />
+HOME HYGIENE<br />
+<span class="wee">AND</span><br />
+CARE OF THE SICK</h1>
+
+<p class="center"><span class="taller"><span class="sm2">BY</span><br />
+<span class="lg">JANE A. DELANO, R. N.</span></span><br />
+<span class="sm2">Chairman of the National Committee, Red Cross Nursing Service; Director,<br />
+Department of Nursing, American Red Cross; Late Superintendent<br />
+of the Nurse Corps, U. S. A.; of the Training Schools<br />
+for Nurses, Bellevue Hospital, New York City; and of the<br />
+Training School for Nurses, Hospital of the University<br />
+of Pennsylvania, Philadelphia</span></p>
+
+<p class="center"><span class="taller">REVISED AND REWRITTEN<br />
+<span class="sm">BY</span><br />
+<span class="med">ANNE HERVEY STRONG, R. N.</span></span><br />
+<span class="sm2">Professor of Public Health Nursing, Simmons College, Boston</span></p>
+
+<p class="center pad-tb"><i>This is the Second Edition of the American Red Cross<br />
+Text-book in Elementary Hygiene and Home Care of<br />
+the Sick by Jane A. Delano and Isabel McIsaac.</i></p>
+
+<p class="center pad-tb"><span class="sm">PREPARED FOR AND ENDORSED BY</span><br />
+THE AMERICAN RED CROSS</p>
+
+<p class="center pad-tb">PHILADELPHIA<br />
+<span class="lg">P. BLAKISTON'S SON &amp; CO.</span><br />
+1012 WALNUT STREET</p>
+</div>
+
+<p class="smcap center">Copyright, 1918, by American Red Cross</p>
+
+<p class="center">THE MAPLE PRESS YORK PA</p>
+
+<p><!-- Page v --><span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span></p>
+
+<h2>PREFACE</h2>
+
+<p>To the woman who wishes to protect her family
+from preventable diseases and is anxious to fit
+herself in the absence of a trained nurse to give
+intelligent care to those who are sick, this revision
+of the Red Cross text-book on Elementary Hygiene
+and Home Care of the Sick is particularly directed.
+It should appeal to men and to women who are
+interested in maintaining the health of their
+neighborhoods and communities and in affording
+effective coöperation to the public health authorities.
+To teachers wishing to impart protective
+health information to high school pupils, the book
+also should be useful as a class text as well as a
+guide.</p>
+
+<p>The war, which has caused the withdrawal from
+private practice of thousands of physicians and
+graduate nurses, makes it peculiarly important to
+the nation for every adult to have sound knowledge
+as to how to prevent contagion and epidemics,
+especially by precautionary attention to home and
+local sanitation. With nurses becoming more
+difficult to secure, the safety of the family demands
+that some member in each household know enough
+about elementary nursing to make a patient
+comfortable and to carry out accurately the instructions
+of the physician.</p>
+
+<p><!-- Page vi --><span class='pagenum'><a name="Page_vi" id="Page_vi">[vi]</a></span>
+The work of revision, based upon the latest
+knowledge of hygiene, sanitation and methods of
+home-nursing has been done by Miss Anne Hervey
+Strong, Professor of Public Health Nursing,
+Simmons College, under the personal direction of
+the author and the National Committee on Red
+Cross Nursing Service. The material has been
+painstakingly read by Dr. H. W. Rucker and Dr.
+Taliaferro Clarke of the United States Public
+Health Service, and Lieutenant Colonel Clarence
+H. Connor, Medical Corps, United States Army.
+Indebtedness to Dr. H. M. McCracken, President
+of Vassar College and Director of the Red Cross
+Junior Membership, for his valuable suggestion
+as to adapting the book for high school use as well
+as for the assistance rendered by his Department,
+also is gladly acknowledged.</p>
+
+<p class="ralign">J. A. D.</p>
+
+<div class="figcenter" style="width: 75px;">
+<img src="images/med-line-thin.png" width="75" height="1" alt="" title="" />
+</div>
+
+<h2 id="ack">ACKNOWLEDGMENT</h2>
+
+<p>I wish to express my gratitude to those who have
+so kindly helped in the work of preparing the
+present edition. Thanks are especially due to
+Professor Isabel Stewart, Miss Anna C. Jamme,
+Professor Curtis M. Hilliard, Professor Maurice
+Bigelow, Miss Katharine Lord, Miss Josephine
+Goldmark, and Miss Evelyn Walker.</p>
+
+<p class="ralign">A. H. S.</p>
+
+<p><!-- Page vii --><span class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></span></p>
+
+<h2>CONTENTS</h2>
+
+<div class="figcenter" style="width: 75px;">
+<img src="images/med-line-thin.png" width="75" height="1" alt="" title="" />
+</div>
+
+<table id="toc" summary="Table of Contents">
+
+<tr><td class="smcap">Preface</td>      <td align="right"><a href="#Page_v">v</a></td></tr>
+
+<tr><td class="smcap">Introduction</td>      <td align="right"><a href="#Page_xi">xi</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER I</td></tr>
+
+<tr><td></td>            <td align="right" class="smcap">Page</td></tr>
+
+<tr><td><span class="smcap">Causes and Prevention of Sickness</span>
+
+<p>Communicable diseases, <a href="#Page_1">1</a>. Micro-organisms and bacteria, <a href="#Page_1">1</a>.
+Parasites, <a href="#Page_3">3</a>. Structure and development of parasites, <a href="#Page_4">4</a>.
+Bacteria, <a href="#Page_4">4</a>. Shape, <a href="#Page_4">4</a>. Size, <a href="#Page_5">5</a>. Motion, <a href="#Page_5">5</a>. Multiplication,
+<a href="#Page_5">5</a>. Spores, <a href="#Page_7">7</a>. Distribution, <a href="#Page_8">8</a>. Protozoa, <a href="#Page_8">8</a>. Visible parasites,
+<a href="#Page_8">8</a>. Transmission of pathogenic organisms, <a href="#Page_9">9</a>. Defenses
+of the body, <a href="#Page_12">12</a>. Immunity, <a href="#Page_13">13</a>. Vaccination and inoculation,
+<a href="#Page_15">15</a>. Carriers, <a href="#Page_17">17</a>. Non-communicable diseases, <a href="#Page_20">20</a>.
+Physical examinations, <a href="#Page_22">22</a>.</p></td>     <td class="tocnum"><a href="#Page_1">1</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER II</td></tr>
+
+<tr><td><span class="smcap">Health and the Home</span>
+
+<p>Heredity, <a href="#Page_27">27</a>. Hygiene of environment and person, <a href="#Page_28">28</a>.
+Ventilation, <a href="#Page_29">29</a>. Lighting, <a href="#Page_32">32</a>. Cleanliness of houses, <a href="#Page_33">33</a>.
+Garbage, <a href="#Page_37">37</a>. Insects, <a href="#Page_38">38</a>. Sewage, <a href="#Page_39">39</a>. Personal cleanliness,
+<a href="#Page_41">41</a>. Oral hygiene, <a href="#Page_44">44</a>. Treatment of teeth, <a href="#Page_46">46</a>. Clothing, <a href="#Page_47">47</a>.
+Food, <a href="#Page_48">48</a>. Elimination, <a href="#Page_52">52</a>. Rest and fatigue, <a href="#Page_53">53</a>. Sleep, <a href="#Page_55">55</a>.
+Recreation, <a href="#Page_55">55</a>.</p></td>      <td class="tocnum"><a href="#Page_27">27</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER III</td></tr>
+
+<tr><td><span class="smcap">Babies and Their Care</span>
+
+<p>Growth and development, <a href="#Page_64">64</a>. Average size, <a href="#Page_64">64</a>. Muscular
+development, <a href="#Page_65">65</a>. Development of special senses, of speech,
+of teeth, <a href="#Page_66">66</a>. Normal excretions, <a href="#Page_67">67</a>. Clothing, <a href="#Page_68">68</a>. Sleep, <a href="#Page_70">70</a>.
+Fresh air, <a href="#Page_72">72</a>. Diet, <a href="#Page_72">72</a>. Intervals of feeding, <a href="#Page_73">73</a>. Water,
+<a href="#Page_75">75</a>. Weaning, <a href="#Page_75">75</a>. Nursing bottles and nipples, <a href="#Page_75">75</a>. Tables of
+diet, <a href="#Page_78">78</a>. Bathing, <a href="#Page_78">78</a>. Eyes, <a href="#Page_80">80</a>. Mouth, <a href="#Page_81">81</a>. Nostrils, <a href="#Page_81">81</a>.
+Genital organs, <a href="#Page_81">81</a>. Development of habits, <a href="#Page_82">82</a>. Exercise, <a href="#Page_83">83</a>.
+Play and toys, <a href="#Page_85">85</a>.</p></td>       <td class="tocnum"><a href="#Page_60">60</a></td></tr>
+
+<tr><td class="chap" colspan="2"><!-- Page viii --><span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span>
+CHAPTER IV</td></tr>
+
+<tr><td><span class="smcap">Indications of Sickness</span>
+
+<p>Objective symptoms, <a href="#Page_92">92</a>. Temperature, <a href="#Page_92">92</a>. Pulse, <a href="#Page_96">96</a>.
+Respiration, <a href="#Page_99">99</a>. General appearance, <a href="#Page_100">100</a>. Special senses,
+<a href="#Page_101">101</a>. Voice, tongue, throat, gums, <a href="#Page_102">102</a>. Cough, <a href="#Page_103">103</a>. Appetite,
+<a href="#Page_103">103</a>. Excretions, <a href="#Page_103">103</a>. Loss of weight, <a href="#Page_104">104</a>. Sleep, <a href="#Page_104">104</a>.
+Mental conditions, <a href="#Page_104">104</a>. Subjective symptoms, <a href="#Page_105">105</a>. Pain,
+<a href="#Page_105">105</a>. Records, <a href="#Page_107">107</a>. Tuberculosis, cancer and mental illness,
+<a href="#Page_107">107</a>. Tuberculosis, <a href="#Page_109">109</a>. Cancer, <a href="#Page_111">111</a>. Mental illness, <a href="#Page_112">112</a>.</p></td>
+<td class="tocnum"><a href="#Page_88">88</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER V</td></tr>
+
+<tr><td><span class="smcap">Equipment and Care of the Sick Room</span>
+
+<p>Choice of a sick room, <a href="#Page_118">118</a>. Furnishing, <a href="#Page_120">120</a>. Ventilation, <a href="#Page_123">123</a>.
+Heating, <a href="#Page_124">124</a>. Lighting, <a href="#Page_124">124</a>. Cleaning, <a href="#Page_126">126</a>. The attendant,
+<a href="#Page_127">127</a>.</p></td>       <td class="tocnum"><a href="#Page_117">117</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER VI</td></tr>
+
+<tr><td><span class="smcap">Beds and Bedmaking</span>
+
+<p>Bedsteads, <a href="#Page_133">133</a>. Mattresses, <a href="#Page_135">135</a>. Care of the mattress, <a href="#Page_136">136</a>.
+Pillows, <a href="#Page_136">136</a>. Protection of the mattress and pillows, <a href="#Page_137">137</a>.
+Rubber sheets and pillow-cases, <a href="#Page_138">138</a>. Sheets, <a href="#Page_139">139</a>. Draw
+sheets, <a href="#Page_139">139</a>. Pillow covers, <a href="#Page_140">140</a>. Blankets, <a href="#Page_140">140</a>. Comforters
+and quilts, <a href="#Page_141">141</a>. Counterpanes, <a href="#Page_141">141</a>. Bedmaking, <a href="#Page_141">141</a>. To
+make an unoccupied bed, <a href="#Page_143">143</a>. To change a patient's pillows,
+<a href="#Page_146">146</a>. Lifting a patient in bed, <a href="#Page_146">146</a>. To turn a patient in bed,
+<a href="#Page_147">147</a>. To change sheets while patient is in bed, <a href="#Page_147">147</a>. To move
+patient from one bed to another, <a href="#Page_150">150</a>.</p></td>
+<td class="tocnum"><a href="#Page_132">132</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER VII</td></tr>
+
+<tr><td><span class="smcap">Baths and Bathing</span>
+
+<p>Cleansing baths, <a href="#Page_154">154</a>. Bed bath, <a href="#Page_156">156</a>. Care of the mouth and
+teeth, <a href="#Page_160">160</a>. Care of the hair, <a href="#Page_163">163</a>. To wash the hair of a bed
+patient, <a href="#Page_164">164</a>. Hot foot-baths, <a href="#Page_165">165</a>. Cool sponge bath, <a href="#Page_166">166</a>.</p></td>
+<td class="tocnum"><a href="#Page_154">154</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER VIII</td></tr>
+
+<tr><td><span class="smcap">Appliances and Methods for the Sick-Room</span>
+
+<p>Devices to give support, <a href="#Page_172">172</a>. Bedpans, <a href="#Page_176">176</a>. Daily routine
+in the sick-room, <a href="#Page_179">179</a>. Time for visitors, <a href="#Page_182">182</a>.</p></td>
+<td class="tocnum"><a href="#Page_169">169</a></td></tr>
+
+<tr><td class="chap" colspan="2"><!-- Page ix --><span class='pagenum'><a name="Page_ix" id="Page_ix">[ix]</a></span>
+CHAPTER IX</td></tr>
+
+<tr><td><span class="smcap">Feeding the Sick</span>
+
+<p>The digestive process, <a href="#Page_188">188</a>. Feeding the sick, <a href="#Page_191">191</a>. Liquid
+diet, <a href="#Page_192">192</a>. Semi-solid diet, <a href="#Page_192">192</a>. Light or convalescent diet,
+<a href="#Page_193">193</a>. Full diet, <a href="#Page_193">193</a>. Serving food for the sick, <a href="#Page_195">195</a>. To
+feed a helpless patient, <a href="#Page_197">197</a>.</p></td>
+<td class="tocnum"><a href="#Page_187">187</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER X</td></tr>
+
+<tr><td><span class="smcap">Medicines and Other Remedies</span>
+
+<p>Action of drugs, <a href="#Page_200">200</a>. Amateur dosing, <a href="#Page_202">202</a>. Patent remedies,
+<a href="#Page_205">205</a>. Administration of medicine, <a href="#Page_206">206</a>. Suppositories, <a href="#Page_209">209</a>.
+Enemata, <a href="#Page_210">210</a>. Sprays and gargles, <a href="#Page_213">213</a>. Inhalation, <a href="#Page_213">213</a>.
+Inunction, <a href="#Page_214">214</a>. Household medicine cupboard, <a href="#Page_215">215</a>.</p></td>
+<td class="tocnum"><a href="#Page_200">200</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER XI</td></tr>
+
+<tr><td><span class="smcap">Application of Heat, Cold and Counter-Irritants</span>
+
+<p>Inflammation, <a href="#Page_220">220</a>. Hot applications, <a href="#Page_225">225</a>. Dry heat, <a href="#Page_225">225</a>.
+Moist heat, <a href="#Page_227">227</a>. Stupes or hot fomentations, <a href="#Page_229">229</a>. Cold
+applications, <a href="#Page_231">231</a>. Dry cold, <a href="#Page_231">231</a>. Moist cold, <a href="#Page_232">232</a>. Cold
+compresses for the eyes, <a href="#Page_232">232</a>. Counter-irritants, <a href="#Page_233">233</a>. Mustard
+paste, <a href="#Page_233">233</a>. Mustard leaves, <a href="#Page_234">234</a>.</p></td>
+<td class="tocnum"><a href="#Page_220">220</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER XII</td></tr>
+
+<tr><td><span class="smcap">Care of Patients with Communicable Diseases</span>
+
+<p>Incubation period, <a href="#Page_238">238</a>. Care of patients with colds or other
+slight infections, <a href="#Page_238">238</a>. Care during more serious infections,
+<a href="#Page_242">242</a>. Children's diseases, <a href="#Page_246">246</a>. Rules for isolation and exclusion
+from school, <a href="#Page_247">247</a>. Disinfection, <a href="#Page_248">248</a>. Care of nose and
+throat discharges, <a href="#Page_249">249</a>. Care of discharges from the bowels and
+bladder, <a href="#Page_249">249</a>. Bath water, <a href="#Page_250">250</a>. Care of the hands, <a href="#Page_250">250</a>.
+Care of utensils, <a href="#Page_251">251</a>. Care of linen, <a href="#Page_251">251</a>. Disinfection of
+the person, <a href="#Page_252">252</a>. Termination of quarantine, <a href="#Page_252">252</a>. Terminal
+disinfection, <a href="#Page_253">253</a>. Fumigation, <a href="#Page_254">254</a>.</p></td>
+<td class="tocnum"><a href="#Page_236">236</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER XIII</td></tr>
+
+<tr><td><span class="smcap">Common Ailments and Emergencies</span>
+
+<p>Conditions in which the nervous system is involved, <a href="#Page_257">257</a>.
+Headache, <a href="#Page_257">257</a>. Sleeplessness, <a href="#Page_258">258</a>. Fainting, <a href="#Page_259">259</a>. Convulsions,
+<a href="#Page_260">260</a>. Shock, <a href="#Page_261">261</a>. Stimulants, <a href="#Page_263">263</a>. Sunstroke and
+heat exhaustion, <a href="#Page_264">264</a>. Conditions in which the digestive tract
+is affected, <a href="#Page_265">265</a>. Nausea and vomiting, <a href="#Page_265">265</a>. Hiccough, <a href="#Page_265">265</a>.<!-- Page x --><span class='pagenum'><a name="Page_x" id="Page_x">[x]</a></span>
+Diarrhœa, <a href="#Page_266">266</a>. Constipation, <a href="#Page_266">266</a>. Colic, <a href="#Page_266">266</a>. Conditions
+in which the eyes or ears are affected, <a href="#Page_267">267</a>. Styes, <a href="#Page_267">267</a>. Foreign
+bodies in the eye, <a href="#Page_267">267</a>. Disorders affecting the ears, <a href="#Page_268">268</a>.
+Conditions in which the skin is affected, <a href="#Page_269">269</a>. Prickly heat,
+<a href="#Page_269">269</a>. Insect bites and stings, <a href="#Page_270">270</a>. Ivy poisoning, <a href="#Page_270">270</a>. Other
+emergencies, <a href="#Page_270">270</a>. Chills, <a href="#Page_270">270</a>. Croup, <a href="#Page_271">271</a>. Bleeding, <a href="#Page_272">272</a>.
+Treatment of slight wounds, <a href="#Page_272">272</a>. Nose bleed, <a href="#Page_274">274</a>. Profuse
+menstruation, <a href="#Page_275">275</a>. Other injuries, <a href="#Page_275">275</a>. Sprains, <a href="#Page_275">275</a>.
+Bruises, <a href="#Page_276">276</a>. Burns and scalds, <a href="#Page_277">277</a>. Brush burn, <a href="#Page_278">278</a>.</p></td>
+<td class="tocnum"><a href="#Page_257">257</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER XIV</td></tr>
+
+<tr><td><span class="smcap">Special Points in the Care of Children, Convalescents,
+Chronics, and the Aged</span>
+
+<p>Children, <a href="#Page_281">281</a>. Physical defects, <a href="#Page_283">283</a>. Eye-strain, <a href="#Page_284">284</a>. Enlarged
+tonsils and adenoids, <a href="#Page_284">284</a>. Defective hearing, <a href="#Page_285">285</a>.
+Defective teeth, <a href="#Page_286">286</a>. Posture, <a href="#Page_286">286</a>. Predisposition to nervousness,
+<a href="#Page_292">292</a>. Convalescent patients, <a href="#Page_294">294</a>. Chronic patients,
+<a href="#Page_299">299</a>. Care of the aged, <a href="#Page_303">303</a>.</p></td>
+<td class="tocnum"><a href="#Page_280">280</a></td></tr>
+
+<tr><td class="chap" colspan="2">CHAPTER XV</td></tr>
+
+<tr><td class="smcap">Questions for Review</td>
+<td align="right"><a href="#Page_312">312</a></td></tr>
+
+<tr><td><span class="smcap">Appendix</span>
+
+<p>Circulars of information issued by Division of Child Hygiene,
+New York Department of Health.</p></td>
+<td class="tocnum"><a href="#Page_319">319</a></td></tr>
+
+<tr><td class="smcap">Glossary</td>      <td align="right"><a href="#Page_326">326</a></td></tr>
+
+<tr><td class="smcap">Index</td>      <td align="right"><a href="#Page_331">331</a></td></tr>
+</table>
+
+<p><!-- Page xi --><span class='pagenum'><a name="Page_xi" id="Page_xi">[xi]</a></span></p>
+
+<h2>INTRODUCTION</h2>
+
+<p>Health and sickness, at all times momentous
+factors in the welfare of our nation, now as never
+before are matters of vital importance. To win
+its victories both in peace and in war, the nation
+needs all its citizens with all their powers, and
+it is a matter of more than passing interest that,
+as conservative estimates show, at least three
+persons out of every hundred living in the United
+States are constantly incapacitated by serious
+sickness. In 1910 these seriously sick persons
+numbered more than 3,000,000. Even more
+significant, perhaps, is the fact that at least half
+of our national sickness could be prevented if
+knowledge and resources that we now possess
+were fully utilized.</p>
+
+<p>The problem of sickness is by no means peculiar
+to our own day and generation. It has been a
+medical, a religious, and a social problem in every
+age. From the time of Job its meaning has baffled
+philosophers; from his day to ours thoughtful men
+have devoted their lives to searching for causes
+and cures. Yet before the middle of the last century
+little progress was made, either in scientific
+treatment or in prevention of disease.</p>
+
+<p><!-- Page xii --><span class='pagenum'><a name="Page_xii" id="Page_xii">[xii]</a></span>
+The invention of the microscope first made possible
+a real understanding of sickness. Through
+the microscope a new world was revealed,&mdash;a
+world of the infinitely small, swarming with tiny
+forms of animal and vegetable life. No one,
+however, appreciated the significance of these
+hitherto invisible plants and animals until the
+latter part of the 19th century, when the great
+French savant, Pasteur, proved that little vegetable
+forms, now called bacteria, cause putrefaction
+and fermentation, and also certain diseases
+of animals and man. Pasteur's discoveries were
+carried still further by other scientists, with the
+result that bacteriology has revolutionized
+medicine, agriculture, and many industries, and
+has made possible the brilliant achievements
+of modern sanitary science. For the first time
+in history the prevention of epidemics has become
+possible, and sickness is no longer regarded as a
+punishment for sin.</p>
+
+<p>Actual care of the sick, both in homes and in
+hospitals, has always been one of the responsibilities
+of women. The first general public
+hospital was built in Rome in the 4th century
+after Christ by Fabiola, a patrician lady. There
+she nursed the sick with her own hands, and from
+her day to ours extends an unbroken line of
+devoted women, handing down through the<!-- Page xiii --><span class='pagenum'><a name="Page_xiii" id="Page_xiii">[xiii]</a></span>
+centuries their tradition of compassionate nursing
+service. It remained for Florence Nightingale,
+however, to give to the training its technical
+and scientific foundation, and thus to found the
+profession of nursing. As a result of her work,
+effectiveness was added to the spirit of service,
+that spirit which inspires the modern nurse no
+less than in an earlier day it inspired the Sisters
+of Charity who died nursing the wounded on the
+battlefields of Poland.</p>
+
+<p>But different generations have different needs,
+and to meet them the spirit of service must manifest
+itself in widely varying ways. The sick
+need care today no less than they did when St.
+Elizabeth bathed the feet of the lepers; but such
+limited service, however beautiful, is no longer
+enough. Today we serve best by preventing sickness.
+Cure of sickness and alleviation of suffering
+must never be neglected; not in cure, however, but in
+prevention lies the hope of modern sanitary science,
+of modern medicine, and of modern nursing.</p>
+
+<p>Nearly every woman at some time in her life
+is called upon to assist in caring for the sick.
+Indeed, approximately 90% of all sick persons
+in the United States are cared for at home,
+even in cities where hospital facilities are good.
+Moreover, every woman is largely responsible
+for maintaining her own health, and few escape<!-- Page xiv --><span class='pagenum'><a name="Page_xiv" id="Page_xiv">[xiv]</a></span>
+responsibility at some time for maintaining the
+health of others. For such responsibility most
+women are poorly prepared. Every year in our
+own country thousands of persons, many of them
+babies and children, die merely because someone,
+in many cases a woman, is fatally ignorant of
+the laws governing sickness and health.</p>
+
+<p>Only prolonged and careful training, such as
+good hospital training-schools afford, can furnish
+the skill and judgment required in nursing
+persons who are seriously ill. Upon the trained
+nurse the modern practice of medicine makes
+great and ever-increasing demands: a nurse must
+perform complicated duties, meet critical situations,
+and carry out a wide variety of measures
+based on scientific principles which she must
+understand. Good will and sympathy are no
+longer enough; amateur nursing, even when performed
+with the best intentions, may involve
+grave dangers for those who are seriously ill.</p>
+
+<p>On the other hand, although it is true that a
+little knowledge is a dangerous thing, it is no less
+true that total ignorance may be more dangerous
+still. For instance, in cases of incipient, slight,
+or chronic illness, and in certain emergencies
+a little knowledge may be safer far than no
+knowledge at all; and no one, surely, should be
+ignorant of the principles of hygiene.</p>
+
+<p><!-- Page xv --><span class='pagenum'><a name="Page_xv" id="Page_xv">[xv]</a></span>
+The American Red Cross, recognizing the part
+that women can and should play in preventing
+sickness and in building up the health and vigor
+of the nation, has added to its larger patriotic
+services this elementary course of instruction
+in hygiene and home care of the sick. The lessons
+are not intended to take the place of a nurse's
+training, and procedures requiring technical skill
+are necessarily omitted. The object of the book
+is to supply a little knowledge of sickness, which
+though limited may yet be safe. The book
+is also designed to set forth some general laws
+of health; to make possible earlier recognition
+of symptoms; to teach greater care in guarding
+against communicable disease; and to describe
+some elementary methods of caring for the sick,
+which, however simple, are essential to comfort,
+and sometimes indeed to ultimate recovery.</p>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>A History of Nursing&mdash;Dock and Nutting, Volume I.</li>
+
+<li>The Life of Florence Nightingale&mdash;Cook.</li>
+
+<li>The Life of Pasteur&mdash;Vallery-Radot.</li>
+
+<li>The House on Henry Street&mdash;Wald.</li>
+
+<li>Public Health Nursing&mdash;Gardner, Part I, Chapters I-III.</li>
+
+<li>Origin and Growth of the Healing Art&mdash;Berdoe.</li>
+
+<li>Medical History from the Earliest Times&mdash;Withington.</li>
+
+<li>Under the Red Cross Flag&mdash;Boardman.</li>
+
+<li>Report on National Vitality&mdash;Fisher, (Bulletin 30 of the
+Committee of One Hundred on National Health.
+Government Printing Office, Washington).</li>
+</ul>
+
+<p><!-- Page xvi --><span class='pagenum'><a name="Page_xvi" id="Page_xvi">[xvi]</a></span></p>
+
+<p><!-- Page 1 --><span class='pagenum'><a name="Page_1" id="Page_1"><br />[1]</a></span></p>
+
+<h2><span class="sm2">CHAPTER I</span><br />
+<br />
+CAUSES AND PREVENTION OF
+SICKNESS</h2>
+
+<p>Diseases of two kinds have long been recognized:
+first, those transmitted directly or indirectly
+from person to person, like smallpox, measles,
+and typhoid fever; and second, diseases like
+heart disease and apoplexy, which are not so
+transmitted. These two classes are popularly
+called "catching" and "not catching;" the former
+are the infectious or communicable diseases,
+and the latter the non-infectious or non-communicable.
+The term contagious, formerly applied
+to diseases supposed to be spread only by direct
+contact, is no longer an accurate or useful term.</p>
+
+<h3>THE COMMUNICABLE DISEASES</h3>
+
+<p>The invention of the microscope, as we have
+seen, revealed the existence of innumerable
+little plants and animals, so small that even many
+millions crowded together are invisible to the
+naked eye. These tiny living creatures are called
+micro-organisms or germs. The plant forms are
+called bacteria (singular, bacterium), and the animal<!-- Page 2 --><span class='pagenum'><a name="Page_2" id="Page_2">[2]</a></span>
+forms protozoa (singular, protozoön). The
+common belief that all or even most bacteria are
+harmful is quite unfounded. As a matter of
+fact, while not less than 1500 different kinds of
+micro-organisms or germs are known, only about
+75 varieties are known to produce disease.</p>
+
+<p>Most bacteria belong to the class of micro-organisms
+called saprophytes, which find their food
+in dead organic matter, both animal and vegetable,
+and cannot flourish in living tissues. These
+saprophytes act upon the tissues of dead animals
+and vegetables, and resolve them into simpler substances,
+which are then ready to serve as nourishment
+for plants higher in the vegetable kingdom.
+Thus the processes which we know as fermentation
+and putrefaction are due to the action of saprophytes.
+Higher plants in turn furnish food for
+men and animals, and so the food supply is used
+over and over in different forms, making what is
+known as the <i>food cycle</i>. If it were not for bacterial
+activities vegetation would be robbed of its
+supply of nourishment, and plant life would
+speedily end; destruction of plant life would
+deprive the animal kingdom of food and thus all
+life would become extinct. The saprophytes
+are consequently essential to the existence of both
+animals and vegetables.</p>
+
+<p>There are, however, other organisms called<!-- Page 3 --><span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span>
+<i>parasites</i>, which can exist in living tissues of
+animals or vegetables. The organisms at whose
+expense the parasites live are called their <i>hosts</i>.
+Parasites not only contribute nothing to their
+hosts, but generally harm them by producing
+poisonous substances or depriving them of food.
+Some parasites are able to lead a saprophytic
+existence also, but as a rule they live at the expense
+of animal or plant life. Pathogenic, or
+disease-producing, germs belong to the group of
+parasites. The pathogenic germs which find
+favorable soil in the body produce poisons called
+toxins. These poisons or toxins interfere with
+the bodily functions, and thus cause what we know
+as communicable disease. Communicable diseases
+are caused by specific germs only: that is,
+a certain disease cannot develop unless its particular
+germs are present; the germs of typhoid
+for instance, can cause typhoid fever only, and
+not tuberculosis or other disease.</p>
+
+<p>A number of diseases are caused by micro-organisms
+that are now well known. Chief among
+these diseases are colds, septicæmia (blood poisoning),
+influenza, pneumonia, diphtheria, typhoid
+fever, tuberculosis, whooping cough, Asiatic cholera,
+bubonic plague, meningitis, tetanus ("lock
+jaw"), leprosy, gonorrhœa, syphilis, relapsing
+fever, typhus fever, glanders, and anthrax. Micro-<!-- Page 4 --><span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span>organisms
+not yet identified probably cause the
+communicable diseases whose origin is not known
+with certainty. These include infantile paralysis,
+smallpox, scarlet fever, measles, mumps, chicken-pox,
+Rocky Mountain spotted fever, yellow fever,
+hydrophobia (rabies), foot-and-mouth disease.
+We can hardly doubt that the intensive laboratory
+research now in progress will reveal in the
+near future the specific germs of these diseases
+also.</p>
+
+<h3>STRUCTURE AND DEVELOPMENT OF
+PARASITES</h3>
+
+<p>The group of parasites consists of two general
+classes, the vegetable, and the animal. In the
+former class belong the bacteria, and in the latter
+the protozoa. The two classes are not sharply
+differentiated, but in general the vegetable parasites
+are less highly organized than the animal.</p>
+
+<h3>BACTERIA</h3>
+
+<div class="run-in">
+<h4>Shape.</h4><p>&mdash;Bacteria are composed of single cells
+and are consequently called unicellular organisms.
+Under the microscope individual cells are seen to
+differ in size, shape, and structure. In shape
+bacteria show three different types; the rod-shaped
+(bacillus), the spherical (coccus), and
+the spiral (spirillum). The organisms causing<!-- Page 5 --><span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span>
+typhoid fever for example are a variety of bacilli,
+those causing pneumonia are cocci, while those
+causing Asiatic cholera are spirilla.</p>
+</div>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig1.png" width="400" height="77" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 1.</span>&mdash;<span class="smcap">Bacilli of Various Forms.</span> (<cite>Williams.</cite>)</span>
+</div>
+
+<div class="run-in">
+<h4>Size.</h4><p>&mdash;Bacteria vary greatly in size. Average
+rod-shaped bacteria are about <sup>1</sup>/<sub>25000</sub> of an inch
+long, but there are undoubtedly organisms so
+small that they cannot be seen, even by means
+of the strongest microscopes we now possess.</p></div>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig2.png" width="400" height="71" alt="" title="" />
+<span class="caption"><span class="smcap">Staphylococci. Streptococci. Diplococci. Tetrads. Sarcinæ.</span><br />
+<span class="smcap">Fig. 2.</span>&mdash;(<cite>Williams.</cite>)
+</span>
+</div>
+
+<div class="run-in">
+<h4>Motion.</h4><p>&mdash;The power of motion in certain
+species of bacteria is due to hair-like appendages
+called flagella. These flagella by a lashing movement
+somewhat resembling the action of oars
+enable the organisms to move through fluids.</p>
+</div>
+
+<div class="run-in">
+<h4>Multiplication.</h4><p>&mdash;After bacteria have fully developed,
+each cell divides into two equal parts;
+the process of division is called fission. Each<!-- Page 6 --><span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span>
+of these two parts rapidly grows into a full-sized
+organism. Then fission again takes place, so
+that four bacteria replace the original one. In
+each of the four, fission occurs again, and so
+the process of multiplication continues. As
+bacteria develop they group themselves in characteristic
+ways. Some, like the streptococci,
+arrange themselves in chains; the diplococci, in
+pairs; the tetrads, in groups of four; others in
+packets called sarcinæ, and still others, the
+staphylococci, form masses supposed to resemble
+bunches of grapes.</p>
+</div>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig3.png" width="400" height="115" alt="Fig. 1.&mdash;Bacilli of Various Forms. (Williams.)" title="" />
+<span class="caption">
+<span class="smcap">Fig. 3.&mdash;Spirilla of Various Forms.</span> (<cite>Williams.</cite>)
+</span>
+</div>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig4.png" width="400" height="90" alt="" title="" />
+<span class="caption">
+<span class="smcap">Fig. 4.&mdash;Bacteria showing Flagella.</span> (<cite>Williams.</cite>)
+</span>
+</div>
+
+<p>Under favorable conditions fission occurs
+rapidly; in some types a new generation may
+appear as often as every 15 minutes. Enormous<!-- Page 7 --><span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span>
+multiplication would result if nothing occurred
+to check the process. But in nature such increase
+never continues unhindered, and bacteria, acting
+upon their food substances, produce acids and
+other materials injurious to themselves. Furthermore,
+lack of proper food, moisture, or favorable
+temperature, and competition with other organisms
+tend to prevent their unrestricted growth
+and multiplication.</p>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig5.png" width="400" height="99" alt="" title="" />
+<span class="caption">
+<span class="smcap">Fig. 5.&mdash;Bacteria with Spores.</span> (<cite>Williams.</cite>)
+</span>
+</div>
+
+<div class="run-in">
+<h4>Spores.</h4><p>&mdash;Most bacteria die if conditions become
+unfavorable to their growth, but some enter into
+a resting stage. This stage is characterized by
+the development of round or oval glistening bodies
+called spores, which are of dense structure and
+possess an extraordinary power to withstand
+heat, chemicals, and unfavorable surroundings.
+Except in rare instances a single cell produces
+but one spore. As soon as favorable conditions
+of temperature, moisture, and food supply are
+restored, the spore develops into the active form
+of the germ; it may, however, remain dormant<!-- Page 8 --><span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span>
+for months or years. Spore formation, however,
+occurs in only a very few varieties of pathogenic
+bacteria.</p>
+</div>
+
+<div class="run-in">
+<h4>Distribution.</h4><p>&mdash;Bacteria are very widely distributed
+in nature; they are in fact found practically
+everywhere on the surface of the earth.
+They are present in plants and water and food;
+on fabrics and furniture, walls and floors; and
+they are found in great numbers on the skin,
+hair, many mucous surfaces, and other tissues
+of the body.</p>
+</div>
+
+<h3>PROTOZOA</h3>
+
+<p>The protozoa are the lowest group of the animal
+kingdom. Like bacteria they are composed of
+single cells so small as to be visible only under
+the microscope. They play an important part
+in causing certain diseases of man, especially
+in the tropics. Among the well-known human
+diseases of protozoan origin are malaria, amoebic
+dysentery, and sleeping-sickness. Protozoa also
+cause several wide-spread and serious plagues of
+domestic animals.</p>
+
+<h3>VISIBLE PARASITES</h3>
+
+<p>A few diseases are caused by parasites large
+enough to be seen with the naked eye. One of
+the most important is hookworm disease. This<!-- Page 9 --><span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span>
+disease is caused by a tiny worm which penetrates
+the victim's skin and ultimately finds its way
+into the intestine. Other diseases also are caused
+by parasitic worms, such as tapeworms, pinworms,
+and trichinæ. The latter are acquired
+as a result of eating infected meat, particularly
+infected pork that has not been thoroughly
+cooked.</p>
+
+<h3>TRANSMISSION OF PATHOGENIC
+ORGANISMS</h3>
+
+<p>Pathogenic or disease producing organisms
+need for their development food, moisture,
+darkness, and warmth, conditions that exist
+within the human body. When one or more
+of these factors is unfavorable, development of
+germs is checked; if unfavorable conditions
+are extreme or long continued, the organisms
+begin to die. It is difficult to say at exactly
+what moment they will die if deprived of moisture
+or exposed to extremes of temperature or other
+unfavorable conditions, just as it would be impossible
+to state at exactly what moment a
+collection of house plants would all be dead if
+water were withheld, or if the room temperature
+were greatly reduced.</p>
+
+<p>Most pathogenic organisms, however, do not
+flourish long outside the body, and owe their<!-- Page 10 --><span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span>
+continued existence to a fairly direct transfer
+from person to person. They gain access to the
+body through mucous surfaces such as the respiratory
+and digestive tracts, and through breaks
+in the skin, such as cuts, abrasions, and the bites
+of certain insects. They leave the body chiefly
+in the nasal and mouth discharges, as in coughing,
+sneezing, and spitting, in the urine and bowel
+discharges, and in pus or "matter."</p>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/fig6.png" width="500" height="340" alt="Flow chart depicting spread of typhoid fever." title="" />
+<span class="caption">
+<span class="smcap">Fig. 6.</span> (<cite>L. H. Wilder.</cite>)
+</span>
+</div>
+
+<p>The problem of controlling communicable
+diseases, consequently, lies in preventing the
+bodily discharges of one person from travelling<!-- Page 11 --><span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span>
+directly into the body of another. If a person
+is not expelling pathogenic germs, it is clear that
+he cannot pass diseases on to others. But both
+pathogenic and harmless germs follow the same
+routes from person to person, so that safety as well
+as decency lies in preventing so far as possible
+all exchanges of bodily discharges.</p>
+
+<p>There are five routes by which the bodily discharges
+most frequently travel from one person
+to another. Four of these routes of infection
+are called public, because in most cases efforts
+of individuals alone are not sufficient to control
+them. The public routes are water, milk, food,
+and insects. The fifth, or private route, includes
+all means by which fresh discharges of one person
+are passed to another, as when nose and mouth
+discharges are carried in coughing, sneezing, and
+kissing, or when bowel and bladder discharges
+are carried by the hands. These five routes in a
+given case differ greatly in relative importance,
+but the fifth, or direct route plays an immense
+part, although its importance in causing sickness
+has only lately been recognized. It cannot be
+too strongly emphasized that the chief agent in the
+spread of human diseases is man himself, and the
+human hand is the great carrier of disease germs
+both to and from the body. If unclean hands
+could be kept away from the orifices of the body,<!-- Page 12 --><span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span>
+particularly the mouth, many diseases would soon
+cease to exist.</p>
+
+<h4 class="norm">Defenses of the Body</h4>
+
+<p>In view of all the dangers from disease-producing
+germs it may seem surprising that the human
+race has not long ago succumbed to its invisible
+enemies. But the body has various defenses by
+means of which it may prevent invasion, or successfully
+combat its enemies in case they do gain
+access.</p>
+
+<p>The unbroken skin is usually impassable to
+bacteria. Virulent organisms are often found
+upon the skin of perfectly healthy persons,
+where they appear to be harmless unless an abrasion
+occurs which affords entrance into the deeper
+tissues. Most bacteria breathed in with the air
+cling to the moist surfaces of the air-passages and
+never reach the lungs.</p>
+
+<p>Mucous membranes lining the mouth and other
+cavities of the body would prove favorable sites
+for the growth of bacteria if the mucus secreted
+by them were not frequently removed. The
+mouth of a healthy person may contain bacteria of
+many kinds, but the saliva has a slight disinfectant
+power and serves as a constant wash to the
+membranes. The normal gastric (stomach) juice
+is decidedly unfavorable to the growth of bacteria,<!-- Page 13 --><span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span>
+although it does not always kill them; they often
+pass through the stomach and are found in large
+numbers in the intestines. Other bodily secretions,
+such as the tears and perspiration, tend to
+discourage bacterial growth.</p>
+
+<p>Tissues of the body vary greatly in their power
+to resist invading germs, so that the route by
+which germs enter influences the severity of their
+effects. Typhoid bacilli and the spirilla of Asiatic
+cholera when taken with food or water produce
+far more serious disturbances than when injected
+under the skin; infections from pus germs through
+an abrasion of the skin may result in a slight local
+disturbance, while the same amount introduced
+into a deeper wound might cause a fatal infection.
+Certain germs nourish in certain tissues only;
+even tuberculosis, which attacks practically all
+tissues, has its favorite locations.</p>
+
+<div class="run-in">
+<h4>Immunity.</h4><p>&mdash;In addition to its mechanical defenses
+against disease, the body shows a varying
+degree of <i>immunity</i>, or the power possessed by
+living organisms to resist infections. Immunity
+or resistance is the opposite of susceptibility. It is
+exceedingly variable, being greater or less in
+different people and under different conditions,
+but the exact ways in which it is brought about
+are still in many cases far from clear.</p></div>
+
+<p>Immunity may be <i>natural</i> or <i>acquired</i>. By<!-- Page 14 --><span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span>
+natural immunity is meant an inherited characteristic
+by which all individuals of a species are
+immune to a certain disease. The natural immunity
+of certain species of animals to the diseases of
+other animals is well known. Man is immune to
+many diseases of lower animals, and they in turn
+are immune to many diseases of man. Cattle,
+for instance, are immune to typhoid and yellow
+fever, while man shows high resistance to rinderpest
+and Texas fever; both, however, are susceptible
+to tuberculosis, to which goats are immune.
+There are all gradations of immunity within the
+same species. Moreover, certain individuals
+have a personal immunity against diseases to
+which others of the same race or species are
+susceptible.</p>
+
+<p>Immunity may be <i>acquired</i> in several ways. It
+is commonly known that one attack of certain
+communicable diseases renders the individual
+immune for a varying length of time, and sometimes
+for life. Among these diseases are smallpox,
+measles, whooping-cough, scarlet fever, infantile
+paralysis, typhoid fever, chicken-pox, and mumps;
+erysipelas and pneumonia on the other hand
+appear to diminish resistance and to leave a
+person more susceptible to later attacks.</p>
+
+<p>Again, in some cases immunity may be artificially
+acquired by introducing certain substances<!-- Page 15 --><span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span>
+into the body to increase its resistance. Examples
+of this method include the use of antitoxin as a
+protection against diphtheria, of sera in pneumonia
+and other infections, and vaccination against
+smallpox and typhoid fever whereby a slight form
+of the disease is artificially induced. Laboratory
+research goes on constantly, and doubtless many
+more substances will eventually be discovered
+that will reduce human misery as vaccines and
+antitoxin have already reduced it.</p>
+
+<p>Vaccination and inoculation have saved thousands
+of lives. Smallpox, once more prevalent
+than measles, was the scourge of Europe until
+vaccination was introduced. During the 18th
+century it was estimated that 60,000,000 people
+died of it, and at the beginning of the 19th century
+one-fifth of all children born died of smallpox
+before they were 10 years old. In countries
+where vaccination is not practised the disease is as
+serious as ever; in Russia during the five years
+from 1893-97, 275,502 persons died of smallpox,
+while in Germany where vaccination is compulsory,
+only 8 people died of it during the year 1897.
+Death rates from diphtheria and typhoid fever
+have been greatly reduced by the use of antitoxin
+and antityphoid vaccine. Thus in New York
+State in 1894, before antitoxin was generally used,
+99 out of every 100,000 of the population died of<!-- Page 16 --><span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span>
+diphtheria, while only 20 out of 100,000 died of it in
+1914. In 1911 a United States Army Division of
+more than 12,000 men camped at San Antonio,
+Texas, for four months. All of these men were
+vaccinated against typhoid fever and only a
+single case occurred during the summer, although
+conditions of camp life always tend to spread the
+disease.</p>
+
+<p>While many and various factors tend to lower
+resistance rather than to increase it, the idea that
+these factors act equally in all kinds of infection is
+erroneous.</p>
+
+<blockquote>
+<p>"The principal causes which diminish resistance to
+infection are: wet and cold, fatigue, insufficient or unsuitable
+food, vitiated atmosphere, insufficient sleep and rest,
+worry, and excesses of all kinds. The mechanism by which
+these varying conditions lower our immunity must receive
+our attention, for they are of the greatest importance in
+preventive medicine. It is a matter of common observation
+that exposure to wet and cold or sudden changes of
+temperature, overwork, worry, stale air, poor food, etc.,
+make us more liable to contract certain diseases. The
+tuberculosis propaganda that has been spread broadcast
+with such energy and good effect has taught the
+value of fresh air and sunshine, good food, and rest in
+increasing our resistance to this infection.</p>
+
+<p>"There is, however, a wrong impression abroad that
+because a lowering of the general vitality favors certain
+diseases, such as tuberculosis, common colds, pneumonia,
+septic and other infections, it plays a similar rôle in all<!-- Page 17 --><span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span>
+communicable diseases. Many infections, such as smallpox,
+measles, yellow fever, tetanus, whooping-cough,
+typhoid fever, cholera, plague, scarlet fever, and other
+diseases, have no particular relation whatever to bodily
+vigor. These diseases often strike down the young and
+vigorous in the prime of life. The most robust will succumb
+quickly to tuberculosis if he receives a sufficient dose
+of the virulent micro-organisms. A good physical condition
+does not always temper the virulence of the disease;
+on the contrary, many infections run a particularly severe
+course in strong and healthy subjects, and, contrariwise,
+may be mild and benign in the feeble. Physical weakness,
+therefore, is not necessarily synonymous with increased
+susceptibility to all infections, although true for some of
+them. In other words, 'general debility' lowers resistance
+in a specific, rather than in a general, sense."&mdash;(Rosenau:
+Preventive Medicine and Hygiene, pp. 403
+and 404.)</p>
+</blockquote>
+
+<h3>CARRIERS</h3>
+
+<p>Well persons who carry in their bodies pathogenic
+germs but who themselves have no symptoms
+of disease are called carriers. Thus typhoid
+carriers have typhoid bacilli in the intestinal tract,
+while they themselves show no symptoms of
+typhoid fever; diphtheria carriers have bacilli of
+diphtheria in the throat or nose, but have themselves
+no symptoms of diphtheria, and so on. It
+has now been proved that many patients harbor
+bacteria for weeks, months, or even years following
+an infection, and are dangerous distributors of<!-- Page 18 --><span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span>
+disease; also, some healthy individuals without a
+history of illness harbor living bacteria which
+may infect susceptible persons in the usual ways.
+Transmission by healthy carriers goes far to explain
+the occurrence of diseases among persons
+who have apparently not been exposed. This
+explanation has greatly clarified the whole problem
+of the spread of communicable diseases.
+Carriers, unfortunately, exist in large numbers, and
+render the ultimate control of disease exceedingly
+difficult. They can usually be identified by
+bacteriological tests. To some extent they can be
+supervised; food handlers at least should be
+legally obliged to submit to physical examinations,
+and should be licensed only when proved free
+from communicable disease.</p>
+
+<p>Diseases are also spread by persons suffering
+from them in a form so mild or so unusual
+that they pass unrecognized. These persons are
+known as "missed" cases. Carriers of disease and
+"missed" cases go freely about the community,
+handling food, using common drinking cups, travelling
+in crowded street cars, standing in crowded
+shops; in various ways coming into close contact
+with other people, coughing and sneezing and
+kissing their friends no less often than normal
+individuals. It is consequently clear that the
+bodily discharges of supposedly normal persons<!-- Page 19 --><span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span>
+may be hardly less a menace than those of persons
+known to be infected.</p>
+
+<p>Diseases that depend for transmission upon milk,
+water, food, and insects may be controlled by
+public action, that is, by specific measures taken
+by a large group of people in order to protect the
+individual. Such action constitutes <i>public sanitation</i>.
+There is, however, a large group of diseases,
+chiefly sputum-borne, that cannot be controlled
+except by individual action. Such individual
+action constitutes a large part of <i>personal hygiene</i>.</p>
+
+<p>The whole problem of controlling infections
+sounds simple, depending as it does for the most
+part upon unpolluted water, milk, and food,
+extermination of certain insects, and cleanliness
+in personal behaviour. In practice the problem is
+not so easy. Public sanitation has performed miracles
+in the past, and will do much in the future;
+behaviour, however, will continue to be influenced
+by many factors, social and economic as well as
+personal. Ignorance of the laws of health is an
+obstacle to progress, but in modern conditions
+even the instructed may be unable to control
+their ways of living and working. Indeed, such
+control is at present limited to the privileged few.
+On the ignorant and the poor, those least able to
+bear it, society loads the heaviest burden of sickness.
+Only when ignorance and poverty are<!-- Page 20 --><span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span>
+abolished, as one day they will be, can the final
+stage be reached in the fight for public health.</p>
+
+<h3>THE NON-COMMUNICABLE DISEASES</h3>
+
+<p>In this group is included a great variety of
+maladies. Of some the causes are known, while
+in the case of others, origin, prevention, and remedy
+are still obscure. Here belong defects in structure
+of the body, both hereditary and acquired;
+insanity and other nervous diseases; new growths,
+like tumors and cancer; disturbances of bodily
+processes, as malnutrition and gout; and the
+important class of degenerative diseases, like
+arteriosclerosis, in which tissues become hardened
+and fibrous and hence less able to perform their
+normal functions.</p>
+
+<p>The degenerative diseases are playing a menacing
+part in national health. The average length
+of life in the United States has shown a marked
+increase it is true, during the last 40 years. But
+this gain represents chiefly the saving of life
+through prevention of communicable diseases, especially
+among babies and children; among people
+who have passed the 30th year on the other hand,
+death rates are actually increasing. This increase
+is most marked after the age of 45, and is caused
+chiefly by the increase of cancer, and of degenerative
+diseases of the heart, blood vessels, and<!-- Page 21 --><span class='pagenum'><a name="Page_21" id="Page_21">[21]</a></span>
+kidneys. Degeneration of tissues is normally a
+condition typical of old age, and in aged persons
+it may occur in any tissue. There is no elixir of
+youth, and for old age there is no cure. But the
+important facts in this connection are that degenerative
+changes now occur prematurely, and
+that among a vast number of people, in various
+classes of society and various occupations, the
+vital organs show a marked tendency to break
+down after the age of 45.</p>
+
+<p>This condition is not inevitable. Before the
+beginning of the present war, death rates at all
+ages were decreasing in England, Sweden, and
+other European countries. In America also
+degenerative diseases can be checked or prevented
+to a large extent, and it is highly important that
+their causes should be generally understood.</p>
+
+<p>The two groups following include some of
+the probable causes:</p>
+
+<p>1. Conditions of life which result in continued
+overwork, and mental overwork in particular;
+worry, excitement, insufficient recreation and
+exercise, and other kinds of nervous strain typical
+of modern life, especially in cities.</p>
+
+<p>2. Irritating substances in the body, including
+poisonous substances resulting from infectious
+diseases, and from syphilis in particular; poisons
+from chronic infections, alcohol, and industrial<!-- Page 22 --><span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span>
+poisons such as lead and other metals; overeating
+and improper eating, especially of meat and other
+proteins, and rich or highly seasoned food;
+faulty digestion, constipation, and imperfect
+elimination through the kidneys.&mdash;(See Dr. A.
+E. Shipley, in bulletin of the N. Y. City Dept. of
+Health, Feb., 1915.)</p>
+
+<p>The importance of early recognition cannot
+be overemphasized. In many of these troubles
+the symptoms are not pronounced, and the victims
+have no knowledge of their condition until
+they happen to be examined for life insurance,
+or until the disease is far advanced. And even
+when they realize that trouble exists, as for
+example constipation or overwork, most people
+absolutely fail to realize how serious the consequences
+may be. The first step toward remedy is
+periodic complete physical examination by a
+competent physician, in order to learn in time how
+to prevent these degenerative diseases, if present,
+from growing worse. The custom of undergoing
+an annual physical examination is becoming
+more common, and "such a course, conservatively
+estimated, would add 5 years to the average
+life of persons between 45 and 50."&mdash;(Winslow.)</p>
+
+<blockquote>
+<p>"Recently, we have been making examinations of
+the employees of whole institutions, large banks and
+other industrial concerns in New York City, and we<!-- Page 23 --><span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span>
+find almost the same conditions there. Out of 2000
+such examinations among young men and women of
+an average age of 33, just in the early prime of life,
+men and women supposedly picked because of their
+especial fitness for work, only 3.14% were found free of
+impairment or of habits of living which are obviously
+leading to impairment. Of the remaining persons,
+96.69% were unaware of impairment; 5.38% of the total
+number examined were affected with chronic heart trouble;
+13.10% with arteriosclerosis; 25.81% with high or low
+blood pressure; 35.65% with sugar, casts or albumen in
+the urine; 12.77% with combination of both heart and
+kidney disease; 22.22% with decayed teeth or infected
+gums; 16.03% with faulty vision uncorrected....
+The fact of greatest import, however, was that impairment,
+sufficiently serious to justify the examiner in referring
+the examinee to his family physician for medical
+treatment, was found in 59% of the total number of
+cases, while 37.86% were on the road to impairment because
+of the use of "too much alcohol," or "too much
+tobacco," constipation, eye-strain, overweight, diseased
+mouths, errors of diet, and so forth....</p>
+
+<p>"And what is the cause of this appalling increase, in
+the United States, of these and other degenerative diseases?
+I believe it can be shown to the satisfaction of
+any reasonable person that the increase is largely due to
+the neglect of individual hygiene in United States....</p>
+
+<p>"If a man were suddenly afflicted with smallpox or
+typhoid fever or any other acute malady, he would lose
+no time in getting expert advice and applying every
+known means to save his life. But his life may be threatened
+just as seriously, though possibly not so imminently,
+by arteriosclerosis, heart disease, or Bright's disease,<!-- Page 24 --><span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span>
+and he will do nothing to prevent the encroachment of
+these diseases until it is too late, but will continue to eat
+as he pleases, drink as he pleases, smoke as he pleases,
+or overwork, and worry himself into a premature grave."&mdash;("Conservation
+of Life at Middle Age," Prof. Irving
+Fisher, Am. Journal of Public Health, July, 1915.)</p>
+</blockquote>
+
+<p>Periodic physical examinations are as necessary
+for children as for adults, in order to detect
+physical defects. These defects are known to
+have such an immense bearing upon health that
+routine examinations of all children have become
+an integral part of the work of enlightened
+public schools.</p>
+
+<p>Prevention of degenerative disease, then, as well
+as of the enormous numbers of preventable accidents
+and injuries, depends in large measure upon
+proper living conditions and proper personal
+habits. The infectious diseases, according to
+Dr. Hill, cost us annually at least 10 billion dollars
+in addition to the loss of life, and he adds:
+"The infectious diseases in general radiate from
+and are kept going by women."&mdash;(Hill&mdash;New
+Public Health, p. 30.) Women, it is true, can
+prevent many of the infections, but they can do
+still more, for hygienic habits to be effective
+must be acquired early, and mothers and teachers,
+because they have practically the entire control
+of children, have the power to prevent many cases<!-- Page 25 --><span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span>
+of degenerative as well as of communicable
+disease.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Distinguish between communicable and non-communicable
+disease.</li>
+
+<li>Describe the part played by micro-organisms in
+causing disease.</li>
+
+<li>Describe the structure of bacteria and their method
+of multiplication.</li>
+
+<li>In what ways are pathogenic germs transmitted
+from person to person?</li>
+
+<li>Upon what preventive measures does the control
+of communicable diseases depend?</li>
+
+<li>What is meant by immunity?</li>
+
+<li>Against what diseases may immunity be acquired
+artificially? How has the practice of immunizing
+affected death rates from communicable diseases?</li>
+
+<li>What factors tend to lower resistance? Do they
+act equally in the case of all diseases?</li>
+
+<li>Define a carrier, and explain the importance of
+carriers in the spread of disease.</li>
+
+<li>Name some of the characteristics and causes of
+degenerative diseases.</li>
+
+<li>Whom do the degenerative diseases most commonly
+affect?</li>
+
+<li>Describe methods that should be employed to
+prevent degenerative diseases.</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>The New Public Health&mdash;Hill, Chapters I-IX.</li>
+
+<li>Health and Disease&mdash;Roger I. Lee, Chapters XV-XXIV.</li>
+
+<li>Principles of Sanitary Science and the Public Health&mdash;Sedgwick,
+Chapters I, II, III.</li>
+
+<li><!-- Page 26 --><span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span>
+Scientific Features of Modern Medicine&mdash;Frederic S. Lee,
+Chapters II, IV-VI.</li>
+
+<li>Disease and Its Causes&mdash;Councilman, Chapter I.</li>
+
+<li>Preventive Medicine and Hygiene&mdash;Rosenau.</li>
+
+<li>Publications of the Life Extension Institute&mdash;25 West 45th
+Street, New York City.</li>
+</ul>
+
+<p><!-- Page 27 --><span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span></p>
+
+<h2><span class="sm2">CHAPTER II</span><br />
+<br />
+HEALTH AND THE HOME</h2>
+
+<p>Of all the considerations that determine health,
+heredity is the one unalterable factor. Although
+certain characteristics are obviously hereditary,&mdash;complexion,
+height, and mental and physical traits
+in great variety,&mdash;yet in the past heredity has
+been little understood. In consequence it has
+served too often as a scape goat for faults
+and failings not beyond an individual's control.
+Our first clear understanding of the principles
+underlying heredity resulted from experiments
+made by Mendel, an Austrian monk, during the
+last century, and it is now possible to predict
+with a high degree of accuracy the inheritance of
+certain characteristics.</p>
+
+<p>Many diseases, formerly considered hereditary
+because their actual causes were unknown, are
+now known to be communicable. Thus, it is now
+understood that tuberculosis is not hereditary,
+although little children may be infected by
+tuberculous parents. No germ diseases are inherited
+in the strict sense of the word; but a<!-- Page 28 --><span class='pagenum'><a name="Page_28" id="Page_28">[28]</a></span>
+baby may be infected with syphilis before birth
+if his father or his mother has the disease.</p>
+
+<p>It is true, however, that certain tissue
+weaknesses of the body seem to be hereditary,
+and in consequence one family is more susceptible
+to digestive disorders, another to diseases of the
+lungs, a third to deafness, and so on. Moreover,
+general low vitality may be inherited. It should
+be emphasized, however, that hereditary weakness
+does not inevitably lead to disease. Many persons
+have succeeded in preventing the development
+of active disease by guarding against strain in
+directions where they are weak by inheritance.</p>
+
+<p>Of all tissue weaknesses that may be inherited,
+defects of the nervous system are the most
+serious. Nervous disorders of every degree of
+severity, from slight nervous instability even to
+insanity, may result when these tissues are defective;
+but it is now a recognized fact that nervous
+disorders in many cases can be prevented from developing.
+Feeblemindedness, another condition
+due to defective tissue, is known to be inherited in
+the majority of cases, and in all cases it is incurable.</p>
+
+<h3>HYGIENE OF ENVIRONMENT AND
+PERSON</h3>
+
+<p>By environment is meant everything outside
+the body that affects it; taken in its complete<!-- Page 29 --><span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span>
+meaning the word might include everything that
+is or ever was in the whole universe. It is possible
+to consider here a few only of the many
+environmental and personal factors affecting
+the health of individuals.</p>
+
+<p>The home constitutes the important part of
+environment for most persons, and for children
+in particular, since they spend the greater part of
+their time in or about it, and get there the
+foundation on which their health in later years depends.
+For persons employed away from home,
+industrial and occupational hygiene is hardly less
+important; but those subjects are too extensive
+to be considered here.</p>
+
+<p>Most people live where they must, and few
+have any part in planning the construction of
+their own houses. In choosing a house, however,
+one should remember that rooms where sunshine
+never enters are unfit for continued occupation.
+For children in particular fresh air and sunshine
+are essential, and it may be economy in the end to
+pay a comparatively high rent for an apartment
+having sunshine during at least a part of the day.
+Ignorance and carelessness, unfortunately, can
+spoil the best living conditions, and sometimes
+even in the country fresh air and sunshine are excluded
+from sleeping and living rooms.</p>
+
+<div class="run-in">
+<h4>Ventilation.</h4><p>&mdash;Ventilation has a direct bearing<!-- Page 30 --><span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span>
+on health, although, contrary to former belief, the
+actual amount of oxygen in the air is not ordinarily
+the most important factor; even badly ventilated
+rooms contain more than enough oxygen to
+support life. The factors of prime importance
+in ventilation are temperature, humidity, air
+movement, and the number of persons in a given
+space since the greater the distance from one
+another the less is the probability that diseases
+will be spread.</p></div>
+
+<p>Room temperature should not be above 70° F.
+and, except for the aged or sick, it is better to be
+between 60° and 65°. Some moisture in the air
+is desirable; the amount needed is from 50% to
+55% of the total moisture that the air can hold at
+a given temperature. We have no apparatus to
+decrease humidity in the air of houses, and in
+summer we are obliged to endure humidity, if excessive,
+no matter how uncomfortable we may be.
+But in winter the air in most houses is too dry,
+so that the mucous membranes of the nose and
+throat often become irritated and susceptible to
+infection. Most heating systems, particularly in
+small buildings, make no provision for supplying
+moisture. Keeping water in open dishes on or
+near radiators is often recommended, and would
+greatly improve the condition of the air, if people
+remembered to keep the dishes filled.</p>
+
+<p><!-- Page 31 --><span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span>
+The following is a simple but effective device to
+increase humidity: Roll an ordinary desk blotter
+into a cone about 8 inches in diameter at the base,
+and keep it constantly submerged for about one
+inch in a dish of water. The water rises to the
+top of the blotter and a large surface for evaporation
+is thus afforded.</p>
+
+<div class="figcenter" style="width: 200px;">
+<img src="images/fig7.png" width="200" height="161" alt="Cone made of desk blotter sitting in shallow dish of water." title="" />
+<span class="caption"><span class="smcap">Fig. 7.</span>
+</span>
+</div>
+
+<p>Stagnant air is harmful. Air should be in
+constant though not necessarily perceptible motion.
+Air about the body, if motionless, acts like
+a warm moist blanket, preventing the passage of
+heat from the body.</p>
+
+<p>The three factors, heating, humidity, and air
+motion, must be considered together. Every
+person requires each hour about 3000 cubic
+feet of air, and the problem of heating and
+ventilating is that of providing this amount in
+gentle motion, at a temperature of about 65° F.,
+and of humidity from 50-55%. Higher temperatures<!-- Page 32 --><span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span>
+and stagnant air cause disinclination to
+work, headache, nausea, restlessness, or sleepiness,
+and if continued are likely to result in loss of
+appetite, and anemia. The tuberculosis movement
+has clearly shown the benefits both for
+the sick and the well of living in the open air,
+and has caused great and beneficial changes
+within a generation. The more time spent in the
+open air the better; since however most persons
+who work must spend the greater part of the
+day indoors, ventilation is a matter of great
+importance.</p>
+
+<p>Although fresh air enthusiasts are still too few,
+yet some go to the extreme and think that because
+cool air in motion is good, the colder the air
+and more violent the motion the better. On the
+contrary, chilling the whole body or a part of the
+body lowers resistance. Draughts of air have no
+bad effects upon persons in good health, particularly
+those accustomed to changes in temperature.
+But draughts are likely to be injurious to aged or
+sick persons and babies, by diminishing their
+resistance to such infections as common colds
+and pneumonia. It should be remembered that
+draughts or cold alone cannot cause colds; the
+specific germs must be present.</p>
+
+<div class="run-in">
+<h4>Lighting.</h4><p>&mdash;Amount and direction of light are
+physiologically important. Defects of the eyes,<!-- Page 33 --><span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span>
+too prolonged use, and insufficient light are the
+commonest causes of eye strain. Most eye defects
+can be relieved by glasses. Children's eyes
+should be examined upon entering school, and
+as often afterward as the oculist advises. Prolonged
+use causes fatigue of the eyes, especially
+when the illumination is poor; within limits,
+the amount of light needed depends on the nature
+of the work. Light should come from the left
+side of right handed people; never from the front.
+Light reflected from snow, sand, glazed white
+paper of books, or other bright surfaces is fatiguing
+from its intensity, and from the unusual angle
+at which it enters the eyes. Too much light
+is harmful, and probably causes some of the effects,
+such as nausea and headache, commonly attributed
+to poor ventilation.</p></div>
+
+<p>Almost all blindness is preventable, and
+blindness due to industrial accidents and processes
+is no exception to this rule. Surely no individual
+precautions or legal measures are too great in
+order to guard against this saddest of all physical
+defects.</p>
+
+<div class="run-in">
+<h4>Cleanliness of Houses.</h4><p>&mdash;A clean, well-cared
+for house is desirable from every point of view,
+but certain kinds of cleanliness affect health
+more than others.</p></div>
+
+<p>The most scrupulous care should be exercised<!-- Page 34 --><span class='pagenum'><a name="Page_34" id="Page_34">[34]</a></span>
+wherever food is stored or prepared. The kitchen
+is in reality a laboratory; in it either intelligently
+or ignorantly are formed chemical compounds
+which have a far-reaching effect upon family
+health. From the standpoint of health no other
+room in the house is so important. It
+should be bright, airy, and easy to clean. In
+cleaning kitchen tables and woodwork water
+should not be allowed to soak into cracks and dark
+corners, carrying with it particles of food for the
+nourishment of bacteria and insects. Linoleum,
+if used to cover the floor, should be well fitted
+at the edges to prevent water from running
+underneath. There should be neither cracks nor
+crevices in wall or floor, and no dark corners
+or out-of-the-way cupboards in which dust, food
+particles, and moisture can accumulate. Such
+conditions not only attract mice and roaches,
+but furnish favorable soil for the development of
+moulds and fungi which by their growth affect
+food deleteriously. Waging a constant warfare
+against the development of bacteria constitutes
+a large part of good housekeeping.</p>
+
+<p>All cooking utensils should be thoroughly
+washed, scalded, and dried before they are put
+away; the use of carelessly washed dishes is
+bad. Enameled or agate ware which has begun
+to chip should be discarded. Dish-cloths and<!-- Page 35 --><span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span>
+towels should be washed and boiled after using,
+and if possible dried in the sun.</p>
+
+<p>Every place in which food is kept should have
+constant care. The refrigerator is particularly
+important. Its linings should be water-tight, and
+the drain freely open at all times; otherwise the
+surrounding wood will become foul and saturated
+with drainings. At least once a week it should
+be entirely emptied and cleaned in the following
+way: The racks should be thoroughly washed in
+hot soapsuds to which a small amount of washing
+soda has been added, rinsed in boiling water,
+dried and placed in the sun and air. All parts of
+the refrigerator should be washed in the same
+manner, especially grooves and projections where
+food or dirt may lodge. The drainpipe should
+be flushed, the whole interior rinsed again with
+plain hot water, thoroughly dried with a clean
+cloth, and left to air for at least an hour. The
+drainage pan should be washed and scalded
+frequently. Food showing the slightest evidence
+of spoiling should be removed from the refrigerator
+at once.</p>
+
+<p>Even more attention should be paid to the hands
+of the cook. They should be washed always
+before handling food, and always after visiting
+the toilet, using the handkerchief, or otherwise
+coming in contact with nose, mouth, or other<!-- Page 36 --><span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span>
+bodily secretions. Theoretically coughing and
+sneezing ought not to occur in the neighborhood
+of food, especially of food to be eaten raw; and
+persons with coughs, colds, or other communicable
+disease, however slight, ought not to handle
+food. If this rule were observed in practice,
+more persons would go hungry, but fewer would
+be sick.</p>
+
+<p>Thorough cleaning of rooms involves soap,
+water, sunshine, air, and elbow grease, just as it
+did before germs were discovered. Cleaning
+means actually removing dirt and dust, not merely
+stirring it up to settle again; consequently dry
+sweeping and dusting are ineffectual. Vacuum
+cleaning, and sweeping and dusting with damp or
+"dustless" mops and dusters are good. Deodorants
+and disinfectants do not take the place of
+ordinary cleanliness.</p>
+
+<p>Dust does not carry living disease germs to an
+appreciable extent; the fact is now well established
+that diseases formerly thought to be transmitted
+by dust or even supposed to travel directly through
+the air, are carried on tiny particles of moisture
+and mucus expelled in coughing and sneezing.
+This mode of transmission is called droplet or
+spray infection; it is one of the most active agents
+in spreading certain kinds of communicable
+diseases.</p>
+
+<p><!-- Page 37 --><span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span>
+Nevertheless dust in motion is harmful; it
+irritates the lining membranes of the nose, throat,
+bronchial tubes, and lungs, even causing tiny
+wounds through which disease germs enter. Thus
+tuberculosis is especially prevalent among stone
+cutters, felt workers, and others engaged in dusty
+trades. Metallic dust is especially harmful,
+because it is harder and sharper than dust from
+organic substances like wool and cotton. Furthermore,
+presence of dust indicates a low standard
+of cleanliness. People who tolerate it generally
+tolerate uncleanliness in other forms, more serious
+though less apparent.</p>
+
+<p>Cleaning would not be so great a problem if
+most houses were not littered with such dust
+catchers as carpets, so-called ornaments, carved
+and upholstered furniture, banners, draperies,
+and a vast collection of articles that can only
+be classified as Christmas presents. In actual
+practice things that are difficult or expensive to
+clean seldom are cleaned; carpets for example are
+considered unhygienic, not because they cannot
+be cleaned, but because they are not. William
+Morris' advice to exclude from houses all articles
+not known to be useful or believed to be beautiful
+would, if followed, add years to the lives of housekeepers.</p>
+
+<div class="run-in">
+<h4>Garbage</h4><p>, has little bearing on health, except<!-- Page 38 --><span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span>
+in so far as it affords a breeding place for flies. If
+it contains disease germs it may be dangerous,
+but statistics show that garbage handlers, although
+they can hardly be called especially careful, are
+not more subject to sickness than other men of
+their class. Garbage disposal is chiefly a question
+of preventing a public nuisance; it is a matter of
+cleanliness and public decency.</p></div>
+
+<div class="run-in">
+<h4>Insects.</h4><p>&mdash;Flies, cockroaches, and other scavenging
+insects may carry disease germs on their feet
+and thus infect food on which they walk. Typhoid,
+cholera, dysentery, and other diseases have
+been carried by flies. Flies are always a menace,
+and should not be tolerated; moreover, the
+thought of their coming to food directly from
+manure piles and privy vaults is disgusting.
+Houses should be thoroughly screened in the
+fly season, but it is better to destroy the nuisance
+at its source. The chief breeding places of flies<!-- Page 39 --><span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span>
+are garbage cans and manure piles. If the garbage
+can is water tight, closely covered, frequently
+emptied, and thoroughly cleaned, flies will not
+develop in it; about ten days must elapse from
+the time when the egg is laid until the insect is
+ready to fly. Fly traps to fit on the garbage can
+are useful. Manure should be screened and
+removed frequently, or it can be treated chemically.
+Methods for treating it are given in "Preventive
+Medicine and Hygiene."&mdash;Rosenau, p.
+255, and in Bulletin No. 118, of the U. S. Dept.
+of Agriculture, July 14, 1914.</p></div>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig8.png" width="400" height="113" alt="" title="" />
+<span class="caption">
+<span class="smcap">Fig. 8.&mdash;A Fly with Germs (Greatly Magnified) on Its Legs.</span><br />
+(<cite>U. S. Dept. Agri.</cite>)
+</span>
+</div>
+
+<p>Other diseases carried by insects are malaria
+and yellow fever, each by a special species of
+mosquito; typhus fever, by lice; and bubonic
+plague, by rat fleas. Various diseases less common
+in this country are carried by other insects.
+Even when mosquitoes are not carrying disease
+germs their bites may be harmful since they are
+often rubbed, especially by children, until the
+skin is broken, and various infections may enter
+through the wounds. Insects of every kind,
+rats, mice, and vermin should be excluded from
+houses.</p>
+
+<div class="run-in">
+<h4>Sewage.</h4><p>&mdash;Discharges from the bowels and
+bladder contain various germs, and constitute one
+of the most important routes by which germs of
+typhoid fever, cholera and certain other diseases<!-- Page 40 --><span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span>
+travel from person to person. Keeping sewage
+out of the water supply is consequently of great
+importance. Where a system of sewage disposal
+exists, the responsibility of making the system
+adequate and thus safeguarding public health
+rests upon the community as a whole. Communities
+ordinarily get just as much, or just as little
+typhoid fever as they are willing to endure.</p></div>
+
+<div class="figcenter" style="width: 500px;">
+<img class="border" src="images/fig9.png" width="500" height="327" alt="Illustration of ground water contamination via excrement from privy and barnyard." title="" />
+<p class="caption">
+<span class="smcap">Fig. 9.&mdash;How a well may be polluted.</span> (<cite>From "The
+Human Mechanism."</cite> Copyright by Theodore Hough and
+William T. Sedgwick. Ginn and Company, publishers. Used
+by permission.)</p>
+</div>
+
+<p>In places having no system of drainage privies
+must be used. They can be made harmless, as
+army camps prove, but they require scrupulous<!-- Page 41 --><span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span>
+care. Fecal matter must be prevented from draining
+into wells and other water supplies, and must
+be screened from flies. The privy should be
+located at a distance from the well. The minimum
+distance that is safe depends in each case
+upon the nature of the soil and the direction of the
+natural drainage. Even when the privy is situated
+below the well on sloping ground, drainage may still
+occur from the privy to the well; however, a well-made,
+properly located pit privy is safe unless
+it is near a limestone formation. The dry earth
+system is satisfactory in places having an efficient
+public scavenger system; in this system pails or
+cans are used to receive the discharges, which are
+then covered with sand, ashes, earth or, preferably,
+chloride of lime. The buckets are frequently
+emptied and the contents buried at least one foot
+below the surface of the ground. The objection
+to this method for more extended use is that
+proper care of the cans is a disagreeable duty of
+which most households soon tire.</p>
+
+<div class="run-in">
+<h4>Personal Cleanliness.</h4><p>&mdash;The main functions of
+the skin are three: to protect underlying tissues,
+to excrete waste matter, and to regulate bodily
+heat by checking or allowing the evaporation of
+perspiration. After perspiration has evaporated
+solid matter is left upon the skin, and oily matter
+also is deposited on it by the glands that keep the<!-- Page 42 --><span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span>
+skin lubricated. Removing these and other
+materials at least once a day is desirable to improve
+the bodily tone and sense of well-being.
+Real cleanliness is impossible without frequent use
+of warm water and soap.</p></div>
+
+<p>Cold baths are stimulating, though not very
+efficacious for cleansing purposes. They are
+valuable tonics if properly used, but delicate or
+elderly persons should use them only by a physician's
+advice. Chilly feelings or depression
+following should be the signal for any person
+to discontinue cold bathing or swimming in cold
+water.</p>
+
+<p>Warm baths are soothing in their effects, and
+are appropriate at bed time, particularly for
+persons inclined to sleeplessness. Very hot baths,
+especially if prolonged, may be harmful, and
+should not be taken often.</p>
+
+<p>There is no clear connection between general
+cleanliness and disease. Frequent bathing does
+not protect a person from any particular disease,
+except in so far as bathing necessarily includes
+washing the hands. If typhoid germs for example
+have actually been swallowed, a clean bodily
+exterior is of no avail in preventing typhoid fever
+or in diminishing its severity. The same is true
+of other diseases.</p>
+
+<p>But it is impossible to emphasize unduly the<!-- Page 43 --><span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span>
+importance of clean hands. Hands are prime
+offenders in distributing fresh bodily secretions,
+and germs both innocent and harmful. All
+health authorities agree on this point.</p>
+
+<blockquote>
+<p>"Perhaps 90% of all infections are taken into
+the body through the mouth. They reach the mouth
+in water, food, fingers, dust, and upon the innumerable
+objects that are sometimes placed in the mouth.
+The fact that the great majority of infections are
+taken by way of the mouth gives scientific direction
+to personal hygiene. Sanitary habits demand that the
+hands should be washed after defecation and again
+before eating, and fingers should be kept away from
+the mouth and nose, and that no unnecessary objects
+should be mouthed. All food and drink should be clean
+or thoroughly cooked. These simple precautions alone
+would prevent many a case of infection."&mdash;(Rosenau:
+Preventive Medicine and Hygiene, p. 366.)</p>
+</blockquote>
+
+<p>As Dr. Chapin says:</p>
+
+<blockquote>
+<p>"Probably the chief vehicle for the conveyance of nasal
+and oral secretion from one to another is the fingers.
+If one takes the trouble to watch for a short time his
+neighbors, or even himself, unless he has been particularly
+trained in such matters, he will be surprised to note
+the number of times that the fingers go to the mouth and
+the nose. Not only is the saliva made use of for a great
+variety of purposes, and numberless articles are for one
+reason or another placed in the mouth, but for no reason
+whatever, and all unconsciously, the fingers are with
+great frequency raised to the lips or the nose. Who can<!-- Page 44 --><span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span>
+doubt that if the salivary glands secreted indigo the fingers
+would continually be stained a deep blue, and who can
+doubt that if the nasal and oral secretions contain the
+germs of disease these germs will be almost as constantly
+found upon the fingers? All successful commerce is
+reciprocal, and in this universal trade in human saliva the
+fingers not only bring foreign secretions to the mouth of
+their owner, but there exchanging them for his own,
+distribute the latter to everything that the hand touches.
+This happens not once, but scores and hundreds of times
+during the day's round of the individual. The cook
+spreads his saliva on the muffins and rolls, the waitress
+infects the glasses and spoons, the moistened fingers
+of the peddler arrange his fruit, the thumb of the milkman
+is in his measure, the reader moistens the pages
+of his book, the conductor his transfer tickets, the
+"lady" the fingers of her glove. Every one is busily engaged
+in this distribution of saliva, so that the end of
+each day finds this secretion freely distributed on the doors,
+window sills, furniture and playthings in the home, the
+straps of trolley cars, the rails and counter and desks
+of shops and public buildings, and indeed upon everything
+that the hands of man touch. What avails it if the pathogens
+do die quickly? A fresh supply is furnished each
+day."&mdash;(Chapin: The Sources and Modes of Infection,
+p. 188.)</p>
+</blockquote>
+
+<div class="run-in">
+<h4>Oral Hygiene.</h4><p>&mdash;Cleanliness and proper care
+of the mouth and teeth can hardly be over emphasized.
+Their bearing upon health is direct.
+Long ago it was recognized that persons with
+decayed or missing teeth frequently suffered<!-- Page 45 --><span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span>
+from dyspepsia, a natural result of inability to
+masticate properly, but only within recent years
+has it been realized that decayed teeth give rise
+to many other diseased conditions. Bacteria are
+constantly present in the mouth. If the mucus
+of the mouth is not removed, it forms a sticky
+coat upon the surfaces of the teeth and gums.
+In this bacteria collect, and pus or matter may
+also be formed, which, if carried by the blood to
+other parts of the body, may cause digestive
+troubles, rheumatism, and diseases of heart and
+kidneys. (See Dr. T. B. Hartzell, Health News,
+Oct., 1915, "The Importance of Mouth Hygiene
+and How to Practise it.")</p></div>
+
+<p>To keep the mouth and teeth healthy they must
+have:</p>
+
+<p>1. Proper use.</p>
+
+<p>2. Proper care.</p>
+
+<p>3. Proper treatment.</p>
+
+<p>1. Teeth, like other parts of the body, need
+exercise. Foods that require a considerable
+amount of chewing should be included in the
+diet. Such food is needed by children as soon
+as their first teeth have come, but care must
+be exercised to see that the food is actually chewed
+before it is swallowed.</p>
+
+<p>2. A good brush should be provided. The
+stiffness of the bristles should be regulated according<!-- Page 46 --><span class='pagenum'><a name="Page_46" id="Page_46">[46]</a></span>
+to the individual. The brush should
+be thoroughly rinsed after using, and discarded
+as soon as it is worn. Dental floss is generally
+needed to remove particles that have lodged
+between the teeth.</p>
+
+<p>Brushing the teeth by passing the bristles
+across them is not efficacious. They should be
+brushed not across but with the cracks, as a good
+housewife sweeps a floor.</p>
+
+<blockquote>
+<p>"In the light of recent investigation conducted by
+some of the leading students of mouth hygiene, the
+most effective way to use the toothbrush is to place the
+bristles of the brush firmly against the teeth, applying
+firm pressure, as though trying to force the bristles between
+the teeth, using a slight rotary or scrubbing motion....
+After a little practice the user of this method
+will be surprised at the results obtained. Care should
+be used to go over all the surfaces of the teeth in this
+manner."&mdash;(See Dr. W. G. Ebersole. "The Importance
+of Mouth Hygiene and How to Practice it," Health
+News, Oct., 1915.)</p>
+</blockquote>
+
+<p>After brushing the teeth, the mouth should
+be rinsed by forcing lukewarm water about the
+teeth, using all the force that can be brought
+to bear by the cheeks, lips, and tongue.</p>
+
+<div class="run-in">
+<p>3.</p> <h4>Treatment.</h4><p>&mdash;The teeth, including the first
+teeth of children, should be inspected by a competent
+dentist at least twice a year. Periodic
+cleansing by a dentist, and early attention to<!-- Page 47 --><span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span>
+small cavities, may prevent serious ill health
+and impairment of the body, as well as the acute
+suffering generally accompanying treatment of
+advanced dental defects.</p></div>
+
+<div class="run-in">
+<h4>Clothing.</h4><p>&mdash;Clothing was originally used for
+purposes of ornament. Desire for protection
+from cold and dampness came later. The amount
+of clothing required varies greatly according to
+individual needs and habits, but it is increasingly
+recognized that light clothing is best, provided
+that the wearer is really protected from cold.
+Clothing should be porous in order to allow ventilation
+of the body, supported so far as possible
+from the shoulders, and clean and well aired.
+Dampness favors the growth of germs which may
+cause irritation of the skin.</p></div>
+
+<p>Clothing should not constrict the body or
+hamper its movements. Perhaps the worst health
+menace for which clothing is to blame comes from
+the high heeled shoes on which many women prefer
+to limp through life. From the health standpoint
+shoes are of great importance. Bad shoes
+are responsible for many cases of flat feet, whose
+muscles have degenerated through non-use, and
+for much so-called "rheumatism," which is merely
+the protest of abused muscles. Bad shoes also,
+by distorting the feet, prevent comfortable walking,
+which is the only out-of-door exercise readily<!-- Page 48 --><span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span>
+available for the vast majority of people; and
+still worse, the resulting unnatural position of the
+body sometimes has serious consequences by
+bringing injurious strains on other muscles and
+organs.</p>
+
+<div class="run-in">
+<h4>Food.</h4><p>&mdash;Two distinct problems are encountered
+here: the problem of nutrition, and the problem
+of preventing sickness. Nutrition, or proper
+feeding, is a subject beyond the scope of this book;
+it is nevertheless one of the most important, if
+not the most important, factor in maintaining
+health. Food preparation and care of children,
+the two most important functions of the home,
+are unfortunately relegated to the least intelligent
+and least interested members of most households
+in which servants are employed.</p></div>
+
+<p>Most American families eat too much protein
+food, such as meat and eggs. Excess of protein
+probably leads to degeneration of tissues, and
+plays a part in causing the degenerative diseases
+already mentioned. Habit is important here as
+in other ways of living, but cereals and vegetables
+should in large measure make up the diet of
+sedentary persons and indeed of everyone in
+warm weather.</p>
+
+<p>The amount of food required in 24 hours depends
+on many factors: age, height, weight,
+occupation, season, and habit. Underweight and<!-- Page 49 --><span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span>
+overweight are both abnormal conditions; probably
+the latter is the more easily remedied.
+Both require the advice of a physician. Rapid
+reduction of weight involves certain dangers,
+especially for persons with weak hearts.</p>
+
+<p>Food may cause sickness either because it is
+in itself harmful, or because it carries disease
+germs. Meat from diseased animals should be
+destroyed before it reaches the market, but bacterial
+activities in food originally wholesome may
+form in it poisonous substances.</p>
+
+<p>The chief diseases known to be carried by food,
+water, or milk are typhoid fever, paratyphoid,
+dysentery and other diarrhœal diseases, scarlet
+fever, diphtheria, septic sore throat, and tuberculosis.
+The sole problem here is to keep human
+and animal excretions out of food, water, and milk.
+Since thorough cooking kills disease germs, danger
+arises chiefly from raw foods. All fruits and
+vegetables eaten raw should first be thoroughly
+washed.</p>
+
+<p>Water is essential to health. At least three
+pints should be taken daily, the amount varying
+somewhat according to diet, exercise, temperature,
+and so forth. Most persons drink too little
+water.</p>
+
+<p>Cities and towns should of course have public
+supplies of pure water. Contamination of water,<!-- Page 50 --><span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span>
+when it occurs, is caused chiefly by sewage from
+cesspools, privies, and drains. All well or spring
+water must be constantly watched and Boards
+of Health are always ready to examine samples
+of water and to report whether it is safe to drink.
+At the present time a porcelain filter is the only
+satisfactory kind for a household, but many
+domestic filters are so badly cared for that in actual
+practice they are worse than none. Danger from
+a filter containing an accumulation of impurities
+is greater than the danger from most ordinary
+water supplies. Boiling water for ten minutes
+kills all pathogenic germs, but this method is
+inconvenient on a large scale and is not practical
+for continued family use.</p>
+
+<p>Every effort should be made to insure a regular
+supply of pure water in every house. It is not
+satisfactory to have two kinds, one for drinking
+and one for other purposes, since mistakes are
+sure to be made, especially by children. Some
+families who use only bottled or filtered water
+for drinking purposes habitually run the risk involved
+in using impure water from the tap for
+cleaning the teeth.</p>
+
+<p>Freezing destroys most germs, but ice is not
+necessarily free from bacterial life, and should be
+used in drinking water only when known to be
+free from impurities. Neither does freezing milk<!-- Page 51 --><span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span>
+or cream necessarily kill germs that may be contained
+in it.</p>
+
+<p>Raw milk plays so important a part in the spread
+of disease that its fitness for human consumption
+is open to serious question. Certified milk, where
+obtainable, is safe but expensive. Boiled milk is
+safe, but changed in taste and to some extent in
+quality. If milk is heated to 142°-145° F. and
+kept at that temperature for 30 minutes all disease
+germs in it are killed. This process, called pasteurization,
+renders milk safe. The objection is
+sometimes made that continued use of pasteurized
+milk for infants causes scurvy, but in New York
+City where over 90 per cent. of the milk is pasteurized
+no increase in scurvy has been noticed, while
+a large diminution in deaths of infants from diarrhœal
+diseases has resulted, as in all cities where
+pasteurization is required.</p>
+
+<p>The following is a simple method for pasteurizing
+a quart bottle of milk. If the directions
+are exactly followed the milk will be pasteurized
+at the end of the process; no thermometer need
+be used. To prevent the bottle from breaking,
+it is first warmed by placing it for a few minutes
+in a pail of warm water.</p>
+
+<blockquote>
+<p>"From the results of the experiments it was concluded
+that any housewife can pasteurize a one quart bottle of
+milk by:</p>
+
+<p><!-- Page 52 --><span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span>
+1. Boiling 2½ quarts of water in a large agate saucepan;
+or better</p>
+
+<p>2. Boiling 2 quarts of water in a 10 pound tin lard pail,
+placing the slightly warmed bottle from the ice chest in it,
+covering with a cloth and setting in a warm place. At the
+end of one hour the bottle of milk should be removed and
+chilled promptly. The water must be boiled in the container
+in which the pasteurization is to be done."&mdash;(Ruth
+Vories, in "Health News," Sept., 1916.)</p>
+</blockquote>
+
+<div class="run-in">
+<h4>Elimination.</h4><p>&mdash;Careful attention should be paid
+to elimination through the bowels and kidneys.
+Constipation is responsible for many common ailments;
+among them are headache, disinclination to
+work, irritable temper, and lowered resistance. If
+long continued, constipation becomes serious both
+from congestion and displacement of pelvic organs,
+and from absorption over a considerable time of
+even small amounts of the poisonous substances
+resulting from decomposition of food in the large
+intestine. The bowels can best be regulated by
+diet, water, exercise, and habit. The habitual use
+of cathartic and laxative drugs is most unwise,
+because they tend to aggravate the trouble.
+Moreover the habitual and continued use of injections
+and "internal baths" is harmful, and
+would not be considered necessary if bran and
+coarse flour and vegetables were substituted for
+concentrated foods. Greed, laziness, and lack of<!-- Page 53 --><span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span>
+intelligence lead most persons suffering with constipation
+to prefer pills to the restraints demanded
+by hygienic living. The habit of evacuating the
+bowels at a regular time, if established in early
+childhood and rigidly adhered to, will prevent constipation
+among most healthy people. Any person
+who thinks drugs necessary should consult a
+physician, and be prepared to follow the régime he
+advises over a considerable period of time and at
+the cost of some self-denial.</p></div>
+
+<p>For healthy people, voiding urine presents no
+difficulty if a sufficient amount of water is taken;
+but some persons reduce the amount of liquid
+taken in order to escape the inconvenience of urination.
+This practice is harmful, and may involve
+insufficient cleansing of the entire system. If
+frequent urination disturbs sleep, liquids may
+be withheld during the evening; but the total
+amount of water taken in 24 hours should not be
+diminished.</p>
+
+<div class="run-in">
+<h4>Rest and Fatigue.</h4><p>&mdash;A fatigued person is a
+poisoned person. Muscular exertion burns the
+fuel constituents of the body, as we recognize by
+the greater heat generated within us during muscular
+exertion. Waste products, resulting from
+this burning process, accumulate if not removed,
+and clog the body in somewhat the same way that
+ashes and cinders clog a furnace. The fatigued<!-- Page 54 --><span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span>
+person remains fatigued, consequently, until the
+accumulations of waste matter are removed by the
+normal action of the lungs, skin, and kidneys.</p></div>
+
+<p>Fatigue is caused by both mental and physical
+work, and when excessive, affects the nervous
+system most disastrously. The body can and
+should respond to occasional extra drafts on
+strength and endurance; its flexibility and power
+of adjusting to varying conditions may even be
+stimulated thereby. But even slight fatigue, if
+continued and especially if associated with anxiety
+or worry, has caused many nervous and mental
+breakdowns.</p>
+
+<p>Work carried beyond the point of normal fatigue
+requires a proportionately longer time for recovery.
+For example, if the point of fatigue has been
+reached by a certain finger muscle after 15 contractions,
+and if half an hour is required to rest it completely,
+one might suppose that one hour would
+rest it after 30 contractions. This is not so, however;
+after 30 contractions 2 hours are required, or 4
+times as much rest for twice the amount of work, if
+continued beyond the point of fatigue. Laboratory
+experiments and experience alike show that this
+principle holds true in other forms of fatigue.
+Thus the output of factories has been shown in
+many instances to be greater, other things being
+equal, when operatives work 8 hours a day than<!-- Page 55 --><span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span>
+when they work longer. Excessive hours in any
+kind of work are the poorest economy.</p>
+
+<p>Fatigue is increased in direct proportion not
+only to muscular exertion but also to the amount of
+speed, complexity, responsibility, monotony, noise,
+and confusion involved in an occupation. Ability
+to bear fatigue differs greatly with different people,
+as ability varies to bear other kinds of strain.
+Rest at night and on Sunday, and the annual
+vacation should be enough to keep a person in
+good condition. If not, there is probably something
+wrong with the worker's health, the nature
+of his work, or his adaptation to his particular kind
+of work. This statement is not only true of persons
+regularly employed, but of those living at home,
+including children in school, women in "society,"
+and especially mothers of families.</p>
+
+<div class="run-in">
+<h4>Sleep.</h4><p>&mdash;A sufficient amount of sleep is essential
+to health, but individual requirements vary
+widely. Each person should know and regard his
+own need, and children and young people should
+be obliged to go to bed early. Ability to sleep is
+largely habit; good habits should be formed and
+continued. Sleep-producing drugs should never
+be taken, except by a doctor's prescription.</p></div>
+
+<div class="run-in">
+<h4>Recreation.</h4><p>&mdash;Owing to the speed, complexity,
+and worry of modern life among all classes, and to
+the monotony of work in industry, recreation has<!-- Page 56 --><span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span>
+become a matter of vital importance for everyone.
+Some muscular activity, preferably in the open air,
+is needed by every healthy person. Recreation
+should be as unlike the regular occupation as
+possible: going to the theatre, for example, is not
+the best exercise for sedentary workers employed
+all day in artificially lighted offices. The element
+of pleasure is essential. Hoisting dumb-bells
+purely from conscientious motives is seldom
+beneficial, and is generally soon abandoned.</p></div>
+
+<p>The part played by habit in matters of health is
+often overlooked. Although the body adjusts
+itself to widely varying conditions and even to
+unfavorable ones, the importance of forming
+desirable habits cannot be overemphasized.
+Sudden or radical changes in living, however,
+particularly among people no longer young, may
+play havoc. New and violent systems of exercise,
+weight reduction, and food fads forced on families
+by enthusiastic discoverers involve considerable
+risk.</p>
+
+<p>Many elements enter into health; in no single
+one is found hygienic salvation. Temptation
+always exists to emphasize one element at the
+expense of others. For instance, people who insist
+upon overventilating rooms regardless of others'
+comfort may themselves be utterly careless in
+regard to necessary sleep, and more than one fastidiously<!-- Page 57 --><span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span>
+clean person has disregarded the highly
+unclean condition of constipation. To maintain
+sound health only a rational program will
+suffice: properly balanced work and play, sleep
+and food and all other elements must be included
+in due proportion. And over-anxious health
+seekers might well remember that health is not so
+much an end in itself, as a means to a happy and
+productive life; even in concern over health, it
+is possible for him that saveth his life to lose it.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Explain the difference between an hereditary disease
+and hereditary susceptibility to a disease. How may
+hereditary susceptibility to a disease be combatted?</li>
+
+<li>What are the essentials of good ventilation?</li>
+
+<li>What is the proper temperature for a living room?
+What are the effects of higher temperatures? Of lower
+temperatures?</li>
+
+<li>Describe methods for maintaining household cleanliness.</li>
+
+<li>Discuss the importance from the point of view of
+health, of dust; of insects; of garbage; of sewage.</li>
+
+<li>What principles should guide one in deciding
+whether a certain water supply is safe to use for drinking
+purposes? What are the dangers of impure water?
+How can impure water be rendered safe?</li>
+
+<li>What diseases may be carried by milk? How can
+milk be rendered safe?</li>
+
+<li>Explain the health aspects of personal cleanliness.</li>
+
+<li><!-- Page 58 --><span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span>
+What care should be given the teeth and mouth?
+Why?</li>
+
+<li>What bad results frequently follow constipation?
+How should constipation be remedied?</li>
+
+<li>Name seven factors that are important in causing
+fatigue. Why is it uneconomical to continue work, either
+physical or mental, beyond the point of fatigue?</li>
+
+<li>What facilities for recreation, especially in the open
+air, does your community provide for little children?
+For school children? For working boys and girls? For
+grown people?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Health and Disease&mdash;Roger I. Lee, Introduction and Chapters
+I, III-V, VII-IX.</li>
+
+<li>How to Live&mdash;Fisher and Fisk, Chapters I, III-V.</li>
+
+<li>The Human Mechanism&mdash;Hough and Sedgwick, Chapters V,
+XXII-XXIX.</li>
+
+<li>Disease and Its Causes&mdash;Councilman, Chapters X, XII.</li>
+
+<li>Fatigue and Efficiency&mdash;Goldmark, Chapters II, III.</li>
+
+<li>Preventive Medicine and Hygiene&mdash;Rosenau.</li>
+
+<li>A Manual of Personal Hygiene&mdash;6th Edition, Edited by Walter
+L. Pyle.</li>
+
+<li>Four Epochs of a Woman's Life&mdash;Galbraith.</li>
+
+<li>Hygiene and Physical Culture for Women&mdash;Galbraith.</li>
+
+<li>The Home and Its Management&mdash;Kittredge.</li>
+
+<li>Exercise and Health&mdash;F. C. Smith, Supplement 24 to the Public
+Health Reports, Government Printing Office, Washington.</li>
+
+<li>The Sanitary Privy&mdash;Farmers' Bulletin 463, United States
+Department of Agriculture, Government Printing Office,
+Washington.</li>
+
+<li>Safe Disposal of Human Excreta at Unsewered Homes&mdash;Lumsden,
+Stiles and Freeman, Bulletin 68, Public Health Reports,
+Government Printing Office, Washington.</li>
+
+<li><!-- Page 59 --><span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span>
+The Disposal of Human Excreta and Sewage of the Country
+Home&mdash;New York State Department of Health, Albany.</li>
+
+<li>Milk and Its Relation to Public Health&mdash;Bulletin 56, Hygienic
+Laboratory, Government Printing Office, Washington.</li>
+
+<li>Milk and Its Relation to Health&mdash;New York State Department
+of Health, Albany.</li>
+
+<li>Other Publications of the United States Public Health Service
+and of the Departments of Health of the different states
+and cities.</li>
+</ul>
+
+<p><!-- Page 60 --><span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span></p>
+
+<h2><span class="sm2">CHAPTER III</span><br />
+<br />
+BABIES AND THEIR CARE</h2>
+
+<p>The principles of hygiene are fundamentally
+the same for young and old. The applications,
+however, differ at different ages. From the
+time when physical growth and development are
+complete until changes due to old age appear,
+an individual commonly has greater resistance
+than at other ages, and is able in consequence to
+endure unfavorable conditions of life with more
+success.</p>
+
+<p>Babies, on the other hand, are exceedingly
+sensitive to their environment. Surroundings
+that are even slightly unfavorable are likely
+to make babies sick. In order to remain healthy,
+they must have exactly the right kind of food,
+in the right quantities and at the right times;
+their sleep, exercise, and clothing must be carefully
+regulated; they must be protected from
+careless handling, from nervous strain, and above
+all, from the many kinds of infection to which
+they are peculiarly susceptible. The life of a
+baby fortunately can be controlled almost completely;<!-- Page 61 --><span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span>
+when properly regulated it offers, therefore,
+an unequalled opportunity to see how
+hygienic principles work out in actual practice.</p>
+
+<p>The primitive mother's instinct to nourish and
+protect and succor her helpless child was the
+original form of nursing. Instinct alone, unfortunately,
+has never accomplished much in
+preserving health. The human race has now
+had an experience in the care of infants that extends
+over thousands of years. Yet today we
+are still, on the whole, less successful in keeping
+babies alive than we are in raising domestic
+animals; we still allow society to continue, like a
+modern Herod, in its ruthless career of slaughtering
+the innocents.</p>
+
+<p>About 14 babies out of every 100 born in the
+registration area<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a> of the United States die before
+reaching the age of one year, while in some of
+our industrial cities as many as 25 out of every
+100 born die before they are a year old. Most
+of these deaths are preventable. Thus, in a few
+American cities, the death rates have been so
+reduced that fewer than 10 babies out of every 100
+die before completing the first year; while in
+Dunedin, New Zealand, as a result of the work
+of the Society for the Health of Women and
+<!-- Page 62 --><span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span>Children, the infant death rate has been so reduced
+that in 1912 only about 4 out of every 100
+babies died before they were a year old.</p>
+
+<p>While ignorant mothers, who may or may not be
+uneducated women, and contaminated milk, are
+as a matter of fact, chiefly responsible for our
+high infant death rates, yet as we have already
+seen, every factor in the environment has its effect
+upon a baby. This fact has led Sir Arthur Newsholme,
+an eminent English authority, to say:</p>
+
+<blockquote>
+<p>"Infant Mortality is the most sensitive index we possess
+of social welfare. If babies were well born and well
+cared for, their mortality would be negligible. The
+infant death rate measures the intelligence, health, and
+right living of fathers and mothers, the standards of
+morals and sanitation of communities and governments,
+the efficiency of physicians, nurses, health officers, and
+educators."</p></blockquote>
+
+<p>Care of the child should begin at the earliest
+possible moment: that is, nearly nine months before
+he is born. Care before birth, for want of a
+better name, is called prenatal care of the mother.
+Every woman who thinks that she is pregnant
+should put herself at once under the care of a competent
+physician, so that he can make the necessary
+examinations as early as possible. If she
+follows his advice in regard to hygiene and proper
+regulation of her life, she may be free from anxiety,<!-- Page 63 --><span class='pagenum'><a name="Page_63" id="Page_63">[63]</a></span>
+and may justly expect that her delivery will be a
+safe and normal process.</p>
+
+<p>A demonstration of the value of prenatal care
+was recently made by the Boston District Nursing
+Association. During the year 1915 prenatal care
+was given to 751 expectant mothers in 5 wards of
+the city; each woman attended a pregnancy clinic,
+where she was under the care of an experienced
+obstetrician, and was visited at intervals by a
+nurse who kept careful watch of her general condition
+and gave necessary advice and encouragement.
+In consequence the death rate among the
+babies whose mothers had prenatal care was only
+half as great, through the whole first year of life,
+as the death rate of babies in the same wards
+whose mothers had not had prenatal care. Moreover,
+the rate of still-births was only half as great
+as the rate among the general population of Boston.
+If prenatal care can save so many lives, surely it
+ought to be available for every pregnant woman in
+the land, including even that generally neglected
+class of people who are neither very rich nor
+very poor.</p>
+
+<p>Each baby's birth should be recorded by the
+registrar of births, and parents should make sure
+that registration has been attended to in the city
+or town where they live. In some states birth
+registration is already obligatory, but in any case<!-- Page 64 --><span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span>
+it is required by the child's own interest. For
+instance, in later life it may be necessary for him
+to prove the date and place of birth in order to
+establish, among other things, his right to vote and
+to inherit property, and to settle the question of
+his liability to military service. Moreover, complete
+and accurate birth registration is needed by
+every community because it is essential to such
+reforms as reducing infant mortality and abolishing
+child labor.</p>
+
+<h3>GROWTH AND DEVELOPMENT</h3>
+
+<p>Statements in regard to growth and development
+are based on observations of many children. It
+should be remembered that the following figures
+represent averages only, and that healthy children
+may vary from them considerably without giving
+cause for alarm.</p>
+
+<div class="run-in">
+<h4>Average Size.</h4><p>&mdash;The average weight of a baby
+at birth is from 7 to 7½ lbs. and the average length
+is about 20 inches, but it is not unusual for a child to
+weigh anywhere from 5 to 10 pounds at birth and to
+measure from 16 to 22 inches in length. During the
+first week of life a baby loses slightly in weight.
+After the first week a healthy baby should gain from
+4 to 8 ounces a week until he is six months old; after
+that time the weekly gain is less. The weight at
+birth will usually double during the first five<!-- Page 65 --><span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span>
+months, and treble during the first year. Consequently,
+a baby weighing 7 pounds at birth may
+be expected to weigh 14 pounds when five months
+old, and 21 pounds when a year old. Weight is
+one of the most important indications of a baby's
+condition. He should be weighed every week
+during the first 6 months, once in two weeks during
+the second 6 months, and once a month throughout
+the 2nd year.</p></div>
+
+<div class="run-in">
+<h4>Muscular Development.</h4><p>&mdash;A baby at birth is
+helpless, and during the first few months he has
+little muscular control. During the third month
+he ordinarily begins to lift his head, and he can
+usually hold it up without support by the time he
+is 3 months old; when 7 to 8 months old he sits
+erect and begins to play with toys. From this
+time a baby makes rapid progress; he attempts to
+stand on his feet, begins to creep, and by the time
+he is 14 months old he is usually able to stand
+alone, or even to walk a few steps. He is usually
+running about without difficulty when fifteen or
+sixteen months old.</p></div>
+
+<p>Babies should never be urged to walk or to bear
+their weight on their feet. If healthy they are
+generally eager to go about unaided, and like to
+investigate their surroundings without assistance.
+If walking is unusually delayed, a physician should
+be consulted.</p>
+
+<p><!-- Page 66 --><span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span></p>
+
+<div class="run-in">
+<h4>Development of Special Senses.</h4><p>&mdash;A new-born
+baby is unable to distinguish objects, but the
+eyes are sensitive to light and need careful protection.
+Hearing, although undeveloped at birth,
+soon becomes acute; consequently the child should
+stay in a quiet room. When six or eight weeks
+old he notices objects, and at three months old
+he welcomes his mother when he is hungry. A
+month or two later he begins to distinguish between
+familiar and unfamiliar faces, and to show
+approval or disapproval.</p></div>
+
+<div class="run-in">
+<h4>Development of Speech.</h4><p>&mdash;A baby six or seven
+months old begins consciously to utter sounds,
+and usually can say a few unconnected words
+by the time he is a year old. The average child,
+however, does not begin to form sentences of
+more than two or three words until he is about
+two years old.</p></div>
+
+<div class="run-in">
+<h4>Development of Teeth.</h4><p>&mdash;The so-called milk
+teeth are twenty in number; they are followed by
+thirty-two permanent teeth. The two lower
+front teeth (central incisors) generally appear
+when a child is from five to nine months old, and
+in from one to three months later the four upper
+front teeth (upper incisors) appear. All the first
+or milk teeth should have come through by the
+time a child is two and a half years old, but wide
+variations occur both in the time and order of<!-- Page 67 --><span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span>
+appearance and should occasion no uneasiness if
+the child seems well. Unusual conditions of any
+sort should be referred to the physician; it is a
+great mistake to attribute all illness at this time
+to teething.</p></div>
+
+<p>The first of the permanent teeth appear when a
+child is about six years old. Mothers sometimes
+mistake the first permanent molars for temporary
+teeth, a mistake that frequently leads to neglect
+and even extraction of highly important teeth.
+All but the last four molars, sometimes called
+wisdom teeth, should be through by the time a
+child is fifteen. The wisdom teeth may not
+appear before the 20th or even the 25th year.</p>
+
+<div class="run-in">
+<h4>Normal Excretions.</h4><p>&mdash;A new-born baby should
+have one or two bowel movements during the
+first twenty-four hours; the first bowel movements
+are sticky and almost black in color. After the
+baby begins to nurse, three to four movements
+a day are not unusual, and throughout infancy
+and childhood as well as adult life there should
+be one or two evacuations of the bowels daily.
+The character of the stools is more important than
+the number. While the baby is taking milk only,
+the movements should be soft, yellow in color, and
+nearly odorless. Change in frequency of the
+movements, or appearance of undigested food or
+curds of milk in the stool, should be carefully noted<!-- Page 68 --><span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span>
+and if continued, reported to a physician; they
+may be the first signs of serious digestive trouble.</p></div>
+
+<p>The urine of an infant should be odorless and
+colorless. It should be voided at least once
+during the first twenty-four hours, and much
+more frequently after the baby begins to nurse.
+Marked diminution in the amount of urine should
+be reported to a doctor.</p>
+
+<p>Efforts should be made early to develop habits
+of regularity in the evacuation of the bladder and
+bowels. If taken up regularly most children
+learn to use a chamber for bowel movements by
+the time they are three months old. Normal
+children, if properly trained, usually have no
+bladder discharge during the night after they are
+18 months old, and they learn even earlier to
+indicate a desire to urinate during the day time.</p>
+
+<div class="run-in">
+<h4>Clothing.</h4><p>&mdash;The amount and weight of a baby's
+clothing should depend upon the season; but garments
+worn next to the skin, except the diaper,
+should be wholly or partly of wool, the lightest
+weight in summer and heavier weight in winter.
+During the first few weeks a baby's abdomen
+should be supported by a flannel binder about six
+inches wide, applied snugly but not tightly
+enough to restrict either the abdomen or chest
+walls. It may be replaced later by a loosely
+fitting knitted band worn for warmth only. Such<!-- Page 69 --><span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span>
+a band is especially necessary if there is tendency
+to diarrhœa, but in no case should it be discarded
+before the 18th month. All garments except the
+diaper and first flannel binder should hang from
+the shoulders, and should fit loosely but well.</p></div>
+
+<p>Clothing for babies should be of soft materials
+and should be simply made. Even the first
+clothes should not be very long. The weight
+of very long clothing is an unnecessary burden,
+and prevents free movements of the legs. At
+night an entire change of clothing should be made,
+and a nightgown of warmer material substituted
+for the petticoat and slip. Most children are
+dressed too warmly indoors, but in low temperatures
+they need to be well protected.</p>
+
+<p>Diapers should be soft and absorbent. It may
+be necessary to wash new diapers several times
+before using in order to make them soft enough.
+Care should be taken not to apply them too
+tightly, or in such a way as to cause pressure on
+the genitals. They should be changed during
+the day whenever wet or soiled, and at night
+when the baby is taken up to be fed. Proper
+care of diapers is highly important, however
+laborious. They should be well washed, boiled,
+and thoroughly dried before they are used a second
+time. Diapers that have been wet but not soiled
+should not be dried and used again before being<!-- Page 70 --><span class='pagenum'><a name="Page_70" id="Page_70">[70]</a></span>
+washed. Much work can be saved if pads of
+loosely woven absorbent material are used inside
+the diaper to receive discharges. The pads can
+be burned, but even if washed the labor is less
+than washing full sized diapers. Like all other
+infant's garments, diapers should be washed with
+pure white soap and without starch. Waterproof
+material used to cover the diaper is almost sure to
+irritate the baby's skin, and is consequently harmful.</p>
+
+<div class="run-in">
+<h4>Sleep.</h4><p>&mdash;During his first few weeks a normal
+baby sleeps about nine-tenths of the time, and
+should be left undisturbed except for necessary
+care. He should sleep in a crib, bassinet or
+basket protected from light and drafts; in no
+circumstances should a baby sleep in the bed
+with his mother or any other person. Pillows are
+unnecessary for babies, and indeed for older
+children, but if used they should be thin and firm.</p></div>
+
+<p>The amount of sleep necessary gradually
+diminishes, but during all the years of growth
+a child needs more sleep than an adult. The
+amount of sleep required daily is approximately
+as follows:</p>
+
+<table rules="none" frame="void" cellpadding="2" summary="Sleep Requirements for Babies and Children">
+<tr><td>First month</td>                 <td>18 to 20 hours</td></tr>
+<tr><td>Second to sixth month</td>        <td>16 to 18 hours</td></tr>
+<tr><td>Sixth month to one year</td>      <td>14 to 15 hours</td></tr>
+<tr><td>One to two years</td>             <td>13 to 14 hours</td></tr>
+<tr><td>Two to four years</td>            <td>11 to 12 hours</td></tr>
+</table>
+
+<p><!-- Page 71 --><span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span>
+After this time a child should sleep at least
+ten hours out of the twenty-four. During the
+first year a nap in the middle of the forenoon
+and another in the afternoon are desirable. A
+child who is inclined to sleep so long that his
+nap interferes with his night's sleep, should be
+waked from his nap, but at the same hour every
+day. When a child is a year old, one nap during
+the day is often sufficient, if he is doing well,
+but the habit of taking a nap at some time during
+the day should be continued through the fifth
+year if possible, or even later.</p>
+
+<p>Babies should not be rocked or otherwise coaxed
+to go to sleep; they should be made comfortable
+and then left alone. They learn to go to sleep
+by themselves as soon as they are convinced
+that sleep is expected of them, and that no unfounded
+objections on their part will be regarded.
+Continued inability to sleep normally usually indicates
+discomfort or poor general condition, and
+should be taken up with the doctor. Pacifiers and
+thumb-sucking should not be allowed, since they
+lead to changes in the shape of the jaw with resulting
+imperfect adjustment of the teeth. Soothing syrup
+and like medicines should never be given to a baby;
+death or permanent injury has resulted from their
+use. It is impossible to emphasize too strongly
+the danger of giving them even a single time.</p>
+
+<p><!-- Page 72 --><span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span></p>
+
+<div class="run-in">
+<h4>Fresh Air.</h4><p>&mdash;All that has been said about the
+importance of fresh air for adults applies with
+even greater force to infants and children. During
+his first month especially a baby is susceptible
+to draughts; nevertheless, the room should be well
+ventilated and its temperature kept between 68°
+and 70° F. during the day, and at about 65° F.
+at night. Even in cold weather the room should
+be well aired two or three times a day; the baby
+should be removed to another room while the
+windows are open. After the baby is three or
+four months old the windows may be left open
+at night provided the outside temperature does
+not fall below freezing. A healthy baby two or
+three weeks old may be taken out-of-doors for
+a short time in mild weather; when he is three
+months old he may be taken out-of-doors even
+in winter on bright sunny days. The time
+spent out-of-doors should be gradually increased
+until the baby stays out the greater part of the
+day; but he should not be exposed to storms,
+wind, flying dust, dampness, extremes of temperature,
+or insects. The eyes should not be
+covered by veils, but they should be shielded
+from the direct rays of the sun at all times.</p></div>
+
+<div class="run-in">
+<h4>Diet.</h4><p>&mdash;A baby, in order to thrive, must have
+suitable food, given at regular intervals. During
+the first few months of life no other food can<!-- Page 73 --><span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span>
+take the place of mother's milk. Breast-fed
+babies are more robust than bottle-fed babies;
+more than this, they are less likely to contract
+infectious diseases or to suffer from digestive
+disorders. The number of bottle-fed babies who
+die every year is three times as great as the
+number of breast-fed babies who die. Many
+mothers do not understand the risk involved
+in weaning small babies; and so every year many
+little lives are lost, and lost needlessly. When
+poverty forces nursing mothers to wean their
+babies and seek work outside their homes, one
+can only say that a society which tolerates such
+a waste of infant life is indeed regardless of its
+own welfare.</p></div>
+
+<p>Special conditions, of course, may make it undesirable
+for a mother to nurse her baby. No one
+but the physician is competent to decide this; not
+even neighbors, grandmothers, other members of
+the family, or the mother herself. Where artificial
+feeding must be used, it should be carefully
+adapted to the individual child, and in consequence
+it must be prescribed by the doctor. Patent foods,
+notwithstanding the claims on their printed labels,
+should be used only under his advice.</p>
+
+<div class="run-in">
+<h4>Intervals of Feeding.</h4><p>&mdash;Little milk is secreted
+during the first two days after the birth of a child.
+The baby should, nevertheless, be put to the<!-- Page 74 --><span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span>
+breast as soon as he has had his first bath, if the
+mother is sufficiently rested. Always before and
+after nursing the mother's nipples should be
+washed in water that has been boiled. Nursing
+should be repeated at intervals of six hours during
+the first two days.</p></div>
+
+<p>The following schedule for the feeding of
+healthy babies is given by Holt in "Care and
+Feeding of Infants." (1917.)</p>
+
+<table rules="groups" frame="hsides" cellpadding="2" summary="Feeding Schedule for Infants">
+<caption>
+<span class="smcap">Schedule for Healthy Infants for the First Year</span>
+</caption>
+<colgroup />
+<colgroup />
+<colgroup />
+<colgroup />
+<colgroup />
+<colgroup />
+<thead>
+<tr><th>Age</th>
+<th>Interval<br /> between<br /> meals by<br /> day</th>
+<th>Night<br /> feedings,<br /> 6 p.m.<br /> to<br /> 6 a.m.</th>
+<th>No. of<br /> feedings,<br /> in 24<br /> hours</th>
+<th>Quantity<br /> for one<br /> feeding</th>
+<th>Quantity<br /> for 24<br /> hours</th></tr>
+</thead>
+<tbody>
+<tr><td></td>                  <td align="center">Hours</td> <td></td>   <td></td>     <td align="center">Ounces</td> <td align="center">Ounces</td></tr>
+<tr><td>2d to 7th day</td>     <td align="center">3</td>     <td align="center">2</td>  <td align="center">7</td>    <td align="center">1-2</td>    <td class="r-p1">1-14</td></tr>
+<tr><td>2d and 3d weeks</td>   <td align="center">3</td>     <td align="center">2</td>  <td align="center">7</td>    <td class="r-p">2-3½</td>   <td class="r-p1">14-24</td></tr>
+<tr><td>4th to 6th week</td>   <td align="center">3</td>     <td align="center">2</td>  <td align="center">7</td>    <td align="center">3-4</td>    <td class="r-p1">21-28</td></tr>
+<tr><td>7th week to 3 mos.</td><td align="center">3</td>     <td align="center">2</td>  <td align="center">7</td>    <td class="l-p">3½-5</td>   <td class="r-p1">25-35</td></tr>
+<tr><td>3 to 5 months</td>     <td align="center">3</td>     <td align="center">1</td>  <td align="center">6</td>    <td class="l-p">4½-6</td>   <td class="r-p1">27-36</td></tr>
+<tr><td>5 to 7 months</td>     <td align="center">3</td>     <td align="center">1</td>  <td align="center">6</td>    <td class="r-p">5½-6½</td>  <td class="r-p1">33-39</td></tr>
+<tr><td>7 to 12 months</td>    <td align="center">4</td>     <td align="center">1</td>  <td align="center">5</td>    <td class="r-p">7-8½</td>   <td class="r-p1">35-43</td></tr>
+</tbody>
+</table>
+
+<p>During the period when seven feedings are given
+in 24 hours the following hours will be found convenient:
+6 a.m., 9 a.m., 12 m., 3 p.m., 6 p.m., 10
+p.m. and 2 a.m. The 2 a.m. feeding is the one
+omitted when the number of feedings is reduced
+from seven to six. Food should be given on exact<!-- Page 75 --><span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span>
+schedule time; the baby if asleep should be waked
+for any meal except the one due at 2 a.m.</p>
+
+<div class="run-in">
+<h4>Water.</h4><p>&mdash;Pure boiled water should be given
+regularly even to a young baby. He is often satisfied
+with a little warm water if he is fretful between
+the hours of nursing. Water may be given
+from a cup, a spoon, or a bottle; it is desirable,
+however, for the baby to learn to drink from a cup
+before the period of weaning begins.</p></div>
+
+<div class="run-in">
+<h4>Weaning.</h4><p>&mdash;Ordinarily, a baby should be fed
+from the breast until he is seven months old, either
+exclusively or with the exception after the second
+month of one bottle-feeding in twenty-four hours.
+This exception will do the baby no harm and may
+be a great relief to his mother. Partial breast-feeding
+should continue if possible through the
+ninth month, but every baby should be entirely
+weaned by the time he is one year old. It may be
+necessary, if either the baby or the mother is not
+thriving, to change the food before the ninth
+month; but it is desirable not to make the change
+in hot weather. Healthy babies, it should be
+remembered, increase in weight constantly, and
+steady gain in weight is the best indication that a
+baby's food is suitable.</p></div>
+
+<div class="run-in">
+<h4>Nursing Bottles and Nipples.</h4><p>&mdash;Nursing bottles
+should be of heavy glass, cylindrical in shape,
+without angles or corners to make cleaning difficult.<!-- Page 76 --><span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span>
+The number of bottles provided should be
+two or three more than the number of feedings
+given in 24 hours.</p></div>
+
+<p>Short black rubber nipples which slip over the
+neck of the bottles should be selected. They
+should be of such a shape that they can easily be
+turned inside out; a nipple turner costs little, and
+is well worth the price. Nipples should be discarded
+when they become soft or when the opening
+grows so large that the milk runs in a stream
+rather than drop by drop.</p>
+
+<p>As soon as the baby has finished his meal, the
+bottle should be removed from his mouth, rinsed
+in clear hot water, and left standing filled with cold
+water until a convenient time for boiling all the
+bottles to be used during the next 24 hours. Sufficient
+time must be allowed for the bottles to cool
+thoroughly between the time when they are boiled
+and the time when they are refilled. When it is
+time to boil the bottles they should be placed in an
+agate or other suitable kettle, covered with water,
+and boiled vigorously for three minutes. A cloth
+placed in the bottom of the kettle will help to
+prevent the bottles from breaking. After the
+bottles have been removed from the boiling water,
+they should be stoppered at once, either with
+rubber stoppers or plugs of sterile cotton. The
+stoppers, if used, should be boiled with the<!-- Page 77 --><span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span>
+bottles; sterile cotton may be purchased by the
+package.</p>
+
+<p>An easy and satisfactory method to care for
+rubber nipples is the following: Provide as many
+nipples as the number of feedings given in 24
+hours, and another, if desired, to be used in case of
+accident; provide also two cups of ordinary white
+enamel, each one large enough to hold all the
+nipples at once. One cup should have a cover;
+the other should not. To avoid mistakes it is
+well to have the cups different in shape. As soon
+as each feeding is finished the nipple should be
+thoroughly cleansed under running water by
+scrubbing it inside and out with a nipple brush.
+The nipple thus cleansed is placed in the cup
+without a cover. When all the nipples have been
+used, cleansed, and collected in the uncovered cup,
+they are transferred into the other cup; water is
+added, the cup is covered and its contents are
+boiled for three minutes. The nipples remain
+covered in the boiled water until needed; they are
+removed one by one for the successive feedings.
+Care must be used in removing a nipple to take it
+by the rim, not to touch other nipples during the
+process and not to dip the fingers into the water.
+The best way is to remove them by means of a
+glass rod, which is boiled with the nipples and
+kept with them in the cup when not in use. There<!-- Page 78 --><span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span>
+are several advantages of this method of caring
+for nipples: it is easy; it reduces to a minimum the
+necessary handling of the nipples after boiling; and
+it reduces the probability of using the wrong
+nipple, since boiled nipples are always in one
+kind of receptacle and used nipples in another. It
+also prevents the too common practice of continuing
+to keep nipples in a supposedly antiseptic
+solution long after the solution has become badly
+soiled.</p>
+
+<div class="run-in">
+<h4>Tables</h4>&nbsp;<p>of diet for children over one year of age
+may be found in the Appendix, <a href="#Page_322">page 322</a>.</p>
+</div>
+
+<div class="run-in">
+<h4>Bathing.</h4><p>&mdash;Usually the cord has separated and
+the navel has entirely healed by the time a baby
+is 10 days old. After this time a daily tub bath
+should be given; it should be given not less than
+one hour after feeding. The temperature of the
+room should be from 70-72°, measured by a thermometer
+placed in the part of the room where the
+bath is to take place. In order to avoid chilling or
+tiring the baby the bath should be given quickly,
+without confusion or interruption; success can be
+achieved by using even a moderate amount of
+foresight. Before undressing the baby everything
+to be used should be collected and placed
+within easy reach,&mdash;clean clothing, soft towels, 2
+wash cloths, pure white soap, powder, absorbent
+cotton, etc. The bath tub should last of all be<!-- Page 79 --><span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span>
+filled with water, and its temperature tested by
+means of a bath thermometer. The temperature
+of the water should be from 98° to 100°. After the
+baby is three months old slightly cooler water
+should be splashed over his chest, back, neck, and
+arms just after he is removed from the tub, and as
+he grows older the temperature of his cool splash
+can be reduced. Children who become accustomed
+to cool water in this way take kindly to their
+cold showers later.</p></div>
+
+<p>The baby's face should be washed first and
+dried carefully, while his body is still covered.
+Next the head should be washed; a little soap
+should be used, but it must on no account enter
+the eyes. Next the entire body should be soaped
+with the hand; and then the baby should be placed
+gently in the bath, his head and shoulders supported
+by the attendant's left hand and forearm.
+Care should be taken to rinse off all the soap. The
+baby should not stay in the tub more than 2 or
+3 minutes; after he has been removed from the
+tub he should be wrapped at once in a soft bath
+towel. He should be dried gently but thoroughly
+by patting with soft, warm towels rather than by
+rubbing. Folds of the skin should be dried with
+special care. A little powder may be applied, but
+a baby who is kept both clean and dry will not
+need much powder, if any. The baby should<!-- Page 80 --><span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span>
+next be quickly dressed, with as little turning and
+moving as possible. Clothing should be drawn on
+over the feet instead of over the head, and the
+petticoat should be placed inside the slip so that
+the two garments may go on simultaneously.</p>
+
+<div class="run-in">
+<h4>Eyes.</h4><p>&mdash;Secretion accumulating in the corners of
+a baby's eyes should be removed by means of a
+bit of absorbent cotton moistened in boiled water.
+The secretion should be wiped away gently; a
+different piece of cotton should be used for each
+eye, and a piece that has been used should not be
+put back into the water. Further than this,
+eyes in a normal condition do not need cleansing.</p></div>
+
+<p>Every person who handles a baby should be very
+sure that her hands are clean; she should be doubly
+sure before she touches his eyes, since a baby's
+eyes are peculiarly susceptible to infection from
+any source. More than a quarter of all totally
+blind persons in the United States became blind
+by infection of the eyes at birth. Blindness of the
+new born can be prevented in practically all cases
+if the doctor uses a preparation of silver in the
+baby's eyes immediately after birth. This treatment
+is effective and entirely safe.</p>
+
+<p>If at any time the eyelids look red or swollen,
+or if a drop of matter appears between the lids, the
+physician should be summoned at once. Total<!-- Page 81 --><span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span>
+blindness may result if treatment is delayed even
+a few hours.</p>
+
+<div class="run-in">
+<h4>Mouth.</h4><p>&mdash;The mouth should be rinsed after
+feeding by giving the baby a teaspoonful of boiled
+water. Until the teeth come it does not require
+other cleansing, and attempts to clean it may injure
+the delicate membranes that line it. Indeed,
+except in an emergency, fingers should not be
+inserted into a baby's mouth. The teeth when
+they appear should be cleaned by means of a soft
+tooth-brush.</p></div>
+
+<div class="run-in">
+<h4>Nostrils.</h4><p>&mdash;The nostrils need no cleaning other
+than removal of mucus that can easily be reached
+by means of a piece of cotton. If a little vaseline
+is placed in the nostrils on a small piece of
+absorbent cotton in the early morning, collections
+of mucus will usually be softened so that
+they can be removed easily at bath time.</p></div>
+
+<div class="run-in">
+<h4>Genital Organs.</h4><p>&mdash;The genital organs of girl
+babies should be gently washed twice a day, using
+absorbent cotton, and tepid water. Treatment
+other than cleanliness is ordinarily unnecessary.
+Vaseline may be applied if the genitals are slightly
+reddened; any discharge or abnormal appearance
+should be reported to the doctor. In the case of
+boy babies the foreskin should be gently drawn
+back twice a week after immersion in the tub;
+after the parts have been gently washed with<!-- Page 82 --><span class='pagenum'><a name="Page_82" id="Page_82">[82]</a></span>
+absorbent cotton, it should be drawn forward
+again. No force should be employed in retracting
+the foreskin; the physician should be consulted
+if it cannot be retracted easily.</p></div>
+
+<div class="run-in">
+<h4>The Development of Habits.</h4><p>&mdash;During his first
+few months crying is a child's only means of expression,
+and he quickly learns to make effective
+use of his limited opportunities. It is important
+for the mother to distinguish between crying
+caused by pain, illness, or hunger, and crying
+caused by temper. These cries are more or less
+distinctive, but no one can be sure in every
+case just what a crying baby is attempting to
+express.</p></div>
+
+<p>A cry caused by hunger is fretful and often interrupted
+by sucking the thumb; it ceases when
+the child is fed. A cry caused by indigestion is
+similar; the child is relieved for a short time by
+feeding, but soon begins to cry again. If he has
+acute pain, such as earache, the cry is sharp, repeated
+at frequent intervals and accompanied by
+other symptoms of distress, such as restlessness,
+contraction of the features, and drawing up the
+legs. In serious illness the cry is usually feeble,
+fairly constant except when the child is asleep, and
+exaggerated by slight causes.</p>
+
+<p>A limited amount of crying is useful exercise for
+a baby, and should not distress his mother unduly.<!-- Page 83 --><span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span>
+Moreover, crying may be merely the expression
+of a wish to be taken up, to be played with, carried
+about or otherwise amused, to be given a pacifier,
+or to be indulged in other bad habits. If not
+indulged in these ways he may cry from temper.
+The cry of temper is loud and violent, accompanied
+by vigorous kicking or by holding the body rigid.
+Proper treatment of the baby may prevent many
+months of discomfort, and spare him the formation
+of his first bad habit. All other possible causes for
+crying should be eliminated. If the child continues
+to cry when he is warm and dry and comfortable,
+"It should simply be allowed to cry it
+out. This often requires an hour and in extreme
+cases two or three hours. A second struggle will
+seldom last more than ten or fifteen minutes and
+a third will rarely be necessary" (Holt). Gas
+may form in the child's stomach during prolonged
+crying. It is consequently permissible to
+take him up after 15 minutes, and hold him erect;
+he generally expels gas at once, and immediately
+experiences relief. As soon as he is relieved, he
+should go back to his crib.</p>
+
+<div class="run-in">
+<h4>Exercise.</h4><p>&mdash;Exercise is essential to the development
+of the body, but during the first few weeks
+warmth and quiet are so important that a baby
+should not be disturbed except for necessary care.
+His position, however, should be changed occasion<!-- Page 84 --><span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span>ally;
+if he lies on the same side constantly the soft
+bones of the head may become misshapen from
+pressure. As the baby grows older he needs more
+exercise, and he may be given an opportunity for
+it by removing his outer clothing and placing him
+on a bed in a warm room for a short time each day.
+Unnecessary handling is not good for a baby at
+any age.</p></div>
+
+<p>After he becomes more active, he may play on a
+mattress or thick blanket placed on the floor. The
+blanket should be covered with a washable pad or
+rubber cloth and clean sheet, and the whole should
+be surrounded by a fence at least two feet high.
+In such an enclosure a baby may safely be left to
+play if protected from draughts and cold. Elevated
+pens that can be folded when not in use are
+more convenient but more expensive than the
+home-made arrangement. As soon as a child
+begins to run about he takes ample exercise, and
+he may even need to be guarded from too great
+fatigue, especially toward bedtime. Games and
+play should be adapted to the age of the child and
+sufficiently varied to exercise all portions of the
+body; but they should not be too violent nor too
+prolonged. Some supervision of children's play
+is necessary, but they should be given as much
+freedom as possible and allowed to develop their
+own initiative.</p>
+
+<p><!-- Page 85 --><span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span></p>
+
+<div class="run-in">
+<h4>Play and Toys.</h4><p>&mdash;The desire for play does not
+develop until a child is about six months old. At
+this age toys that can be washed, such as those of
+hard or soft rubber, should be selected. A baby
+instinctively carries everything to his mouth,&mdash;first
+his thumb, then playthings, and later whatever
+he may find, no matter how unsuitable. For
+his safety and protection this habit should be
+overcome as soon as possible, and he must learn
+to put nothing in his mouth except food and
+drink. Relatives are nearly always tempted to
+give too many and too fragile toys; they merely
+teach a child to be destructive and constantly to
+expect something new. Toys are the first possessions
+of which a child is conscious, and through
+them many desirable qualities may be developed:
+neatness and order, gentleness and a feeling of
+protection toward the helpless doll or Teddy bear,
+and unselfishness in sharing special treasures with
+playmates. Later the child may be given pets and
+made responsible for their care; but animals should
+not be subjected to unintentional cruelties from
+small children.</p></div>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What two factors are chiefly responsible for the
+deaths of babies under a year old? What other factors
+contribute? In your city or town what is the number of
+deaths per 1000 births of babies under one year old?</li>
+
+<li><!-- Page 86 --><span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span>
+Why is birth registration important to an individual?
+to a community? Is it required by law in your city?</li>
+
+<li>What is the average weight of babies at birth? Describe
+the rate at which they should gain.</li>
+
+<li>At what age may a normal child be expected to sit
+erect? to stand? to walk? to speak? When should
+his first teeth appear? his permanent teeth?</li>
+
+<li>Describe normal bowel movements of a baby.</li>
+
+<li>How should a young baby be dressed?</li>
+
+<li>Describe a baby's bath and toilet.</li>
+
+<li>Describe the surroundings that are suitable for a
+baby.</li>
+
+<li>What is the best food for a healthy baby? Why?</li>
+
+<li>Describe in detail a good daily program for a healthy
+baby four months old.</li>
+
+<li>What habits are desirable for a baby to form, and
+how may he be trained so that he will form them?</li>
+
+<li>Name all the indications that would tell you when a
+baby was not thriving, and in each case tell what you
+would do about it.</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>The Care and Feeding of Children&mdash;Holt.</li>
+
+<li>The Care and Feeding of the Baby&mdash;Truby King.</li>
+
+<li>The Baby's First Two Years&mdash;R. M. Smith.</li>
+
+<li>The Care and Feeding of Children&mdash;J. L. Morse.</li>
+
+<li>Preventive Medicine and Hygiene&mdash;Rosenau, Section III, Chapter
+II.</li>
+
+<li>Pamphlets:
+
+<ul class="sublist">
+<li>Prenatal Care, Mrs. Max West.</li>
+
+<li>Infant Care, Mrs. Max West.</li>
+
+<li>Child Care, Mrs. Max West. Published by the Children's
+Bureau, United States Department of Labor, Washington,
+D. C. (Free on request.)</li>
+</ul></li>
+
+<li><!-- Page 87 --><span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span>
+The Care of the Baby&mdash;Supplement No. 10 to the Public Health
+Reports, 1913, Government Printing Office, Washington,
+D. C.</li>
+
+<li>Your Baby: How to Keep It Well&mdash;New York State Department
+of Health, Albany.</li>
+
+<li>Publications of the American Association for the Study and
+Prevention of Infant Mortality&mdash;1211 Cathedral Street,
+Baltimore, Md. (Free on request.)</li>
+
+<li>Publications of the National Committee for the Prevention of
+Blindness&mdash;130 East 22d Street, New York City. (Free
+on request.)</li>
+</ul>
+
+<div class="footnotes">
+<h3>Footnotes:</h3>
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> An area including about two-thirds of the population of
+the United States.</p></div>
+</div>
+
+<p><!-- Page 88 --><span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span></p>
+
+<h2><span class="sm2">CHAPTER IV</span><br />
+<br />
+INDICATIONS OF SICKNESS</h2>
+
+<p>By indications of sickness we mean all evidences
+of deviation from a normal physical condition.
+They may be apparent only to the person in whom
+they occur, or to a second person only, or to
+both. These deviations, commonly called the
+symptoms of sickness, are always important to
+notice, whether the conditions they indicate are
+serious or not.</p>
+
+<p>Early symptoms of sickness are often slight;
+hence they easily pass unnoticed. Yet a slight
+trouble, easily checked in its early stages, may,
+if neglected, grow into a serious or even fatal
+disorder: just as a burning match, which anyone
+could extinguish instantly, may kindle a fire
+beyond the power of an entire city to control.</p>
+
+<p>It is important, then, to notice even slight
+symptoms of sickness, first, in order to determine
+the nature of the trouble, and second, in order to
+institute treatment as early as possible. It is,
+however, hardly less important to observe symptoms
+accurately during the entire course of an
+illness. A patient's progress can be determined<!-- Page 89 --><span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span>
+only by careful comparison between present and
+past conditions.</p>
+
+<p>Many symptoms can be detected only by
+methods requiring scientific apparatus as well
+as the knowledge and skill of a physician, but
+very pronounced symptoms are generally evident
+to anyone. The neighbors do not need to be told
+when a person has advanced tuberculosis; neither
+is an expert required to see that something ails a
+man with a broken leg. Furthermore less pronounced
+symptoms may often be clearly seen by
+any observant person, even by those not specially
+trained. Accordingly it is important for every
+woman who has charge of others, sick or well, to
+form the habit of noticing unusual appearances of
+any kind. This habit is one that most people
+must take pains to acquire, because people generally
+see only the things that their own experience
+in life has taught them to see. An added difficulty
+is the fact that when illness begins it is not a
+trained observer, but the untrained sufferer or
+untrained member of his family who decides
+whether to send for the doctor and thus to set in
+motion the machinery for treatment and cure.</p>
+
+<p>All the training and experience of a physician
+are required in order to decide what symptoms
+indicate, and to prescribe proper remedies.
+Diagnosis, or the process of determining the<!-- Page 90 --><span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span>
+nature of illness from the symptoms observed, is
+often exceedingly difficult; it must take into
+consideration not one symptom only but the
+presence or absence of a number of symptoms.
+Untrained persons who attempt to make diagnoses
+are frequently led astray by the fact that actual
+causes of trouble may be situated far from the
+places where symptoms are felt or observed. For
+instance, the real cause of headache may lie in a
+region far removed from the head; and so-called
+heart-burn, which is caused by disordered digestion,
+has nothing to do with the heart. Again,
+an early symptom of tuberculosis of the hip
+joint is pain under the knee; a mother is
+clearly not doing the best thing when she assumes
+that any pain in a joint means rheumatism, and
+therefore doses her suffering child with the medicine
+that "helped" his rheumatic grandfather.
+No untrained person is equipped to make a diagnosis,
+and still less to prescribe medicine or
+treatment.</p>
+
+<p>Symptoms, like all other forms of discomfort,
+tend to trouble a patient in proportion to the
+amount of attention that he gives them. Hence,
+in order to avoid calling his attention to them
+unnecessarily they should be observed so far as
+possible without his knowledge; when it is unavoidable
+for him to realize what is going on,<!-- Page 91 --><span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span>
+observation should be made a matter of routine,
+so that his interest may not be especially excited.
+For instance, everyone who has seen the routine
+medical inspection of school children realizes
+how little attention the children themselves give
+to the process, apparently regarding it merely
+as one of the many inexplicable proceedings of
+grown people. On the other hand, children who
+know their symptoms are over-anxiously watched
+soon learn to watch themselves and to exaggerate
+every little ache and pain.</p>
+
+<p>Symptoms may be divided into two classes:
+first, objective symptoms, or those that can be
+noted by an observer, like cough, pulse rate, or
+color of the skin; and second, the subjective
+symptoms, which are apparent only to the person
+affected, like pain and fatigue. The success of
+any woman who cares for the sick depends to a
+large extent upon her quickness and accuracy
+in noticing and reporting these symptoms and
+their variations. It should be remembered that
+pronounced symptoms are not the only ones of
+importance: even slight symptoms that continue
+over an appreciable length of time may be of very
+great importance. A brief description of some
+important symptoms follows, in order to help
+persons without technical training to describe the
+symptoms as well as to observe them.</p>
+
+<p><!-- Page 92 --><span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span></p>
+
+<h3>OBJECTIVE SYMPTOMS</h3>
+
+<div class="run-in">
+<h4>Temperature.</h4><p>&mdash;Bodily heat is produced by slow
+burning of food materials, which goes on for the
+most part in actively working muscles
+and glands. Heat thus generated is
+distributed by the blood to all parts of
+the body, but the surface of the body
+is generally cooler than the interior.
+In health the body temperature varies
+only a few degrees, no matter how
+much the temperature of its surroundings
+varies; consequently a temperature
+is abnormal if it is higher or
+lower than the usual temperature of a
+healthy person.</p></div>
+
+<div class="figleft" style="width: 80px;">
+<img src="images/fig10.png" width="68" height="400" alt="" title="" />
+<span class="caption">
+<span class="smcap">Fig. 10.&mdash;<br />Clinical
+Thermometer.</span>
+</span>
+</div>
+
+<p>The temperature is taken by means
+of a clinical thermometer placed either
+in the mouth, the rectum, or the armpit
+(axilla).</p>
+
+<p>To take the mouth temperature, first
+wash the thermometer, using cold water
+and absorbent cotton or clean soft
+cloth. Next shake it until the mercury
+thread registers 96° or below. It
+is well before purchasing a thermometer
+to see whether it can be shaken
+down easily. Next place the thermometer in the<!-- Page 93 --><span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span>
+patient's mouth, with its bulb under his tongue;
+he must then keep his lips closed until it is removed.
+Leave the thermometer in his mouth for
+two minutes. Then remove the thermometer,
+read the temperature and record the result. Clean
+the thermometer at once, using first cold water and
+soap, and then alcohol, 70%.</p>
+
+<p>The mouth temperature of a healthy person is
+about 98.6° F. This statement holds true if the
+person has been sitting with his mouth shut for a
+little while before his temperature is taken; but a
+hot bath, breathing through the mouth, eating or
+drinking, and so forth may cause marked temporary
+changes.</p>
+
+<p>The temperature in the rectum generally varies
+less than the temperature in the mouth unless it
+is taken when the rectum contains fecal matter.
+The temperature should be taken by rectum in
+babies and young children, restless, drowsy, or
+delirious patients, patients who cannot be trusted
+to keep the thermometer under the tongue, mouth
+breathers, and in any patients who have difficulty
+in keeping the mouth shut. The temperature is
+normally about half a degree higher in the rectum
+than in the mouth.</p>
+
+<p>In order to take a temperature by rectum, adults
+generally find it more convenient to lie on the side
+and prefer, if they are able, to insert and hold the<!-- Page 94 --><span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span>
+thermometer themselves; but the attendant should
+be certain that they can do so without breaking
+the thermometer. Rectal thermometers should be
+lubricated with oil or vaseline before using; they
+should be inserted about two inches, left in three
+minutes, and cleansed in the same way as the
+mouth thermometer. A thermometer used to
+take rectal temperatures should never be used in
+the mouth.</p>
+
+<p>In taking the temperature of a baby place him
+on his back, hold him firmly with his legs elevated,
+and carefully insert the bulb of the thermometer,
+well oiled, for about one inch. Keep the child
+quiet, and hold the thermometer in place three
+minutes. Great importance should not be attached
+to a slight fever of short duration. The
+temperature of a child is much more easily affected
+by slight causes than that of an adult, and rectal
+temperatures between 97.5° and 100.5° should
+not cause anxiety unless continued.</p>
+
+<p>Temperatures taken in the axilla are less accurate
+than those taken by mouth or rectum. Consequently
+the method is less often used. The
+axilla should first be wiped; then the thermometer
+should be inserted and held for 5 minutes by pressing
+the arm tightly against the chest wall. The
+temperature in the axilla is normally about half a
+degree lower than in the mouth.</p>
+
+<p><!-- Page 95 --><span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span>
+The temperature varies somewhat according to
+the time of day. It is not unusual for the mouth
+temperature of persons who are entirely healthy to
+be as low as 97° in the early morning, or as high as 99°
+in the late afternoon, and probably most people's
+temperatures vary as much as a degree during the
+twenty-four hours. Even greater variations that
+are not long continued have little if any significance
+in people who feel well.</p>
+
+<p>Decided variations either above or below normal
+are highly important symptoms. A temperature
+below 98° is called subnormal, and one above
+99.5° is called fever. The number of degrees of
+fever does not necessarily bear a direct relation to
+the severity of an illness. Thus, it does not follow
+that one person is twice as sick as another, because
+his temperature is twice as many degrees above
+normal. All symptoms, including variations in
+temperature, must be considered in connection
+with one another, and it is generally impossible to
+state the significance of any one symptom taken
+by itself.</p>
+
+<p>The temperature should be taken once or twice
+a day as a matter of routine in almost every form
+of illness, and oftener when the patient's condition
+requires it. Also it should be taken as a matter of
+routine whenever there is indication of beginning
+sickness; especially when there is headache, pain,<!-- Page 96 --><span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span>
+sore throat, coated tongue, cough or cold, chill,
+vomiting, diarrhœa, or rash. It is not a good
+plan to take one's own temperature oftener than
+necessary, or indeed anyone's; certainly not a
+baby's, since frequent use of the thermometer may
+irritate the rectum.</p>
+
+<div class="run-in">
+<h4>Pulse.</h4><p>&mdash;Each time the heart beats, blood is
+forced out from the heart into the arteries, thus
+causing an expansion of the arterial walls. This
+expansion, called the pulse, can be felt in some
+places where arteries lie close to the surface of the
+body. The character of the pulse beat and its
+rate, or the number of times the beat occurs each
+minute, give information about the heart and
+blood vessels; taken together they are perhaps
+more important than any other one symptom.</p></div>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig11.jpg" width="500" height="309" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 11.&mdash;Taking the pulse at the wrist. Note the position of arm.</span> (<cite>From
+&quot;Elementary Nursing Procedures,&quot; California State Board of Health.</cite>)</span>
+</div>
+
+<p>The pulse rate varies much more than the temperature.
+It differs in different individuals and at
+different ages, and it often shows great temporary
+changes, especially during exercise or eating, or as
+a result of excitement, fear, or other emotion.
+Definite statements in regard to normal pulse
+rates are hard to make, because different individuals
+though in perfect health show marked variations;
+we generally say, however, that the pulse
+rate of a normal man at rest is about 72 a minute,
+and that of a normal woman is about 80 a minute.
+At birth the pulse is quickest; it may then be<!-- Page 97 --><span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span>
+from 124 to 144. From the 6th to the 12th month
+it may be from 105 to 115 a minute, and from 90
+to 105 between the 2d and 6th years. About<!-- Page 98 --><span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span>
+the time of puberty it reaches the adult rate, and
+during old age it may be decidedly slower than
+the adult rate.</p>
+
+<p>What we chiefly want to know about the pulse is</p>
+
+<p>1. Its rate, or number of beats per minute,</p>
+
+<p>2. Its force,&mdash;whether weak or strong,</p>
+
+<p>3. Its rhythm,&mdash;whether regular or irregular.</p>
+
+<p>Much practice is necessary before the pulse rate
+can be counted with any degree of accuracy, and
+wide experience with both normal and abnormal
+pulses is required in order to judge its strength,
+rhythm, or other characteristics.</p>
+
+<p>The pulse may be felt most conveniently on the
+thumb side of the front of the wrist. The pulse
+should be counted while the patient is lying down,
+and the watch used must have a second hand.
+To count the pulse, one should place two or three
+fingers (not the thumb) on the patient's wrist, and
+after the pulse has been felt distinctly for a few
+beats, the exact time by the second hand of the
+watch should be noticed and the counting begun
+immediately. It is generally best to count for
+half a minute, multiply the result by two to
+get the rate for a whole minute, and then to
+repeat for another half minute. The two results
+should agree within two beats, if the patient is
+quiet. A greater variation than two beats may
+mean that the pulse rate is varying, but when it is<!-- Page 99 --><span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span>
+counted by inexperienced persons the apparent
+difference is generally the result of inaccurate
+counting, and it may be necessary to count two or
+three times more. The force of the pulse varies
+also in different individuals; it is, however, important
+to notice when it grows stronger or weaker in
+the same person. Normally the pulse-beat is
+regular like the ticking of a clock; it is called irregular
+if a few rapid or slow beats are followed by
+others of a different rate. During sickness the
+pulse should be counted whenever the temperature
+is taken, or oftener; and the result should
+be written down at once. The pulse of a sick
+person often shows changes both in rate and
+character; these changes are generally important
+and should be noticed.</p>
+
+<div class="run-in">
+<h4>Respiration.</h4><p>&mdash;Variations in the rate and character
+of respiration or breathing should be noticed.
+The normal rate of respiration for an adult at
+rest is 16 to 20 each minute, but it may be much
+faster, especially during muscular exercise. In
+babies the rate is about 30 to 35 a minute, and 20
+to 25 in little children. The respirations, especially
+of babies, can best be counted during sleep
+by placing the hand lightly on the chest or abdomen.
+Since the respiration rate is partly under a
+person's control, it is almost sure to alter if the
+patient knows it is being counted; hence when the<!-- Page 100 --><span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span>
+patient is awake it is better to keep one's fingers
+on his wrist, to place his hand upon his chest, and
+then to count the rise and fall of the chest while
+apparently counting the pulse. Sometimes it is
+possible to count the respirations merely by watching
+the rise and fall of the nightgown or bed
+clothes. The respiration is usually counted for
+a full minute. A watch with a second hand must
+be used, and the result should be recorded
+immediately.</p></div>
+
+<p>In certain forms of sickness breathing may become
+rapid, especially if the lungs or air passages
+are affected. In addition to the rate anything
+unusual about the breathing should be noticed
+whether it seems difficult or painful; if noisy,
+whether the sound is like snoring, or wheezing,
+or sighing, and so on.</p>
+
+<div class="run-in">
+<h4>General Appearance.</h4><p>&mdash;Any unusual expression
+of the face should be noted; whether it is drawn,
+pinched, anxious, excited, or dull and stupid;
+and also, whether the face is thin, swollen, or
+puffy under the eyes. The condition and appearance
+of the skin are significant: the skin may be
+dry, moist and clammy, hot or cold; its color, and
+the color of the face especially, may be flushed or
+pale or slightly yellow or blue. A bluish tinge
+about the nose, tips of the fingers, or the feet
+should be specially noticed. Reddened or discolored<!-- Page 101 --><span class='pagenum'><a name="Page_101" id="Page_101">[101]</a></span>
+areas on any part of the body may be
+important, and also eruptions, rashes, swellings,
+or sores. It should be noticed whether the
+abdomen is normal or whether it is distended and
+hard.</p></div>
+
+<p>Strength or weakness is indicated to some extent
+by the way the patient moves, and by his ability
+to walk, stand, sit, hold up his head, feed himself,
+or turn in bed without assistance. The position
+he habitually takes is sometimes significant;
+in heart affections, for instance, he may be unable
+to lie down, in pleurisy he ordinarily lies on the
+affected side, and during abdominal pain he generally
+draws the knees up.</p>
+
+<div class="run-in">
+<h4>Special Senses.</h4><p>&mdash;The special senses are frequently
+disturbed in sickness. The eyes may be
+blood-shot; the patient may be over-sensitive
+to light, or see spots floating before the eyes, or he
+may be unable to see at all. The pupils of the
+eyes may be unusually large or small, or one may
+be large while the other is small. Swelling, redness,
+or discharge from the eyes should be noticed.
+Hearing and touch and smell may be impaired;
+or they may be abnormally acute, and cause real
+suffering. Taste may be impaired, especially
+when the nose is affected or when the mouth is not
+clean. Discharge from the nose or ears should be
+reported. Not only discharge, but also trouble of<!-- Page 102 --><span class='pagenum'><a name="Page_102" id="Page_102">[102]</a></span>
+any kind, such as pain, tenderness, or swelling, is
+important if situated in or near the ears.</p></div>
+
+<div class="run-in">
+<h4>The voice</h4>&nbsp;<p>is often much altered in sickness. It
+may be weak, hoarse, or whispered. Speech may
+be clear or thick, or the ability to speak may be
+entirely lost; in extreme weakness speaking is
+generally difficult, and may be impossible. Moaning,
+groaning, and other unusual sounds should be
+noted. A loud, sharp cry at night with or without
+waking, if a repeated occurrence, may be an early
+symptom of some diseases of children.</p></div>
+
+<div class="run-in">
+<h4>The tongue</h4>&nbsp;<p>in health is red and moist; when
+extended it is somewhat pointed and can be held
+steadily. In sickness it may be cracked, dry and
+parched, or if the patient is not properly cared for,
+it may be covered with white, yellow, or brown
+coating; in many exhausting illnesses it is flabby
+and trembling. In scarlet fever the tongue is
+often a vivid red color, and is then called strawberry
+tongue. The odor of the breath may be
+foul from decay or neglect of the teeth, from indigestion,
+constipation, nasal catarrh, or special
+diseases.</p></div>
+
+<div class="run-in">
+<h4>The throat</h4>&nbsp;<p>and tonsils are sometimes red and
+swollen as in simple sore throat; or they may be
+covered by white patches.</p></div>
+
+<div class="run-in">
+<h4>The gums</h4>&nbsp;<p>may be swollen, tender, or bleeding.
+A collection of sticky brownish material may<!-- Page 103 --><span class='pagenum'><a name="Page_103" id="Page_103">[103]</a></span>
+appear on the teeth and gums of neglected
+patients.</p></div>
+
+<div class="run-in">
+<h4>Cough</h4>&nbsp;<p>when present may be: dry, or accompanied
+by expectoration; painful, frequent, loud,
+or whooping; and worse by day or by night. The
+sputum may be yellow, white, gray, rusty, blood-streaked,
+dark, or frothy. The amount of sputum
+should be noticed as well as its appearance.</p></div>
+
+<div class="run-in">
+<h4>Appetite</h4>&nbsp;<p>or absence of appetite should be noted,
+and also the amount of food actually eaten by a
+patient; the amount eaten is frequently not the
+same as the amount carried to him on a tray.</p></div>
+
+<div class="run-in">
+<p>If</p>&nbsp;<h4>vomiting</h4>&nbsp;<p>occurs, the color, consistency,
+amount, and general appearance of the vomitus
+should be noted; if its appearance is unusual
+the vomitus should be saved for the doctor's
+inspection.</p></div>
+
+<div class="run-in">
+<h4>Excretions.</h4><p>&mdash;The number of bowel movements
+is important, and also their character. The
+consistency of the feces may be hard, soft or
+fluid; their color may be any shade of brown,
+yellow or green, from black to clay color.
+They should be saved for the doctor to see if
+appearance or odor is unusual.</p></div>
+
+<div class="run-in">
+<h4>The urine</h4>&nbsp;<p>in health is clear, amber colored,
+and slightly acid. From 30 to 50 ounces should
+be excreted in 24 hours; the amount varies,
+however, especially according to the amount of<!-- Page 104 --><span class='pagenum'><a name="Page_104" id="Page_104">[104]</a></span>
+fluid taken. It is important to notice whether
+the urine is scanty or greatly increased in amount,
+dark or pale, clear or cloudy, and whether sediment
+is deposited after standing. It is essential
+that urine should be voided in sufficient amount;
+the necessity for watching its quantity is frequently
+overlooked in the home care of the sick.
+Frequency of urination should also be noted.
+Inability to urinate, particularly where the urine
+has previously been scanty, is serious if continued;
+it should be reported to the doctor without
+delay. Inability to control the bladder and bowels
+are also symptoms to be reported.</p></div>
+
+<div class="run-in">
+<h4>Loss of weight</h4>&nbsp;<p>is significant in both adults and
+children, and failure of babies and children to
+gain in weight is a danger signal.</p></div>
+
+<div class="run-in">
+<h4>Sleep.</h4><p>&mdash;The number of hours a patient sleeps
+should be noticed and recorded as accurately
+as possible. The word of the patient on this
+subject is not sufficient evidence. Character of
+sleep should also be noted, whether it is quiet
+or restless, and whether the patient sleeps lightly
+or is difficult to arouse.</p></div>
+
+<div class="run-in">
+<h4>Mental Conditions.</h4><p>&mdash;It is important to watch
+carefully the mental condition of a patient;
+whether, for example, he is normal, or depressed,
+irritable, restless, apathetic, dull, excited, wandering,
+delirious, or unconscious. Hasty judgment<!-- Page 105 --><span class='pagenum'><a name="Page_105" id="Page_105">[105]</a></span>
+of mental conditions should be avoided, but
+close attention to them is necessary.</p></div>
+
+<h3>SUBJECTIVE SYMPTOMS</h3>
+
+<div class="run-in">
+<h4>Pain</h4>&nbsp;<p>is the most important subjective symptom
+and should never be disregarded. Bodily pain
+does not occur in persons who are in all regards
+physically and mentally well; hence pain is a
+sign that something, small or great, is out of
+order.</p></div>
+
+<blockquote>
+<p>"Of all symptoms pain is the one which interests
+patients the most. We here emphasize the truth, too
+little understood, that pain is an unpleasant sensation,
+nothing more, and is <em>never</em> imagined. Imagination may
+be its cause, but the pain thus produced hurts just as
+truly as pain produced by a real disease. Pain is only a
+phenomenon of consciousness; it is always real, even that
+felt in a dream. If the patient is too unconscious to feel
+it, there simply is no pain, no matter how badly the person's
+body is injured." (Emerson: Essentials of Medicine,
+p. 356.)</p></blockquote>
+
+<p>One should remember that no possible method
+exists to measure the intensity of pain exactly,
+or to describe its quality accurately. Therefore
+in describing pain, it is best to use the patient's
+own language. Four points should especially be
+observed, (1) its location; (2) its character, which
+may be dull or sharp, stabbing, throbbing or<!-- Page 106 --><span class='pagenum'><a name="Page_106" id="Page_106">[106]</a></span>
+continuous, slight or severe; (3) the time at
+which it is worst; certain diseases, for instance,
+are characterized by more severe pain at night;
+(4) it should be noticed whether the pain is relieved
+or increased by change of position, eating
+or drinking, heat or cold, or the like. Pain may
+be felt in a part far from the place where the
+trouble really lies; thus a dislocated shoulder
+causes pain in the elbow.</p>
+
+<p>Pain is always a danger signal, although the
+significance is not always so great as the sufferer
+thinks. The more attention a patient gives to his
+pain, the more severe it always becomes, therefore
+his attention should not be called to it unnecessarily.
+A good observer, however, can get much
+information by noticing the patient's expression,
+position, motions, etc., without constantly asking
+him how he feels. Although many persons overestimate
+pain, others persistently disregard it,
+either because they are unwilling to take the
+necessary measures to remedy it, or because they
+wish to appear heroic. Both courses of action are
+mistaken; everyone should realize the folly and
+danger of bearing pain if it is possible to remove
+the cause.</p>
+
+<p>Nausea, fatigue and malaise are other subjective
+symptoms; malaise is the name given to a
+general feeling of physical discomfort not restricted<!-- Page 107 --><span class='pagenum'><a name="Page_107" id="Page_107">[107]</a></span>
+to any one part of the body. All three
+are abnormal when there is not apparent or
+sufficient cause.</p>
+
+<div class="run-in">
+<h4>Records.</h4><p>&mdash;An accurate record should be kept
+of the patient's symptoms, medicine, diet, treatment,
+etc., so that the doctor may have a continuous
+record, and so that another person taking
+charge temporarily may know just what has been
+done for the patient. The record must be written;
+otherwise details cannot be remembered exactly.
+It should be as simple and concise as possible;
+it is the place for facts, not for opinions, and if
+inaccurate it is worse than none. It is better
+not to keep the record in the patient's room,
+for the patient should not see his own record,
+nor hear its contents discussed. The doctor
+usually writes his orders on the record sheet
+itself, or on a separate sheet to be attached to
+the record for reference. Blank record forms
+can be purchased, but a form that is made at
+home is entirely satisfactory. An example of a
+daily record sheet follows.</p></div>
+
+<p><!-- Page 108 --><span class='pagenum'><a name="Page_108" id="Page_108">[108]</a></span></p>
+
+<table rules="groups" frame="hsides" cellpadding="2" summary="Example of Daily Record Sheet for a Patient">
+<caption><span class="smcap">Record</span></caption>
+<colgroup /><colgroup /><colgroup /><colgroup /><colgroup /><colgroup /><colgroup /><colgroup />
+<thead>
+<tr><th>Date</th>   <th>Hour</th>   <th>Tem.</th><th>Pulse</th><th>Resp.</th><th>Diet and
+                                                                                 medicine</th>
+                                                                                           <th>B.M.</th><th>Urine</th><th>Remarks</th></tr>
+</thead>
+<tbody>
+<tr><td>1916</td>   <td></td>       <td></td>     <td></td>   <td></td>   <td></td>        <td></td>     <td></td><td></td></tr>
+
+<tr><td>Jan. 1</td> <td>4 p.m.</td> <td>100°</td> <td>76</td> <td>24</td> <td>Medicine</td><td></td>     <td></td><td></td></tr>
+<tr><td></td>       <td>5 p.m.</td> <td></td>     <td></td>   <td></td>   <td></td>        <td>1</td>  <td><span title="ounces">â„¥</span> vii</td><td></td></tr>
+<tr><td></td>       <td>6 p.m.</td> <td></td>     <td></td>   <td></td>   <td>Supper:<br />
+                                                                              Baked potato,
+                                                                              toast, fruit,
+                                                                              tea.</td>    <td></td>   <td></td>   <td></td></tr>
+<tr><td></td>       <td>8 p.m.</td> <td></td>     <td></td>   <td></td>   <td>Medicine</td><td></td>   <td></td>   <td>Sponge bath.</td></tr>
+<tr><td></td>       <td>9:30 p.m.</td><td></td>   <td></td>   <td></td>   <td></td>        <td></td>   <td></td>   <td>Asleep.</td></tr>
+
+<tr><td>Jan. 2</td><td>3 a.m.</td>  <td></td>     <td></td>   <td></td>   <td></td>        <td></td>   <td><span title="ounces">â„¥</span> ix</td><td></td></tr>
+<tr><td></td>      <td>8 a.m.</td>  <td>99°</td>  <td>74</td> <td>22</td> <td>Medicine</td><td></td>   <td></td>       <td>Patient slept most of the night.</td></tr>
+<tr><td></td>      <td>8:30 a.m.</td>    <td></td>     <td></td>   <td></td>   <td>Breakfast:<br />
+                                                                              Cereal, orange,
+                                                                              toast, coffee.</td><td></td>  <td></td>   <td></td></tr>
+<tr><td></td>      <td>9:30 a.m.</td><td></td>    <td></td>   <td></td>    <td>Bath.</td>        <td></td>  <td></td>   <td></td></tr>
+<tr><td></td>      <td>11:30 a.m.</td><td></td>   <td></td>   <td></td>    <td></td>             <td></td>  <td></td>   <td>Sat up 1 hour.</td></tr>
+</tbody>
+</table>
+
+<div class="run-in">
+<h4>Tuberculosis, Cancer, and Mental Illness.</h4><p>&mdash;As
+we have seen, early symptoms of sickness
+are always important; yet it seems worth while
+to mention particularly the early symptoms of
+tuberculosis, cancer, and mental disorders, because
+each of these diseases, though curable in many<!-- Page 109 --><span class='pagenum'><a name="Page_109" id="Page_109">[109]</a></span>
+cases when taken in the early stages, is serious
+and often fatal if neglected. Certain facts relating
+to their cause and prevention should be known to
+everyone. Tuberculosis, long our greatest cause
+of death, is gradually growing less; but cancer and
+mental disease are now on the increase.</p></div>
+
+<div class="run-in">
+<h4>Tuberculosis.</h4><p>&mdash;Every year tuberculosis causes
+the death of about 150,000 people in the United
+States. It is caused by the bacillus tuberculosis, a
+germ which may attack any tissue of the body,
+although it most frequently affects the lungs of
+grown people, and the bones and glands of
+children. The disease is not inherited, but
+susceptibility to it appears to be; it is readily
+communicated from person to person. The germ
+of tuberculosis is so widely distributed that probably
+few persons over 30 years of age have not been
+infected with it at some time, although the infection
+may have been too slight to be noticed.
+Indeed, most people have probably been infected
+many times, though without serious results.</p></div>
+
+<p>Tuberculosis is spread chiefly in two ways:
+(1) through any bodily discharges from infected
+persons, especially through the nose and mouth
+discharges; (2) through milk from infected cows.
+The ways by which the disease is spread indicate
+methods of prevention. Milk, especially
+for children, should either be pasteurized or<!-- Page 110 --><span class='pagenum'><a name="Page_110" id="Page_110">[110]</a></span>
+should come from cows that have been tested
+and proved to be free from the disease. Other
+methods of prevention include avoiding any
+and all bodily discharges of infected persons,
+and increasing bodily resistance as far as possible.
+Good food, sufficient rest and fresh air are not
+only important preventives, but also the most
+efficacious means of cure. Persons who suffer
+from insufficient food, exposure, bad housing,
+long hours, and bad conditions of work are especially
+susceptible to tuberculosis, and thus it is
+rightly called a disease of poverty.</p>
+
+<p>Early symptoms of tuberculosis include cough,
+hoarseness, loss of appetite, pain in the side, loss
+of weight, getting tired easily, feeling run down,
+rise in temperature in the afternoon, night sweats,
+expectoration, and spitting blood. No one, nor
+even several, of these symptoms necessarily
+indicates the presence of tuberculosis; on the
+other hand, even the cough is not necessarily
+present when tuberculosis actually exists. When
+one or more of these symptoms appears and continues,
+a thorough examination should be made
+by a doctor; examination can do no harm, certainly,
+if tuberculosis is not found, and if it is,
+immediate treatment is of the greatest importance.
+No known drug or medicine is a cure for tuberculosis.
+Successful treatment depends on taking<!-- Page 111 --><span class='pagenum'><a name="Page_111" id="Page_111">[111]</a></span>
+the disease in time and in following the doctor's
+advice unremittingly.</p>
+
+<div class="run-in">
+<h4>Cancer.</h4><p>&mdash;The cause of cancer is not known.
+All the evidence, however, goes to show that it is
+neither communicable nor hereditary. Cancer
+may occur on the skin, stomach, or other organs;
+in women it most commonly occurs in the breast
+or uterus (womb). In both sexes it occurs most
+frequently after 40 years of age. No known
+medicine will cure cancer; salves and ointments
+have no effect. Radium and <i>x</i>-ray should not be
+relied upon if the cancer can be removed by operation.
+Safety consists in removing the growth
+entirely, and complete removal is possible only
+in the early stages.</p></div>
+
+<p>Early diagnosis is consequently of the greatest
+possible importance, and an examination can do
+no harm in any case. Warts and moles on the
+skin may develop into cancer, and should be
+removed if they show signs of irritation. Loss
+of appetite and weight, any disturbance of the
+stomach or intestines, and sores that refuse to
+heal should lead a person to consult a physician;
+the same is true of any lump in the breast, and
+of irregular or persistent bleeding from the
+uterus in women over forty. The fact that pain
+is not present in cancer until the late stages leads
+many persons to neglect the trouble until it is<!-- Page 112 --><span class='pagenum'><a name="Page_112" id="Page_112">[112]</a></span>
+too far advanced for operation. Time is all-important;
+hope depends on operation in the
+early stages when there is a very great probability
+of permanent cure.</p>
+
+<div class="run-in">
+<h4>Mental Illness.</h4><p>&mdash;Insanity, like cancer, is increasing.
+Like both cancer and tuberculosis, hope
+lies in prevention and early treatment; and like
+them both, in its early symptoms it is too often
+unrecognized or neglected.</p></div>
+
+<p>Many people are surprised to learn that known,
+avoidable causes are responsible for the condition
+of about 50% of the insane patients now
+under treatment. Chief among these known
+causes is a communicable germ disease called
+syphilis, to which is due the disease called paresis,
+or "softening of the brain." About 25% of
+patients admitted to hospitals for the insane are
+there from the effects of habitual use of alcohol,
+even in "moderate" quantities. Other cases
+of insanity result from diseases of the heart,
+arteries, and kidneys, and still others have been
+traced to the poisons of tuberculosis, typhoid,
+diphtheria, and other communicable diseases.
+Prevention of insanity caused by these diseases
+depends upon prevention or complete cure of the
+diseases themselves.</p>
+
+<p>Still other causes of insanity are known. Hereditary
+nervous weakness may predispose to insanity,<!-- Page 113 --><span class='pagenum'><a name="Page_113" id="Page_113">[113]</a></span>
+and for such persons, those whose nervous
+resistance is naturally not very great, the stress
+of living may prove too much. Mental breakdowns
+are rarely caused by overwork unless accompanied
+by worry or bad hygienic conditions,
+but they result not infrequently from bad mental
+habits.</p>
+
+<blockquote>
+<p>"The average person, little realizes the danger of brooding
+over slights, injuries, disappointments, or misfortunes,
+or of an unnatural attitude towards his fellowmen, shown
+by unusual sensitiveness or marked suspicion. Yet all
+these unwholesome and painful trains of thought, may if
+persisted in and unrelieved by healthy interests and
+activities, tend towards insanity. Wholesome work relieved
+by periods of rest and simple pleasures and an
+interest in the affairs of others, are important preventives
+of unwholesome ways of thinking. We should train ourselves
+not to brood, but to honestly face personal
+difficulties."&mdash;(Why Should Anyone Go Insane?, by Folks
+and Ellwood.)</p></blockquote>
+
+<p>Prevention of insanity consequently depends
+chiefly upon avoiding alcohol and communicable
+diseases, especially syphilis; upon good hygiene,
+self-control, and avoidance of bad mental habits;
+and upon adopting a program of living and working
+that will not overtax one's nervous strength.
+Sleeplessness, unusual nervous fatigue following
+slight exertion, and diminished power to control
+the emotions, are among the danger signals. And<!-- Page 114 --><span class='pagenum'><a name="Page_114" id="Page_114">[114]</a></span>
+when a person becomes unusually depressed or
+morose, excited or irritable, suspicious, unreasonable,
+or "queer," it is probable that expert medical
+advice should be obtained as quickly as possible.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What is a symptom? Why are early symptoms
+especially important?</li>
+
+<li>Distinguish between objective and subjective symptoms.</li>
+
+<li>Tell all you can about normal and abnormal variations
+in the body temperature. What symptoms would
+lead you to take a person's temperature?</li>
+
+<li>Describe the method of taking temperatures.</li>
+
+<li>How should you cleanse a clinical thermometer?
+What are the dangers of neglecting to cleanse it properly?</li>
+
+<li>Describe both normal and abnormal pulse and
+respiration.</li>
+
+<li>Discuss the significance and importance of pain.</li>
+
+<li>Describe early symptoms of tuberculosis, cancer, and
+mental illness. What is the first step to be taken when
+any one of these symptoms appears?</li>
+
+<li>What symptoms of all those mentioned in this chapter
+did you notice in the last sick person with whom you
+had anything to do?</li>
+
+<li>What are the essentials of a good daily record?
+The following is an account that a mother gave of the
+first twenty-four hours of a child's illness. Make a chart
+for the patient, and include in it all the information the
+mother gave. Which do you consider more useful, your
+chart or the narrative?
+
+<p><!-- Page 115 --><span class='pagenum'><a name="Page_115" id="Page_115">[115]</a></span>
+"Yesterday, October 10th, Johnny came home from
+school about half past three, and said he was too cold to
+play outdoors. He lay down and slept till about five,
+when he vomited a large amount of undigested food. I
+took his temperature and found that it was 103.8°, pulse
+126, and respiration 28. At 10 that night his temperature
+was 102.5°, pulse 116, and respiration the same as before.
+The next morning at 8 he had a temperature of 100.6°,
+pulse 114, respiration 24. At noon his temperature was
+101°, pulse 118, respiration 24; and at 4 o'clock his temperature
+was 100.6°, pulse 122, respiration 22. The doctor
+came at 6 o'clock yesterday afternoon; according to his
+orders I put Johnny to bed, gave him half a tablespoonful
+of castor oil at 6.30, and a special gargle. His throat was
+red and sore and he seemed to feel very miserable. The
+doctor took a culture from the child's throat. At 8.15
+and again at 8.50 he had fluid bowel movements. At
+9.30 he had a glass of milk, after which he slept until 6
+a.m. when his bowels moved again and urine was passed.
+He passed eight ounces of urine at noon and four ounces
+at 3.30. He drank a glass of water at 6 this morning, and
+at 6.30 I gave him a cup of hot broth. At 8 he had a glass
+of milk, but at 10 he refused everything but a glass of
+water. At 1.30 he had a large dish of ice cream. He had
+a cool sponge bath last night at 9, and a cleansing bath
+this morning at 8.45. This morning his throat was still
+sore but not so red, and I saw that he gargled every half
+hour when he was awake. This afternoon he seems
+brighter and asked for his harmonica, so his throat is
+probably more comfortable."</p></li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Essentials of Medicine&mdash;Emerson, Chapters XVI, XVII.</li>
+
+<li>The Human Mechanism&mdash;Hough and Sedgwick, Chapter XII.</li>
+
+<li><!-- Page 116 --><span class='pagenum'><a name="Page_116" id="Page_116">[116]</a></span>
+Notes on Nursing&mdash;Florence Nightingale, Pages 105-136.</li>
+
+<li>Why Worry?&mdash;Walton.</li>
+
+<li>Those Nerves&mdash;Walton.</li>
+
+<li>Tuberculosis: Its Cause, Cure, and Prevention&mdash;Otis.</li>
+
+<li>Publications of the National Association for the Study and
+Prevention of Tuberculosis&mdash;105 East 22d Street, New
+York City. (Pamphlets free on request.)</li>
+
+<li>Publications of the National Committee for Mental Hygiene&mdash;50
+Union Square, New York City. (Pamphlets free on
+request.)</li>
+
+<li>Publications of the Mental Hygiene Committee of the State
+Charities Aid Association&mdash;105 East 22d Street, New York
+City. (Pamphlets free on request.)</li>
+
+<li>Publications of The American Society for the Control of
+Cancer&mdash;25 West 45th Street, New York City. (Pamphlets
+free on request.)</li>
+</ul>
+
+<p><!-- Page 117 --><span class='pagenum'><a name="Page_117" id="Page_117">[117]</a></span></p>
+
+<h2><span class="sm2">CHAPTER V</span><br />
+<br />
+EQUIPMENT AND CARE OF THE
+SICK ROOM</h2>
+
+<p>Adequate care of the sick consists to a large
+extent in rendering their physical and mental
+surroundings as favorable as possible. Obviously,
+a sick person, since his strength is already depleted,
+needs not only to have his resistance increased
+in all possible ways, but also to have all
+his remaining strength conserved by eliminating
+every unnecessary tax upon it. In sickness even
+slight fatigue, chill, or nervous strain, insufficient
+ventilation, or improper feeding, may become
+factors of immense importance. Nothing is
+trivial if it affects the welfare and comfort of a
+patient.</p>
+
+<p>Even when perfect provision for the care of the
+sick is out of the question, every effort should be
+made to insure as satisfactory arrangements as possible.
+Ideal conditions are seldom found except in
+buildings originally planned for the sick; yet in
+many houses a few simple changes will produce
+excellent results. Of course, it is not necessary<!-- Page 118 --><span class='pagenum'><a name="Page_118" id="Page_118">[118]</a></span>
+in every case to adopt all the following suggestions.
+Common sense must be the guide. For
+instance, in illness that is slight and likely to be of
+short duration, a patient may be more distressed
+than benefited by radical changes in his surroundings.
+Except when certain essentials are concerned,
+great consideration should be given to a
+patient's preferences; yet on the other hand it is
+not reasonable to make an entire family miserable
+in order to gratify some slight whim.</p>
+
+<div class="run-in">
+<h4>Choice of a Sick Room.</h4><p>&mdash;A south or east exposure
+is generally best for a sick room. A south
+room may be undesirable in very hot weather,
+but sunshine during a part of the day is essential.
+The room should be quiet, near the bath room,
+and well removed from odors from the kitchen.
+It should be situated so that good ventilation is
+possible. It is desirable though not necessary
+for it to have more than one window; in summer
+the windows must be thoroughly screened. It
+should be possible to open the window without
+exposing the patient to a direct current of air,
+and to open the door without placing him in full
+view of all who pass through the hall.</p></div>
+
+<p>It is essential for the patient to have a room to
+himself. Unless he needs care or help or watching
+at night, not even the person caring for him
+should sleep in the room. Neither should the<!-- Page 119 --><span class='pagenum'><a name="Page_119" id="Page_119">[119]</a></span>
+rest of the family keep their possessions in the sick
+room. Closets opening into the room, bureaus,
+and chiffoniers should be emptied of the belongings
+of other members of the family, to prevent
+people from tiptoeing into the sick room at all
+hours to remove garments. The sick room should
+for the time belong exclusively to the patient,
+and resulting inconvenience should be borne by
+well members of the family.</p>
+
+<p>Every possible precaution should be taken to
+exclude from a sick room unnecessary noises of all
+kinds; flapping curtains, squeaky doors and rocking
+chairs, heels without rubber, creaking corsets,
+noisy petticoats, ticking clocks, refractory bureau
+drawers, and rustling newspapers are among the
+everyday sounds that irritate the nerves of sick
+and well alike. Ordinary out-of-door noises do
+not usually disturb the sick, except when the
+country patient is brought to the city, or the
+reverse; but nearby and generally avoidable noise
+is the kind that distracts and harasses nervous
+patients.</p>
+
+<p>Whispering is an annoying sound and should
+not be allowed, either in the patient's room or just
+outside the door. Whatever the subject of conversation
+may be, the patient thinks that he is
+under discussion. Anything undesirable for him
+to hear should be settled well out of his hearing,<!-- Page 120 --><span class='pagenum'><a name="Page_120" id="Page_120">[120]</a></span>
+and in speaking to him there is no possible objection
+to an ordinary well modulated voice.</p>
+
+<p>Usually a person's own room is more restful and
+less disturbing than a strange place, but if it serves
+as a work room as well as a bed room, it may easily
+be the worst place during sickness. The sight of
+a desk piled high with papers or a basket overflowing
+with accumulations of family mending may
+actually delay recovery; even the room itself may
+constantly suggest work, and work necessarily left
+undone. The essential thing to remember is that
+mental rest is no less important than physical,
+and every effort should be made to secure them
+both.</p>
+
+<div class="run-in">
+<h4>Furnishing.</h4><p>&mdash;Superfluous articles add to the
+care of a sick room, and in consequence they
+should be removed at the outset. All the furnishings
+that remain should be easy to clean, but
+it is not necessary for a sick room to look bare and
+desolate.</p></div>
+
+<p>The woodwork as in any other room should
+have a hard finish, and angles and corners that
+harbor dust should be as few as possible. Hard
+wood floors without cracks are best from the point
+of view of cleanliness and convenience. A few
+light, washable rugs make the best floor covering,
+but very small rugs on highly polished floors slide
+easily and are decidedly dangerous. Carpets<!-- Page 121 --><span class='pagenum'><a name="Page_121" id="Page_121">[121]</a></span>
+diminish noise, but are objectionable from every
+other point of view.</p>
+
+<p>In furnishing houses people ought to realize
+more frequently than they do how greatly nervous
+fatigue may be increased by ill chosen wall coverings.
+Plain papers or tinted walls are best
+for bed rooms and the color should not be harsh or
+striking; soft gray, green, or buff is good. The
+design is no less important than the color; a design
+that on casual inspection appears quite harmless
+may become an instrument of torture to a person
+unable to escape from it for a single hour. Weak
+or nervous patients sometimes become quite exhausted
+from attempting to follow an intricate
+pattern, or from counting over and over a design
+that is frequently repeated on the wall. If the
+patient sees grotesque faces and figures in the
+design the paper is more objectionable still.</p>
+
+<p>Necessary furniture includes the bed, which will
+be discussed in detail later, a small table to stand
+by the head of the bed, a dresser, two chairs, and a
+wall thermometer. If the patient is able to sit up
+three chairs are needed, of which one should be an
+armchair with a high back. No rocking chair
+should be allowed in the room unless the patient
+himself prefers to sit in one; no one else should be
+allowed to rock in the room, since the motion is
+almost always annoying to patients. Elaborate,<!-- Page 122 --><span class='pagenum'><a name="Page_122" id="Page_122">[122]</a></span>
+carved, or upholstered furniture is unsuitable in
+a sick room, but if it must be used it should have
+washable covers.</p>
+
+<p>Other desirable articles of furniture are a couch,
+screen, foot-stool and a second, larger table. In
+few cases, if any, is anything further really necessary,
+although patients frequently desire special
+articles to which there can be no objection.</p>
+
+<p>Most ornaments add much work and little
+beauty, and have no place in a sick-room. No
+heavy unwashable curtains or hangings should be
+allowed, but simple washable curtains and clean
+white covers for the tables and dresser are desirable.
+Pictures, if suitable, give much pleasure, but
+must be used with discretion. It goes without
+saying that the subjects should be pleasant, but
+not everyone realizes that complicated subjects
+are undesirable and that pictures of people or
+things in motion should be avoided; patients are
+sometimes worried to see motion that is forever
+incomplete.</p>
+
+<p>Flowers give great pleasure to the sick by adding
+color and variety and interest to their surroundings.
+They should be carefully tended and given
+fresh water daily. Fading flowers and forlorn
+plants should be removed from the sick room, and
+those having strong, heavy odors should not even
+be admitted. They do not need to be very many<!-- Page 123 --><span class='pagenum'><a name="Page_123" id="Page_123">[123]</a></span>
+or very expensive; indeed, a potted plant or a few
+cut flowers are often more acceptable than the
+great masses of costly flowers that are daily
+brought to the private wards of hospitals.</p>
+
+<div class="run-in">
+<h4>Ventilation.</h4><p>&mdash;A patient needs fresh air certainly
+as much as a well person, and probably even more.
+His room should be thoroughly ventilated night
+and day. A fireplace makes the problem easier,
+but in most cases an open window is the main
+dependence. It should be possible to open windows
+at the top as well as at the bottom, and the
+patient may be protected from a direct draught
+by a screen, or by a sheet stretched along the
+side of the bed and fastened at the head and foot
+by tying it around the posts.</p></div>
+
+<p>Ventilating a room without subjecting the patient
+to draughts is not always easy. One method is to
+insert a board three or four inches high under the
+lower sash so that air is admitted between the two
+sashes. Another way to ventilate without causing
+a draught is to remove one or two panes of
+glass and tack cheese cloth over the opening; or
+to tack cheese cloth to the lower edge of the upper
+window casing and to the upper edge of the upper
+sash, after the sash has been lowered about a foot.
+Once or twice a day the room should be thoroughly
+aired by opening windows and doors until the air
+has been completely changed. The patient,<!-- Page 124 --><span class='pagenum'><a name="Page_124" id="Page_124">[124]</a></span>
+including his head, must be well-covered during
+the process. An electric fan is useful in summer,
+but it should not be close enough to the bed for
+the patient to feel air blowing upon him.</p>
+
+<div class="run-in">
+<h4>Heating.</h4><p>&mdash;Great care should be taken to maintain
+a suitable temperature in the sick-room, and
+for this purpose a thermometer in the room is a
+necessity. Between 65° and 68° is generally the
+best temperature, and hot water bags and extra
+covers may be given if the patient is chilly. During
+a bath or other treatment in which the patient
+is more or less exposed the temperature should be
+70°. The temperature at night may be lower;
+how low will depend largely on the patient's
+condition and on what must be done for him
+during the night. Hot water, steam heat, or
+electricity is best for the sick room. Gas or oil
+stoves should never be used except in emergencies,
+and then for a short time only.</p></div>
+
+<div class="run-in">
+<h4>Lighting.</h4><p>&mdash;Sunlight is one of the most powerful
+disinfectants, and for this reason if for no other
+it is needed in every sick room. Sunless rooms,
+moreover, even if they were wholesome, are too
+depressing to a patient's spirits for use except
+perhaps in hot summer days. Ordinary well-regulated
+light is best in a sick room, and except in a
+few diseases, especially those in which the eyes are
+affected, it is undesirable to darken the room or to<!-- Page 125 --><span class='pagenum'><a name="Page_125" id="Page_125">[125]</a></span>
+encourage in any way an appearance of gloom.
+The patient's eyes, however, should be protected
+from bright lights shining directly upon them;
+in this connection it is well to remember that
+lights and their reflections strike differently upon
+the eyes of a person lying down from the way
+in which they strike the eyes of persons sitting or
+standing, and a light that seems agreeable to the
+attendant may therefore be painful to the patient.</p></div>
+
+<p>Almost all persons sleep best in dark rooms, and
+in most cases it is undesirable for a sick room to be
+lighted at night. The attendant, however, must
+be able to see what she is doing and generally
+needs a shaded candle, small night light, or electric
+flash. It should be possible to see the patient
+clearly in case of need, otherwise serious changes
+in his condition occurring in the night may pass
+unnoticed.</p>
+
+<p>A reading lamp on the bedside table is desirable
+for patients allowed to read, but reading in bed
+even with a well-regulated light is fatiguing, and
+should not be continued for long uninterrupted
+periods. A pocket flash light is safer than matches
+and a candle for patients who wish to consult their
+watches in the night; indeed, matches in the hands
+of patients always involve risk. Some patients
+find twilight a time of great depression. In such
+a case it had best be shortened by drawing the<!-- Page 126 --><span class='pagenum'><a name="Page_126" id="Page_126">[126]</a></span>
+shades early, turning on the lights, and remembering
+not to leave him alone.</p>
+
+<div class="run-in">
+<h4>Cleaning.</h4><p>&mdash;The sick-room should be kept thoroughly
+clean at all times, and the less dust stirred
+up in doing so the better. Dry sweeping or
+dusting should not be allowed. Ordinary brooms
+should be dampened or covered with damp cloths,
+and dust cloths should be dampened also; but
+dustless mops and dusters are still better. Vacuum
+cleaning is very desirable; the noise, which is its
+only disadvantage, is not a serious objection in
+most cases. The cleaning of rooms after a communicable
+disease will be considered later.</p></div>
+
+<p>A sick room must be kept tidy as well as
+clean. The effect of order is quieting, but it
+should be maintained whether the effect upon the
+patient is apparent or not. Food and medicine
+should not be kept in the sick-room, and all used
+dishes, tumblers, soiled linen, etc., should be
+removed at once. Unnecessary articles should
+not be found in the room at any time; every necessary
+article should be kept in its place, and its
+place should be a good one.</p>
+
+<p>Maintaining order in the room does not mean
+that patients should be made uncomfortable. All
+patients, especially old people, want certain possessions
+within reach, and their wishes should be
+considered in spite of the fact that the æsthetic<!-- Page 127 --><span class='pagenum'><a name="Page_127" id="Page_127">[127]</a></span>
+effect is generally far from good. For instance, a
+perfectly smooth bed is undesirable if in order to
+make it smooth the patient must be tucked in so
+tightly that he is uncomfortable. And it would be
+a mistake to remove an old man's newspapers
+before he has read them, even if he persists in
+strewing them all over the floor.</p>
+
+<div class="run-in">
+<h4>The Attendant.</h4><p>&mdash;One person and one person
+only should carry the entire responsibility for the
+patient. She should plan for him as well as care
+for him, should see the doctor and take the doctor's
+orders. Confusion and innumerable mistakes
+result when several members of the family
+attempt to do the talking and directing.</p></div>
+
+<p>The attendant should wear washable dresses
+with sleeves that can be rolled up, washable aprons,
+and shoes with rubber heels. All her clothing
+should be comfortable. She should be neat in
+appearance, scrupulously clean in person, and
+should keep her finger nails short and smooth.
+Jewelry, especially rings and chains that rattle,
+and finery of any sort are all out of place in a sick-room.</p>
+
+<p>The attendant must learn that her own sleep,
+her diet, and her out-of-door exercise are essential
+to the patient's well-being hardly less than to her
+own. An amateur nurse often considers that going
+without food and sleep is a proof of her devotion.<!-- Page 128 --><span class='pagenum'><a name="Page_128" id="Page_128">[128]</a></span>
+In a passion of self-sacrifice she neglects herself
+utterly for the first few days, and as a consequence
+is quite useless at a later period when her services
+may be most needed. An exhausted, sleepy nurse,
+trained or untrained, is wholly unfit to be trusted
+with medicines and doctor's orders, to note changes
+in the patient's condition, or to give him kindly
+attention. Efficiency and fatigue have never
+pulled together since the world began, and no one
+can do good work when suffering from lack of sleep
+and rest.</p>
+
+<p>The person, then, who genuinely wishes to give
+her patient the best possible care should not make
+a martyr of herself. She should go out of doors
+daily; both fresh air and occasional absence from
+the patient are essential to her physical and mental
+well-being. Moreover, she will be showing her
+patient the greatest kindness in the long run if
+during her recreation time she thinks of him as
+little as possible. Indeed, she need not consider
+herself inhuman if she has a thoroughly good time.</p>
+
+<p>On the other hand, a person who is responsible
+for the care of a patient must be made to realize
+that she and she only is ultimately responsible
+during the entire 24 hours of every day. Being
+responsible for a patient does not mean that she
+should be with him every minute, or do everything
+herself: it does mean that she should plan so effectively<!-- Page 129 --><span class='pagenum'><a name="Page_129" id="Page_129">[129]</a></span>
+that everything necessary is done, either
+by herself or by another competent person. When
+she goes away for even half an hour, she should
+appoint someone else to be responsible in her
+place and to her when she comes back. She must
+consequently make very clear just what she wants
+done. If there is medicine, nourishment, or
+treatment to be given, she can easily make a list,
+with the time for each, and ask that each item be
+crossed off the list as soon as the work has been
+done. She should not forget to ask for the list
+when she returns.</p>
+
+<p>What is really needed is a little executive ability.
+As Florence Nightingale said:</p>
+
+<blockquote>
+<p>"It is impossible in a book to teach a person in charge of
+the sick how to <em>manage</em>, as it is to teach her how to nurse.
+Circumstances must vary with each different case. But
+it is possible to press upon her to think for herself. Now
+what does happen during my absence? I am obliged to
+be away on Tuesday. But fresh air, or punctuality is not
+less important to my patient on Tuesday than it was on
+Monday. Or: At 10 p.m. I am never with my patient;
+but quiet is of no less consequence to him at 10 than it was
+at 5 minutes to 10. Curious as it may seem, this very
+obvious consideration occurs comparatively to few, or,
+if it does occur, it is only to cause the devoted friend or
+nurse to be absent fewer hours, or even fewer minutes from
+her patient&mdash;not to arrange so as that no minute and no
+hour shall be for her patient without the essentials of her
+nursing."&mdash;(Notes on Nursing.)</p></blockquote>
+
+<p><!-- Page 130 --><span class='pagenum'><a name="Page_130" id="Page_130">[130]</a></span>
+It is exceedingly difficult to care for members
+of one's own family or to be cared for by them.
+Too much or too little is almost invariably expected
+by one person or the other, and where
+great affection is involved not only is the strain increased
+on both sides, but often harm results from
+too great unselfishness on either side or both.
+But sometimes the reverse is true, and then one
+should remember that normal behavior may be
+impossible for the sick. During weakness and
+pain, irritability and unreasonableness are as
+characteristic as other symptoms, and it is as
+foolish to demand a normal mental state from a
+sick person as it would be to demand a normal
+temperature. For a cheerful, reasonable, and unselfish
+patient&mdash;and there are surprisingly many&mdash;one
+should be devoutly thankful, but patience
+and pity should be given no less to those whose
+tortured nerves cause suffering to others as well
+as to themselves.</p>
+
+<p>Every woman who cares for the sick should
+remember that she is the patient's chief if not
+his only link with the normal world, and that
+his plight is pitiful indeed if she is complaining or
+irritable or unwilling. Anyone who cares for the
+sick should remember also that she is necessarily
+in a most intimate relation with the patient,
+and that such enforced intimacy calls for<!-- Page 131 --><span class='pagenum'><a name="Page_131" id="Page_131">[131]</a></span>
+extra consideration on her part, and for the most
+scrupulous respect for confidential matters. It
+is inexcusable even for members of the patient's
+family to discuss with one another the patient's
+private concerns, or his queer or unreasonable or
+annoying ways. During sickness the skeletons
+in most people's mental closets walk forth, and
+anyone who misuses special opportunities to know
+intimate affairs can only be classed with eavesdroppers
+and village gossips.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What are the essentials of a good sick room as to:
+<ul class="sublist">
+<li>(<i>a</i>) Situation and exposure.</li>
+<li>(<i>b</i>) Lighting and heating.</li>
+<li>(<i>c</i>) Furnishing.</li>
+<li>(<i>d</i>) Ventilation.</li></ul>
+</li>
+
+<li>How may a sick room be ventilated without exposing
+the patient to draughts?</li>
+
+<li>How should the bed be placed in relation to doors,
+windows, and walls?</li>
+
+<li>How should a sick room be cleaned?</li>
+
+<li>What in general are the duties of the attendant?</li>
+
+<li>Make a plan of your own bedroom, and show what
+changes, if any, would be desirable if it were to be used as a
+sick room.</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Notes on Nursing&mdash;Florence Nightingale, Pages 1-63, 84-105.</li>
+</ul>
+
+<p><!-- Page 132 --><span class='pagenum'><a name="Page_132" id="Page_132">[132]</a></span></p>
+
+<h2><span class="sm2">CHAPTER VI</span><br />
+<br />
+BEDS AND BEDMAKING</h2>
+
+<p>The common saying that the best bed for an
+invalid is his own bed contains an element of
+truth. Taking from a patient his own accustomed
+bed, even when a better is substituted, sometimes
+disturbs him greatly and makes him feel that he
+is indeed very ill. Nevertheless, a suitable bed
+is essential to the proper care of a helpless person,
+and no patient should continue to use an unsuitable
+one, unless his illness is slight and also
+likely to be of very short duration.</p>
+
+<p>Besides being comfortable, a bed suitable for
+the sick must be clean and easy to keep in a
+sanitary condition. The springs should be firm,
+and the mattress should be elastic and should
+give an even support without lumps and hollows.
+The bed covers should be clean, light, and warm;
+the pillows should be sufficient in number not
+only to make the head and shoulders comfortable,
+but also any other part of the body in need of
+support. Moreover, the bed should be so placed
+and of such a kind that the work of caring for<!-- Page 133 --><span class='pagenum'><a name="Page_133" id="Page_133">[133]</a></span>
+the patient may be rendered as easy for the
+attendant as possible. In every household at
+least one bed suitable for a sick person should
+be available in case of need.</p>
+
+<div class="run-in">
+<h4>Bedsteads.</h4><p>&mdash;Beds of white enameled iron,
+brass, or brass and iron combined are most
+easily kept clean, and are the best in every way.
+The frame should be strong enough to stand
+firmly, yet not so heavy that it is hard to move.
+It should have as few angles as possible, and all
+its joints should be smooth and well finished.
+The springs should be made of wire stretched
+tightly on a metal frame that fits smoothly into
+the head and foot pieces. Large castors should
+be used; they may be removed from the foot
+if the bed moves too easily.</p></div>
+
+<p>A bed to be used in sickness should have the
+following dimensions&mdash;length, 6 ft. 6 in., height
+24 to 26 inches, width, 36 inches. If a bed is
+either too high or too low the labor of lifting and
+moving the patient is greatly increased. If the
+bed is too narrow the patient is insecure. If the
+bed is too wide, its center is difficult or impossible
+to reach without leaning or kneeling upon it;
+and if too short, it will prove uncomfortable
+for a tall person. A bed that is too low may be
+raised on four heavy boxes of the same height;
+or still better, upon heavy wooden blocks which<!-- Page 134 --><span class='pagenum'><a name="Page_134" id="Page_134">[134]</a></span>
+any carpenter can easily make, and which are
+well worth a little trouble to obtain. In the top
+of each block a hollow should be made into which
+the leg of the bed will fit after the castor has
+been removed. A broad firm stool or a low
+chair may be provided for a patient who has
+difficulty in getting in and out of a high bed.</p>
+
+<p>Beds with complicated attachments for moving
+patients are not recommended for family use.
+They are expensive, likely to get out of order,
+seldom needed, and generally unsatisfactory. In
+some surgical cases a bed with a firm, flat surface
+is necessary. Such a surface may be secured by
+placing between the mattress and springs two
+boards slightly separated, or one wide board
+with holes bored in it to afford ventilation.</p>
+
+<p>Wooden beds are undesirable: they are difficult
+to keep clean, they readily absorb moisture and
+odors, they cannot well be disinfected, and their
+solid frames prevent a free circulation of air.
+Moreover, it is almost impossible to render fit for
+use again a wooden bed into which vermin have
+once made their way. Folding beds and lounges
+even of the best type are unhygienic, usually too
+low for the patient's comfort, and often insecure.</p>
+
+<p>A bedstead should be wiped frequently with a
+damp cloth; if it is of enameled iron it may be
+washed with soap and water. The springs may<!-- Page 135 --><span class='pagenum'><a name="Page_135" id="Page_135">[135]</a></span>
+be cleansed with a stiff brush dipped in kerosene
+oil. Excessive use of water upon the springs
+is likely to make them rust.</p>
+
+<div class="run-in">
+<h4>Mattresses.</h4><p>&mdash;Various substances are used in
+the manufacture of mattresses, but nothing
+has yet been found that is as satisfactory as
+curled hair. It is light and clean and elastic, it
+does not readily absorb odors, and it is easily
+renovated. Although hair is more costly than
+other materials, a hair mattress may be used
+almost indefinitely if it is occasionally made
+over.</p></div>
+
+<p>Felt or cotton mattresses are firm, but heavy,
+difficult to keep clean, and likely to absorb odors. A
+useful mattress made from straw is sometimes
+found in country districts. Such a bed is
+thoroughly hygienic, for the worn straw may be
+burned and the tick washed and refilled with
+clean straw; but straw beds are generally hard
+and lumpy. The least desirable of all mattresses
+is the old fashioned feather bed, and it should
+never be used if a better can by any possibility
+be obtained; but a feather bed should not be
+arbitrarily taken away from an old person accustomed
+to its use, unless his welfare is really
+at stake.</p>
+
+<p>A mattress made in two sections is unnecessary
+for a single bed; indeed, a mattress made in one<!-- Page 136 --><span class='pagenum'><a name="Page_136" id="Page_136">[136]</a></span>
+piece is more easily kept in place if the patient
+is restless. A good quality of blue and white
+ticking makes a serviceable cover for both mattress
+and pillows since its color is not likely to run.</p>
+
+<div class="run-in">
+<h4>Care of the Mattress.</h4><p>&mdash;A mattress should be
+brushed frequently with a whisk broom, especially
+around the tufts and edges. If a patient is long
+confined to bed, a fresh one should occasionally
+be substituted so that the regular mattress may
+be removed, well brushed, beaten with a carpet
+beater, and left exposed to the sun and air for a
+day or two. A mattress that is badly soiled
+should be sent to a cleaner and made over; it
+cannot be cleaned properly at home. It is generally
+possible to remove blood stains, if they have
+not soaked through the ticking, by applying a
+thick cream made from raw starch and cold water.
+When the starch becomes dry it should be brushed
+away, and the application should be repeated until
+the stain has disappeared. For the best results
+the starch should be applied before the stain is
+dry.</p></div>
+
+<div class="run-in">
+<h4>Pillows.</h4><p>&mdash;One patient can use an almost unlimited
+number of feather pillows. Some should
+be soft and others firm, some large and some small;
+but pillows that are very large and thick are less
+useful than a greater number of smaller ones. It
+is well to have several small pillows of varying<!-- Page 137 --><span class='pagenum'><a name="Page_137" id="Page_137">[137]</a></span>
+size and thickness to support different parts of
+the body.</p></div>
+
+<p>Hair pillows are often acceptable in warm
+weather, and they are also desirable for patients
+with high fever or excessive perspiration. Rubber
+air pillows are a convenience in traveling and add
+much to the comfort of a patient when he first
+goes out in a carriage or motor car, but air pillows
+are not sufficiently durable for general use.</p>
+
+<p>If a pillow tick becomes soiled, the feathers may
+be transferred to a clean tick by making an opening
+about six inches long in the end of each pillow,
+sewing the ticks together, and then shaking the
+feathers from one tick to the other. The soiled
+tick can then be washed. If the feathers themselves
+have become soiled they should be renovated
+by a cleaner. Pillows, like mattresses, should
+be frequently brushed, sunned, and aired. They
+should not be held in the mouth while a clean
+pillow-case is adjusted.</p>
+
+<div class="run-in">
+<h4>Protection of the Mattress and Pillows.</h4><p>&mdash;In all
+cases of sickness the mattress must be adequately
+protected. Neglect is inexcusable and may cause
+expense and trouble as well as discomfort to the
+patient.</p></div>
+
+<p>The following may be used to protect the
+mattress or pillows: large quilted pads, small pads
+of cotton batting covered with old muslin or cheese<!-- Page 138 --><span class='pagenum'><a name="Page_138" id="Page_138">[138]</a></span>
+cloth, slip covers for the mattress, rubber sheets
+and pillow-cases, old blankets and quilts that may
+be washed easily. Heavy wrapping paper, builders'
+paper, and newspapers serve well in emergencies,
+or for a short time.</p>
+
+<div class="run-in">
+<h4>Rubber Sheets and Pillow-cases.</h4><p>&mdash;Soft rubber
+cloth, single or double faced, is most frequently
+used when it is necessary to protect the bed from
+discharges. It may be purchased by the yard.
+Rubber sheets should not be used unless they are
+really necessary. They are hot and uncomfortable,
+and increase the tendency to perspire.
+When used, a rubber sheet should be 1 yard wide
+or wide enough to reach from the lower edge of the
+pillows down to the patient's knees, and long
+enough so that it can be tucked in securely on
+both sides of the bed. Rubber sheets may be
+cleaned by laying them on a flat surface and washing
+on both sides with soap and water, using a
+small brush if necessary. After rinsing they
+should be wiped, and when thoroughly dry they
+should be rolled rather than folded, to prevent the
+rubber from breaking.</p></div>
+
+<p>Rubber pillow-cases are used for a patient who
+perspires profusely, or who has a discharge of any
+kind from the head or neck, and also when substances
+which may wet or stain the pillow are
+applied to the head. They should be put on next<!-- Page 139 --><span class='pagenum'><a name="Page_139" id="Page_139">[139]</a></span>
+to the pillow, securely fastened with tapes, snap
+hooks, or buttons, and covered with the regular
+pillow slip.</p>
+
+<p>Rubber sheets and pillow-cases are not durable.
+They should be used carefully, and frequently
+examined for holes or worn places by holding them
+up to the light. Even a pin hole near the center
+may render a rubber sheet or pillow-case as useless
+as a sieve.</p>
+
+<div class="run-in">
+<h4>Sheets.</h4><p>&mdash;Sheets of ample proportions are necessary
+for comfort, and important for sanitary
+reasons as well. For a bed of the dimensions
+mentioned in this lesson sheets should be three
+yards long, and two yards wide. A safe rule for
+any bed is to have the sheets one yard longer and
+one yard wider than the mattress. A sheet of
+these dimensions is large enough to be tucked
+under the sides and foot of the mattress, while at
+least twelve inches are left to fold over the blankets
+at the top. Cotton sheets are as good as
+linen for general use, or even better, and are far
+less expensive.</p></div>
+
+<div class="run-in">
+<h4>Draw sheets</h4>&nbsp;<p>are used to cover rubber sheets,
+and to protect beds when the rubbers are not used.
+In hospitals special draw sheets are usually provided,
+but an ordinary sheet folded answers every
+purpose. New and expensive sheets should not
+be used for draw sheets, since they are more<!-- Page 140 --><span class='pagenum'><a name="Page_140" id="Page_140">[140]</a></span>
+likely than other sheets to become stained. Draw
+sheets should be wide enough to extend about
+four inches beyond the rubber sheet at the top and
+bottom.</p></div>
+
+<div class="run-in">
+<h4>Pillow Covers.</h4><p>&mdash;Pillow covers are generally
+made of cotton, but persons who can afford the
+cost frequently prefer linen, especially in hot
+weather. Unless fastened with buttons or tapes,
+a pillow case should be several inches longer than
+its pillow. It should be wide enough to slip on
+easily, but not so wide that it wrinkles or allows the
+pillow to turn. If it is too small the pillow will become
+hard and uncomfortable. These small things,
+unimportant as they are to the well, may cause
+much discomfort to a restless or nervous patient.</p></div>
+
+<div class="run-in">
+<h4>Blankets.</h4><p>&mdash;All wool blankets are both light and
+warm, and are consequently the most comfortable
+bed covering. But unless they can be dry cleaned
+frequently, it is better to select blankets made
+from one part wool and two parts cotton. Blankets
+containing equal parts of wool and cotton are
+warmer, but are more injured by washing. Very
+light blankets of wool or outing flannel are useful
+in summer. Double blankets should always be
+cut in two and bound at the ends, since single
+blankets are easier than double blankets to
+handle and wash. Patients are frequently too
+warmly covered by day. Too much warmth<!-- Page 141 --><span class='pagenum'><a name="Page_141" id="Page_141">[141]</a></span>
+is enervating, it causes the patient to perspire,
+and makes him restless and more susceptible to
+draughts and to changes of temperature. Two
+light blankets are warmer and more comfortable
+than one heavy blanket.</p></div>
+
+<div class="run-in">
+<h4>Comforters and Quilts.</h4><p>&mdash;Heavy cotton comforters
+are burdensome without being correspondingly
+warm. Eiderdown quilts or those
+padded with wool are good for a patient who sleeps
+out of doors, or whose room is kept at a low temperature.
+Bed covers that cannot be laundered
+readily should be protected by basting on both
+sides of the top a wide piece of muslin or linen,
+which can be removed and washed.</p></div>
+
+<div class="run-in">
+<h4>Counterpanes.</h4><p>&mdash;White dimity counterpanes are
+desirable, since they are light in weight, easily
+laundered, and inexpensive. A heavy counterpane
+is uncomfortable at any time, and still more
+uncomfortable in sickness. If a light spread is
+not available, a sheet makes a good substitute.
+A counterpane should be wide enough to cover
+the sheets and blankets at the sides when the bed
+is open, and long enough to protect the bedding
+at the top and bottom.</p></div>
+
+<h3>BED MAKING</h3>
+
+<p>All methods of making beds for the sick are
+based upon a few underlying principles. The<!-- Page 142 --><span class='pagenum'><a name="Page_142" id="Page_142">[142]</a></span>
+aim in every case is to obtain the following results
+with the least expenditure of time and labor:
+first, to secure comfort for the patient, and to
+eliminate all causes of friction, irritation, or pressure<!-- Page 143 --><span class='pagenum'><a name="Page_143" id="Page_143">[143]</a></span>
+upon his skin; next to keep the covers firmly
+in place, so that the bed will not easily become
+disarranged; then to protect the mattress, and
+last, to secure as good an appearance as possible.</p>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig12.jpg" width="500" height="308" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 12.&mdash;The Draw Sheet in Place.</span> (<cite>From "Elementary
+Nursing Procedures," California State Board of Health.</cite>)</span>
+</div>
+
+<div class="run-in">
+<h4>To Make an Unoccupied Bed</h4><p>, proceed as
+follows: remove the pillows and covers one at a
+time, and place them on chairs, near an open
+window if possible. Brush the mattress and then
+set it up on its ends to air, or turn it back over the
+foot board. Wipe the bedstead with a damp cloth.
+Replace the mattress after it has aired, turning it
+from side to side and from end to end on alternate
+days. Cover the mattress, unless it is enclosed
+in a slip cover, with a white quilted pad or an
+old blanket, and then spread the lower sheet over
+the mattress, so that the middle fold of the sheet
+lies upon the center of the mattress in a straight
+line from the head of the bed to the foot. Tuck
+the sheet under, first at the top and then at the
+bottom, drawing it so that it is firm and tight.
+If the sheet is of proper length tuck fourteen or
+sixteen inches under at the top, but take care to
+cover the mattress at the foot also. Next tuck the
+sheet under at the side, folding its corners to
+make a neat finish like an envelope. Place the
+rubber sheet, if it must be used, across the bed,
+with its upper edge where the lower edge of the
+pillows will come. A draw sheet somewhat wider<!-- Page 144 --><span class='pagenum'><a name="Page_144" id="Page_144">[144]</a></span>
+than the rubber sheet is needed next; an ordinary
+sheet, folded once the long way of the sheet,
+may be used, with the fold toward the head of the
+bed. Tuck both rubber and draw sheet securely
+under the mattress at the side. In some cases
+the rubber sheet may be placed next to the
+mattress, and covered by the mattress pad and
+lower sheet. Place the draw sheet as directed,
+whether the rubber is used or not. After the
+lower, rubber, and draw sheets have been adjusted
+on one side of the bed, go to the opposite side,
+draw them over smoothly, and tuck them under
+the mattress as tightly as possible.</p></div>
+
+<p>Next spread the upper sheet over the bed so
+that its upper edge reaches to the upper edge of
+the mattress, and its middle crease lies over the
+middle line of the mattress, and place it right side
+down, so that the smooth side of the hem will be
+uppermost when the sheet is turned over the
+blankets. Place the blankets so that their upper
+edges lie a little higher than the place where the
+lower edge of the pillow will come, and tuck
+them in firmly at the bottom and sides. If the
+blankets are not long enough to tuck in at the
+foot, place the lower blanket as directed and
+the upper blanket five or six inches lower than
+the first. When tucked in, the upper blanket
+holds the lower one in place fairly well. Place<!-- Page 145 --><span class='pagenum'><a name="Page_145" id="Page_145">[145]</a></span>
+the counterpane evenly and smoothly, tuck it
+under at the foot, turn its corners neatly, turn its
+upper edge under the upper edge of the blankets
+and fold the upper sheet down over the whole.<!-- Page 146 --><span class='pagenum'><a name="Page_146" id="Page_146">[146]</a></span>
+Last of all, shake the pillows and place them neatly
+on the bed.</p>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig13.jpg" width="500" height="308" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 13.&mdash;The Closed Bed.</span> (<cite>From "Elementary Nursing Procedures," California
+State Board of Health.</cite>)</span>
+</div>
+
+<p>Practice is necessary before it is possible to make
+a bed quickly and well, and a certain amount of
+proficiency in making an unoccupied bed should
+be acquired before undertaking to make a bed with
+a patient in it. One should learn to work in an
+orderly way, without confusion, unnecessary motion,
+or jarring of the bed.</p>
+
+<div class="run-in">
+<h4>To Change a Patient's Pillows.</h4><p>&mdash;Stand preferably
+on the right side of the bed and slip the left
+arm under the patient's shoulders, supporting his
+head in the hollow of the arm. Raise him slightly
+and remove the pillows one at a time with the right
+hand, drawing them outward on the left side of the
+bed. Place a small pillow under his head. Shake
+the pillows, change the cases if necessary, and
+replace them on the left side of the bed, ready to be
+drawn back into position. Raise the patient as
+before, remove the small pillow and draw the
+others into place. It is sometimes better to hold
+the patient on the upper pillow while removing and
+replacing the under one.</p></div>
+
+<div class="run-in">
+<h4>Lifting a Patient in Bed.</h4><p>&mdash;Patients tend to slip
+down toward the foot of the bed, and they should
+be raised if unable to help themselves. To raise
+the patient, instruct him to flex his knees and to
+press his feet firmly upon the bed; place one arm<!-- Page 147 --><span class='pagenum'><a name="Page_147" id="Page_147">[147]</a></span>
+under his shoulders, as when changing pillows,
+the other arm under the thighs, and lift him upward
+without jerking. The lifting can be done
+more easily by two people, and with less discomfort
+to the patient: if he is entirely helpless two people
+are necessary. Two people should proceed as
+follows: Let <i>A</i> place her left arm under the
+patient's head and shoulders as before, her right
+arm under the small of his back; let <i>B</i> place her
+right arm also under the small of his back and her
+left arm under his thighs, and at a signal let them
+lift together. In this way the weight is so evenly
+distributed that a heavy person can be lifted
+without great difficulty.</p></div>
+
+<div class="run-in">
+<h4>To Turn a Patient in Bed.</h4><p>&mdash;A patient may be
+turned toward or away from you. In turning a
+patient toward you, place one hand over his farther
+shoulder and the other over his hip, and turn
+him toward you. Then flex his knees slightly.
+To turn a patient from you, pass one hand as far
+as possible under the shoulders, and the other as
+far as possible under the thighs. Then raising the
+patient slightly, draw him back toward you,
+turning him at the same time, and then flex the
+knees. Lastly place a pillow firmly against his
+back to support it.</p></div>
+
+<div class="run-in">
+<h4>To change the sheets while the patient is in
+bed</h4>&nbsp;<p>proceed as follows: First collect the fresh<!-- Page 148 --><span class='pagenum'><a name="Page_148" id="Page_148">[148]</a></span>
+linen and place it conveniently near the bed. Then
+draw the bedclothes from beneath the mattress,
+raising the mattress meanwhile with one hand to
+prevent jarring the bed. Remove first the spread
+and then the upper blanket if there are two, fold
+each once and place it on a chair. Hold the remaining
+blanket in place with one hand, while with the
+other you draw the upper sheet out from under it;
+then fold the edges of the blanket up over the
+patient to keep them out of the way. The upper
+sheet, unless soiled, may be folded once and used
+again as a draw sheet. Next remove all the pillows,
+unless the patient prefers to keep one. Then
+move the patient toward one side of the bed and
+turn him on his side so that he faces the edge
+nearest him. Roll the draw sheet and rubber
+sheet together if both are to be removed, or
+separately if the rubber sheet is to remain on the
+bed; then roll the bottom sheet throughout its
+entire length, and bring the three sheets, all rolled
+as flat and as tightly as possible, close to the
+patient's back. Pleat about half of the fresh
+lower sheet lengthwise and place the pleated portion
+as close as possible to the rolled soiled sheets.
+Tuck in the other half of the fresh sheet at the top,
+bottom and side, draw the rubber sheet if it is to
+be replaced back over the fresh lower sheet,
+arrange the fresh draw sheet in place, tuck it in at
+<!-- Page 149 --><span class='pagenum'><a name="Page_149" id="Page_149">[149]</a></span>
+<!-- Page 150 --><span class='pagenum'><a name="Page_150" id="Page_150"><br />[150]</a></span>
+the side, and roll its free portion close to the
+patient's back. The fresh side of the bed is then
+ready for the patient. Lift his feet back over the
+rolled sheets keeping his knees flexed, then turn
+him back over the rolled sheets on to the fresh
+smooth part, remove the soiled sheets and arrange
+the fresh ones in place on the side where the
+patient has just been lying. Be careful to keep
+him well covered with the blanket. After the
+lower sheets are in place and firmly tucked in,
+spread above the blanket the fresh upper sheet,
+and over the sheet spread the second blanket.
+Hold the sheet and blanket in place with one hand
+while using the other hand to draw out the first
+blanket from beneath the sheet. In this way the
+patient is constantly covered by a blanket. Place
+the blanket just removed above the other and finish
+the bed according to the directions given for an unoccupied
+bed, using special care, however not to
+draw the covers too tightly over the patient's feet.</p></div>
+
+<div class="figcenter" style="width: 345px;">
+<img class="photo" src="images/fig14.jpg" width="345" height="500" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 14.&mdash;Changing the Draw Sheet.</span> (<cite>From Pope "Home Care
+of the Sick," American School of Home Economics, Chicago.</cite>)</span>
+</div>
+
+<div class="run-in">
+<h4>To Move a Patient from One Bed to Another.</h4><p>&mdash;On
+the fresh bed have the lower sheets in place
+but not the upper covers. Place the two beds
+close together side by side, and draw one mattress
+a little over the place where the two sides meet.
+Loosen the draw sheet under the patient, roll it
+on both sides close to the body and draw him
+gently over by means of this sheet, moving his
+<!-- Page 151 --><span class='pagenum'><a name="Page_151" id="Page_151">[151]</a></span>
+<!-- Page 152 --><span class='pagenum'><a name="Page_152" id="Page_152"><br />[152]</a></span>
+shoulders at the same time. If the beds are unequal
+in height, use firm pillows or folded blankets
+to make an inclined plane.</p></div>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig15.jpg" width="500" height="366" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 15.&mdash;Changing a Patient from One Bed to Another.</span> (<cite>From Pope "Home Care of the
+Sick," American School of Home Economics, Chicago.</cite>)</span>
+</div>
+
+<p>If the beds differ greatly in height and indeed
+in most cases, it is better to carry the patient
+from one bed to the other. At least two people
+are needed; one alone should never attempt to
+carry anyone heavier than a small child. One
+method for lifting is as follows: Let two bearers,
+<i>A</i> and <i>B</i> stand on the same side of the bed.
+If the patient is to be moved into the right side
+of the fresh bed let both bearers stand on the
+right side of the occupied bed; if he is to go into
+the left side of the fresh bed, let them both stand
+on the left side of the occupied bed. Let <i>A</i> place
+one arm under the patient's shoulders and her
+other under the small of his back, while <i>B</i> places
+one arm under his hips and the other just below
+his knees. Draw the patient to the edge of the
+bed, instruct him to place his arms about the shoulders
+of <i>A</i> and to hold the body rigid, and then
+lift together at a given signal, keeping his weight
+well up on the chests of the bearers.</p>
+
+<p>Whenever a patient must be turned, lifted,
+carried, or moved in any way, let him know
+beforehand just what you intend to do so that
+he may not be startled, and also that he may
+coöperate if possible. Grasp him firmly but<!-- Page 153 --><span class='pagenum'><a name="Page_153" id="Page_153">[153]</a></span>
+gently, avoid pinching the skin, and move him
+steadily and smoothly, avoiding jerks and false
+starts. Do not attempt alone more than your
+strength is amply sufficient to accomplish, and
+endeavor at all times to handle the sick with
+the utmost gentleness and consideration.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Describe a bedstead and mattress suitable for a sick
+person's use, and tell why they are to be preferred.</li>
+
+<li>How should the bedstead be cared for? the mattress?
+the pillows?</li>
+
+<li>How should a mattress and pillows be protected?</li>
+
+<li>Describe in detail the bed covers that are desirable
+for use in sickness.</li>
+
+<li>Name the results that a good method of bedmaking
+aims to secure.</li>
+
+<li>Describe the method of making an unoccupied bed.</li>
+
+<li>How should one change the pillows of a helpless
+patient?</li>
+
+<li>Describe the way in which you would lift and turn a
+patient in bed.</li>
+
+<li>Describe the method of changing sheets and remaking
+a bed while the patient is in it.</li>
+
+<li>Why are beds and bedmaking considered so important
+in the care of the sick?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Notes on Nursing&mdash;Florence Nightingale, Pages 79-84.</li>
+</ul>
+
+<p><!-- Page 154 --><span class='pagenum'><a name="Page_154" id="Page_154">[154]</a></span></p>
+
+<h2><span class="sm2">CHAPTER VII</span><br />
+<br />
+BATHS AND BATHING</h2>
+
+<p>Bathing is necessary in sickness no less than
+in health. It stimulates and equalizes the circulation,
+is soothing in feverish conditions, is
+refreshing to most people, and by affording a
+certain amount of exercise it lessens the fatigue
+of lying in bed. Moreover, without frequent
+bathing it is impossible to keep the skin in good
+condition, since scales of dead skin, oily matter,
+and solid substances left by perspiration collect
+on the surface of the body when a person is
+lying still in bed as well as when he is leading
+an active life. The common belief that sick
+people are likely to catch cold from bathing is
+quite unfounded; every patient, unless his condition
+is such that the doctor orders otherwise,
+should have one complete cleansing bath each day.
+In addition to the regular cleansing bath other
+kinds are often prescribed as medical treatment.</p>
+
+<h3>CLEANSING BATHS</h3>
+
+<p>A <i>tub bath</i> if allowed by a patient's condition,
+is the most satisfactory kind, but special precautions<!-- Page 155 --><span class='pagenum'><a name="Page_155" id="Page_155">[155]</a></span>
+must be taken to guard her from fatigue
+and chill. The bath room and everything to be
+used should be made ready before she leaves her
+bed. Necessary clothing and toilet articles should
+be collected and arranged conveniently, a chair
+covered with a blanket and also a bath mat should
+be placed beside the tub, and the temperature
+of the bath room should be regulated so that it
+is about 70° F., or a little lower if the room is
+likely to become overheated as the bath proceeds.
+The bath water should be drawn last. Its temperature,
+tested by a thermometer, should be
+between 96° and 100° at the beginning, and may
+be increased if desirable.</p>
+
+<p>If the patient is weak, wash and dry her face,
+neck, and ears, and if necessary cut the finger and
+toe nails before she leaves the bed, in any case
+before she enters the tub. As soon as the patient
+has left the bed, strip it and leave it to air; then
+assist her into the bath room and help her carefully
+into the tub. Do not allow her to stay in the
+water more than ten minutes at most, and stop
+the bath at once if she shows the slightest sign of
+faintness, dizziness, exhaustion, difficult breathing,
+marked change of color, or other unusual
+symptom. Indeed, if the patient is weak or her
+reaction to the bath uncertain, as when she takes
+her first tub bath after an illness, someone should<!-- Page 156 --><span class='pagenum'><a name="Page_156" id="Page_156">[156]</a></span>
+always be within call to help the attendant in
+case of need. A faint, heavy patient in a
+bath tub is an impossible load for one person to
+handle.</p>
+
+<p>While the patient is in the tub, soap her well,
+brush her finger and toe nails, rinse, and rub her to
+stimulate the circulation. Then help her from the
+tub, seat her in the chair, draw the blanket closely
+about her from neck to feet, dry her with warm
+towels, exposing the body as little as possible, and,
+if she is to return to bed, put on a fresh night
+gown, and wrapper and slippers. Next place the
+lower sheet, the draw sheet, and one pillow on the
+bed as quickly as possible, help the patient into
+bed, keeping her well covered with a blanket, and
+finish making the bed. If she seems chilly, give a
+hot water bag and hot drink and leave the blanket
+next her in place. After the patient has been
+made comfortable, clean the tub and put the bath
+room in order.</p>
+
+<p>Even patients supposedly able to take tub
+baths without assistance should not lock the bath
+room door nor be left alone a long time.</p>
+
+<div class="run-in">
+<h4>Bed Bath.</h4><p>&mdash;Practice is essential in order to give
+a bed bath skillfully. The aim is to make the
+patient thoroughly clean and thoroughly dry,
+without chilling, fatiguing, or exposing her,
+without making the bed damp, and without unnecessary<!-- Page 157 --><span class='pagenum'><a name="Page_157" id="Page_157">[157]</a></span>
+haste or delay. One method of giving
+a bed bath follows, but any method that accomplishes
+these aims is likely to be satisfactory.</p></div>
+
+<p>First see that the room is about 70° F. and likely
+to remain so, and exclude draughts. Collect
+everything to be used, including a blanket to cover
+the patient, an old blanket or large bath towel to
+protect the bed, at least two other towels, one a
+bath towel and the other a face towel, two wash
+cloths, soap, nail brush, powder, alcohol, comb and
+brush, nail file, scissors, etc.; fresh bed and personal
+linen; a large basin containing water at 105°,
+a jug of hotter water, and a slop jar. Remove the
+upper bed clothes except one blanket, which
+should cover the patient constantly during the
+bath, and spread them where they will air; remove
+all the pillows but one, and place the bath blanket
+under the patient as the under sheet is placed in
+bed making. If a bath blanket is not used, keep
+the bath towel under the part that is being bathed
+by moving the towel from place to place.</p>
+
+<p>Next remove the night gown in the following
+way: Let the patient lie on her back, with her
+knees flexed; draw the gown up as far as possible,
+then raise or get her to raise her hips so that the
+gown may be drawn up above the waist. Next
+raise her head and shoulders with one arm and
+draw the night gown up to the neck with the<!-- Page 158 --><span class='pagenum'><a name="Page_158" id="Page_158">[158]</a></span>
+other; remove one sleeve, draw the gown over the
+head and then off the other arm.</p>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig16.jpg" width="500" height="397" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 16.&mdash;Washing a Patient Without Exposure.</span> (<cite>Sanders
+"Modern Methods in Nursing."</cite>)</span>
+</div>
+
+<p>The patient is now ready for the bath. Wet the
+wash cloth thoroughly, but hold it gathered in the
+hand so that it will not drip. Wash the face,
+neck, and ears first, dry them thoroughly, and
+next, using the second wash cloth, wash the arms
+and hands, chest and abdomen, giving particular
+attention to the armpits and navel. Raise the<!-- Page 159 --><span class='pagenum'><a name="Page_159" id="Page_159">[159]</a></span>
+blanket slightly with one hand to keep it from
+becoming damp, but expose the patient as little as
+possible; the arms and legs need not remain
+covered while being washed. Dry each part
+thoroughly before washing the next. Next turn
+the patient on her side and wash the back, the
+buttocks, and upper part of the thighs; give special
+attention to the fold between the buttocks.
+Then turn the patient on her back, and wash the
+thighs, legs, and feet. If it is important to move
+the patient as little as possible, leave the back
+until last so that the under sheet may be changed
+without turning her again. Cut the toe nails if
+necessary before washing, and clean them carefully
+afterward. Unless there is a reason to the
+contrary, wash the hands and the feet in the basin,
+first protecting the bed with a towel, newspaper, or
+clean wrapping paper. Be sure to clean well
+between the toes, and to dry the feet thoroughly;
+they may need some friction. Throughout the
+bath empty and refill the basin as necessary.</p>
+
+<p>Wash the genital region last. Let the patient
+lie upon her back with knees flexed and separated,
+or upon one side with the knees flexed and one
+slightly raised. Patients who are able may take
+this part of the bath themselves with whatever
+assistance may be necessary. The attendant,
+however, must either do it herself or make sure<!-- Page 160 --><span class='pagenum'><a name="Page_160" id="Page_160">[160]</a></span>
+that the patient does it thoroughly. To neglect a
+helpless patient is always unkind, and no less unkind
+when the motive is a mistaken sense of
+modesty. If discharge from the genitals is present
+use absorbent cotton, or clean, soft old cloth
+to wash the parts, and burn it afterward. It is
+sometimes desirable to place the patient on a bedpan
+and rinse the parts by a gentle stream of
+warm water poured from a jug. After the attendant
+has completed this part of the bath she
+should wash her own hands thoroughly.</p>
+
+<p>After the bath rub the patient with alcohol. If
+a complete alcohol rub is impossible, at least rub
+the points where pressure comes, especially the
+back. After the rub apply a little toilet powder
+if the patient desires it. When the toilet is complete
+remove the bath blanket, remake the bed and
+put the room in order.</p>
+
+<div class="run-in">
+<h4>Care of the Mouth and Teeth.</h4><p>&mdash;In sickness the
+mouth and teeth require more than ordinary
+attention; indeed, the condition of a patient's
+mouth is a fair index to the quality of the care she
+is receiving. If the patient can brush her own
+teeth she should do so in the morning, at night,
+and after meals. At those times the attendant,
+without waiting to be asked, should bring her a
+towel, tooth-brush, cup of tepid water, tooth paste
+or powder, and a small basin or dish to receive the<!-- Page 161 --><span class='pagenum'><a name="Page_161" id="Page_161">[161]</a></span>
+used water. The process is generally more
+thorough when the patient does it herself, and
+even a patient unable to sit up can brush her
+teeth successfully if the nurse holds the powder<!-- Page 162 --><span class='pagenum'><a name="Page_162" id="Page_162">[162]</a></span>
+and cup of water, and provides a basin shallow
+enough for the patient to use by turning her head
+to one side.</p></div>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig17.jpg" width="500" height="309" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 17.&mdash;The Nurse Assisting the Patient in Brushing the Teeth.</span>
+(<cite>From "Elementary Nursing Procedures," California State Board of Health.</cite>)</span>
+</div>
+
+<p>The attendant must cleanse the mouth of a
+patient who is unable to do it herself. If this
+cleansing is neglected, a dark tenacious substance
+collects upon the teeth and gums, composed chiefly
+of food particles, bacteria, mouth secretions, and
+worn out cells of the mucous membrane. Once
+formed it is difficult to remove, hence the mouths
+of all patients and especially those who have fever,
+must receive proper care from the very beginning
+of illness. Cotton swabs are convenient for
+cleansing the mouth; they are made by winding
+a small piece of absorbent cotton upon a match or
+wooden tooth-pick.</p>
+
+<p>To cleanse the mouth of a helpless patient, take
+to the bedside the mouth wash prescribed by the
+doctor, a towel to protect the bedclothes, several
+swabs, and a receptacle for used swabs; the latter
+should be a strong paper bag or several thicknesses
+of newspaper. Clean the tongue, gums, teeth,
+and spaces between the teeth gently but thoroughly,
+using especial care if the gums are tender.
+Dip only clean swabs in the solution, discard
+each one after using it once, and burn it afterward.
+Let the patient rinse her mouth after
+cleansing it if she is strong enough. If the mouth<!-- Page 163 --><span class='pagenum'><a name="Page_163" id="Page_163">[163]</a></span>
+is very dry, encourage her to drink more water.
+Notify the doctor if the gums and tongue crack
+or bleed since he may wish to order a special
+mouth wash. Cold cream or boracic ointment
+may be used if the lips are dry and cracked.</p>
+
+<p>False teeth should be thoroughly brushed and
+cleansed, and kept in cold water if taken out during
+the night.</p>
+
+<div class="run-in">
+<h4>Care of the Hair.</h4><p>&mdash;Long hair, if neglected,
+becomes tangled and matted in a surprisingly
+short time. Unless the patient is actually in a
+dying condition she is not too sick to have it
+properly attended to at least once a day. Before
+combing the hair protect the pillow with a towel;
+then part the hair in the middle from the forehead
+to the nape of the neck, and draw it to either side.
+Begin to comb at the ends, holding the strand of
+hair firmly in one hand placed between the head
+and the comb; in this way tangles can be removed
+without hurting. After combing and brushing
+the hair, braid it in two braids, beginning near the
+ears; draw it as tightly or loosely near the head as
+the patient prefers, but remember that tight
+braids mean fewer tangles. If the hair is heavy
+or badly tangled the patient may be too much
+fatigued to have it all combed at one time; in this
+case braid the part that has been finished and
+complete the work later.</p></div>
+
+<p><!-- Page 164 --><span class='pagenum'><a name="Page_164" id="Page_164">[164]</a></span></p>
+
+<div class="run-in">
+<h4>To Wash the Hair of a Bed Patient.</h4><p>&mdash;The hair
+of a patient can be successfully washed in bed if
+sufficient care is taken not to chill or tire the
+patient, or to wet the bed. The following articles
+are needed: one small jug of strong soap suds made
+by dissolving a pure soap in hot water, one large
+jug of hot water at about 112° F., one jug of
+cold water, a slop jar or foot tub, one long rubber
+sheet or piece of enamel cloth, and several towels
+including at least one bath towel. Let the
+patient lie as near the edge of the bed as possible.
+Roll one small towel lengthwise, place it below the
+hair at the back of the neck, bring it up above the
+ears to the forehead and pin tightly, in order to
+catch water that might wet the face and neck.
+Next make a kind of trough of the large rubber by
+rolling its long edges inward for a few inches.
+Place this across the bed under the patient's head
+so that her neck rests on the lower roll. Raise
+by means of pillows the end of the rubber trough
+that lies toward the middle of the bed, in order to
+prevent water from running into the bed or collecting
+under the patient's head. Let the other end
+of the rubber extend over the edge of the bed
+down into the slop jar or foot tub, which may be
+placed on a chair or stool. Then wash the hair
+and scalp with the soap solution, and rinse them
+thoroughly with water from the large jug. Squeeze<!-- Page 165 --><span class='pagenum'><a name="Page_165" id="Page_165">[165]</a></span>
+as much water as possible from the hair, remove
+the rubber and substitute a heavy bath towel, and
+rub and fan the hair until dry. A shampoo in bed
+is tiring. Do not attempt it unless the patient is
+strong enough to stand not only the shampoo
+itself, but also a complete change of bed clothing,
+which will almost certainly be necessary if the
+attendant has been careless or clumsy in the
+slightest degree.</p></div>
+
+<div class="run-in">
+<h4>Hot foot baths</h4>&nbsp;<p>properly speaking are medical
+treatment, but they are taken by many persons
+to relieve colds, headache, or insomnia. Let
+the patient sit, well wrapped, with her feet in
+water at about 105°, and then increase the
+temperature gradually by adding hotter water.
+Take care to add hot water slowly and not to
+pour it directly upon the patient's feet or ankles;
+otherwise she may be scalded. Mustard may
+be added to the bath water in the proportion of
+one tablespoonful of mustard to each gallon of
+water. If mustard is to be used make it into a
+smooth paste with cold water, thin the paste
+with warm water, and when thin enough to pour
+easily add it to the bath water and stir well.
+The bath may continue for 10 to 20 minutes, and
+the feet should be dried afterward without
+friction. The patient should go to bed at once;
+she should not wander about, clearing away her<!-- Page 166 --><span class='pagenum'><a name="Page_166" id="Page_166">[166]</a></span>
+foot bath, doing forgotten things, getting herself
+chilled, and losing all the good effects.</p></div>
+
+<p>A foot bath may be given easily to a patient
+in bed. Bring to the bedside a blanket, a towel,
+the tub filled with water, and something with
+which to protect the bed; this may be a rubber
+sheet, bath towel, old blanket folded, or several
+thick clean newspapers. Loosen the upper covers
+at the foot of the bed, fold them back above the
+patient's knees, and cover her legs and feet with
+the extra blanket making it overlap the bed
+clothing so that it will not slip. Flex the patient's
+knees, put the bed protector under her feet,
+place the tub on the side of the bed, raise the legs
+and feet with one hand and arm, and slide the
+tub into place with the other, raising the elbow
+in such a way that it keeps the blanket out of
+the water. Lower the feet slowly into the water,
+fold the towel, and place it over the edge of the
+tub in order to protect the patient's knees from
+the cold rim; then tuck the blanket closely about
+the tub and legs and proceed as before. After
+the bath use the towel, unless it is wet, to receive
+the feet when they are withdrawn from the tub.
+Remove the tub, dry the feet thoroughly, cover
+them warmly, and remake the bed.</p>
+
+<div class="run-in">
+<h4>Cool Sponge Bath.</h4><p>&mdash;For feverish patients
+doctors often order cool sponge baths. In order<!-- Page 167 --><span class='pagenum'><a name="Page_167" id="Page_167">[167]</a></span>
+to give a cool sponge bath, first protect the bed
+thoroughly, but leave the patient uncovered
+except for a towel laid over the hips. Use cool
+water, or cool water and alcohol, and have the
+wash cloth as wet as it can be without dripping.
+Bathe the body without friction, using long,
+light strokes, and leave each part wet until the
+bath has been completed. Do not use soap.
+Sponge in this way the arms, legs, chest, and
+back, but not the abdomen, for ten to twenty
+minutes, giving special attention to the neck
+and inner side of the arms and legs, because in
+those places large blood vessels lie nearer the surface
+of the body. After finishing the bath dry the
+body by patting it gently with towels.</p></div>
+
+<p>Take the patient's pulse occasionally during the
+bath, and stop the bath at once if the patient's
+pulse grows weaker, if she shivers violently,
+or if her face, fingers, or toes turn a bluish color.
+Babies react rapidly to cool sponging; for a baby
+use tepid water, sponge for five minutes only,
+and watch the child closely during the bath.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What may a bath be expected to accomplish in
+addition to cleansing?</li>
+
+<li>In giving a tub bath, what precautions should be
+taken to avoid chilling the patient? to avoid tiring the
+patient?</li>
+
+<li><!-- Page 168 --><span class='pagenum'><a name="Page_168" id="Page_168">[168]</a></span>
+What symptoms would lead you to think that a
+tub bath was not agreeing with a patient? What should
+you do in such a case?</li>
+
+<li>Name six essentials of a skillfully given bed bath.</li>
+
+<li>What preparations should be made and what articles
+assembled before beginning a bed bath?</li>
+
+<li>Describe the method of bathing a patient in bed.</li>
+
+<li>What care should the mouth and teeth of every
+sick person receive? How should such care be given to
+a patient who is helpless?</li>
+
+<li>Describe the daily care of a patient's hair, and tell
+how a shampoo may be given to a patient in bed.</li>
+
+<li>How should you give a mustard foot bath to a
+patient in bed?</li>
+
+<li>When and how should you give a cool sponge
+bath?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>The Human Mechanism&mdash;Hough and Sedgwick, Chapter XI.</li>
+</ul>
+
+<p><!-- Page 169 --><span class='pagenum'><a name="Page_169" id="Page_169">[169]</a></span></p>
+
+<h2><span class="sm2">CHAPTER VIII</span><br />
+<br />
+APPLIANCES AND METHODS FOR THE
+SICK-ROOM</h2>
+
+<p>Patients who are confined to bed even for a few
+days often suffer acutely from muscular tension,
+from pressure, and from fatigue due to lack of
+exercise. Indeed, many a sick person is surprised
+to find that the bed which had seemed so infinitely
+desirable can change into a place of torment after
+a few short days of illness. "Bed-weariness" is
+hard to bear in any case of illness, but it is doubly
+hard for persons who are really helpless.</p>
+
+<p>Unless the patient is an experienced sufferer he
+often has no idea what should be done to make him
+comfortable; while an equally inexperienced helper,
+though full of good will, is often discouraged to
+find that the arrangement she had thought perfect
+soon fails to satisfy her restless patient. But if
+she is willing to devote thought and ingenuity to
+removing small annoyances, she can do many
+things to alleviate his misery.</p>
+
+<div class="run-in">
+<h4>Bed sores</h4><p>, or pressure sores, are caused by continued
+pressure upon the skin. The weight of the<!-- Page 170 --><span class='pagenum'><a name="Page_170" id="Page_170">[170]</a></span>
+body, or of a part of the body, if it comes for a
+long time upon one place finally interferes with
+the circulation in the tissues on which the part
+rests, and consequently interferes with the nutrition
+of the affected part. Any tissue to which the
+blood is not bringing all its necessary food supply
+tends to lose its tone, to become weak, and if the
+condition persists, to break down altogether.</p></div>
+
+<p>The direct cause of bed sores then is pressure,
+and pressure is aggravated by moisture, wrinkles
+in the bed clothes, crumbs or other hard particles,
+lack of cleanliness, friction of any kind, or by rough,
+careless handling. Bed sores occur most often
+over bony prominences, such as the end of the
+spine, elbows, heels, shoulders, hips, ankles, and
+knees, but they may form anywhere, even on the
+ears or back of the head. They are more likely to
+appear on thin, aged, or depleted patients. These
+painful and serious sores can be prevented almost
+always by faithful care. When they occur, they
+result in the great majority of cases purely from
+negligence, and a person who knows the danger
+and yet through carelessness allows one to develop
+upon a patient may justly feel herself disgraced.</p>
+
+<p>Prevention of bed sores depends upon keeping
+the skin dry and clean and upon relieving pressure
+by special devices and by turning the patient
+frequently. The parts where pressure comes<!-- Page 171 --><span class='pagenum'><a name="Page_171" id="Page_171">[171]</a></span>
+should be washed at least twice daily with warm
+water and soap, rubbed frequently with alcohol to
+improve the circulation and to keep up the tone of
+the skin, and powdered with a little good toilet
+powder. Much powder is likely to do harm by
+collecting in hard, irritating particles. The bed
+should be kept constantly dry and smooth, and
+free from crumbs, lumps, wrinkles, or other inequalities.
+Prolonged pressure should be relieved
+by turning the patient often,&mdash;once every waking
+hour is not too often if the body is emaciated,&mdash;and
+by pillows, pads, and rings.</p>
+
+<p>Small pillows or thick pads of cotton should be
+placed under the patient's back and shoulders,
+between the knees and ankles when he lies on his
+side, and in other places where sores are likely to
+develop. Rubber rings are useful, but few patients
+like them for a long time. They should not be
+inflated more than necessary to raise the affected
+part from the bed; if much inflated, they are uncomfortable
+and may do harm. The ring may be
+covered with a muslin pillow case, or it may be
+wound smoothly with long strips of bandage or old
+muslin. Ordinary cotton batting wound with
+strips of muslin may be made into rings and used
+to remove pressure from heels, elbows, or other
+parts. These cotton rings are less heating than
+pads, and give better support.</p>
+
+<p><!-- Page 172 --><span class='pagenum'><a name="Page_172" id="Page_172">[172]</a></span>
+The first sign of a bed sore is either redness of the
+skin or a dark discoloration like a bruise. Every
+point where a bed sore may form should be inspected
+daily. If the slightest symptom of a sore
+appears, the patient must not lie on the affected
+part, and every effort should be made to keep the
+skin from breaking; vigorous rubbing at this stage
+is dangerous, and will by no means make up for
+previous neglect. The condition should be reported
+to the doctor at once. If in spite of all
+efforts the skin does break, a peculiarly difficult
+kind of open wound results which must be treated
+and dressed according to the doctor's directions.</p>
+
+<div class="run-in">
+<h4>Devices to Give Support.</h4><p>&mdash;The variety and
+number of pillows one patient can use is almost
+unlimited. A weak patient when lying on his side
+should have his back supported by a pillow. When
+he lies on his back a pillow should be placed under
+his knees to lessen muscular tension, and if he
+may be raised in bed, several pillows are needed to
+support him comfortably. A back rest is useful
+for a patient who can sit up in bed. Satisfactory
+back rests of several types can be purchased, or
+one may be improvised from a straight chair
+placed on the bed bottom side up, so that its legs
+lie against the head of the bed and its back forms
+an inclined plane. Back rest and chair alike
+should be covered by several pillows to make them<!-- Page 173 --><span class='pagenum'><a name="Page_173" id="Page_173">[173]</a></span>
+comfortable, and other pillows should be used to
+support the patient's arms.</p></div>
+
+<p>A person who is sitting up in bed always tends
+to slip down toward the foot. This tendency
+may be corrected by using a foot rest, knee pad,
+or pillow. A hard pillow may be placed in
+the bed at the foot for the patient to brace his
+feet against; or a short board, well padded, may
+be arranged as follows for the feet to rest against:
+Fasten ropes to the board, as the ropes of a swing
+are fastened to the seat; set the padded board
+on edge at a convenient point below the patient's
+feet, and hold it in place by tying the ropes of
+the "swing" to the head of the bed. A pillow
+may be used in the same way, either at the feet
+or under the knees, by folding it over a long strip
+of muslin, the ends of which are then tied to the
+sides of the bed, brought up to the head, and there
+tied to prevent slipping. A cylindrical cushion
+six or eight inches in diameter and as long as an
+ordinary pillow, stuffed with firm material, may
+also be used for this purpose. It should be
+held in place by strips of strong muslin or ticking
+sewed to the ends of the cushion and tied to
+the head of the bed. The cushion should have
+a washable cover.</p>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig18.jpg" width="500" height="375" alt="" title="" />
+<span class="caption">
+<span class="smcap">Fig. 18.&mdash;Showing Foot-sling for Supporting Patient
+in the Upright Position.</span> (<cite>Sanders "Modern Methods in
+Nursing."</cite>)</span>
+</div>
+
+<p>Supports called <i>bed cradles</i> are used to keep the
+weight of the bed covers from sensitive parts of<!-- Page 174 --><span class='pagenum'><a name="Page_174" id="Page_174">[174]</a></span>
+the body, generally the feet or abdomen. They
+are semi-circular pieces of wood or iron fastened
+together so that they will stand up. A satisfactory
+cradle may be improvised as follows:
+Cut a barrel hoop in two, cross the halves at
+right angles and tie them together firmly; place
+the cradle over the affected part under the bed
+clothes. A smaller cradle may be made by taking
+sections that are less than half of the barrel
+hoop. If used for one foot only, the cradle should<!-- Page 175 --><span class='pagenum'><a name="Page_175" id="Page_175">[175]</a></span>
+be small enough not to interfere with the motion
+of the other foot; if used for both feet, it should
+be large enough to allow some freedom of motion.
+Since the cradle leaves an air space, the feet
+should be wrapped in a piece of soft flannel.
+A cradle used for the protection of the abdomen
+should extend a little beyond the body on each
+side.</p>
+
+<div class="figcenter" style="width: 300px;">
+<img src="images/fig19.png" width="300" height="233" alt="" title="" />
+<span class="caption smcap">Fig. 19.&mdash;Adjustable Bed Rest.</span>
+</div>
+
+<p>Adjustable tables are convenient for patients
+who are able to sit up in bed. These tables are
+supported on one side only so that they may extend
+over the bed. Another kind of bedside
+table has short legs and stands directly on the
+bed. Such a table can easily be made at home
+from a wide board with supports six or eight<!-- Page 176 --><span class='pagenum'><a name="Page_176" id="Page_176">[176]</a></span>
+inches high nailed to each end. A lap board supported
+by heavy books may serve for temporary
+use. Indeed, home-made substitutes are often as
+good as expensive apparatus or even better. If
+sick-room appliances must be bought, it is well to
+remember that simple standard designs are best.
+Complicated apparatus is soon out of order, and is
+generally a trial both to the patient and to those
+who must adjust it. Persons taking care of
+chronic patients may often obtain valuable suggestions
+in regard to appliances by consulting
+a visiting nurse or the superintendent of the local
+hospital.</p>
+
+<div class="figcenter" style="width: 234px;">
+<img src="images/fig20.png" width="234" height="300" alt="" title="" />
+<span class="caption smcap">Fig. 20.&mdash;Adjustable Table.</span>
+</div>
+
+<div class="run-in">
+<h4>Bedpans</h4>&nbsp;<p>are utensils to receive bowel and bladder
+discharges of patients lying in bed. Enamel<!-- Page 177 --><span class='pagenum'><a name="Page_177" id="Page_177">[177]</a></span>
+bedpans are better than porcelain, although more
+expensive. The shape known as the "Perfection"
+is best for general use. A "slipper" bedpan,
+although harder to clean and ordinarily
+less comfortable, may be preferable if it is especially
+difficult or undesirable to raise the patient.
+The square or douche pan is preferred by some
+people, and is especially useful when the quantity
+of discharge is large, as after an injection.</p></div>
+
+<p>When a patient asks for the bedpan it should
+be brought if possible without a moment's delay,
+not only because no other form of neglect makes
+a patient realize her helplessness more acutely,
+but also because the desire to use it often passes
+quickly and delay may encourage the habit of
+constipation. If the patient does not ask for
+the bedpan, the attendant should offer it at
+suitable times. Bedpans should be warmed
+before use. An easy way to warm one is to let
+hot water run over it; the outside should afterward
+be dried.</p>
+
+<p>To place the bedpan, first flex the patient's
+knees and push the night gown up; place one hand
+under the patient's hips, raise them slightly,
+and with the other hand slip the pan into place.
+If the patient is entirely helpless two persons
+are needed to lift her. Place a pad or folded
+cloth between the patient's back and the pan;<!-- Page 178 --><span class='pagenum'><a name="Page_178" id="Page_178">[178]</a></span>
+then lower the patient gently. Before removing
+the pan, bring toilet paper, water and two pieces
+of soft old muslin or gauze. A patient, if able,
+prefers to use the toilet paper without assistance;
+her hands should afterward be thoroughly washed.
+If she is unable, the attendant must do everything
+needed. After the patient has been cleaned
+as thoroughly as possible with paper raise her
+hips with one hand and then remove the pan;
+it is important to raise her first because the skin
+often adheres and may be injured if the pan is
+suddenly pulled away; carelessness in managing
+the bedpan has caused more than one bed sore.
+Then remove the pan with one hand and cover
+at once. Turn the patient, if helpless, on her side,
+wash the parts with one piece of old muslin,
+thoroughly dry them with the other, and either
+burn or thoroughly wash both pieces afterward.</p>
+
+<p>Empty the bedpan and clean it at once; ordinarily
+one can clean it without wetting or soiling
+the hands. Use cold water first, removing all
+adhering solid particles with a tightly rolled
+piece of toilet paper. Do not use a brush for
+this purpose. After using cold water, rinse the
+pan thoroughly in hot water, and at least once a
+day wash it well in hot soapsuds. Directions for
+disinfecting the pan will be given later, but remember
+that a properly kept pan needs no deodorant<!-- Page 179 --><span class='pagenum'><a name="Page_179" id="Page_179">[179]</a></span>
+solution. Glass urinals should be provided for
+men, and kept clean in the same way. Contents
+of both bedpan and urinal should always be carefully
+inspected; neither should be emptied in the
+dark.</p>
+
+<h3>DAILY ROUTINE IN THE SICK-ROOM</h3>
+
+<p>Obviously the routine of a patient's day must
+vary according to her condition, her preferences,
+and the amount of time the attendant has to give
+her. The temperature, pulse, and respiration
+must be taken and all medicine, nourishment, and
+treatment given at the exact times ordered, but
+the attendant should learn whether or not the
+doctor wishes her to wake the patient for food or
+treatment. Good management in the sick-room
+depends upon foresight and planning, and therefore
+it is well to keep in mind the following
+suggestions:</p>
+
+<p>Vitality is lowest in the early morning, hence
+baths and treatments, especially if they are fatiguing
+or painful, should if possible be left until after
+breakfast. Patients often wake early and wait,
+weak and miserable, for the day to begin. A hot
+drink at this time may give relief and enable the
+patient to sleep again. Even though breakfast
+time is near, nourishment should be given as soon
+as the patient wakes. She may not admit that<!-- Page 180 --><span class='pagenum'><a name="Page_180" id="Page_180">[180]</a></span>
+she is hungry, but her nourishment should not be
+delayed until the family breakfast is ready, or still
+worse, finished.</p>
+
+<p>Before breakfast the bedpan should be offered,
+the patient's face and hands should be washed,
+her teeth brushed, her hair tidied, the bed straightened,
+and the room put in order. These services
+should require a few minutes only. The room if
+properly arranged at bed time needs only a little
+attention now unless untidy work has gone on
+during the night; disorder in a sick-room is as
+unnecessary in the early morning as at any other
+time.</p>
+
+<p>After the patient has finished her breakfast she
+may rest, or if allowed, read her mail or the newspaper
+while the attendant prepares for her day's
+work; about an hour after breakfast the patient
+should be bathed, unless she prefers her bath in
+the evening. After the bath some form of light
+nourishment should be given, even to a patient
+who has regular meals. If a patient is able to
+sit up in a chair, the best time for her to do so is
+generally just after the bath and toilet have been
+completed; but if she feels tired she had better
+wait until afternoon. The bed room can be
+better aired and cleaned if it is possible to take her
+into another room; and she herself generally
+profits by a change of scene.</p>
+
+<p><!-- Page 181 --><span class='pagenum'><a name="Page_181" id="Page_181">[181]</a></span>
+The doctor should definitely state when and for
+how long a patient may sit up for the first time
+after an illness, and an amateur who may be
+ignorant of the dangers involved should not assume
+the responsibility of deciding. When a
+patient is to sit up for the first time, put on her
+stockings, slippers, and wrapper before she leaves
+the bed. Arrange an arm chair with pillows in
+the seat and at the back, bring it close to the
+bedside and cover it with a large blanket unfolded.
+The chair may face either the head or the foot of
+the bed. Help the patient to a sitting position on
+the extreme edge of the bed, with her feet hanging
+down. Next, standing in front of her and supporting
+her well, let her slip down until she stands
+upon her feet, then let her turn, and gently lower
+her into the chair. See that the patient while
+sitting up is warmly covered, and that her foot-stool,
+pillows, etc., are adjusted comfortably.
+Move her chair so that the outlook may be as
+interesting as possible, and at least a little different
+from the view from the bed. Most patients like
+to look out of the window; children and old people
+enjoy it particularly.</p>
+
+<p>If the patient shows signs of fatigue, she should
+go back to bed even before the appointed time.
+To help her back to bed, reverse the process of
+helping her out. A footstool may be needed<!-- Page 182 --><span class='pagenum'><a name="Page_182" id="Page_182">[182]</a></span>
+if the bed is high, or two people to lift her if she is
+weak or heavy. When a patient is in bed no
+one should ever sit on the bed, lean against it,
+use it as a table for folding linen, making pads,
+etc., take hold of the bed posts in passing, or
+touch the bed unnecessarily in any way.</p>
+
+<p>The best time for visitors is the last of the morning
+or the early afternoon. A judicious visitor
+may do an immense amount of good, especially
+to a chronic patient; indeed, she may be the only
+ray of light in a dark day. Subjects of conversation
+should be pleasant, but not too stimulating
+or exciting. The visitor should be prepared to
+carry the burden of the conversation, to drop
+topics skillfully that seem to involve fatigue or
+excitement, and either to go or to stop talking if
+the patient seems tired. Visitors should remember
+to talk naturally and cheerfully on ordinary
+topics, and to avoid excessive sympathy and
+labored attempts to cheer the patient. They
+should also remember that few patients bear well
+even the mildest forms of teasing. The patient's
+room is not the place to discuss personal or family
+troubles; yet it is only too often chosen for such
+purposes, probably because the complainer knows
+that in it an audience is always to be found.</p>
+
+<p>Visitors not belonging to the family should not
+be present in the sick-room during treatment of<!-- Page 183 --><span class='pagenum'><a name="Page_183" id="Page_183">[183]</a></span>
+any kind, unless their help is required; neither,
+as a rule, should they stay during the patient's
+meals. A member of the family may stay with
+advantage if the patient tires of eating alone, but
+casual visitors almost invariably offend by undue
+urging if the patient's appetite is poor, or by facetious
+remarks if it is good.</p>
+
+<p>Ordinarily only one visitor should be admitted
+at a time, since a weak patient may be tired merely
+by looking from one to another. If it is desirable
+to limit the call, the attendant should tell the
+visitor beforehand how long to stay, or arrange a
+signal for the visit to end. To announce baldly
+in the sick-room that the patient is tired and the
+visitor must go, will only elicit aggrieved protests
+from both. In illness lasting only a day or two
+all visitors should be discouraged; during colds,
+because they are communicable; during general
+fatigue, headaches, digestive upsets, and painful
+menstruation, because rest and quiet are highly
+desirable. Visitors at such times too frequently
+give injudicious sympathy, and may actually
+delay the recovery of patients who enjoy playing
+the rôle of interesting invalid.</p>
+
+<p>The time when a trustworthy visitor is present
+may be the best time for the attendant to rest.
+The patient should be told when the attendant is
+going, and approximately when she will return.<!-- Page 184 --><span class='pagenum'><a name="Page_184" id="Page_184">[184]</a></span>
+It is a mistake to slip away while the patient sleeps;
+she seldom fails to wake before the time scheduled
+and to resent the desertion. Surprises of any
+kind, pleasant or unpleasant, are seldom good for
+patients.</p>
+
+<p>Toward the end of the afternoon the patient
+is probably tired, especially if she has not slept
+during the day. When fever is present her headache
+and restlessness increase as the day goes on,
+but it should be remembered that uncomfortable
+beds and too heavy covers cause much of the
+restlessness attributed to fever. Rubbing the
+back and legs with alcohol, giving a tepid sponge
+bath, remaking the bed or changing her position
+may help to soothe her.</p>
+
+<p>The evening should be kept free from excitement,
+and every possible effort should be made
+to encourage sleep. It is a mistake to think that
+a better night results from keeping a sleepy
+patient awake all the evening; sick people should
+sleep when they can. Just before bedtime the
+attendant should prepare her own cot, and then
+make the following preparations for the patient
+to sleep: wash the patient's face and hands or
+give a sponge bath if it is desired, brush the hair,
+change the night gown, brush crumbs from the
+bed, tighten the sheets or remake the bed if necessary,
+rub the back and other pressure points<!-- Page 185 --><span class='pagenum'><a name="Page_185" id="Page_185">[185]</a></span>
+with alcohol, shake the pillows, give liquid nourishment,
+preferably hot, cleanse the mouth, and
+give the bedpan. See that the patient's feet are
+warm, the bed covers right, the room ventilated
+properly and in good order, and the light extinguished
+or arranged for the night. If the patient
+is inclined to be wakeful a hot foot bath may
+help her, or sponging the entire length of the spine
+for fifteen minutes, using very hot water and long
+downward quiet strokes. No conversation should
+be encouraged during preparations for the night.
+Patients in bed all day often lose the habit of
+sleeping at the regular time, and lie awake far into
+the night from a vague feeling that someone else
+is coming or something further is to be done for
+them. Consequently last of all ask the patient
+if she wants anything more; if not, say good-night,
+go out and stay out, at least until she has
+had a chance to go to sleep. She is thus helped to
+realize that nothing further is likely to happen,
+and that it is time to go to sleep.</p>
+
+<p>Toward morning the patient grows weaker.
+More bed covers will probably be needed, and
+they may often be added without waking her.
+Night at the best is a dreary time for the sick.
+Pain and weariness and discouragement are less
+bearable in the darkness; nervous fears and morbid
+fancies defy control. Never is kindness more<!-- Page 186 --><span class='pagenum'><a name="Page_186" id="Page_186">[186]</a></span>
+needed or more appreciated than it is by those who
+lie awake and watch for the morning.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Name all the causes, direct and indirect, of pressure
+sores.</li>
+
+<li>Why are pressure sores generally more serious than
+injuries of equal extent to the skin of a well person?</li>
+
+<li>Where are pressure sores most likely to occur and
+what are their symptoms?</li>
+
+<li>What measures should be employed to prevent
+pressure sores?</li>
+
+<li>Describe ways to support a person lying down in
+bed.</li>
+
+<li>Describe ways to support a person sitting up in
+bed.</li>
+
+<li>How may the weight of the bedclothes be removed
+from any particular part of the body?</li>
+
+<li>How should a bedpan be cared for?</li>
+
+<li>Describe in detail a day's routine either of yourself
+the last time you were ill in bed, or of another patient
+personally known to you. Could the plan of the day have
+been improved, and if so, in what ways?</li>
+</ol>
+
+<p><!-- Page 187 --><span class='pagenum'><a name="Page_187" id="Page_187">[187]</a></span></p>
+
+<h2><span class="sm2">CHAPTER IX</span><br />
+<br />
+FEEDING THE SICK</h2>
+
+<p>Substances used for food are generally grouped
+into three classes, called the three nutrients. The
+nutrients are: first, the proteids or nitrogenous
+substances, which are found in meat, fish, eggs,
+milk, cheese, peas, beans, etc.; second, the carbohydrates,
+which include sugars and starch; and
+third, the fats, which are found in butter, oil, the fat
+of meat, etc. In addition to the nutrients, water
+and certain mineral salts are essential to life,
+while some indigestible material like the fibre of
+vegetables is needed to give bulk and to stimulate
+the action of the intestines.</p>
+
+<p>The nutrients furnish the body with materials
+for growth, and for repair of tissues worn out by
+use; they also furnish fuel substances from which
+the body obtains its heat and its energy. All
+three nutrients can serve as fuel, but the proteids
+alone can furnish materials for growth and repair
+of tissues. In order to be used by the body for
+any purpose, nutrients must first go through a
+series of complicated changes known as digestion,<!-- Page 188 --><span class='pagenum'><a name="Page_188" id="Page_188">[188]</a></span>
+which renders them soluble so that they can soak
+through the walls of the intestine.</p>
+
+<h3>THE DIGESTIVE PROCESS</h3>
+
+<p>Digestion begins in the mouth. There the
+food is crushed and its fibres separated by the
+teeth, it is moistened by the saliva, and substances
+in the saliva begin a chemical action upon the
+starch. Chewing should be sufficient to reduce
+the food to a soft mass well moistened with saliva.
+Slow eating is desirable, but the emphasis should
+be placed on thorough chewing. For instance,
+long intervals between bites are of no special benefit
+if mouthfuls of food are washed down by swallows
+of water.</p>
+
+<p>After it has been swallowed, the food passes into
+the stomach and remains there for a variable
+length of time, while it undergoes further preparation
+for absorption. It is moved about by the
+contraction of the muscular walls of the stomach,
+so that it becomes mixed with the stomach juices
+and more thoroughly softened. Some digestion
+of proteids goes on in the stomach, and a little
+absorption through the walls.</p>
+
+<p>Little by little the food is discharged from the
+stomach into the small intestine, and the most
+important part of digestion then begins. It is
+acted upon chemically by a fluid flowing into the<!-- Page 189 --><span class='pagenum'><a name="Page_189" id="Page_189">[189]</a></span>
+intestine from an organ called the pancreas; this
+pancreatic juice acts upon all three nutrients and is
+of great importance in the digestive process. The
+bile and other juices that flow into the intestine
+perform important functions also.</p>
+
+<p>The food masses are moved along by rhythmic
+contractions of the intestine, and absorption goes
+on when the food has been so changed that it can
+soak through the intestinal walls into the blood
+and lymph vessels. The small intestine is about
+20 feet long, and consequently affords a large
+surface for absorption, as does also the large intestine,
+into which the small intestine opens. The
+blood and lymph carry the digested food substances
+to all parts of the body, and thus the different
+tissues are provided with the materials they
+need for growth, repair, and energy. Excess of
+food substances may be stored as fat or expelled
+from the body.</p>
+
+<p>As the blood and lymph go through the tissues
+they take from the tissues the refuse, or the part
+that remains after the fuel substances have been
+consumed. This refuse from the tissues may be
+likened to the ashes from a furnace; it is finally
+eliminated from the body through the kidneys and
+lungs, and to some extent through the skin and
+bowels. The part of the food that is not digested
+of course never soaks through the intestinal walls;<!-- Page 190 --><span class='pagenum'><a name="Page_190" id="Page_190">[190]</a></span>
+it merely passes through the small and large intestines
+and is finally expelled as feces or bowel
+movements. The characteristic odor of fecal
+matter results from the action of bacteria upon it
+while in the large intestine.</p>
+
+<p>It must be remembered that the body is not
+nourished merely by swallowing food: in order to
+nourish the body food must also be digested, absorbed,
+and made use of by the tissues. Many
+factors may operate both in health and in sickness
+to render food indigestible. It may be originally
+unsuited to the human digestive apparatus, or
+spoiled, or poor in quality, or badly cooked. But
+even when wholesome in itself it may be ill-adapted
+to a particular person at a particular time;
+thus it may be too great in amount, or eaten at
+improper hours. Moreover a person's own idiosyncrasy
+or manner of living or fatigue or illness
+may render it especially indigestible for him.</p>
+
+<p>Experiments have shown that pain, fear, worry,
+and other unpleasant emotions actually stop the
+action of the digestive juices and check muscular
+contractions of the small intestine. Furthermore,
+even the absence of pleasant anticipation of food
+has been shown to delay digestion for hours.
+Thus scientific knowledge confirms our common
+experience that such mental states seriously
+interfere with digestion. The converse is also<!-- Page 191 --><span class='pagenum'><a name="Page_191" id="Page_191">[191]</a></span>
+true. Agreeable taste and odor of food, or even
+pleasurable thought of it, start the secretion of
+digestive fluids. It is a common saying that the
+mouth waters at the prospect of inviting food, but
+it is less well known that appetizing food does
+actually start the stomach juices also. A person
+who understands the physiological effect that the
+emotions have upon digestion is in a far better
+frame of mind to cope successfully with the difficulties
+of feeding the sick than one who considers
+sick persons' likes and dislikes entirely irrational.</p>
+
+<h3>FEEDING THE SICK</h3>
+
+<p>Nourishing the sick is not always an easy problem,
+but its importance can hardly be overestimated.
+Indeed, proper feeding in many illnesses
+makes the difference between life and death. The
+actual amount of nourishment needed in sickness
+is often less than in health, but it may be just as
+great, or even greater if the illness causes increased
+tissue waste. Yet the digestive process of a sick
+person must be rendered as little laborious as
+possible, all foods ordinarily difficult to digest must
+be eliminated, certain others must be withheld or
+restricted according to the nature of the sickness,
+and in addition one may have to deal with an
+appetite that is capricious, diminished, or totally
+absent.</p>
+
+<p><!-- Page 192 --><span class='pagenum'><a name="Page_192" id="Page_192">[192]</a></span>
+Diet for the sick is often a part of medical
+treatment; in such cases the doctor will prescribe
+special diets and his orders must be carefully
+carried out. Except for special diets, food for the
+sick is generally divided into four classes: first,
+liquid or fluid diet; second, semi-solid diet; third,
+light or convalescent diet; and lastly, full diet.
+These diets are not very sharply distinguished.</p>
+
+<div class="run-in">
+<h4>Liquid diet</h4>&nbsp;<p>generally includes milk, eggnog,
+albumen water, broths, soup, beef juice, thin
+gruel, and beverages. Liquid diet makes least
+demand upon the digestive powers, because it consists
+of food already dissolved and therefore nearer
+the condition in which it can be absorbed. Moreover,
+it is less likely than other foods to contain
+excess of fat, improperly cooked starches, and other
+indigestible material. Liquids must be given at
+regular intervals and at shorter intervals than
+solid foods; 6 to 8 ounces every two or three hours
+is not too much if the patient can take it. The doctor
+usually specifies the amount and the interval.
+Some patients will take more nourishment at one
+time if the interval is slightly increased.</p></div>
+
+<div class="run-in">
+<h4>Semi-solid diet</h4>&nbsp;<p>includes all fluids and in addition
+soft milk toast, soft cooked eggs, well cooked
+cereal, custards, ice cream and ices, junket, and
+gelatine jellies. Liquid or semi-solid diet is commonly
+given in acute fevers because digestive<!-- Page 193 --><span class='pagenum'><a name="Page_193" id="Page_193">[193]</a></span>
+juices and other fluids of the body are then diminished,
+and also because their digestion places a
+minimum of work upon a system already burdened
+with bacterial poisons.</p></div>
+
+<div class="run-in">
+<h4>Light or convalescent diet</h4>&nbsp;<p>generally means a
+simple mixed diet. In addition to the articles in
+the two preceding diets it includes oysters, chicken,
+baked potatoes, most fruits except bananas, simple
+desserts, white fish, and other meats and vegetables
+added judiciously until full diet is reached. Fried
+foods should not be included.</p></div>
+
+<div class="run-in">
+<h4>Full diet</h4>&nbsp;<p>means an unrestricted menu, but even
+from full diets especially indigestible foods should
+be excluded. The principles of feeding sedentary
+persons as described in manuals of dietetics apply
+to patients who are obliged to be inactive although
+not really ill, as for example, a patient suffering
+from a broken leg. Ordinarily in such cases, as in
+other kinds of illness, the appetite is greatly
+diminished, but a word of warning should be given
+against overfeeding patients whose meals are their
+chief interest. Such patients are only too likely
+to interpret full diet as anything they desire in any
+quantity at any time of day or night, and then to
+attribute their discomfort and irritability to their
+illness rather than to overeating.</p></div>
+
+<p>Constipation is especially stubborn in sickness,
+since the patient is deprived of his usual exercise<!-- Page 194 --><span class='pagenum'><a name="Page_194" id="Page_194">[194]</a></span>
+and variety of food. So far as possible the bowels
+should be regulated by diet. Laxative foods
+include most vegetables with a large amount of
+fibre, coarse cereals and flour, oils and fats, and
+most fruits and fruit juices. Unfortunately many
+laxative foods are difficult for sick persons to digest
+and must therefore be used with caution. A glass
+of hot or cold water or orange juice an hour before
+breakfast may be helpful, and at bed time hot
+lemonade, oranges, prunes, figs, or other fruit if
+allowed.</p>
+
+<p>It is essential for patients to drink water freely,
+and it should be given between meals and also
+between liquid nourishments. Persons inexperienced
+in the care of the sick frequently make the
+mistake of bringing water only when a patient
+asks for it.</p>
+
+<p>Many acute illnesses begin with fever, headache,
+sore throat, and especially among children with
+vomiting, diarrhœa, and other digestive disturbances.
+In such cases all food should be withheld
+until the doctor comes, but boiled water, hot or
+cold, should be given freely. Efforts to tempt the
+appetite are then mistaken; few people are injured
+and many are benefited by omitting food even for
+24 hours at the beginning of an acute illness, and
+with few exceptions a doctor can be found in a
+shorter time.</p>
+
+<p><!-- Page 195 --><span class='pagenum'><a name="Page_195" id="Page_195">[195]</a></span></p>
+
+<div class="run-in">
+<h4>Serving Food for the Sick.</h4><p>&mdash;Food for the sick
+should always be most carefully prepared and of
+the best quality, and in addition it should be
+as inviting, as varied, and as well served as possible.
+Neglect in these respects is inexcusable.
+Even slight carelessness in preparing or serving
+food may arouse disgust and thus banish permanently
+some valuable article from the dietary.</p></div>
+
+<p>Trays, dishes, tray cloths, and napkins for the
+patient must be absolutely clean and as attractive
+as possible. Cracked or chipped dishes should
+not be used. Individual sets of dishes for the
+sick may be purchased, and their convenience
+makes them well worth their price. Paper napkins
+may be used in many cases to save laundry
+work; clean white paper is always superior to
+soiled linen.</p>
+
+<p>Before the tray is brought to the bedside,
+everything should be arranged so that the patient
+can eat in comfort. It is bad management to
+let the soup cool while the patient's pillows
+and table are being adjusted. In setting the
+tray great care should be devoted to placing the
+articles conveniently, and to the appearance
+and garnishing of the food. Careful serving
+requires more thought, but little if any more actual
+time than slovenly serving. Dishes should not
+be so full that food is spilled in transit; hot dishes<!-- Page 196 --><span class='pagenum'><a name="Page_196" id="Page_196">[196]</a></span>
+should be covered; hot dishes should reach the
+patient hot, and cold dishes cold. Liquid nourishment
+in a glass or cup should be served on a
+small tray or plate covered with a doily. Neither
+glass nor cup should be held by the rim.</p>
+
+<p>It is not uncommon to overload trays and to
+serve everything at once in order to save steps,
+but a patient is ordinarily more interested in
+a meal that is served in courses unless very
+long intervals elapse between. Moreover, if the
+meal is served in courses he is not tempted to
+eat dessert first and then to refuse the rest of the
+meal. If food is given sufficiently often it is
+safer to err on the side of serving too little at a
+time rather than too much, since the sight of
+large amounts of food is often disgusting.</p>
+
+<p>The patient's likes and dislikes should be considered
+as far as possible, but most patients
+should not be consulted about their menus
+beforehand. Great variety in one meal is not
+necessary; it should be introduced by varying
+successive meals. An article that has been
+especially disliked should not be served a second
+time, unless it can be disguised beyond a possibility
+of detection. An article of food to which a
+patient objects should be removed at once; one
+may appear disappointed if it seems wise, but
+should never argue. When patients persistently<!-- Page 197 --><span class='pagenum'><a name="Page_197" id="Page_197">[197]</a></span>
+refuse necessary nourishment a difficult situation is
+presented; persuasion and every form of ingenuity
+must be used, and the doctor's coöperation enlisted.
+When, for example, a strict milk diet
+is ordered for a patient who announces that he
+never takes milk in any circumstances the situation
+may seem hopeless but it is not necessarily so.</p>
+
+<div class="run-in">
+<h4>To Feed a Helpless Patient.</h4><p>&mdash;Helpless and
+weak patients must be assisted to eat or drink.
+A napkin should first be placed under the patient's
+chin. The attendant should place her hand
+under the pillow, raise the head slightly, and
+hold the glass to his lips with her other hand.
+An ordinary tumbler can be used by a patient
+lying down if it is not more than a quarter full,
+or a special feeding cup may be purchased. Bent
+glass tubes may be used for cool liquids; they
+should be washed immediately after use. A
+child who can sit up sometimes takes more nourishment
+if it is given through a soda water straw.</p></div>
+
+<p>If the patient must be fed with a spoon care
+should be taken that the liquid is not too hot,
+but the attendant should not blow upon it to
+cool it. It should be given from the point of a
+spoon placed at right angles to the lips, and plenty
+of time between mouthfuls should be allowed.
+A swallow should not be given at the moment
+when the patient is drawing the breath in. Great<!-- Page 198 --><span class='pagenum'><a name="Page_198" id="Page_198">[198]</a></span>
+patience is required if a helpless person is to be
+fed acceptably. The attendant should sit by
+the bedside rather than stand, should present
+at least the appearance of having unlimited time,
+and should endeavor not to deprive the patient
+in any way of the satisfaction he may derive
+from his nourishment.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What needs of the body do food substances supply?</li>
+
+<li>Give an outline of the digestive process.</li>
+
+<li>Describe the effect of different mental states upon
+digestion, and give examples of the ways by which a
+knowledge of these effects may be utilized in feeding
+patients.</li>
+
+<li>Why is the problem of nourishing the body of especial
+importance in sickness?</li>
+
+<li>Name the four ordinary classes of diet for the sick,
+and mention all the articles you can belonging to each
+class.</li>
+
+<li>Why is constipation a common ailment among
+patients confined to bed, and what attempts should be
+made to overcome it by the diet?</li>
+
+<li>Why is it necessary for sick persons to drink water
+freely, and what efforts should the attendant make to
+encourage them to do so?</li>
+
+<li>Describe the proper serving of a patient's tray.</li>
+
+<li>How should helpless patients be assisted to eat?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Health and Disease&mdash;Roger I. Lee, Chapter II.</li>
+
+<li>The Human Mechanism&mdash;Hough and Sedgwick, Chapters VIII,
+XIII, XIX.</li>
+
+<li><!-- Page 199 --><span class='pagenum'><a name="Page_199" id="Page_199">[199]</a></span>
+Notes on Nursing&mdash;Florence Nightingale, Pages 63-79.</li>
+
+<li>How to Live&mdash;Fisher and Fisk, Chapter II.</li>
+
+<li>Bodily Changes in Pain, Hunger, Fear and Rage&mdash;Cannon,
+Chapter I.</li>
+
+<li>Food for the Invalid and the Convalescent&mdash;Winifred S. Gibbs.</li>
+
+<li>Practical Dietetics&mdash;Pattee, Chapters IV, V.</li>
+
+<li>Feeding the Family&mdash;Rose.</li>
+
+<li>Diet in Health and Disease&mdash;Friedenwald and Ruhrah.</li>
+
+<li>Feeding Children from Two to Seven Years Old&mdash;New York
+City Department of Health.</li>
+
+<li>American Red Cross Text Book on Home Dietetics&mdash;Ada Z.
+Fish.</li>
+
+<li>Emergency Cooking&mdash;Pamphlet 708, American Red Cross.</li>
+
+<li>War Diet in the Home&mdash;Pamphlet 706, American Red Cross.</li>
+
+<li>Red Cross Conservation Food Course for Children and Special
+Classes&mdash;Pamphlet 705, American Red Cross.</li>
+</ul>
+
+<p><!-- Page 200 --><span class='pagenum'><a name="Page_200" id="Page_200">[200]</a></span></p>
+
+<h2><span class="sm2">CHAPTER X</span><br />
+<br />
+MEDICINES AND OTHER REMEDIES</h2>
+
+<div class="run-in">
+<h4>Action of Drugs.</h4><p>&mdash;Modern medical practice increasingly
+emphasizes diet, baths, exercises, and
+other hygienic measures in the treatment of
+sickness. Drugs are given far less than they were
+a generation ago; yet medicines are still the most
+familiar of all remedies, and the most abused by
+those who persist in treating themselves. Misuse
+of medicine even by intelligent people is astonishingly
+common.</p></div>
+
+<p>Problems of sickness and health would be
+enormously clarified if the uses and limitations of
+drugs were more generally understood. Many
+people still believe that every disease can be cured
+by a drug if only the doctor is clever or lucky
+enough to think of the right one to give. Such
+beliefs result naturally enough from centuries of
+faith in charms and magic, and occasionally
+are confirmed by remarkable cures apparently
+brought about by drugs, but really pure coincidence
+or the result of suggestion.</p>
+
+<p>It is a fact that a few medicines are known<!-- Page 201 --><span class='pagenum'><a name="Page_201" id="Page_201">[201]</a></span>
+which if rightly used actually do cure certain
+diseases. An example of their action is the curative
+effect of quinine in malaria. Such medicines,
+unfortunately, are few. In the great majority of
+cases medicines do not cure disease; their beneficial
+action is ordinarily indirect and is due to their
+power either to increase or to check certain processes
+within the body.</p>
+
+<p>It is here that the abuse of drugs comes in.
+Disordered bodily processes give rise to symptoms
+of disease; and it is the symptoms of disease, not
+the disease itself, that trouble the patient. A
+patient with typhoid, for example, is not conscious
+of the toxins in his blood, but of headache,
+weakness, and fever; the man with eyestrain is
+not aware of an imperfectly shaped lens, but of
+headache and indigestion. What the patient
+wants is to have his symptoms relieved; in some
+cases they can be controlled by drugs, and the
+sufferer then considers himself cured. But the
+original condition persists: it may in the meantime
+be improving, but it may on the other hand be
+growing worse.</p>
+
+<p>Not infrequently it is best to check symptoms,
+and to check them by means of drugs. When they
+should be checked, only a thoroughly trained
+physician is qualified to decide. The question
+is not one for amateurs, since the whole practice<!-- Page 202 --><span class='pagenum'><a name="Page_202" id="Page_202">[202]</a></span>
+of medicine, including the prescription of drugs,
+constantly becomes more nearly an exact science.
+People should obtain and follow expert advice in
+regard to health as they would in regard to other
+affairs of life. The constant self-dosing practised
+by thousands of people is harmful and unintelligent;
+it is, however, no less irrational to go to the
+other extreme and refuse to take medicine prescribed
+by a competent doctor.</p>
+
+<div class="run-in">
+<h4>Amateur Dosing.</h4><p>&mdash;Amateur dosing either of
+oneself or of others is dangerous in more ways
+than one. In the first place, time is lost. Moreover,
+symptoms are characteristic; checking or
+altering them increases the difficulty of finding the
+real trouble. The man with eyestrain who takes
+one drug to stop his headache and another to
+"cure" his stomach, is simply delaying the time
+when properly adjusted glasses will relieve both.
+In this case the result may not be serious; but such
+a loss of time in finding the trouble and beginning
+proper treatment might prove fatal in the case
+of tuberculosis.</p></div>
+
+<p>Another objection to amateur prescription of
+medicine is the fact that most drugs have more
+than one effect. In addition to their main action
+they have others, subordinate or ordinarily less
+marked. These minor effects may be serious in
+some cases. Many headache remedies, for example,<!-- Page 203 --><span class='pagenum'><a name="Page_203" id="Page_203">[203]</a></span>
+affect the heart; a dose that is harmless for
+a normal person may be strong enough to injure
+seriously a person with a weak heart. A doctor,
+and a doctor only, is competent to decide when
+and in what quantity medicines will be beneficial,
+because he alone understands both the condition
+of the patient and all the possible effects of the
+drug.</p>
+
+<p>In no circumstances should medicine prescribed
+for one person be taken by another. This rule
+seems obvious enough; yet every day people pass
+on their pet remedies to friends. Some medicines
+deteriorate after standing, and others grow
+stronger; nevertheless, medicine supposed to have
+cured a cough or a tonic supposed to have strengthened
+some member of the family after an attack
+of grippe is cheerfully administered months later
+to another member of the family, who, to make
+matters worse, may differ in age, strength, and
+probably in the nature of his sickness. Drugs are
+expensive, and it is considered economical to use
+them up; measured by lost time and impaired
+health such practices may be anything but thrifty.</p>
+
+<p>Cathartics, tonics, and various drugs to relieve
+pain and sleeplessness are among the remedies
+most commonly taken without medical advice.
+Enough has already been said about constipation
+to indicate proper hygienic treatment, but another<!-- Page 204 --><span class='pagenum'><a name="Page_204" id="Page_204">[204]</a></span>
+warning should be given against habitual use of
+cathartics. Many of these drugs are irritating;
+even when not irritating, they are harmful, since
+the body depends more and more upon the drug
+to do for it what it should be enabled to do for
+itself, by remedying the original cause of the
+trouble. Licorice powder, cascara, saline cathartics
+such as Seidlitz powders and Rochelle
+Salts and some others are harmless for occasional
+use, if occasional is not too liberally interpreted.</p>
+
+<p>Tonics are poor substitutes for proper diet,
+rest, and fresh air. Using them may be likened
+to beating a tired horse; the horse goes faster,
+but he is not really stronger. In some emergencies
+the horse must go faster and there is nothing to do
+but beat him, and in some cases the tonic should
+be given; these, however, are cases for a doctor
+to decide. People persist in taking tonics because
+they are unwilling or unable to rest, or otherwise
+to change their ways of living.</p>
+
+<p>Medicines to stop pain or to induce sleep are
+probably the most pernicious of all self-prescribed
+remedies, for they add to other dangers the possibility
+of forming drug habits. These habits
+are so insidious and so powerful that it is not safe
+to take habit-forming drugs even once except by
+a doctor's direction. In short periods of time
+strong people, apparently firm in will and character,<!-- Page 205 --><span class='pagenum'><a name="Page_205" id="Page_205">[205]</a></span>
+have acquired habits from supposedly moderate
+use of drugs like morphine, cocaine, and
+alcohol. No one, no matter how sure of his own
+self-control, can afford to run so grave a risk.</p>
+
+<div class="run-in">
+<h4>Patent Remedies.</h4><p>&mdash;Objections to self dosing in
+general apply even more strongly to using patent
+medicines. The ingredients of patent medicines
+are ordinarily unknown, so that using them is
+unintelligent at best. Sometimes they contain
+habit-forming or other harmful drugs. In other
+cases the ingredients are innocent enough, but
+totally unable to bring about the results claimed
+for them. The old story about a powerful
+remedy discovered by accident and thus unknown
+to the medical profession deceives only the ignorant
+or credulous; with our present knowledge of
+chemistry and physiology powerful remedies are
+not discovered in that way.</p></div>
+
+<p>Even to these comparatively harmless patent
+preparations there are two serious objections.
+One is the loss of time, during which the patient
+may grow worse. The other is that money is
+obtained under false pretenses; fraud is a common
+element in the success of patent remedies. One
+of the least harmful, a substance called "Murine"
+may be taken as an example<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a>. This substance was
+widely advertised at one time as a "positive cure
+for sore eyes." Analysis showed it to be a solution
+<!-- Page 206 --><span class='pagenum'><a name="Page_206" id="Page_206">[206]</a></span>of borax, which cost about five cents a gallon to
+prepare. It sold for one dollar an ounce, or at
+the rate of $128.00 a gallon. Although it could
+not bring about the wonderful cures advertised,
+it was practically harmless, and buyers of "Murine"
+must have been injured chiefly in pocket.
+But with "cancer cures" and "consumption cures"
+it is a different story. Early treatment of these
+diseases is essential to recovery; delay in many
+cases means robbing the sufferer of his only chance
+of life. No drugs are now known that will cure
+these diseases, and it seems incredible that anyone
+should be willing to practise such cruel deception
+upon ignorant people merely for the sake of making
+money.</p>
+
+<div class="run-in">
+<h4>Administration of Medicine.</h4><p>&mdash;Medicines may
+be introduced into the body in a number of ways.
+In the majority of cases they are swallowed and
+finally carried to the tissues by the blood just
+as digested food is carried.</p></div>
+
+<p>Except in rare emergencies no medicine should
+be given to a sick person without the doctor's
+order. The prescribed dose should be accurately
+measured in a medicine glass having a scale to
+show the number of teaspoonfuls. When measuring
+medicine, think only of what you are doing;
+neither talk nor listen to conversation. First
+read the label on the bottle. Next, shake the<!-- Page 207 --><span class='pagenum'><a name="Page_207" id="Page_207">[207]</a></span>
+bottle, if the medicine is liquid, in order to mix
+the contents thoroughly. Then remove the cork
+with the second and third fingers, and hold it
+between them while pouring, thus keeping the
+cork clean and protecting the contents of the bottle.
+Hold the medicine glass on a level with the eyes,
+and in the other hand hold the bottle, with the
+side bearing the label uppermost to avoid soiling
+it; pour out the dose, measuring exactly, wipe
+the bottle, replace the cork, and again read the
+label on the bottle.</p>
+
+<p>Most medicines should be diluted with a little
+water. Pills and capsules should not be presented
+to patients in the attendant's fingers, but on a
+saucer or teaspoon. Acids and medicines containing
+iron should be taken through a glass tube kept
+for medicine exclusively. Tubes and glasses
+should be washed at once after use, and neither
+they nor the bottles should stay in the patient's
+room. If a dose is omitted for any reason, do
+not increase the next dose; give the regular dose
+at the next regular time.</p>
+
+<p>Serious mistakes in giving or taking drugs are
+far too common, and no precautions are too great
+to guard against them. Never use medicine from
+a box or bottle that has no label. Never take or
+give another person a medicine selected in the
+dark, even though you have positive knowledge<!-- Page 208 --><span class='pagenum'><a name="Page_208" id="Page_208">[208]</a></span>
+that there is no other bottle or box of medicine
+in the whole house; in just such circumstances the
+fatal mistakes occur.</p>
+
+<p>A few things can be done to make medicines
+more palatable. The water used to dilute the dose
+and to be taken after it should be very cold.
+Holding the nose is helpful. A piece of cracker,
+a peppermint, or a slice of lemon or orange, if
+allowed, may be taken afterward. Giving disagreeable
+medicine in ordinary food, as lemon
+juice, orange juice, or milk, and giving bitter
+powders in jam or jelly, is unwise because it
+sometimes results in life long dislike for a useful
+article of diet. Where food is given directly after
+the dose to take away its taste, the association of
+dislike seems to be formed less frequently.</p>
+
+<p>The taste of castor oil is so disgusting that it
+often causes vomiting, but if skillfully given the oil
+need not be tasted by a patient who is willing to
+coöperate. Its way of sticking to the tongue and
+teeth constitutes the chief difficulty; the object
+therefore is to prevent it from sticking by swallowing
+the dose all at once. To administer the oil,
+wet the inside of a medicine glass or large spoon
+with very cold water, and leave a little water in the
+bottom. Pour the required dose in slowly and
+cover it with more cold water. Let the patient
+hold in his hand something to take away the<!-- Page 209 --><span class='pagenum'><a name="Page_209" id="Page_209">[209]</a></span>
+taste,&mdash;cracker, bread, peppermint, or whatever is
+allowed; for castor oil water is not very effectual.
+Then direct him to hold his nose, open his mouth,
+and hold his breath; caution him to let the oil run
+down without swallowing until all has been taken,
+and afterward to chew the cracker, continuing to
+hold his nose until he has swallowed the cracker.
+When the patient understands and is ready, pour
+the dose in quickly as far back as possible, taking
+care not to spill the last drop on the lips. This
+process may seem unduly troublesome, but when
+castor oil is needed it is badly needed and efforts
+to make it stay down are worth while. The following
+method also effectually disguises the taste
+of castor oil: place in a glass a teaspoonful
+of baking soda, add the prescribed dose of oil
+and then the juice of half a lemon. Mix all together
+thoroughly and let the patient take the
+mixture while it is effervescing. This method
+may be used unless the patient is not allowed soda
+and lemon juice. Castor oil may be bought
+in capsules, but on account of their size many
+people find the capsules impossible to swallow.</p>
+
+<div class="run-in">
+<h4>Suppositories.</h4><p>&mdash;Sometimes medicines are given
+through the rectum. For this purpose they are
+combined with cocoa butter or other material, and
+made into small cones called suppositories. They
+melt at a low temperature and should be kept on<!-- Page 210 --><span class='pagenum'><a name="Page_210" id="Page_210">[210]</a></span>
+ice until needed. A suppository should be lubricated
+with vaseline, and inserted very gently as
+far as the finger can be introduced, while the
+patient is lying on the back or left side.</p></div>
+
+<div class="run-in">
+<h4>Enemata.</h4><p>&mdash;An injection of a fluid into the
+rectum is called an enema. (Plural, enemas, or
+enemata.) Enemas are generally used to cause
+evacuation of the bowels.</p></div>
+
+<p>For a simple purgative enema one of the following
+is generally used: plain water; or a solution of
+common salt in the proportion of one teaspoonful
+of salt to one pint of water; or soap suds made
+with a white soap such as castile or ivory. Unless
+otherwise ordered the temperature of the enema
+should be between 105° and 110° F.</p>
+
+<p>To give an enema, one should proceed as follows:
+First protect the bed by placing under the patient's
+hips a rubber sheet, covered by a draw sheet
+or large towel. Let the patient lie on the back,
+with the knees flexed and head low. Bring to the
+bedside a commode or bedpan, and lastly the solution
+contained in a fountain syringe having a long
+rubber tube, stopcock and short hard rubber
+nozzle. The bag of the syringe may be hung on
+the bed post or elsewhere, but it should not be
+more than three feet at most above the patient's
+head. Lubricate the nozzle with vaseline either
+from a tube, or removed from a jar by means of a<!-- Page 211 --><span class='pagenum'><a name="Page_211" id="Page_211">[211]</a></span>
+piece of toilet paper; never dip the nozzle itself into
+a vaseline jar. Let the solution flow into the bedpan
+until it runs warm and smoothly; a jerky
+flow means presence of air bubbles which cause
+pain if injected into the bowels. Unless the
+patient is able to do it herself, gently insert the
+nozzle, and at the same time start the flow.
+Force must not be used in inserting the nozzle,
+and the flow should be gentle; if the solution
+goes in rapidly the patient may be unable to
+retain it. If there is a desire to expel the enema
+as soon as the injection has begun, shut off the
+current and wait a minute, meanwhile making
+gentle pressure upon the patient's abdomen with
+one hand; then lower the bag a little and begin
+again. A grown person should take from two to
+four pints, and a child from one to two pints.
+After the enema is finished give the bedpan immediately;
+the enema will, however, be more
+effective if retained a few minutes. The bedpan
+should be given and removed according to the
+directions on <a href="#Page_176">page 176</a>. Sometimes an enema is
+expelled with such violence that it soils the upper
+sheet; to protect the covers a rubber sheet may be
+spread over the patient's knees and legs. Since
+an enema sometimes causes nausea or faintness, a
+patient should be watched constantly during the
+process.</p>
+
+<p><!-- Page 212 --><span class='pagenum'><a name="Page_212" id="Page_212">[212]</a></span>
+To give an enema to a baby one may use a small
+syringe having a soft rubber bulb with a nozzle
+directly attached, or the ordinary fountain syringe
+with the small, hard rubber tip designed for
+infants. The enema should be given in a warm
+room free from draughts, and the baby must be
+warmly covered throughout the process. First
+cover the lap with a pad or folded blanket. Upon
+the blanket place a warmed rubber sheet, and over
+the rubber a warm diaper. Hold the baby on
+your lap, so that he lies on his back with his knees
+drawn up. Hold his feet or legs firmly in your
+left hand. Lubricate the nozzle thoroughly with
+vaseline. Be sure that all the air is expelled from
+the syringe, and then proceed as already directed.
+A baby will take from two or three ounces up to
+half a pint or even more, according to the size of
+the child. After the injection is finished place a
+small vessel under the baby's hips, and hold it
+until the fluid has been expelled, keeping the child
+well covered all the time.</p>
+
+<p>After being used, the nozzle of a fountain
+syringe should be washed with soap and water,
+boiled, dried and put away in a clean place. Inserting
+the nozzle into the bag of the syringe
+immediately after withdrawing it from the rectum
+is a filthy but not uncommon practice. The
+syringe should be kept clean inside and out; it<!-- Page 213 --><span class='pagenum'><a name="Page_213" id="Page_213">[213]</a></span>
+should be washed in hot soapsuds, rinsed in clean
+hot water, drained, and when thoroughly dry
+wrapped in a clean towel or tissue paper. The
+ordinary fountain syringe hanging for months by a
+dirty string on a hook in the bath room is an unpleasant
+and generally an unclean object.</p>
+
+<div class="run-in">
+<h4>Sprays and Gargles.</h4><p>&mdash;Several other methods of
+administering medicines are occasionally employed.
+Some remedies may be applied directly to
+the throat by gargles, and to the nose and throat
+by sprays. The throat may be cleansed by
+gargling with a solution of a teaspoonful of baking
+soda or common salt in a glass of warm water.
+Nose sprays should not be used except under
+medical advice, and it is well to remember that if
+the mouth washes, gargles, and sprays advertised
+to be disinfectants were really strong enough to
+kill germs, they would be too harsh for common
+or continued use. The nozzles of nose and
+throat sprays should be boiled immediately after
+use. A surprising number of families who have progressed
+far beyond common drinking cups and
+towels, continue to use a common nose spray without
+even washing the nozzle. Children while they
+are well should be taught to gargle the throat;
+a child with a sore throat and an aching head is
+in a poor condition to learn anything.</p></div>
+
+<div class="run-in">
+<h4>Inhalation</h4>&nbsp;<p>or breathing in, is another method<!-- Page 214 --><span class='pagenum'><a name="Page_214" id="Page_214">[214]</a></span>
+used to introduce drugs into the membranes of the
+nose, throat, and lungs. Smelling salts are an
+example of substances used for inhalation; they
+are used to stimulate persons who are faint. They
+should not be placed close to the nostrils, nor used
+at all when the patient is totally unconscious.</p></div>
+
+<p>Inhalations of steam are often used in asthma,
+croup, and bronchitis. Special croup kettles are
+made for the purpose, but an ordinary pitcher
+half full of boiling water may be used instead.
+The patient's head should be held closely over the
+pitcher, and a towel should be adjusted around the
+top covering the patient's nose and mouth, but
+admitting just enough air to make it possible for
+him to breathe. If a drug is ordered it should be
+added to the water.</p>
+
+<div class="run-in">
+<h4>Inunction</h4><p>, or rubbing a substance into the skin,
+is sometimes ordered for delicate babies and children.
+After the skin of the abdomen has been
+washed with warm soapy water and thoroughly
+dried, the substance ordered, generally olive oil or
+cod liver oil, should be applied by means of a
+circular movement of the palm of the hand. The
+oil should be warm and the rubbing continued
+until it is absorbed.</p></div>
+
+<p>Ointments are also applied by inunction. A
+small quantity at a time should be rubbed in,
+using a circular motion. If an ointment is ordered<!-- Page 215 --><span class='pagenum'><a name="Page_215" id="Page_215">[215]</a></span>
+to be applied where the skin is broken, the ointment
+should be spread upon gauze and applied
+without friction. Liniments are rubbed in in the
+same way as ointments. In many cases rubbing
+accomplishes more than the ointment or liniment
+itself, so that this part of the treatment must not
+be slighted.</p>
+
+<div class="run-in">
+<h4>Household Medicine Cupboard.</h4><p>&mdash;In every
+household a small cupboard is needed for medical
+and surgical supplies. Glass shelves are desirable,
+because they show when dirty and are easily
+cleaned, but a wooden cupboard can easily be lined
+with clean paper or white enamel cloth held in
+place with thumb tacks. Dirty, stained shelves
+should not be tolerated. The cupboard should be
+kept locked and the key put well out of the reach
+of children. In the cupboard should be kept
+medicines in daily use; they should not be paraded
+on family dinner tables.</p></div>
+
+<p>Poisonous drugs should have rough glass bottles
+and conspicuous labels. All medicine bottles
+should be kept well corked, since evaporation may
+take place and the remaining solution, by becoming
+stronger, may be dangerous to use in the
+ordinary amount. Pills and tablets sometimes
+deteriorate by standing, and may become so hard
+that they pass through the stomach and intestines
+without dissolving. It is best to buy drugs and<!-- Page 216 --><span class='pagenum'><a name="Page_216" id="Page_216">[216]</a></span>
+surgical supplies in small quantities; when it is
+cheaper to buy more at a time the druggist should
+be asked whether they will deteriorate or not.</p>
+
+<p>Almost every family needs to keep on hand some
+cathartics, some disinfectants, some material for
+first aid, and a few simple appliances. Most
+families have certain other needs peculiar to
+themselves, and for those who live at a distance
+from drug stores a greater quantity and variety
+may be required. Elaborate equipment and extensive
+supplies of medicines are neither economical
+nor necessary for household use.</p>
+
+<p>Castor oil, Rochelle or other laxative salts, and
+two grain cascara tablets ordinarily constitute a
+sufficient supply of cathartics. The dose of
+castor oil is one or two teaspoonfuls for a baby up
+to a tablespoonful for an adult. Rochelle salts
+and seltzer aperient are given dissolved in water;
+the ordinary dose is from one to four teaspoonfuls.
+Seidlitz powders come in two packets, one white
+and one blue. The contents of the packets
+should first be dissolved in separate glasses each
+filled about a quarter full of water. One solution
+should then be poured into the other and the mixture
+taken while it is effervescing. Cascara
+tablets are generally given in one to ten grain
+doses.</p>
+
+<p>A small bottle of tincture of iodine and one of<!-- Page 217 --><span class='pagenum'><a name="Page_217" id="Page_217">[217]</a></span>
+70% alcohol should be kept for disinfecting.
+Neither one is for internal use. The iodine is
+used to disinfect small wounds and abrasions of
+the skin. It is applied with cotton swabs and
+several swabs should be made and kept on hand in
+a box or envelope. Alcohol is used to disinfect
+thermometers and other instruments that cannot
+be boiled, for rubbing, and may also be used for disinfecting
+the skin. A 90% solution is sometimes
+used for rubbing; it need not be bought until
+needed. Denatured and wood alcohol are poisons
+and should be used in households only in
+spirit lamps; they are not safe for other purposes.</p>
+
+<p>First aid materials may include two gauze
+bandages two and one-half inches wide and two
+bandages one inch wide, one American Red Cross
+First Aid Outfit, a small package of absorbent
+cotton, a roll of old muslin, a package of adhesive
+plaster one inch wide, boracic ointment, picric
+acid gauze or other application for burns, safety
+pins, and a pair of scissors.</p>
+
+<p>For use in cases of fainting or exhaustion it is
+well to keep aromatic spirits of ammonia on hand.
+Its bottle should have a rubber stopper. The
+dose is one-half to one teaspoonful, in a quarter to
+half a glass of water. Hot coffee and tea are also
+good stimulants, but the time necessary to prepare
+them makes it desirable to have aromatic<!-- Page 218 --><span class='pagenum'><a name="Page_218" id="Page_218">[218]</a></span>
+ammonia on hand. Household or ordinary ammonia
+must not be used as a substitute.</p>
+
+<p>Olive oil, mustard, and baking soda may be
+brought from the kitchen when needed. It is
+assumed that vaseline, cold cream, hand lotion,
+talcum powder, and other toilet preparations will
+also be available.</p>
+
+<p>Only a few appliances are necessary. Among
+them are a medicine glass, a teaspoon, clinical
+thermometer, hot water bag, fountain syringe,
+and an alcohol lamp in houses without gas or
+electric stoves. It is better not to buy other
+appliances until they are needed, particularly
+rubber goods since they deteriorate rapidly.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Why is it dangerous for persons without medical
+training to prescribe medicines? What is the especial
+danger of dosing oneself?</li>
+
+<li>What is meant by a habit-forming drug? Name all
+you can, and tell why they are peculiarly dangerous.</li>
+
+<li>What are the special objections to patent medicines?</li>
+
+<li>What precautions should be taken in order to administer
+medicine accurately? What precautions to avoid
+giving wrong medicines?</li>
+
+<li>How may some disagreeable medicines be made
+more palatable?</li>
+
+<li>Tell how to prepare and give a soapsuds enema.</li>
+
+<li>How should a fountain syringe be cared for? a
+throat spray?</li>
+
+<li><!-- Page 219 --><span class='pagenum'><a name="Page_219" id="Page_219">[219]</a></span>
+Describe methods for giving steam inhalations.</li>
+
+<li>Describe the equipment and care of a household
+medicine cupboard.</li>
+
+<li>What drugs is it well for a family to keep on hand?
+What appliances? What materials for first aid?</li>
+
+<li>How many drugs in addition to those prescribed
+by a physician have you or your family on hand at the
+present time? How many do you consider really necessary?
+Are any of these medicines used to remedy
+troubles that might be cured by sufficient attention to
+rest, exercise, diet, and fresh air?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Health and Disease&mdash;Roger I. Lee, Chapter VI.</li>
+
+<li>How to Live&mdash;Fisher and Fisk, Supplementary Notes, Sections
+IV, V.</li>
+
+<li>Scientific Features of Modern Medicine&mdash;Frederic S. Lee, Chapters
+III, VIII.</li>
+
+<li>The Human Mechanism&mdash;Hough and Sedgwick, Chapter XX.</li>
+
+<li>The Conquest of Nerves&mdash;Courtney.</li>
+
+<li>Primitive Psychotherapy and Quackery&mdash;Lawrence, Chapters
+I-V.</li>
+
+<li>Nostrums and Quackery&mdash;American Medical Association. (See
+especially "Cancer Cures" and "Consumption Cures.")</li>
+</ul>
+
+<div class="footnotes">
+<h3>Footnotes:</h3>
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> See "Nostrums and Quackery," p. 445.</p></div>
+</div>
+
+<p><!-- Page 220 --><span class='pagenum'><a name="Page_220" id="Page_220">[220]</a></span></p>
+
+<h2><span class="sm2">CHAPTER XI</span><br />
+<br />
+APPLICATION OF HEAT, COLD, AND
+COUNTER-IRRITANTS</h2>
+
+<div class="run-in">
+<h4>Inflammation.</h4><p>&mdash;A process called inflammation
+sometimes occurs in tissues that have been injured
+or invaded by bacteria. Although painful, it is
+nevertheless one of the reparative processes of the
+body, and therefore beneficial. Common examples
+of inflammation are boils, sore throat, and the
+swollen, painful condition resulting from sprains
+and fractures. Characteristic symptoms of inflammation
+are heat, redness, swelling, and pain.</p></div>
+
+<p>When a tissue has been invaded by bacteria,
+nearby blood vessels dilate, thus bringing an increased
+supply of blood to the affected part.
+This extra supply serves to wash away the offending
+substance, and at the same time it brings
+more white blood corpuscles, one function of
+which is to destroy bacteria. From the increased
+supply of blood the affected part becomes red and
+hot, and so much blood may come that the vessels
+further on are unable to carry it away fast
+enough. Some of the fluid part of the blood is
+then forced out into the tissues, and the part<!-- Page 221 --><span class='pagenum'><a name="Page_221" id="Page_221">[221]</a></span>
+becomes swollen. Distension of the tissues and
+pressure on the nerve endings cause pain, and
+the injured part now exhibits the characteristic
+symptoms of inflammation.</p>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig21.png" width="300" height="260" alt="" title="" />
+<p class="caption">
+<span class="smcap">Fig. 21.&mdash;"The History of a Boil."</span> This figure represents
+a cross-section of normal skin. Note the surface layer, or
+cuticle, and the "true skin," or cutis. In the cutis one sees
+that the blood capillaries are just wide enough for the blood-cells
+to pass through "in single file." The skin has just been pricked
+by a dirty pin. On the point of this pin were several poisonous
+germs which were deposited at <i>a</i>. (<cite>From Emerson's "Essentials
+of Medicine."</cite>)</p>
+</div>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig22.png" width="300" height="284" alt="" title="" />
+<p class="caption">
+<span class="smcap">Fig. 22.&mdash;"The History of a Boil"</span> (continued). The poison
+from these germs diffuses through the cutis. The capillaries
+dilate. The leucocytes force their way through the walls
+of the capillaries and travel towards these germs. Note the
+dumb-bell shape of the leucocytes as they pass through the
+minute holes in the capillary walls, and their pseudopods as they
+travel towards their common destination, attracted by the
+poison from the germs. The skin in this region is now swollen,
+red, hot, and painful. (<cite>From Emerson's "Essentials of Medicine."</cite>)</p>
+</div>
+
+<p>At this point, if the injury begins to heal or
+the bacterial infection to yield, the extra blood
+supply is gradually carried off, the blood vessels
+resume their normal size, and the tissues return
+to their usual condition. If, however, the infection
+does not yield so quickly, more and more
+white blood corpuscles assemble and pass through<!-- Page 222 --><span class='pagenum'><a name="Page_222" id="Page_222">[222]</a></span>
+the walls of the tiny blood vessels into the tissues.
+Here the struggle continues. Some bacteria and
+some white blood corpuscles are killed, and substances
+are formed which liquify these dead cells
+and also some cells of the surrounding tissues.
+The resulting fluid is called pus or matter, and
+in the case of a boil we then say it has come to a
+head. If the infection occurs near a cavity or
+near the surface of the body, the pus may escape
+by breaking through at the point of least resistance,
+and may carry most of the poisons along<!-- Page 223 --><span class='pagenum'><a name="Page_223" id="Page_223">[223]</a></span>
+with it. If the pus finds no outlet it may be
+gradually absorbed by the blood stream, and healing
+may result without discharging. On the other
+hand, the germs may make their way into the
+circulation, thus causing the serious condition
+known as blood poisoning.</p>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig23.png" width="272" height="300" alt="" title="" />
+<p class="caption">
+<span class="smcap">Fig. 23.&mdash;"The History of a Boil"</span> (continued). The migration
+of leucocytes has continued until now they form a dense
+mass surrounding the germs. The poison of the germs has
+killed all the leucocytes and also all the cutis immediately
+around them, and now digestive fluids from the dead leucocytes
+is turning the whole dead mass into liquid pus. The boil has
+"come to a head." There is a little lump on the skin and
+through its thin covering of cuticle can be seen the yellow pus.
+(<cite>From Emerson's "Essentials of Medicine."</cite>)</p>
+</div>
+
+<p>Inflammation may be treated by means of
+hot applications, cold applications, or counter-irritants.
+The effect of heat is to dilate the vessels
+and hence to increase the flow of blood to the injured
+part. This increased blood supply makes<!-- Page 224 --><span class='pagenum'><a name="Page_224" id="Page_224">[224]</a></span>
+the reparative process go on more vigorously,
+and also makes it possible for the accumulated
+fluid to be more rapidly carried away. Moist
+heat softens the tissues so that pus, if formed,
+can escape more easily.</p>
+
+<div class="figcenter" style="width: 400px;">
+<img src="images/fig24.png" width="294" height="300" alt="" title="" />
+<p class="caption">
+<span class="smcap">Fig. 24.&mdash;"The History of a Boil"</span> (concluded). The boil
+has finally ruptured. The liquid pus has escaped carrying with
+it the germs and most of their poisons; the migration of leucocytes
+has stopped; the capillaries are returning to normal size
+and now new tissue will grow and fill up this hole. (<cite>From
+Emerson's "Essentials of Medicine."</cite>)</p>
+</div>
+
+<p>Cold acts in just the opposite way. It decreases
+the size of the blood vessels so that less
+blood comes to cause pain and swelling; at the
+same time it diminishes the number of white blood
+corpuscles and the nutritive substance brought
+by the blood. The nature and location of the
+infection determine whether heat or cold is to be
+preferred.</p>
+
+<p><!-- Page 225 --><span class='pagenum'><a name="Page_225" id="Page_225">[225]</a></span>
+Counter-irritants, of which mustard is an example,
+have a complicated action. A counter-irritant
+affects the blood circulation of the place
+to which it is applied, and at the same time it
+irritates the superficial nerves, which in turn
+stimulate other more distant nerves. The latter
+nerves control the circulation in tissues not
+adjoining those to which the counter-irritant is
+applied, and thus it is possible for a mustard
+paste, for example, if applied at one point to bring
+about changes in the blood supply of another
+part of the body. The mechanism by which
+counter-irritation is brought about is an intricate
+nervous process called reflex action.</p>
+
+<h3>HOT APPLICATIONS</h3>
+
+<p>In applying either moist or dry heat the danger
+of burning or scalding a patient must be constantly
+kept in mind. This danger is always
+great, but it is especially great when the skin is
+tender like that of babies, children, and old people,
+or when the vitality is low as in cases of chronic
+or exhausting illness. Unfortunately accidents
+in applying heat are not uncommon; a moment's
+carelessness may cause serious injury and prolonged
+suffering.</p>
+
+<div class="run-in">
+<h4>Dry Heat.</h4><p>&mdash;Hot water bags are used to apply<!-- Page 226 --><span class='pagenum'><a name="Page_226" id="Page_226">[226]</a></span>
+dry heat. They should be filled not more than
+two-thirds full of hot water, but the water must not
+be so hot that there is the slightest possibility of
+scalding the patient if the bag should leak.
+Boiling water should never be used. Before the
+stopper is screwed on, expel the air by squeezing
+the bag or by resting it upon a flat surface
+until the water reaches the top. After closing
+the bag make sure that both bag and stopper
+are in order, by noting whether leakage occurs
+when the bag is inverted and pressed moderately.
+Before it is placed near the patient the bag should
+be dried and entirely covered with a towel or
+canton flannel bag.</p></div>
+
+<p>Strong bottles, jugs, and jars, if they can be
+securely stoppered, may be used sometimes
+instead of hot water bags. The same precautions
+are necessary. Bricks, flat irons, or thick flannel
+bags containing salt or sand may be heated in
+the oven and used in the same way. Salt and
+sand retain heat for a long time, but are correspondingly
+slow to heat; therefore one bag
+should be heating in the oven while the other is
+in use. Their effect on the skin must be no less
+carefully watched than the effects of other hot
+applications.</p>
+
+<p>Hot dry flannel may be used without fear of
+burning a patient, and it sometimes yields sufficient<!-- Page 227 --><span class='pagenum'><a name="Page_227" id="Page_227">[227]</a></span>
+warmth to relieve pain, particularly
+abdominal pain of babies. After it has been
+heated on a radiator or in an oven, it should be
+applied quickly and covered closely with another
+flannel to prevent escape of heat.</p>
+
+<p>Dry heat can be applied conveniently by an
+electric pad. The part to be heated may be
+wrapped in flannel or placed directly above or
+below the pad. The pad should be carefully
+watched to see that the switch is not accidentally
+turned, as it is possible for the pad to become hot
+enough to burn the patient or to set fire to the
+bed covers.</p>
+
+<div class="run-in">
+<h4>Moist Heat.</h4><p>&mdash;To apply moist heat poultices
+or fomentations (stupes) are used.</p></div>
+
+<p><i>Poultices</i> may be made of various heat-retaining
+substances, but flaxseed meal is generally used.
+The poultices when ready should be applied without
+delay, therefore all preparations should be
+made in advance. To prepare a poultice, first
+provide a piece of gauze or thin old muslin about
+two inches wider than you wish the poultice to be
+when finished, and about two inches more than
+twice as long. In a shallow saucepan boil water,
+varying in amount according to the size of the
+poultice desired; about equal parts of water and
+meal will be needed. When the water is boiling
+briskly add the meal gradually, beating constantly<!-- Page 228 --><span class='pagenum'><a name="Page_228" id="Page_228">[228]</a></span>
+with a spatula or knife. The poultice is done
+when the mixture coheres and is thick enough
+to drop from the spatula leaving it clean. Quickly
+spread a layer of the hot flaxseed from a quarter
+to half an inch thick on one-half of the muslin,
+leaving a margin on three sides of about an inch
+(Fig. 25). Fold in the margins of the cloth
+(Fig. 26) and then bring the other half of the
+cloth over the flaxseed so that the top of
+the poultice is covered. Tuck the free end of the
+upper half of the cloth under the turned in edges
+of the long sides.</p>
+
+<div class="figcontainer">
+<div class="doublefig">
+<div class="leftfig">
+<img src="images/fig25.png" width="199" height="250" alt="" title="" />
+<p class="caption center smcap">Fig. 25.</p>
+</div>
+
+<div class="rightfig">
+<img src="images/fig26.png" width="122" height="150" alt="" title="" />
+<p class="caption center smcap">Fig. 26.</p>
+</div>
+</div>
+
+<p class="caption"><span class="smcap">Fig. 25.</span>&mdash;Turn the edges of the muslin over the flaxseed by
+folding first on the line <i>AA'</i>, and then on the lines <i>BB'</i> and <i>CC'</i>.</p>
+
+<p class="caption"><span class="smcap">Fig. 26.</span>&mdash;Fold on the line <i>EE'</i>, bringing <i>FF'</i> up over the
+flaxseed and tucking it under at <i>D</i> and <i>D'</i>.</p>
+</div>
+
+<p>Carry the poultice on a hot plate, or rolled in<!-- Page 229 --><span class='pagenum'><a name="Page_229" id="Page_229">[229]</a></span>
+a newspaper or hot towel. Test it carefully
+with the back of the hand, apply it to the skin
+gradually, cover it with cotton batting, oiled muslin,
+or several thicknesses of flannel, and keep
+it in place with a bandage or towel. Remove it
+as soon as it has become cold, and unless the skin
+is much reddened apply a fresh poultice. If
+the skin is much reddened, anoint it with vaseline
+or sweet oil, wrap it warmly, and apply the next
+poultice as soon as the appearance of the skin
+is normal.</p>
+
+<p><i>Stupes</i> or <i>hot fomentations</i> are cloths, preferably
+of flannel or flannelette, wrung out of
+boiling water and applied to the skin. Each
+stupe should be three or four times as large as
+the area to be covered. Two are needed, so
+that one may be prepared before removing the
+other. To prevent escape of heat and moisture
+the stupe should be covered after it has been
+applied, first with a piece of rubber cloth or
+oiled silk or muslin, and next with several
+thicknesses of flannel, or cotton batting made
+into a pad. The whole should be kept in place
+with a bandage or towel used as a binder. The
+doctor will tell how often the stupes are to be
+applied, but if the skin becomes irritated they
+must be stopped until its appearance is again
+normal.</p>
+
+<p><!-- Page 230 --><span class='pagenum'><a name="Page_230" id="Page_230">[230]</a></span></p>
+
+<div class="figcenter" style="width: 500px;">
+<img class="photo" src="images/fig27.jpg" width="500" height="311" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 27.&mdash;Wringing Stupe.</span> (<cite>From "Elementary Nursing Procedures,"
+California State Board of Health.</cite>)</span>
+</div>
+
+<p>Great care must be taken in applying fomentations.
+They do little good unless very hot,
+but if applied too hot the patient is likely to
+be scalded. They must be wrung as dry as possible;<!-- Page 231 --><span class='pagenum'><a name="Page_231" id="Page_231">[231]</a></span>
+but it is difficult to wring them without
+scalding the hands unless stupe wringers are used.
+Stupe wringers are heavy pieces of cloth, like
+roller towels or pieces of ticking, long enough
+to extend over opposite sides of the basin
+in which the stupe is to be boiled, and wide
+enough to hold the stupe easily. The wringer
+should be placed in the basin with the stupe arranged
+upon it. Boiling water should then be
+added, or the water, stupe, and wringer may be
+boiled together in the basin. After the stupe
+is ready, the wringer with the stupe upon it
+should be removed from the water by grasping
+the dry ends of the wringer. Then the ends
+should be twisted in opposite directions until the
+stupe inside is as dry as possible. Wringing is
+made easier if the wringer has wide hems into
+which sticks such as pieces of broom handles are
+inserted. By twisting the sticks in opposite
+directions the stupe may be wrung out easily.</p>
+
+<h3>COLD APPLICATIONS</h3>
+
+<div class="run-in">
+<h4>Dry Cold.</h4><p>&mdash;Cold, like heat, may be used either
+dry or moist. Bags of rubber or of Japanese
+paper filled with small pieces of ice are used to
+apply dry cold. When weight is to be avoided,
+the bag should not be completely filled. After
+the bag has been filled and the air has been expelled,<!-- Page 232 --><span class='pagenum'><a name="Page_232" id="Page_232">[232]</a></span>
+it should be stoppered securely and wrapped
+in a towel or piece of flannel, since it is possible
+for an uncovered ice bag to freeze the skin. Ice
+bags are easily punctured, and care should be
+taken not to bring pressure upon them especially
+when filled with sharp pieces of ice. An ice bag
+not in use should be thoroughly dry inside and
+out; it should be put away with enough absorbent
+cotton inside to keep the surfaces from adhering.
+Bags of Japanese paper are less costly than rubber,
+but less durable. To close them one should roll
+the top over and then tie it tightly with string.</p></div>
+
+<div class="run-in">
+<h4>Moist Cold.</h4><p>&mdash;Cold compresses for the head are
+often used for patients with fever or headache;
+they sometimes quiet a patient who is restless. An
+old handkerchief or piece of soft linen folded with
+the raw edges inside may be used as a compress.
+It should be large enough to cover the forehead.
+Two compresses at least should be provided, and
+a large piece of ice in a basin. One compress
+should be wrung so that it will not drip, and then
+applied to the head. The other meanwhile should
+be placed on the ice to cool. As soon as the first
+compress becomes warm, the second should be
+applied in its place.</p></div>
+
+<p><i>Cold Compresses for the Eyes.</i>&mdash;Soft material
+should be selected for eye compresses. Each one
+should be cut only a little larger than the eye and<!-- Page 233 --><span class='pagenum'><a name="Page_233" id="Page_233">[233]</a></span>
+should fit neatly over it. Several compresses
+should be placed on a block of ice while one is
+applied to the eye, and every few minutes the
+compress should be changed. If there is discharge
+from the eye, each compress should be used but
+once; when used, they should be collected in a
+paper and afterward burned. Separate compresses
+should be used if both eyes are being treated.
+Definite directions in regard to changing compresses
+and the length of time the applications should
+be continued are generally given by the physician.</p>
+
+<h3>COUNTER-IRRITANTS</h3>
+
+<p>To some extent all hot applications are counter-irritants,
+but mustard pastes, mustard leaves, and
+the mustard foot-bath already described are the
+counter-irritants most commonly used.</p>
+
+<p><i>Mustard Paste.</i>&mdash;To make a mustard paste, mix
+dry mustard with flour, using for adults one part
+of mustard and six of flour to make a weak paste;
+increase the proportion of mustard up to equal
+parts of mustard and flour, according to the
+strength required. Use a smaller proportion of
+mustard for children; one part of mustard with
+from 6 to 10 parts of flour is generally enough.
+Add to the mustard and flour enough tepid water
+to make a paste, which must be absolutely free
+from lumps. Do not use hot water for this<!-- Page 234 --><span class='pagenum'><a name="Page_234" id="Page_234">[234]</a></span>
+purpose, because it destroys some of the active
+properties of the mustard. Spread the paste on
+thin muslin, apply it to the skin, and remove it as
+soon as the skin is reddened so that its color
+resembles that of a strong sun-burn. If the
+skin is especially sensitive, mix a little sweet oil
+or vaseline with the paste.</p>
+
+<p><i>Mustard leaves</i> should be dipped in tepid water
+and may then be applied to the skin directly,
+but if specially sensitive, the skin should be protected
+by thin muslin or gauze. The leaf should
+remain until the skin is well reddened; a few minutes
+are generally sufficient.</p>
+
+<p>Care must be taken not to leave either a mustard
+leaf or a paste in place long enough to blister
+the skin. After the application has been removed;
+the part should be protected by a soft cloth until
+redness disappears. Vaseline or sweet oil should
+be applied to the skin if it is greatly irritated.</p>
+
+<p>Other counter-irritants in common use are
+iodine, turpentine, ammonia, kerosene, camphorated
+oil, capsicum vaseline, and various liniments.
+Tincture of iodine may be diluted with alcohol
+for especially sensitive skins; it sometimes causes
+blisters, and should not be applied more than once
+a day at most. Ammonia and turpentine cause
+blisters; they should not be used as counter-irritants
+except by a doctor's order, and then<!-- Page 235 --><span class='pagenum'><a name="Page_235" id="Page_235">[235]</a></span>
+only after exact directions have been obtained.
+Turpentine and kerosene are inflammable and
+hence dangerous to use. It should be remembered
+that the action of all counter-irritants is
+physiologically the same, so that no advantage is
+obtained from the use of dangerous substances
+like kerosene and turpentine.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What are the causes and symptoms of inflammation?</li>
+
+<li>Describe the process of inflammation.</li>
+
+<li>What is the effect of heat on an inflamed area? of
+cold?</li>
+
+<li>What are the dangers from hot applications, and
+how may they be guarded against?</li>
+
+<li>How should you fill a hot water bag? How should
+you cover it?</li>
+
+<li>Describe the method of preparing and applying a
+flaxseed poultice.</li>
+
+<li>Tell how to prepare and apply fomentations.</li>
+
+<li>How should you apply cold compresses to the head?
+to the eyes?</li>
+
+<li>How should you make a mustard paste for a baby
+six months old? for a grown person only slightly ill?
+for a feeble old person with a sensitive skin?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Essentials of Medicine&mdash;Emerson, Chapter I.</li>
+
+<li>The Human Mechanism&mdash;Hough and Sedgwick, Chapter IX.</li>
+</ul>
+
+<p><!-- Page 236 --><span class='pagenum'><a name="Page_236" id="Page_236">[236]</a></span></p>
+
+<h2><span class="sm2">CHAPTER XII</span><br />
+<br />
+CARE OF PATIENTS WITH COMMUNICABLE
+DISEASES</h2>
+
+<p>The first chapter of this book described the
+ways in which communicable diseases are carried
+from person to person, and also some principles
+underlying methods of prevention. This chapter
+aims to show how these principles apply in
+the actual care of patients whose diseases are
+transmissible. In order to apply them intelligently,
+it is necessary to keep in mind certain
+facts in regard to the transmission of infections.
+A brief summary of these facts follows.</p>
+
+<p>Disease germs are present in the bodies of
+persons suffering from communicable disease,
+but they may also exist in the bodies of persons
+in good health; if present in the body, they may
+leave it in any bodily discharge. While every
+kind of germ does not leave the body by all the
+different routes, it is nevertheless true that most
+germs expelled from the body are carried in discharges
+from the nose, throat, bladder or bowels.
+Germ-laden discharges of an infected person may<!-- Page 237 --><span class='pagenum'><a name="Page_237" id="Page_237">[237]</a></span>
+be distributed to other persons by water, milk
+and other foods, by certain insects, by unclean
+hands, by common drinking cups, towels, handkerchiefs,
+and similar articles, and directly by nose
+and throat spray. After they have been thus conveyed
+to other persons, the germs make their entrance
+into the body of their new victims through
+the digestive tract, through the nose, throat, and
+other mucous membranes, or through breaks in
+the skin. Prevention of communicable diseases,
+therefore, depends upon the measure of success
+attained in blocking the transit of germs from
+person to person; but methods of prevention,
+though easy to understand, are unfortunately
+sometimes difficult to carry out. In order to
+carry them out effectively one must devote to the
+problem great accuracy, unremitting care, considerable
+intelligence, and a highly developed
+conscience.</p>
+
+<p>Care of a patient suffering from transmissible
+disease is adequate only when it accomplishes
+two definite results. One result, which concerns
+the patient primarily, is to bring about his recovery
+as rapidly and as surely as possible; the
+other result, which concerns the community
+rather than the individual, is to make it impossible
+for the patient to infect others with his disease.
+In every case of communicable disease, from a<!-- Page 238 --><span class='pagenum'><a name="Page_238" id="Page_238">[238]</a></span>
+slight cold in the head up to serious cases of pneumonia
+or typhoid fever, both the patient and the
+community must be constantly safe-guarded.</p>
+
+<div class="run-in">
+<h4>Incubation Period.</h4><p>&mdash;The interval between the
+moment when pathogenic germs enter the body,
+and the time when symptoms first appear and
+the patient begins to feel ill, is called the incubation
+period. Incubation periods vary according
+to the disease from a few hours to two or
+three weeks. The length of the period also varies
+somewhat in different cases of the same disease.</p></div>
+
+<div class="run-in">
+<h4>Care of Patients with Colds or Other Slight
+Infections.</h4><p>&mdash;The usual symptoms of infectious
+diseases include fever, chill, sore throat, nasal
+discharge, cough, headache, vomiting and other
+digestive disturbances, and a general feeling of
+being sick all over. When one or more of these
+symptoms appear, unless they are very slight,
+a doctor should be sent for. The patient, whether
+child or grown person, should go to bed in a room
+alone and should stay in bed at least as long as
+the fever and symptoms of cold in the head
+continue, in order to protect others as well as
+himself. Persons in active life, it is true, are not
+always able to go to bed during colds; but there
+is no doubt that ultimately they would save
+time by doing so. It is especially necessary for
+children to remain in bed when suffering from<!-- Page 239 --><span class='pagenum'><a name="Page_239" id="Page_239">[239]</a></span>
+colds, not only to insure their own well-being
+but also to protect others, since children are notably
+careless in regard to coughing, sneezing, and
+borrowing handkerchiefs. The patient needs mental
+rest as well as physical, and should not be allowed
+to work in bed.</p></div>
+
+<p>The patient's nose and throat discharges
+should be received only in material that can be
+burned, like old linen or muslin, gauze, or paper
+napkins. As soon as they are soiled these handkerchief
+substitutes should be placed in strong
+paper bags and afterward burned. Soiled handkerchiefs
+lurking under pillows or in other parts
+of the bed may infect other people or re-infect
+the patient. Handkerchiefs that may not be
+burned should be placed as soon as soiled in a
+covered receptacle filled with cold water containing
+a little washing soda; when several have
+been collected they should be boiled in the same
+covered receptacle for 20 minutes. After boiling
+they may go to the regular laundry.</p>
+
+<p>The patient's diet at first should be liquid
+or semi-solid. Large amounts of nourishment
+are not necessary during the first day or two,
+especially if the illness is likely to be short,
+but water should be taken as freely as possible.
+Cold drinks are generally acceptable during the
+feverish stage, but lemonade and other acids<!-- Page 240 --><span class='pagenum'><a name="Page_240" id="Page_240">[240]</a></span>
+should be used with caution, since they sometimes
+irritate a sore throat. When the active
+symptoms have subsided the patient will need
+more food than usual, and a liberal, nourishing
+diet for a few days will do much to prevent the
+weakness and depressed vitality that often follow
+colds, tonsilitis, and other comparatively
+slight infections.</p>
+
+<p>The bowels should be carefully regulated, and
+a mild cathartic is often beneficial at the outset.</p>
+
+<p>Even during slight illness a patient should receive
+the daily care already described, and should
+be made as comfortable as possible. As in any
+illness, sponging and alcohol rubs are refreshing.
+An ice bag or cold compress may relieve headache,
+and hot applications or a cold compress on the
+throat are often soothing. The throat may be
+gargled with a solution of one teaspoonful of
+common salt dissolved in a pint of boiled water.
+If the patient perspires profusely he should be
+rubbed with a towel until dry, and provided
+with fresh warm, night clothes. An alcohol rub
+may well follow. It is most unwise for a patient
+who is perspiring freely to get up in a cold room
+and attend to himself.</p>
+
+<p>Common colds are far more serious than
+they are usually supposed to be.</p>
+
+<p><!-- Page 241 --><span class='pagenum'><a name="Page_241" id="Page_241">[241]</a></span></p>
+<blockquote>
+<p>"More people suffer from common colds than from
+any other single ailment.... Could the sum total
+of suffering, inconvenience, sequelæ, and economic loss
+resulting from common colds be obtained, it would at once
+promote these infections from the trivial into the rank of
+the serious diseases.... Colds are contracted from
+other persons having colds, just as diphtheria is contracted
+from diphtheria. Arctic explorers exposed to all the conditions
+ordinarily supposed to produce colds do not suffer
+from these ailments until they return to civilization and
+become infected by contact with their fellowmen....
+While common colds are never fatal, the complications
+and sequelæ are serious. These are rheumatic fever,
+pneumonia, sinusitis, nephritis, and a depressed vitality
+which favors other infections and hastens the progress of
+organic diseases.</p>
+
+<p>"Common colds are perhaps most contagious during the
+early stages. If persons isolate themselves by remaining
+in bed during the first three days of a cold, they would
+not only benefit themselves, but would largely prevent
+the spread of the infection. The contagiousness and
+severity of colds differ in different epidemics and in different
+seasons of the year, depending upon the particular
+micro-organism involved and other factors not well
+understood.</p>
+
+<p>"<b>Prevention.</b>&mdash;The prevention of colds consists, first
+in avoiding the infection, and, secondly, in guarding against
+the predisposing causes. Contact should be avoided with
+persons who have colds, especially in street cars, offices,
+and other poorly ventilated spaces where the risk of
+persons coughing or sneezing directly in one's face is imminent.
+Contact with the infection may further be
+guarded against by a careful self-education in sanitary<!-- Page 242 --><span class='pagenum'><a name="Page_242" id="Page_242">[242]</a></span>
+habits and cleanliness, based upon the modern conception
+of contact infection.</p>
+
+<p>"Colds, like other diseases conveyed in the secretions
+from the nose and mouth, are often conveyed by direct and
+indirect contact through lack of hygienic cleanliness and a
+disregard of sanitary habits. Kissing, the common drinking
+cup, the roller towel, pipes, toys, pencils, fingers, food,
+and other objects contaminated with the fresh secretions
+will transmit the disease."&mdash;("Preventive Medicine and
+Hygiene," Rosenau.)</p></blockquote>
+
+<div class="run-in">
+<h4>Care During More Serious Infections.</h4><p>&mdash;When
+a patient is suffering from serious transmissible
+disease, he needs the most skillful care available,
+and for the sake of others he must be strictly
+isolated or quarantined. By isolating or quarantining
+a patient is meant making such arrangements
+that germs expelled by the patient are
+necessarily destroyed before they can enter the
+body of another person. Isolation, therefore,
+includes disinfection, and while methods vary
+according to the nature of the particular disease,
+yet the principles given below are applicable in
+most cases.</p></div>
+
+<p>The first essential is that the patient should
+have a room to himself. No one except those
+caring for him should enter the sick-room for
+any purpose whatever; visitors should be rigidly
+excluded. At the outset all unnecessary articles
+should be removed from the sick-room, and it<!-- Page 243 --><span class='pagenum'><a name="Page_243" id="Page_243">[243]</a></span>
+should be possible to boil, burn, scrub, or otherwise
+thoroughly clean everything allowed to
+remain. The windows should be screened in
+summer, and flies must be excluded. Fresh air is
+especially needed by patients with communicable
+diseases, and ventilation of the room must be
+adequate both day and night. Foul odors plainly
+indicate that the patient or something in the
+room is not clean. The remedy is obvious and
+deodorants are quite unnecessary if the patient
+and the room are properly cared for. It is highly
+desirable to reserve a bath room for the exclusive
+use of the patient and his attendant and also to
+reserve a room adjoining the patient's room for
+the exclusive use of the attendant. When it is
+impossible, as it often is, to give up so much
+space, each family must make the best arrangement
+it can to separate the patient and his attendant
+from the rest of the family.</p>
+
+<p>The attendant must remember that her ten
+fingers are the ten most active agents in distributing
+the communicable diseases. After handling the
+patient or anything that the patient has touched,
+and whenever she leaves the patient's room, she
+must scrub her hands thoroughly with warm water,
+soap, and a nail brush. She should not soil her
+hands unnecessarily, even though she intends to
+scrub them later. She must remember for her<!-- Page 244 --><span class='pagenum'><a name="Page_244" id="Page_244">[244]</a></span>
+own protection to keep her hands away from her
+mouth and face, and to cleanse them with special
+care just before eating. If disinfection is needed
+in addition to the scrubbing, she must use conscientiously
+whatever solution the doctor orders.</p>
+
+<p>At the same time that she is caring for a patient
+with a communicable disease, the attendant
+ought not to care for children or other members of
+the family, she ought not to prepare food, and she
+ought not to handle dishes or utensils used by
+other persons. Every day, however, many women
+are doing just these things, and it is true that in
+many instances no bad results are observed. Yet
+if any arrangement to insure safety can possibly
+be made, it is inexcusable to run the risk of spreading
+diseases which kill thousands of persons every
+year and injure many more for life.</p>
+
+<p>When home conditions render adequate care
+and strict isolation of the patient impossible, hospital
+care should be seriously considered. No
+personal or sentimental objections should be allowed
+to influence the decision, if removing the
+patient to a hospital is necessary to safeguard his
+welfare or the welfare of the family. Hospital
+care should be considered especially for patients
+with typhoid fever, because untrained persons
+cannot safely care for patients so seriously ill.
+Since a patient with typhoid needs skilled care,<!-- Page 245 --><span class='pagenum'><a name="Page_245" id="Page_245">[245]</a></span>
+and since he greatly endangers other persons,
+most authorities consider hospital care essential
+unless the patient can have the continuous
+services of a trained nurse and almost ideal home
+conditions. Many cases of typhoid, it is true,
+are successfully nursed at home in extremely
+adverse conditions by visiting nurses; yet in few
+kinds of sickness is continuous care by a graduate
+nurse more necessary to protect the community as
+well as to safeguard the patient himself.</p>
+
+<p>Members of a family in which there is typhoid
+should be immunized if the doctor advises it.
+This process, which is performed by the doctor,
+in the majority of cases renders a person immune
+to typhoid fever for three or four years.</p>
+
+<p>The question of home or institutional care for
+persons with tuberculosis must also be carefully
+considered. In some cases tuberculosis may be
+cared for at home with comparative safety, and
+in some other cases the risk is not very great if
+the patient is intelligent, careful, and well supervised.
+But everyone should face the fact
+that all cases of tuberculosis of the lungs involve
+some risk to others in the family, and most cases
+involve great risk. The danger to children is
+greater than to adults. Most tuberculosis infections,
+it is now believed, are acquired in childhood.
+The bad results of an infection acquired<!-- Page 246 --><span class='pagenum'><a name="Page_246" id="Page_246">[246]</a></span>
+in childhood may not show themselves for years,
+since the germs may remain inactive until the
+person's resistance is lowered by some unfavorable
+condition.</p>
+
+<div class="run-in">
+<h4>The Children's Diseases.</h4><p>&mdash;The so-called children's
+diseases are probably the most familiar
+and the least regarded of all those belonging to
+the communicable group. Most persons, it is
+true, realize that scarlet fever is serious; everyone
+should also realize that measles and whooping-cough
+are serious. For example, in the State of
+New York during the year 1916, more children
+died from each of these diseases than from scarlet
+fever: in that year 745, or four times the number
+that died of scarlet fever, lost their lives from
+whooping-cough, while 913 died of measles.
+If diseases that kill hundreds of children every
+year are not serious, one is at a loss to know
+what a serious disease is.</p></div>
+
+<p>Some parents even expose children unnecessarily
+to these infections on the fatalistic theory
+that they must have the diseases sometime,
+and therefore the sooner the better. Nothing
+could be more mistaken; the diseases are not
+inevitable, and there is no advantage whatever
+in having them if escape is possible. Moreover,
+serious as the children's diseases are in themselves,
+their after-effects may be even more serious. At<!-- Page 247 --><span class='pagenum'><a name="Page_247" id="Page_247">[247]</a></span>
+this very moment hundreds of people are going
+through life handicapped by weakened hearts or
+kidneys, by defective sight or hearing, merely
+because their parents considered the children's
+diseases necessary. The common belief that
+children should have these diseases as early as
+possible is also erroneous, since statistics show
+that the younger the child the more likely is
+the disease to prove fatal.</p>
+
+<p>Every mother should realize that the children's
+diseases are most infectious in the early stages.
+Early symptoms include fever, sore throat, and
+nasal discharge, and the trouble at first often resembles
+a severe cold. During this stage the
+diseases are most easily communicated. Measles
+in particular is generally not recognized until its
+most infectious stage has passed. The moral
+to be drawn is that sore throats, coughs, and colds
+should never be regarded lightly, and that their
+spread should be prevented by all possible means.</p>
+
+<p>The accompanying table taken from the regulations
+of the New York State Department of
+Health, gives symptoms of communicable diseases
+among children, and rules for isolation and
+exclusion from school.</p>
+
+<p class="table-link">[<a href="#redcross-table">Click to View Table</a>]</p>
+
+<p>It may be added that the ways by which poliomyelitis,
+or infantile paralysis, is spread are not
+definitely known at the time of writing. We<!-- Page 248 --><span class='pagenum'><a name="Page_248" id="Page_248">[248]</a></span>
+are justified, however, in believing that investigation
+now in progress will make exact information
+available in the near future.</p>
+
+<blockquote>
+<p>"The weight of present opinion inclines to the view that
+poliomyelitis is exclusively a human disease, and is spread
+by personal contact, whatever other causes may be found
+to contribute to its spread. In personal contact we mean to
+include all the usual opportunities, direct or indirect, immediate
+or intermediate, for the transference of body discharges from
+person to person, having in mind as a possibility that the
+infection may occur through contaminated food.</p>
+
+<p>"The incubation period has not been definitely established
+in human beings. The information at hand indicates
+that it is less than two weeks, and probably in the
+great majority of cases between 3 and 8 days."&mdash;(Report
+of Special Committee on Infantile Paralysis, American
+Journal of Public Health, November 1916.)</p></blockquote>
+
+<h3>DISINFECTION</h3>
+
+<p>Specific directions for disinfecting in every kind
+of communicable disease would be too extended
+to be given here. In each case the attendant
+should learn from the doctor just how that particular
+disease is communicated, just what discharges,
+utensils, linen, etc., need to be disinfected,
+and just what disinfectants he prefers to have
+used. The following general methods are now in
+use, but it must be remembered that from time to
+time new methods are devised and new disinfectants
+are discovered.</p>
+
+<p><!-- Page 249 --><span class='pagenum'><a name="Page_249" id="Page_249">[249]</a></span></p>
+
+<div class="run-in">
+<h4>Care of Nose and Throat Discharges.</h4><p>&mdash;The care
+of handkerchiefs has already been described on
+<a href="#Page_239">page 239</a>. Cloths or cotton used to wipe the eyes
+or to receive any other bodily discharge including
+vomitus, should be collected in the same way and
+burned. Everyone should be taught in early
+childhood to cover the nose and mouth with a
+handkerchief during coughing and sneezing; if the
+patient has not already learned to do so he must
+be taught now. If the amount of expectoration is
+great, waterproof receptacles should be provided,
+which should be burned with their contents.</p></div>
+
+<div class="run-in">
+<h4>Care of Discharges from the Bowels and Bladder.</h4><p>&mdash;At
+the present time the following preparations
+are commonly used to disinfect stools and
+urine: 5% solution of carbolic acid; chloride
+of lime solution, made freshly whenever needed
+by mixing thoroughly ½ pound of chloride of lime
+with one gallon of water; and unslaked lime to
+which is added <em>hot</em> water. The amount of carbolic
+solution used should be about equal in bulk
+to the amount of material to be disinfected; the
+chloride of lime solution should be at least twice,
+and the unslaked lime at least one-eighth the bulk.
+Fecal masses should be broken up so that the disinfectant
+may reach every part; they may be
+stirred with tightly twisted toilet paper, which
+should be left in the bedpan and disinfected with<!-- Page 250 --><span class='pagenum'><a name="Page_250" id="Page_250">[250]</a></span>
+the stools. If these substances are used, disinfection
+is considered complete at the end of an hour,
+and the contents of the bedpan may then be
+emptied into the toilet with safety. It may be
+necessary to provide two bedpans so that one
+may be available for use while the contents of the
+other is being disinfected. Bedpans and urinals
+should be boiled daily and kept thoroughly clean
+at all times.</p></div>
+
+<p>In places having no sewerage system, disinfected
+discharges may be emptied into a trench
+situated at a distance from the well, and then
+covered with earth. As an extra precaution, the
+disinfected discharges may be mixed with sawdust
+or kerosene and burned in the trench. Directions
+for installing a sanitary privy may be found in
+Bulletin 68 of the United States Public Health
+Service.</p>
+
+<div class="run-in">
+<h4>Bath water</h4>&nbsp;<p>and water that has been used for
+cleansing the teeth and mouth may be disinfected
+in the same way as urine, or it may be emptied
+into a suitable receptacle and boiled ten minutes.</p></div>
+
+<div class="run-in">
+<h4>Care of the Hands.</h4><p>&mdash;Disinfectants for the
+hands should be used in addition to scrubbing
+with soap and water, not as a substitute. The
+hands may be disinfected after scrubbing by soaking
+them for three minutes in one of the following
+solutions: alcohol 70%, carbolic acid solution<!-- Page 251 --><span class='pagenum'><a name="Page_251" id="Page_251">[251]</a></span>
+2½%, or a solution made by adding one teaspoonful
+of lysol or of creolin to a pint of water. These
+disinfectants are poisons if taken internally; the
+bottles must be carefully labeled and kept in a
+safe place. It is a good plan to wear rubber gloves
+when handling infective material; the gloves
+should afterward be boiled for ten minutes.</p></div>
+
+<div class="run-in">
+<h4>Care of Utensils.</h4><p>&mdash;A sufficient number of dishes,
+spoons, tumblers, basins, etc. must be reserved for
+the patient's exclusive use; these utensils must be
+washed separately and dried with towels not used
+for other dishes. Mistakes frequently occur by
+which other persons use the patient's dishes, and in
+consequence his dishes should not be kept in the
+cupboard with other dishes; if no other safe place
+can be found, they had better stay in the patient's
+room covered with a clean cloth or napkin. The
+dishes should be scalded daily and at the termination
+of the illness they must be boiled briskly for
+ten minutes before they are returned to general use.
+Food left on the patient's tray should be burned;
+it should not be eaten by any one else, nor placed
+in the pantry or refrigerator with other food.</p></div>
+
+<div class="run-in">
+<h4>Care of Linen.</h4><p>&mdash;A satisfactory way to disinfect
+towels, night gowns, bed linen, etc. is to place the
+articles immediately in a wash boiler filled with
+cold water to which a little washing soda has been
+added, and then to boil them in the same water for<!-- Page 252 --><span class='pagenum'><a name="Page_252" id="Page_252">[252]</a></span>
+twenty minutes; they can afterward go safely into
+the regular laundry. The boiling may be done
+once a day; articles soiled in the meantime may be
+left to soak in the cold water and soda.</p></div>
+
+<div class="run-in">
+<h4>Disinfection of the Person.</h4><p>&mdash;"The cleansing
+and disinfection of the person includes washing
+the entire body and the hair with soap and water;
+thorough brushing of the teeth; rinsing the mouth;
+gargling the throat, and douching and spraying
+the nose with an antiseptic solution; and finally,
+a complete change of clothing (or a change of
+underwear) and a thorough shaking and brushing
+of the outer garments out-of-doors before these
+are put on again."&mdash;(New York State Department
+of Health.)</p></div>
+
+<div class="run-in">
+<h4>Termination of Quarantine.</h4><p>&mdash;After the patient
+has recovered, he and the attendant should,
+if the doctor thinks it necessary, disinfect themselves
+as directed above before they mingle again
+with other people. The exact time when it is
+safe for a person to come out of quarantine and
+resume ordinary life varies in different diseases.
+Moreover, opinion differs in regard to quarantine
+periods for the same diseases, so that the regulations
+of Boards of Health in different cities
+show wide variations. It is of course impossible
+to say at just what moment every patient, or
+even the majority of patients, will stop expelling<!-- Page 253 --><span class='pagenum'><a name="Page_253" id="Page_253">[253]</a></span>
+germs. Quarantine periods are intended to protect
+the community as completely as possible
+without causing unnecessary hardship to individuals.
+In any given case, the local regulations
+should be strictly observed but release from
+quarantine is not a guarantee that the patient
+is not still discharging germs, and extreme care
+should still be taken to prevent the spread of
+saliva and other discharges.</p></div>
+
+<div class="run-in">
+<h4>Terminal Disinfection.</h4><p>&mdash;A room that has been
+occupied by a patient with a communicable
+disease should be thoroughly cleaned at the
+termination of the illness. Dishes, utensils,
+bed linen, etc. should be cared for in the ways
+already described. The floor, bedstead, and other
+furniture should be washed with hot water,
+soap, and washing soda. The walls, windows,
+etc., should be wiped with a cloth wrung out of
+hot water, soap suds, and soda. The mattress,
+unless badly soiled with discharges, should be
+scrubbed with the same solution and a stiff
+brush, and left out-of-doors in the sunshine
+for a day or two, or until dry. If badly soiled, it is
+best to destroy the mattress unless the Board of
+Health has facilities for steam sterilization. Ordinary
+washing is all that is generally required for
+blankets, but if badly soiled they should be
+sterilized by steam or burned. The room should<!-- Page 254 --><span class='pagenum'><a name="Page_254" id="Page_254">[254]</a></span>
+then be thoroughly sunned and aired for a day
+or two, with the windows wide open both day
+and night. Sunning and airing are among the
+most important measures in disinfecting a room,
+and should not be slighted. If there has been
+gross pollution, as when a careless consumptive
+persists in spitting on the floor and walls, it may
+be necessary to remove the old paint and paper
+and have the room done over. The room may
+safely be occupied after all these measures have
+been taken.</p></div>
+
+<div class="run-in">
+<h4>Fumigation.</h4><p>&mdash;Many Boards of Health have
+abandoned fumigation after communicable diseases,
+except after those which like typhus and
+yellow fever, are carried by vermin or insects.
+Dry formaldehyde gas, which was formerly used
+for fumigation, has a violent effect on mucous
+membranes, but its power to kill bacteria, even
+on surfaces, appears to be weak, while its penetrating
+power is not sufficient to disinfect bedding,
+carpets, upholstered furniture, and other fabrics.
+Since fumigation is costly, troublesome, and
+ineffectual there seems to be no good reason for
+using it. Moreover, its use gives a false sense
+of security, so that really effective measures
+like sunning, airing, and scrubbing are likely
+to be neglected.</p></div>
+
+<p>Theory and practice of disinfection, it is clear,<!-- Page 255 --><span class='pagenum'><a name="Page_255" id="Page_255">[255]</a></span>
+have radically changed in recent years. Modern
+knowledge requires concurrent disinfection, or
+the destruction of germs from the moment when
+symptoms are first noticed; all the time, day and
+night, this disinfection must go on with unremitting
+care. Today wet sheets are not hung in
+doorways nor are chemicals left about in open
+dishes to disinfect quite harmless air, but
+scrupulous cleanliness at all stages of disease is
+recognized as one of the most important measures,
+if not the most important measure, in disinfection.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Summarize the ways in which infectious diseases are
+spread.</li>
+
+<li>What is meant by the incubation period? State the
+length of the incubation period in measles; Liberty
+measles; whooping-cough; scarlet fever; chicken-pox;
+diphtheria; mumps; typhoid fever.</li>
+
+<li>Name some of the early symptoms common to most
+infectious diseases. If such symptoms appear, what should
+be done while waiting for the doctor to come?</li>
+
+<li>Discuss the importance, prevention, and treatment
+of common colds.</li>
+
+<li>What measures should be taken to isolate a patient
+who is suffering from a communicable disease?</li>
+
+<li>What special care should the attendant of a patient
+with a communicable disease give to her own clothing and
+person?</li>
+
+<li>Why are the children's diseases more serious in reality
+than they are commonly supposed to be?</li>
+
+<li><!-- Page 256 --><span class='pagenum'><a name="Page_256" id="Page_256">[256]</a></span>
+Describe the symptoms of each of the following:
+Measles, scarlet fever, chicken-pox, mumps, whooping-cough,
+and diphtheria.</li>
+
+<li>How should bowel and bladder discharges be disinfected?</li>
+
+<li>How should dishes and other utensils be disinfected?</li>
+
+<li>How should linen be disinfected?</li>
+
+<li>Describe measures necessary for concurrent disinfection.</li>
+
+<li>Describe measures necessary for terminal disinfection.</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Preventive Medicine and Hygiene&mdash;Rosenau.</li>
+
+<li>The New Public Health&mdash;Hill, Chapters VII-XVII.</li>
+
+<li>Essentials of Medicine&mdash;Emerson, Chapters XII-XV.</li>
+
+<li>Health and Disease&mdash;Roger I. Lee, Chapter X-XIV.</li>
+
+<li>Disease and Its Causes&mdash;Councilman, Chapters V-IX.</li>
+
+<li>Publications of the New York State Department of Health,
+Albany, entitled: The Teacher and Communicable
+Disease; A Method for the Control of Communicable Diseases
+in Schools; Regulations and Instructions for Cleansing
+and Disinfection; The Conduct of an Isolation Period
+for Communicable Disease in a Home; Tuberculosis;
+Typhoid Fever; Scarlet Fever; Measles; Whooping-cough;
+Diphtheria; Poliomyelitis, Acute Anterior (Infantile Paralysis);
+Smallpox; Septic Sore Throat; Venereal Diseases.
+(Any of the above pamphlets will be sent upon receipt of
+a three cent stamp.)</li>
+</ul>
+
+<p><!-- Page 257 --><span class='pagenum'><a name="Page_257" id="Page_257">[257]</a></span></p>
+
+<h2><span class="sm2">CHAPTER XIII</span><br />
+<br />
+COMMON AILMENTS AND EMERGENCIES</h2>
+
+<p>This chapter describes a few home treatments
+for the relief of slight ailments and injuries,
+together with some measures that may be employed
+in emergencies. For more extended instructions
+in these subjects the student should
+consult the Red Cross Text-book on First Aid.</p>
+
+<h3>CONDITIONS IN WHICH THE NERVOUS
+SYSTEM IS INVOLVED</h3>
+
+<div class="run-in">
+<h4>Headache.</h4><p>&mdash;Headache is not a disease in itself,
+but a symptom common to many different disorders.
+Among the abnormal conditions often
+causing headaches are fatigue, eyestrain, indigestion,
+constipation, neuralgia, rheumatism, anæmia,
+acute infections, and other disorders. Treatment
+should consist in finding the cause and removing
+it if possible; clearly no one remedy can
+cure so many different causes. A physician
+should be consulted if headaches are of frequent
+occurrence, but in many cases rest and attention<!-- Page 258 --><span class='pagenum'><a name="Page_258" id="Page_258">[258]</a></span>
+to other hygienic requirements are all that is
+needed. During an attack of headache a hot
+foot bath may give relief, or a mustard paste or
+cold applications on the back of the neck, or an
+ice bag or cold compress on the forehead.</p></div>
+
+<div class="run-in">
+<h4>Sleeplessness</h4><p>, like headache, has many possible
+causes, and effective treatment consists in
+finding and removing them. Pain or discomfort
+of any kind, fatigue, overwork, and worry are
+common causes. Sleeplessness easily becomes
+a habit that may persist after its cause has
+been removed; hence a person who has formed the
+habit of sleeplessness should patiently strive to
+break the old habit and to substitute a better.
+A careful hygienic régime is essential for the patient,
+exercise in the open air, and cultivation of
+a hopeful and tranquil spirit. The diet should be
+liberal, but light and unstimulating; tea and coffee
+should be omitted, certainly during the latter
+part of the day. The patient should spend rather
+a dull evening, avoiding excitement and mental
+exertion that is difficult, even though pleasurable.
+He should retire early. A hot tub or foot bath,
+and a hot drink at bed time may help to produce
+sleep. The bedroom should be dark, cool, and
+well ventilated, the bed comfortable and the covers
+light but warm. The patient should be told
+that rest is the most important thing for him,<!-- Page 259 --><span class='pagenum'><a name="Page_259" id="Page_259">[259]</a></span>
+and that he should not try too hard to sleep nor
+worry if unsuccessful. The patient should try
+to banish from his mind, at bed time, thoughts
+that are distressing, and even those that are
+especially interesting. By using patience and
+persistence most persons can regain the power of
+sleeping even when habits of sleeplessness have
+been long established.</p></div>
+
+<div class="run-in">
+<h4>Fainting</h4>&nbsp;<p>is a partial or total loss of consciousness
+due to a diminished supply of blood in the
+brain. It may follow bleeding, exhaustion from
+heat, fatigue from prolonged standing and the
+like, or strong emotional disturbance, like fear
+or surprise. Fainting is less common than it
+formerly was; it now occurs most frequently
+among persons suffering from anæmia, heart
+weakness, or special susceptibility.</p></div>
+
+<p>Symptoms of fainting are pale face, cold perspiration,
+rapid, feeble pulse, and shallow, sighing
+respiration. Treatment consists in removing
+the patient into cool, fresh air, applying cold
+water to the face and keeping the head low. For
+a person who feels faint but has not lost consciousness,
+this treatment will probably prove sufficient;
+if, however, he becomes unconscious, place him
+so that the head is lower than the body, loosen
+the clothing, especially the clothing about the
+neck, apply cold water to the face and chest, and<!-- Page 260 --><span class='pagenum'><a name="Page_260" id="Page_260">[260]</a></span>
+see that fresh air is plentiful. When the patient
+is sufficiently conscious to swallow, give a teaspoonful
+of aromatic spirits of ammonia in half a
+glass of water and keep him quiet until he has
+entirely recovered.</p>
+
+<p>A person who is unconscious from any cause
+always requires immediate attention. In emergency
+work elevate the patient's head if his face
+is flushed, and keep it low if his face is pale. Do
+not try to arouse an unconscious patient by shaking
+him and calling to him, in the first place because
+it is useless to do so, and in the second, because
+consciousness will return spontaneously
+if his condition improves.</p>
+
+<div class="run-in">
+<h4>Convulsions.</h4><p>&mdash;In every case of convulsions
+a doctor is needed at the earliest possible moment.
+Convulsions in adults are very serious; in babies
+and small children although serious they are less
+alarming, since they may follow comparatively
+slight disturbances, particularly disturbances of
+digestion.</p></div>
+
+<p>Treatment for babies and children with convulsions
+consists first in keeping the child as quiet
+as possible, and next in measures to draw blood
+from the brain toward the surface of the body.
+The child should first be undressed, moving him
+as little as possible, and put to bed between
+warm blankets. Cold should be applied to his<!-- Page 261 --><span class='pagenum'><a name="Page_261" id="Page_261">[261]</a></span>
+head by a compress or ice bag, and hot water
+bag should be placed near his feet. An enema
+should then be given. A warm tub bath is sometimes
+used to apply heat, if the convulsion has
+not subsided by the time the child is undressed.
+If the bath is given the temperature of the water
+should not be above 106°, and should be tested
+by a thermometer. If no thermometer is available,
+the water should be tested with the elbow
+rather than the hand, and cold water should be
+added if it feels uncomfortably warm. There
+is great danger of scalding a child during the excitement
+inevitably caused by a convulsion.</p>
+
+<p>Although haste is needed when a child has convulsions,
+yet quiet is essential, since the slightest
+movement tends to increase the convulsions
+or to start them again. As soon as the convulsions
+are over the child should be removed from
+the bath and put to bed between warm blankets.
+Even after the symptoms have completely subsided,
+the greatest care should be taken to keep
+the child quiet. He should be handled and disturbed
+as little as possible. The bath should be
+repeated if convulsions begin again. The doctor,
+when he comes, will probably order a dose of
+castor oil; and therefore, if it is impossible to
+obtain a doctor at once, the dose should be given.</p>
+
+<div class="run-in">
+<h4>Shock</h4>&nbsp;<p>(in the medical sense of the word) or<!-- Page 262 --><span class='pagenum'><a name="Page_262" id="Page_262">[262]</a></span>
+<i>collapse</i>, is a serious condition in which a patient's
+vitality and all his bodily processes are profoundly
+depressed. Generally shock occurs only after a
+severe injury or a long exhausting illness. Since,
+however, some persons are peculiarly susceptible
+to it, the possibility of shock must be kept in mind
+in treating even slight injuries. The probability
+of shock is somewhat increased if patients are
+allowed to see their own wounds. Injured persons
+should always sit or lie down while wounds,
+however slight, are dressed.</p></div>
+
+<p>Symptoms of shock are pallor, pinched, anxious
+expression, dilated pupils, cold clammy skin,
+feeble breathing, and rapid, weak pulse. The
+patient may be mentally normal, or irrational, or
+unconscious, but more frequently he appears
+stupid, and though conscious, he pays no attention
+to what is going on. Unfortunately this condition
+is sometimes mistaken for sleepiness, and he is
+left alone to sleep just when active measures are
+most needed.</p>
+
+<p>If a patient shows any symptom of shock the
+doctor should be summoned immediately, but no
+time should be lost in beginning treatment, since
+the condition may be critical. It should be remembered,
+however, that panic and confusion
+may alarm a patient who is conscious, and thus increase
+the shock. The patient should be covered<!-- Page 263 --><span class='pagenum'><a name="Page_263" id="Page_263">[263]</a></span>
+warmly, and undressed under blankets, without
+exposure or avoidable moving. His head should
+be low, and as quickly as possible hot water bags
+should be placed near but not upon him. If the
+patient is conscious and able to swallow he should
+be given hot coffee or aromatic spirits of ammonia,
+one teaspoonful in half a glass of water. The
+legs and arms should be rubbed from the extremities
+toward the heart, but care should be
+taken to avoid touching or moving injured parts.
+The patient should stay in bed, warmly covered
+and closely watched for some time after he has
+apparently recovered.</p>
+
+<p>Helping a patient into bed is not necessarily
+the first thing to be done in every case of sudden
+illness. Great harm may be done by the injudicious
+moving of injured persons, and often it is
+safer to make a person comfortable with pillows
+and blankets where he happens to be, certainly
+until a sufficient number of people can be found
+to lift him properly. Clothing should be removed
+carefully, and one should not hesitate to cut it
+away if undressing is painful or necessitates much
+moving.</p>
+
+<div class="run-in">
+<h4>Stimulants</h4><p>, in emergency work, are frequently
+misused. They should not be given when the
+head has been injured, when bleeding is profuse,
+or when the face is red and the pulse strong.<!-- Page 264 --><span class='pagenum'><a name="Page_264" id="Page_264">[264]</a></span>
+Neither should attempts be made to give fluids of
+any kind to patients not sufficiently conscious to
+swallow. Safe stimulants to use are black coffee,
+tea, or aromatic spirits of ammonia. Alcoholic
+liquors should not be given unless prescribed by a
+physician.</p></div>
+
+<div class="run-in">
+<h4>Sunstroke and heat exhaustion</h4>&nbsp;<p>are both caused
+by excessive heat either indoors or out, but they
+differ both in symptoms and in treatment.</p></div>
+
+<p>Sunstroke or heat stroke, usually begins with
+acute pain in the head, followed almost immediately
+by loss of consciousness. The skin is dry
+and very hot, the face is red or purple, the pupils
+are dilated, the breathing is difficult, the pulse is
+slow, and the temperature high.</p>
+
+<p>Treatment consists in sending for the doctor,
+removing the patient to a cool place, undressing
+him and applying cold, especially to the head and
+spine, or still better, placing him in a very cold
+bath. The body should be rubbed constantly
+in the direction of the heart. Stimulants should
+not be given.</p>
+
+<p>Symptoms of heat exhaustion, on the other hand,
+resemble those of shock. The doctor should be
+summoned, and the patient should be removed
+to a cool and quiet place, where he should stay
+warmly covered in a reclining position. Stimulants
+should be given, hot water bags applied, and<!-- Page 265 --><span class='pagenum'><a name="Page_265" id="Page_265">[265]</a></span>
+the other measures for treating shock should be
+employed.</p>
+
+<h3>CONDITIONS IN WHICH THE DIGESTIVE
+TRACT IS AFFECTED</h3>
+
+<div class="run-in">
+<h4>Nausea and vomiting</h4>&nbsp;<p>are frequently caused by
+injudicious eating, especially when a person is
+worried or fatigued. A doctor should be consulted
+if either one occurs often, or if vomiting is accompanied
+by pain, prostration, diarrhœa, fever, or
+other acute symptoms. A person who is nauseated
+should lie down in a cool, quiet place. Hot
+fomentations may be applied to the abdomen, or a
+mustard paste over the stomach. Soda mints or a
+teaspoonful of baking soda may be given dissolved
+in hot water, and unless diarrhœa is present a
+Seidlitz powder or other saline cathartic may be
+given. A large quantity of warm water may be
+given to wash out the stomach; it is more effectual
+if salt or mustard is added, in the proportion of one
+teaspoonful to a glass of water.</p></div>
+
+<div class="run-in">
+<h4>Hiccough</h4><p>, which is usually caused by digestive
+disturbances, is not serious in healthy people, and
+can generally be stopped by holding the breath, or
+by drinking water. If these measures are not
+effectual, salt or mustard in water as already
+described or a teaspoonful of the syrup of ipecac,
+may be given to produce vomiting. If the hiccough<!-- Page 266 --><span class='pagenum'><a name="Page_266" id="Page_266">[266]</a></span>
+still continues, medical advice should be
+obtained.</p></div>
+
+<div class="run-in">
+<h4>Diarrhœa</h4>&nbsp;<p>is ordinarily caused by an infection,
+or by an offending substance in the intestines.
+The offending substance should be removed before
+attempts are made to check the diarrhœa. When
+a baby has diarrhœa four things should be done&mdash;all
+food should be withheld; boiled water should be
+given freely; bowel movements should be saved
+for the doctor to see; and unless a doctor can be
+found immediately, castor oil should be given,
+from one-half to one teaspoonful according to the
+age of the child. Similar treatment should be
+given to older children. Adults should take one
+tablespoonful of castor oil and drink boiled water
+freely, but they should take no food until the
+doctor comes.</p></div>
+
+<div class="run-in">
+<h4>Constipation</h4>&nbsp;<p>has been discussed on pages <a href="#Page_193">193</a>
+and <a href="#Page_52">52</a>.</p></div>
+
+<div class="run-in">
+<h4>Colic</h4>&nbsp;<p>is a sharp, intermittent pain in the abdominal
+region; it is caused in many instances by indigestion
+or chilling. The following remedies may
+relieve it: a hot water bag, an emetic, as salt or
+mustard in luke-warm water, a Seidlitz powder or
+other saline cathartic, soda mints, or a teaspoonful
+of syrup of ginger in hot water. Unless it feels
+sore or tender, the abdomen may be rubbed up, on
+the right side, across, just below the waist, and<!-- Page 267 --><span class='pagenum'><a name="Page_267" id="Page_267">[267]</a></span>
+down, on the left side. Babies may be given a few
+teaspoonfuls of warm water, or an enema of salt
+and water.</p></div>
+
+<p>Colic may be serious. The doctor should be
+summoned at once if the patient seems exhausted,
+if the pain is severe, if pain is increased rather than
+relieved by pressure, if the abdomen feels sore,
+especially on the right side, or if sharp abdominal
+pain is accompanied by fever, vomiting, and
+stubborn constipation. If the above-mentioned
+symptoms are present, no food, drink, or medicine
+should be given until the doctor comes.</p>
+
+<h3>CONDITIONS IN WHICH THE EYES OR
+EARS ARE AFFECTED</h3>
+
+<div class="run-in">
+<h4>Styes</h4>&nbsp;<p>generally accompany eyestrain or poor
+general health. The cause should be found and
+treated; and especial attention should be given to
+correcting eyestrain, indigestion, and constipation.
+Hot applications may be used, but if pus
+gathers, the stye should be treated by a physician.</p></div>
+
+<div class="run-in">
+<h4>Foreign bodies in the eye</h4>&nbsp;<p>may sometimes be
+removed by blowing the nose violently, by yawning
+several times, or by drawing the upper lid down
+over the lower. The eye should not be rubbed.
+If it proves impossible to dislodge the object by
+these methods or by others similar, the patient's
+eyelid should be turned back in the following<!-- Page 268 --><span class='pagenum'><a name="Page_268" id="Page_268">[268]</a></span>
+way: Let the patient sit with his head back in a
+low chair placed in a good light, and stand behind
+him holding his head between your side and upper
+arm. In this position the patient's head is held
+firmly while both of the operator's hands are free.
+Next draw down the lower lid, and remove the
+object, if visible, on the corner of a clean handkerchief.
+To turn back the upper lid, grasp the eyelashes
+firmly, draw the lid down, out, and then up
+over a match or pencil placed across the middle
+line of the lid and held in your other hand. Then
+wipe the object carefully away if it is visible.</p></div>
+
+<p>Irritation that persists after the foreign body
+has been removed may be relieved by a cold
+compress continued for an hour or more, or by a
+drop or two of castor oil placed under the lid. If
+attempts to remove the foreign body prove unsuccessful,
+if the injury is severe, or if irritation
+continues after several hours, apply a cold compress,
+bandage it firmly so that the eyeball is kept
+at rest, and seek the aid of a physician.</p>
+
+<div class="run-in">
+<h4>Disorders Affecting the Ears.</h4><p>&mdash;Permanent deafness
+may result from neglecting disorders of the
+ears. Ear-ache, discharge from the ear, swelling
+in or about it, pain or tenderness behind it, all
+require medical attention and no time should be
+lost in securing it. To relieve pain the patient
+may lie with the ear on an ice bag, but nothing<!-- Page 269 --><span class='pagenum'><a name="Page_269" id="Page_269">[269]</a></span>
+whatever should be put into the ear before the
+doctor comes, except when an insect has entered
+the ear, and causes acute distress by the noise of
+its beating wings. If such an accident has occurred,
+the patient should lie on the unaffected side,
+and warm sweet oil should be dropped very gently
+into the affected ear by means of a medicine dropper.
+The insect generally drowns in the oil and
+floats to the opening of the ear canal. After it
+has been removed, the patient should lie on the
+affected side so that the oil may drain out of the
+ear.</p></div>
+
+<p>No attempts should be made to remove foreign
+bodies from the ear or nose, unless they can be
+reached easily with the fingers. Hair pins, crochet
+hooks and similar instruments should never be used
+for this purpose. It is best for a doctor to remove
+foreign objects because unskillful attempts are
+likely to move them further in.</p>
+
+<h3>CONDITIONS IN WHICH THE SKIN IS
+AFFECTED</h3>
+
+<div class="run-in">
+<h4>Prickly-heat</h4><p>, which affects babies and children
+more often than adults, is an eruption caused
+by heat and moisture, and aggravated by flannel
+underwear. It may be prevented by keeping the
+skin dry and cool, and it may be relieved by bathing
+the skin with alcohol and water, about one<!-- Page 270 --><span class='pagenum'><a name="Page_270" id="Page_270">[270]</a></span>
+part of alcohol to three of water, and by using
+after the bath a powder made of two parts of
+starch to one of boracic acid, or any good talcum
+powder.</p></div>
+
+<div class="run-in">
+<h4>Insect Bites and Stings.</h4><p>&mdash;The sting, if still
+in the wound, should first be removed, and then
+ammonia should be applied, since the poison is generally
+acid. Applications of cold water, alcohol
+and water, or wet salt may relieve the subsequent
+burning and itching, but ammonia is generally
+most effective.</p></div>
+
+<div class="run-in">
+<h4>Ivy poisoning</h4>&nbsp;<p>may be treated by applying
+cloths wet in a strong solution of baking soda or of
+boracic acid, or by applications of carbolized vaseline
+or ichthyol. Severe cases should have medical
+attention. Scratching and rubbing seem to
+spread the inflammation, and special care should
+be taken not to rub the face or eyes with infected
+hands. Susceptible people should avoid the plant
+if possible.</p></div>
+
+<h3>OTHER EMERGENCIES</h3>
+
+<div class="run-in">
+<h4>Chills</h4>&nbsp;<p>may be the result of infection or of exposure
+to cold. An early diagnosis of the trouble
+is so desirable that it is well to send for a doctor
+even when symptoms are not severe. If a person
+has a chill his temperature should be taken at
+once; fever and chill together probably indicate<!-- Page 271 --><span class='pagenum'><a name="Page_271" id="Page_271">[271]</a></span>
+invasion by bacteria. When chills follow exposure
+to cold the patient should go to bed between
+warm blankets, his body should be briskly rubbed,
+and hot water bags and a hot drink should be
+given. If he prefers, he may take a hot bath
+before going to bed.</p></div>
+
+<div class="run-in">
+<h4>Croup</h4>&nbsp;<p>is caused by a spasmodic closure of the
+larynx so that breathing is impeded. The child
+who develops croup may have a slight cold, but
+frequently shows no symptoms until he wakes in
+the night with a hoarse ringing cough and difficult
+breathing. True croup, though often distressing,
+is seldom serious, even when the symptoms are
+so severe that the child appears to be partly suffocated.
+An emetic should be given at once,
+preferably syrup of ipecac, one teaspoonful followed
+by warm water, or ten drops every 15 minutes
+until the child vomits freely. Hot fomentations
+may be applied to the throat and chest in
+order to hasten relaxation of the muscular spasm,
+and water should be kept boiling near the bed in
+a teakettle or uncovered saucepan. The child
+should stay in a warm room during the following
+day.</p></div>
+
+<p>Whenever a child develops a croupy cough his
+throat should be examined. A physician should
+be summoned if the throat is red and especially
+if the redness is associated with rise in temperature.<!-- Page 272 --><span class='pagenum'><a name="Page_272" id="Page_272">[272]</a></span>
+Cases of diphtheria have been overlooked
+by neglecting such symptoms.</p>
+
+<h3>BLEEDING</h3>
+
+<p>In the vast majority of cases, bleeding can be
+stopped by elevating the injured part and applying
+pressure over the wound. One should, however,
+remember that loss of blood is not the only
+danger presented by an open wound, for pus-producing
+germs, if they make their entrance,
+may cause an infection which may be as serious
+as the bleeding itself. Hence in dealing with open
+wounds of any sort one should always keep in
+mind the danger of infection as well as the danger
+from loss of blood.</p>
+
+<div class="run-in">
+<h4>Treatment of Slight Wounds.</h4><p>&mdash;Loss of blood
+from slight wounds is seldom so serious as the
+danger of infection; therefore small cuts, pin
+pricks, scratches, etc. should be encouraged to
+bleed by pressure near the wound in order to
+expel the germs that may have entered. After
+the wound has bled a little, tincture of iodine
+should be applied by means of a cotton swab both
+to the wound itself and also to the surrounding skin.</p></div>
+
+<p>After the wound has thus been disinfected it
+should be covered with a sterile dressing; a sterile
+or aseptic dressing is material in which all bacterial
+life has been destroyed. Gauze from a First<!-- Page 273 --><span class='pagenum'><a name="Page_273" id="Page_273">[273]</a></span>
+Aid dressing or from a packet of sterile gauze
+should be used for this compress, or gauze may be cut
+from a sterile bandage. The compress serves two
+purposes: it protects the wound from infection, and
+if applied with pressure it checks further bleeding.</p>
+
+<p>The compress should be securely bandaged in
+place, or its edges may be fastened with adhesive
+plaster or collodion. Neither of the two latter
+should cover the wound itself. The outside bandage
+may be changed when soiled, but the compress
+itself should not be disturbed until the wound
+has healed. It is a mistake to dress wounds
+oftener than necessary, since handling them always
+increases the chance of introducing germs. Most
+children, like Tom Sawyer, delight in wounds,
+but they should be prevented if possible both from
+inspecting and from exhibiting them.</p>
+
+<p>If heat, swelling, redness, or pain develop in a
+wound after a day or two, a doctor should be consulted;
+and not a minute should be lost if the
+patient has a chill or if red streaks appear extending
+from the wound in the general direction of the
+heart. Until the doctor comes the wounded part
+should be elevated and covered with cold applications
+wet in alcohol 25%, or in a solution of common
+salt, a teaspoonful to a pint of water.</p>
+
+<p>Several points should be remembered in dressing
+wounds. In the first place the mouth, which<!-- Page 274 --><span class='pagenum'><a name="Page_274" id="Page_274">[274]</a></span>
+is full of germs, is not a good place for cut fingers.
+Moreover, wounds should not be touched by
+anything, especially the fingers, either washed or
+unwashed, nor should the scissors, fingers or other
+object be allowed to touch the surface of the
+dressing that is to be placed directly upon a wound.
+Unless they contain gross dirt wounds should not
+be washed with water, since washing introduces
+another chance of infection and accomplishes
+nothing except a tidy appearance, which is not
+essential. Furthermore, it should be remembered
+that exposure to the air will not infect a wound,
+and therefore time should be taken to find a suitable
+dressing. When a sterile dressing is quite
+impossible to obtain, the cleanest material available
+should be used; one of the best substitutes
+for a sterile dressing is the inner surface of a handkerchief
+or napkin that has not previously been
+unfolded since it was ironed. It is a common mistake
+to tie up a wound in the first article presented,
+which is usually a generous by-stander's soiled
+handkerchief. The same precautions in regard to
+cleanliness should be taken in dressing wounds
+that are known to be contaminated, since even
+into an infected wound it is possible to introduce
+more germs and more virulent ones.</p>
+
+<div class="run-in">
+<h4>Nosebleed</h4>&nbsp;<p>usually stops of itself, but if it is
+obstinate the patient should sit erect with the<!-- Page 275 --><span class='pagenum'><a name="Page_275" id="Page_275">[275]</a></span>
+head back, and cold compresses should be placed
+on the nose and at the back of the neck. Pressure
+should be made on the upper lip by means of
+the fingers, or by a firm roll of paper or cotton
+placed under the upper lip. Salt or vinegar in
+water, a teaspoonful of either one to a cup of
+water, may be snuffed up the nose. The treatment
+should be continued for ten or fifteen minutes,
+or until bleeding stops; if the bleeding persists
+a doctor is needed.</p></div>
+
+<div class="run-in">
+<h4>Profuse menstruation</h4>&nbsp;<p>should be treated by
+keeping the patient quiet in bed with the head low
+and the feet slightly elevated. "Any marked
+increase, whether by amount, duration, or shortening
+of the interval between the periods ought
+to receive attention and be brought to the physician's
+notice" (Latimer). Painful menstruation
+may be relieved by rest in bed, mental as well as
+physical, by hot drinks and by the application of
+heat. Rest, and hygienic living persistently practised,
+will relieve most menstrual abnormalities.
+The common practice of using patent remedies
+and alcoholic liquors for disordered menstruation
+cannot be too strongly condemned.</p></div>
+
+<h3>OTHER INJURIES</h3>
+
+<div class="run-in">
+<h4>Sprains.</h4><p>&mdash;A sprain is caused by twisting,
+stretching, or tearing the tissues about a joint.<!-- Page 276 --><span class='pagenum'><a name="Page_276" id="Page_276">[276]</a></span>
+The first sharp pain comes from the injury to the
+tissues; subsequent pain is caused by the pressure
+of accumulated fluid. The other symptoms are
+those characteristic of inflammation.</p></div>
+
+<p>When a sprain is slight, the affected part should
+be elevated and kept at rest for the first twenty-four
+hours. Either heat or cold should be applied,
+or heat and cold alternately; a good treatment is to
+soak the part in hot water and afterward to allow
+cold water to run upon it from the tap. Gentle
+rubbing with a circular motion helps to reduce the
+swelling. If the joint must be used it should be
+bandaged tightly.</p>
+
+<p>Injuries to joints should never be neglected; and
+severe sprains always require medical attention,
+since in addition to the sprain a bone may be
+broken. A severely sprained joint should be
+elevated, treated with hot or cold applications,
+and kept at rest until it has been examined by a
+physician.</p>
+
+<div class="run-in">
+<h4>Bruises.</h4><p>&mdash;Bruises need no attention unless they
+are extensive or painful. The skin should be kept
+clean and if possible unbroken, since injured tissues
+are less resistant to infection than tissues in
+their normal state. Applications of cold water or
+of equal parts of cold water and alcohol may relieve
+the pain, but cold should not be used upon
+bruises that are extensive. A compress bandaged<!-- Page 277 --><span class='pagenum'><a name="Page_277" id="Page_277">[277]</a></span>
+tightly in place may help to prevent swelling and
+discoloration.</p></div>
+
+<div class="run-in">
+<h4>Burns and Scalds.</h4><p>&mdash;Injuries from dry heat are
+called burns, and those from moist heat are called
+scalds. Both are painful, and both are dangerous
+if extensive or deep. Burns and scalds require
+medical attention if the injured area is extensive,
+if a large blister is formed, if the skin is destroyed
+or charred, and if symptoms of shock appear.
+Shock often follows burns or scalds even when
+the injury is comparatively slight.</p></div>
+
+<p>Treatment of slight burns, where the skin is
+reddened but not destroyed, has for its main object
+the exclusion of air. One of the following
+may be applied: dry baking soda, or baking soda
+made into a paste with water, picric acid gauze
+moistened in water, boracic acid ointment, vaseline,
+sweet oil, or castor oil; if none of these is obtainable,
+lard, cream, the white of an egg or unsalted
+butter may be used. Old muslin or linen bandaged
+lightly in place, should be used to cover the burn.</p>
+
+<p>The same treatment is used for sunburn, and
+also for small burns where blisters form. A
+blister, if it forms, should not be punctured; but if
+it is accidentally broken the skin of the blister
+should not be removed. It should be remembered
+that a broken blister is an open wound, and therefore
+liable to infection.</p>
+
+<p><!-- Page 278 --><span class='pagenum'><a name="Page_278" id="Page_278">[278]</a></span></p>
+
+<div class="run-in">
+<h4>Brush burn</h4>&nbsp;<p>is a name given to injuries where the
+surface of the skin has been removed. They include
+the scraped arms and legs which are common
+accidents in childhood. In order to dress a
+brush burn, particles of dirt should first be removed
+preferably by means of forceps that have
+been boiled, and the surrounding skin should then
+be cleansed with soap and water. The injured
+part should next be flushed with sterile salt solution,
+made by boiling water five minutes and
+adding to it salt in the proportion of one teaspoonful
+to a pint of water. If the dirt is difficult to
+remove a soap compress should be applied. To
+prepare the compress several thicknesses of
+gauze or muslin should be boiled in a strong
+solution of castile or green soap for ten minutes.
+The compress should remain in place several
+hours, and may be repeated if necessary. After
+the wound has been thoroughly cleansed, it
+should be dressed with old muslin that has been
+saturated in castor oil or spread with boracic ointment.</p></div>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>Name some common causes of headache and of
+sleeplessness, and outline rational treatment for each
+of these disorders.</li>
+
+<li>Describe symptoms and treatment of shock; of
+fainting; of convulsions in children.</li>
+
+<li><!-- Page 279 --><span class='pagenum'><a name="Page_279" id="Page_279">[279]</a></span>
+Describe the treatment of all disturbances of the
+digestive tract mentioned in this book.</li>
+
+<li>What should be done if a foreign body has entered the
+eye? if one has entered the ear? What should be done
+for a person who has a stye? for a person with pain in
+or near the ear?</li>
+
+<li>How would you treat a sprain?</li>
+
+<li>Describe treatment for burns and scalds.</li>
+
+<li>Distinguish between heat stroke and heat prostration,
+and tell what treatment should be given in each
+case.</li>
+
+<li>What are the two principal dangers from slight
+wounds, and how should one guard against them? Show
+how you would dress a small cut.</li>
+
+<li>What should you do for a person with nose bleed?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>American National Red Cross Text Book on First Aid&mdash;Lynch.</li>
+
+<li>Immediate Care of the Injured&mdash;Morrow.</li>
+
+<li>Prompt Aid to the Injured&mdash;Doty.</li>
+</ul>
+
+<p><!-- Page 280 --><span class='pagenum'><a name="Page_280" id="Page_280">[280]</a></span></p>
+
+<h2><span class="sm2">CHAPTER XIV</span><br />
+<br />
+SPECIAL POINTS IN THE CARE OF
+CHILDREN, CONVALESCENTS, CHRONICS,
+AND THE AGED</h2>
+
+<p>In many cases of sickness institutional care has
+marked advantages. It may be the only solution
+when adequate provision for the sick is impossible
+at home; and it is often a necessity when a patient
+requires special equipment or apparatus, expert
+nursing, and medical attention within reach both
+day and night.</p>
+
+<p>On the other hand, it would not be desirable
+even if it were possible for all sick persons to be
+cared for in institutions. Care at home when it is
+adequate may be more successful than equally
+skillful care given elsewhere, since the sick quite
+as much as the well are injured by long separation
+from normal family life. Most children, because
+they need the attention of their own mothers,
+most convalescent and chronic patients, and most
+aged persons are cared for at home; and in the
+great majority of cases no better place for them
+could be found. Since patients of these four
+groups have needs peculiar to themselves, some<!-- Page 281 --><span class='pagenum'><a name="Page_281" id="Page_281">[281]</a></span>
+special points in caring for them are considered
+in this chapter.</p>
+
+<h3>CHILDREN</h3>
+
+<p>Ability to observe quickly and accurately is
+seldom more needed than it is by a woman who
+cares for children. No one expects babies to
+explain their troubles, but people forget that
+small children are unable to describe their physical
+sensations with any degree of accuracy, although
+discomfort or sickness may show itself
+in all degrees of ill temper and bad conduct.
+For these exhibitions many a suffering child has
+been punished, where an older and more articulate
+person would have received considerate attention.</p>
+
+<p>Children, like babies, have a low resistance to disease.
+Moreover, they react quickly both to favorable
+and to unfavorable surroundings. Hence
+slight causes sometimes produce pronounced or
+even violent symptoms in children without giving
+cause for great anxiety, although the same symptoms
+if exhibited by adults, might indicate
+critical illness. On the other hand the recuperative
+power of children is high, and their recoveries
+are sometimes surprisingly rapid. It is a mistake,
+when a child has completely recovered from
+an acute but brief illness, to coddle him for weeks
+afterward merely because a grown person in similar<!-- Page 282 --><span class='pagenum'><a name="Page_282" id="Page_282">[282]</a></span>
+circumstances would have failed to regain
+his strength.</p>
+
+<p>When a child is sick in bed, especial efforts
+should be made to insure adequate ventilation
+without chilling him. Children always lose heat
+rapidly because the body surface is proportionately
+large; when they are ill, therefore, it is especially
+necessary to keep them well covered, to
+see that their hands and feet are warm, and to
+avoid chilling them during their baths. But overheating
+must also be avoided, since all children,
+sick or well, who are too warmly dressed or who
+stay in rooms that are too warm, become weak and
+irritable and more susceptible than others to colds
+and other respiratory disorders. The child's
+skin should be kept clean and dry, but he should
+not be disturbed nor handled unnecessarily.</p>
+
+<p>Sick children require very simple food at short
+intervals. Variety is not so necessary for a child
+as for an adult, unless the child has been allowed
+to form bad habits of eating. Sick children should
+not be indulged unnecessarily, either in regard to
+their food or in other ways. However, attempts
+made during an illness to change the habits of a
+badly trained child are unwise because usually
+unsuccessful; parents who sow the wind by neglecting
+to train their children when they are in
+good health may as well make up their minds to<!-- Page 283 --><span class='pagenum'><a name="Page_283" id="Page_283">[283]</a></span>
+reap a veritable whirlwind when the children are
+ill. Even when children are well trained it is
+difficult and sometimes impossible to prevent them
+from forming bad habits during sickness. Yet
+the labor of training a child reaps perhaps at no
+other time a richer reward than it does when the
+child is ill, and his recovery might be seriously
+impeded by unwillingness to accept necessary
+food, medicine, or treatment.</p>
+
+<div class="run-in">
+<h4>Physical defects</h4>&nbsp;<p>are faults in the structure of
+the body; adenoid growths, imperfect eyes, abnormally
+curved spines, and defective teeth are
+examples. Most physical defects can be cured
+in childhood by treatment or by slight operations.
+If untreated they frequently lead to sickness or to
+serious impairment of the body, and if neglected
+until adult life their injurious consequences are
+generally beyond remedy, even when the defects
+themselves can be repaired.</p></div>
+
+<p>Some indications of common physical defects
+are given below; they ought to be more generally
+known than they are. If a child exhibits one or
+more of the symptoms mentioned, he ought to be
+given a complete physical examination by a
+competent physician, and treatment, if needed,
+should begin without delay. The idea that children
+will outgrow these defects without treatment
+is erroneous. Better, however, than waiting until<!-- Page 284 --><span class='pagenum'><a name="Page_284" id="Page_284">[284]</a></span>
+symptoms appear is the modern way of giving
+every child a physical examination at stated intervals,
+a practice already common in public schools
+where effective health work is carried on.</p>
+
+<div class="run-in">
+<h4>Eyestrain</h4>&nbsp;<p>frequently comes from imperfections
+in the shape of the eye; these imperfections can
+almost always be corrected by glasses. When a
+child is suffering from eyestrain, the eyes themselves
+may show indications of trouble; they may
+be blood-shot, the lids may itch or be crusted or inflamed,
+or styes may appear. In other cases the
+symptoms of eyestrain have no apparent connection
+with the eyes; such symptoms are headache,
+nausea, vomiting, indigestion, fatigue, irritability,
+poor scholarship, and nervous exhaustion.
+If a child shows any of these symptoms, or if he
+rubs his eyes, frowns, squints, wrinkles his forehead,
+sits bent over his book, or develops round
+shoulders, there is sufficient reason for having his
+eyes examined by an oculist. Examination by an
+optician should not be considered sufficient.</p></div>
+
+<div class="run-in">
+<h4>Enlarged Tonsils and Adenoids.</h4><p>&mdash;The tonsils
+are masses of spongy tissue situated at the back of
+the mouth, on either side of the opening into the
+throat. If enlarged they may seriously interfere
+with breathing, and if diseased they frequently
+harbor the germs causing many acute infections,
+as well as germs of rheumatism and most of the<!-- Page 285 --><span class='pagenum'><a name="Page_285" id="Page_285">[285]</a></span>
+heart disease originating in early life. Therefore
+the tonsils ought to be removed if they are diseased
+or greatly enlarged, but there is ordinarily
+no good reason for removing normal tonsils.</p></div>
+
+<p>Adenoids are situated at the back of the nose,
+and like the tonsils are composed of spongy tissue.
+Adenoids sometimes become so enlarged that they
+interfere with the passage of air through the nose,
+thus predisposing to catarrh, colds, and other
+respiratory diseases, to high palate with irregular
+teeth, to inflammation of the middle ear leading to
+deafness, to diminished mental activity, and to
+general poor health.</p>
+
+<p>If a child breathes through his mouth, if he
+snores at night, keeps his mouth open and has a
+dull, apathetic expression, his nose and throat
+should be examined, and if advisable his tonsils
+and adenoids should be removed.</p>
+
+<div class="run-in">
+<h4>Defective Hearing.</h4><p>&mdash;Permanent deafness among
+children in the great majority of cases comes
+from trouble in the throat or nose; hence the most
+effective measure to prevent deafness is to make
+sure that every child's nose, throat, and mouth
+are in a normal condition. Sensitive or timid
+children try to hide infirmities of any kind, but
+deaf children seem peculiarly unable to explain
+their difficulties. "No one," says Cornell, "has
+ever recorded that a small child complained of<!-- Page 286 --><span class='pagenum'><a name="Page_286" id="Page_286">[286]</a></span>
+inability to hear." A child's ears should be
+examined if he breathes through his mouth, if he
+stoops habitually, if he is persistently inattentive,
+or if he is vague or stupid in carrying out directions.
+A child who appears normal at times and
+inattentive or stupid at other times should also
+be examined, since he may be deaf in one ear.</p></div>
+
+<p>Temporary deafness may come from accumulated
+wax in the ear. The wax should be removed
+by a doctor; inexpert attempts are likely
+to cause serious injury to the ear drum. Intermittent
+deafness may be caused by enlarged tonsils
+and adenoids. Children thus affected are not
+infrequently punished for seeming disobedience.
+Such children are especially liable to street
+accidents.</p>
+
+<div class="run-in">
+<h4>Defective teeth</h4>&nbsp;<p>have been considered on <a href="#Page_44">page
+44.</a></p></div>
+
+<div class="run-in">
+<h4>Posture.</h4><p>&mdash;In childhood the bones are soft and
+yield with comparative ease to continued strains;
+hence they often become deformed by bad positions
+assumed in sitting, standing, or in using the
+body in other ways. The postures habitually
+assumed by a child should be noticed and good
+postures should be insisted upon. But it is not
+enough to admonish him. The various causes
+tending to encourage bad positions should be
+corrected; among them are insufficient illumination<!-- Page 287 --><span class='pagenum'><a name="Page_287" id="Page_287">[287]</a></span>
+of books and work, defective eyesight or
+hearing, obstructions in breathing, muscular
+weakness, and low general vitality. Children
+should have their chairs and tables suited to their
+size for their work both at home and in school.</p></div>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/fig28.png" width="500" height="245" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 28.&mdash;Incorrect Sitting Postures.</span>
+<br />(<cite>From Cornell, "Health and Medical Inspection of School
+Children." F. A. Davis Co., Philadelphia.</cite>)</span>
+</div>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/fig29.png" width="225" height="333" alt="" title="" />
+<span class="caption"><span class="smcap"><br />Fig. 29.&mdash;Incorrect Sitting Postures.</span>
+<br />(<cite>From Cornell, "Health and Medical Inspection of School
+Children." F. A. Davis Co., Philadelphia.</cite>)</span>
+</div>
+
+<p><!-- Page 288 --><span class='pagenum'><a name="Page_288" id="Page_288">[288]</a></span></p>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/fig30.png" width="331" height="333" alt="" title="" />
+<span class="caption"><span class="smcap"><br />Fig. 30.&mdash;Incorrect Sitting Postures.</span>
+<br />(<cite>From Cornell, "Health and Medical Inspection of School
+Children." F. A. Davis Co., Philadelphia.</cite>)</span>
+</div>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/fig31.png" width="400" height="425" alt="" title="" />
+<span class="caption"><span class="smcap"><br />Fig. 31.&mdash;Incorrect and Correct Standing Postures.</span>
+<br />(<cite>From Cornell, "Health and Medical Inspection of School
+Children," F. A. Davis Co., Philadelphia.</cite>)</span>
+</div>
+
+<div class="figright" style="width: 96px;">
+<img class="photo" src="images/fig32.jpg" width="96" height="300" alt="" title="" />
+<span class="caption"><span class="smcap">Fig. 32.&mdash;Round
+Shoulders.</span> (<cite>Goldthwait, from Pyle&#39;s &quot;Personal Hygiene.&quot;</cite>)</span>
+</div>
+
+<p>The adjustable chairs and desks now used in
+schools are a marked improvement upon the<!-- Page 289 --><span class='pagenum'><a name="Page_289" id="Page_289">[289]</a></span>
+school furniture which has caused so many
+deformities in the past.</p>
+
+<p>One of the serious deformities caused by habitual
+faulty posture is curvature
+of the spine. A curvature not
+only injures a child's appearance
+and thus handicaps him
+in later life, but it brings strains
+and pressure upon the organs of
+the chest and abdomen which
+may seriously impair his health.
+As curvatures often pass unnoticed
+in their early stages,
+every child should be inspected
+occasionally when all his clothing
+has been removed, to see
+whether the weight is borne
+evenly on both feet, whether
+the development of the two
+sides is uniform, and whether
+the head and shoulders are
+properly carried. It should be
+noticed when the child stands,
+whether one shoulder is higher
+than the other, whether one
+shoulder blade projects more than the other,
+whether one hip is higher than the other, and
+whether one hand is lower than the other when<!-- Page 290 --><span class='pagenum'><a name="Page_290" id="Page_290">[290]</a></span>
+the arms are hanging at the sides. The child
+should walk both toward and away from the
+observer, who should notice whether the child
+uses the two sides of his body in the same way,
+and whether he drags or shuffles his feet or has
+other abnormalities of gait.</p>
+
+<p><!-- Page 291 --><span class='pagenum'><a name="Page_291" id="Page_291">[291]</a></span></p>
+
+<p>If abnormalities are found, a physician should
+be consulted. Often corrective exercises are all
+that is needed, and no one should put braces
+of any kind upon a child unless they have been
+prescribed by a physician. No attempt should
+be made to correct the common tendency of
+children to toe in or "walk pigeon-toed." Toeing-in
+is a natural manner of walking during the<!-- Page 292 --><span class='pagenum'><a name="Page_292" id="Page_292">[292]</a></span>
+formative period and tends to strengthen the
+arch of the foot, while toeing-out tends to
+weaken the arch and to cause flat foot or broken
+arches.</p>
+
+<div class="figcenter" style="width: 330px;">
+<img class="photo" src="images/fig33.jpg" width="200" height="410" alt="" title="" />
+<span class="caption"><span class="smcap"><br />Fig. 33.&mdash;Lateral Curvature.</span> (<cite>From Bancroft's "Posture
+of School Children." The Macmillan Co., New York.</cite>)</span>
+</div>
+
+<div class="figcenter" style="width: 350px;">
+<img class="photo" src="images/fig34.jpg" width="236" height="350" alt="" title="" />
+<span class="caption"><span class="smcap"><br />Fig. 34.&mdash;"Wing Shoulder Blades in Forward Shoulders.</span>
+(<cite>From Bancroft's "Posture of School Children." The Macmillan
+Co., New York.</cite>)</span>
+</div>
+
+<div class="run-in">
+<h4>Predisposition to Nervousness.</h4><p>&mdash;Heredity plays
+an important rôle in the predisposition to nervousness,
+so that children of nervous parents are particularly
+likely to show nervous instability. It
+is, however, difficult to say in a given case how
+much of his nervousness a child inherits and how
+much he acquires by imitating the irritability,
+the out-breaks of temper, and the other evidences
+of imperfect emotional control displayed by his
+nervously disposed parents. On the other hand,
+even children of nervous predisposition sometimes
+overcome their defects to some extent by imitating
+parents who have acquired self-control.</p></div>
+
+<p>Children predisposed to nervousness should be
+watched with special care, but they should not be
+allowed to realize that they are the objects of
+unusual solicitude. They need the most favorable
+surroundings that can be obtained, and
+their general health should be maintained at
+the highest possible level. Any condition that
+lowers vitality tends to increase their troubles;
+nervousness may be caused among children of
+good inheritance, and increased among others,
+by poor nutrition, lack of exercise and play out-of-<!-- Page 293 --><span class='pagenum'><a name="Page_293" id="Page_293">[293]</a></span>doors,
+fatigue, loss of sleep, eyestrain, adenoid
+growths, and the poisons of infectious diseases.</p>
+
+<p>It is characteristic of many nervous children
+that they are too easily stimulated; they may be
+excitable, restless, unnaturally quick in moving,
+over-sensitive to pain and discomfort, easily
+fatigued, irritable in temper, and unable to control
+the emotions. They frequently make involuntary
+motions like grimacing and winking
+the eyes. Children of low nervous tone, however,
+are not necessarily excitable. A nervous child
+may be muscularly weak, awkward in gait, listless,
+dull, clumsy, forgetful, and inattentive.
+Such children often suffer from cold hands
+and feet and from profuse perspiration.</p>
+
+<p>Much can be done for these unfortunate children
+by removing the cause of their troubles if
+possible, by giving them simple and wholesome
+surroundings, by suiting their occupations to their
+strength, by eliminating mental strain, particularly
+during the adolescent period, and by training
+them to control their minds as well as their
+bodies.</p>
+
+<blockquote>
+<p>"In addition to the hardening of the body, the education
+of the child should include measures which increase the
+resistance of the child against pain and discomforts of
+various sorts. Every child, therefore, should undergo a
+gradual process of 'psychic hardening' and be taught to<!-- Page 294 --><span class='pagenum'><a name="Page_294" id="Page_294">[294]</a></span>
+bear with equanimity the pain and discomfort to which
+everyone sooner or later cannot help but be exposed.
+What I have said about clothing, cold baths, walking in
+all weather and at all temperatures, play and exercise in
+the open air, has a bearing on this point, for a child who
+has formed good habits in these various directions will
+have learned many lessons in the steeling of his mind to
+bear pain and to ignore small discomforts."&mdash;(Barker:
+"Principles of Mental Hygiene Applied to the Management
+of Children Predisposed to Nervousness.")</p></blockquote>
+
+<h3>CONVALESCENT PATIENTS</h3>
+
+<p>After serious or prolonged illness the vitality
+is generally low and all bodily processes are likely
+to be depressed. During convalescence, therefore,
+the digestion is feeble, the muscles are weak
+so that fatigue follows slight exertion, and the
+sluggish condition of the circulation renders the
+patient especially sensitive to cold. Since the
+nervous system also becomes depressed and irritable,
+a convalescent patient is easily excited,
+easily discouraged, and quickly fatigued by mental
+effort. He finds the simplest decisions hard
+to make, and his emotions difficult to control;
+indeed, many a patient who has borne acute pain
+with unflinching courage becomes peevish at
+this stage, weeps easily, and expects more expression
+of sympathy than is good for him. Some
+persons naturally make quick recoveries, while<!-- Page 295 --><span class='pagenum'><a name="Page_295" id="Page_295">[295]</a></span>
+others recuperate slowly. A long and tedious
+convalescence, it should be remembered, is the
+patient's misfortune rather than his fault.</p>
+
+<p>In restoring a convalescent patient to normal
+living it is imperative to proceed slowly. Food
+should be increased gradually both in variety
+and in amount; but the patient's appetite is not
+always a safe guide, and it may need to be encouraged
+or to be restrained. Both mental and
+physical exertion should begin only under careful
+supervision, and should increase by slow degrees.
+The patient should sleep as much as possible,
+should take long intervals of rest, and should continue
+no occupation to the point of fatigue. A
+patient who has been ill in a hospital or who has
+had at home the exclusive services of a nurse or
+an attendant, often finds the period following his
+return or following the nurse's departure an exceedingly
+difficult transition. The family should
+not expect or allow him to resume too many duties
+at a time when the mere acts of bathing and dressing
+may demand all the strength he has. Many
+convalescents are obliged, or think they are
+obliged, to take up regular work again before
+their strength is fully restored. There is
+generally no economy in so doing; indeed, time
+is saved in the end by waiting until recovery
+is complete before undertaking full work.</p>
+
+<p><!-- Page 296 --><span class='pagenum'><a name="Page_296" id="Page_296">[296]</a></span>
+Important as it is to build up the patient's
+physical strength, it is hardly less important to
+direct his thoughts away from himself and his
+sickness, and to help him renew his interest in
+normal living. During his illness he has of necessity
+relied upon the judgment and support of
+other persons, and his pain and discomfort have
+forced him to think constantly of himself and his
+many needs. The habit of sickness is readily
+broken by some persons, particularly by those
+whose nervous exhaustion has not been great and
+whose interests outside themselves are naturally
+keen. But the sick point of view has remarkable
+tenacity, and other patients, unless circumstances
+or deliberate efforts redirect their thoughts, will
+look upon themselves as invalids to the end of
+time.</p>
+
+<p>Hopefulness promotes health, while discouragement,
+apprehension, and unhappiness lower
+the tone of the whole system. Hence set backs,
+failures, delays, and relapses should not be dwelt
+upon, but signs of progress should be mentioned;
+judiciously however, since overdone attempts
+to cheer a patient seldom fail to have the opposite
+effect. If objects or situations that suggest undesirable
+thoughts are eliminated, the less often
+those thoughts tend to recur. Therefore, in order
+to break the habit of sickness, old thoughts must<!-- Page 297 --><span class='pagenum'><a name="Page_297" id="Page_297">[297]</a></span>
+be gradually banished and new ones must be
+substituted. Sick-room appliances should be put
+out of sight as soon as they are no longer needed,
+and the patient may profit by moving into a different
+bed room. A few days spent away from
+home as soon as his strength permits often prove
+effective in breaking up sickness associations;
+the patient is generally encouraged when he finds
+that he can sleep in a different bed, endure some
+fatigue, and exist without daily visits from the
+doctor. Even a day spent at a different house
+in the same town sometimes directs the patient's
+thoughts into fresh channels. Gradually, but
+as quickly as safety allows, he should take his
+place in the normal family life and cease to be
+treated as an exception.</p>
+
+<p>Merely eliminating associations with sickness,
+however, is not enough; and exhorting a patient
+to forget himself and to become interested in
+something seldom accomplishes anything, especially
+if he is so depleted by illness that the
+thought of everyday activities suggests only weariness
+and pain. A person so weak that he is
+thoroughly fatigued by dressing himself should
+not be expected to view with enthusiasm the prospect
+of a full day's work. Much, however, may
+be accomplished by providing something that
+the patient really likes to do, and deliberate<!-- Page 298 --><span class='pagenum'><a name="Page_298" id="Page_298">[298]</a></span>
+efforts must be made to stimulate his interest in
+some occupation, however simple it may be.</p>
+
+<p>Occupations for invalids are more than a means
+to pass away the time; they are also of distinct
+curative value. The patient's interest is not always
+easy to arouse, and some ingenuity may be
+needed in the beginning; sometimes interest is
+best aroused by working at some handicraft in
+his presence, and finally offering, as a favor, to
+teach him to do it also. His interest in any occupation
+is invariably increased if a well person
+not only directs but shares in the work.</p>
+
+<p>Care should be taken to select occupations
+suited to the patient's physical condition, to his
+age, tastes, and mental development. Two or
+three occupations are better than one, so that he
+may change from one to another before any one
+becomes tedious. Work requiring fine motions,
+close attention, or concentrated thought should
+be used for short periods, only, and no work should
+be continued to the point of fatigue. The patient
+should not be allowed to feel that he must
+finish a certain amount in a certain time. Even
+poor work is better than none, and a patient should
+always be encouraged by judicious praise.</p>
+
+<p>Games and puzzles are useful to some extent,
+but an aimless occupation is not so beneficial as
+one which has a tangible product, particularly<!-- Page 299 --><span class='pagenum'><a name="Page_299" id="Page_299">[299]</a></span>
+a product that is useful as well as beautiful.
+Occupations frequently possible for invalids and
+convalescents include knitting, crocheting, many
+kinds of needle work, clay modeling, basketry,
+stenciling, weaving, book-binding, metal work, and
+photography. Manuals are now available giving
+directions for these and many other handicrafts.
+Sick children often enjoy collecting stamps, post
+marks, and other objects, making scrap books,
+sewing, weaving, knitting, paper folding, and
+various other kindergarten occupations.</p>
+
+<h3>CHRONIC PATIENTS</h3>
+
+<p>The whole field of caring for the sick offers
+nowhere greater opportunity for fine and finished
+work than it offers in the case of chronic invalids.
+It is an achievement of which an artist might be
+proud to make a chronic patient comfortable in
+body, happy in mind, and agreeable to others.
+Moreover, since success can never be attained by
+one who wearies in well doing, the care given to a
+chronic invalid tests not only the attendant's
+skill but also her moral and spiritual quality.</p>
+
+<p>Care of a chronic patient has for its aims maintaining
+the patient's health, rendering him as
+happy and comfortable in mind and body as it is
+possible for him to be, and providing whatever
+special treatment and attention his case requires.<!-- Page 300 --><span class='pagenum'><a name="Page_300" id="Page_300">[300]</a></span>
+In order to maintain his health constant attention
+must be given to diet, to hygiene of the sick room,
+and indeed to all his surroundings. In many
+chronic illnesses, such as rheumatism and kidney
+disease, the diet is prescribed by the doctor; in
+every case care should be taken that the patient is
+not overfed or underfed, that the food is suited to
+his digestive powers, that foods causing flatulence
+are eliminated, particularly if the patient's trouble
+is heart disease, and not the least important requirement,
+that he derive as much pleasure from his food as possible.</p>
+
+<p>The regular daily care of the patient and of his
+room, already described in this book, should be
+scrupulously carried out, and no less scrupulously
+during the tenth year than it was during the tenth
+day. Cleanliness in every detail is absolutely
+essential to the patient's welfare; no one is more
+unpleasant either to himself or to others than a
+chronic patient who is neglected. Patients who
+are constantly in bed, it should be remembered,
+and paralyzed patients in particular, are peculiarly
+susceptible to pressure sores. If a patient is
+able, it is extremely important for him to sit up
+in a chair part of the day. Sitting up should
+never be omitted because it involves the expenditure
+of time and trouble for the attendant.</p>
+
+<p>It is often said that for most people some personal<!-- Page 301 --><span class='pagenum'><a name="Page_301" id="Page_301">[301]</a></span>
+experience of sickness is beneficial; it can
+safely be said, however, that no one benefits from
+spending any considerable portion of his life in a
+state of helplessness and suffering. Behavior and
+character itself are determined by influences constantly
+coming into the mind from daily surroundings
+and associations with other people: one who
+recalls this fact needs only a moment's reflection to
+realize how ill adapted to healthy development of
+mind and character are the limited lives of the sick.
+Especially unfortunate is the situation of chronic
+invalids, shut off as they are from the objective
+interests and activities of normal life, deprived of
+all practice in making the salutary small adjustments
+and sacrifices required in every day living
+with other people, and self-centered as they necessarily
+tend to become from the inevitable
+focusing of attention upon their own discomforts
+and pain.</p>
+
+<p>On the whole, a surprisingly large number of
+invalids successfully resist the disintegrating
+effects of sickness upon character. But it is
+nevertheless true, as Dr. Weir Mitchell says, that
+"Sickness ennobles a few but debases many."
+A selfish invalid has more than once destroyed the
+happiness of an entire family, or spoiled the life of
+one member of it by monopolizing her whole time
+and attention. Families should remember that<!-- Page 302 --><span class='pagenum'><a name="Page_302" id="Page_302">[302]</a></span>
+their injudicious sacrifices seldom bring enduring
+happiness or contentment to the patient himself;
+indeed, in the long run such sacrifices generally
+injure him even more than they injure his
+victims. Clearly much must and should be
+sacrificed by members of a family to the needs of
+an invalid; but in general it may be said that a
+sacrifice is injudicious if it relieves the patient
+of activity or responsibility that he can support
+without injury, if it makes him more dependent in
+mind or body, if it results in restricting his attention
+to himself and his affairs, or if it increases
+his tendency to make demands on others.</p>
+
+<p>Purposeful activity of some sort and the necessity
+for contributing to the welfare of others are
+essential parts of a wholesome life. If these
+essentials are entirely eliminated from the life of
+an invalid, the patient's greatest needs are probably
+left unsatisfied, even though the physical
+care he receives may be perfect in every detail.
+All that was said in regard to occupations for
+invalids applies with particular force to occupations
+for chronic patients, since however valuable
+manual occupations may be as a means to bring
+about recovery, they are still more valuable in
+furnishing interest and purpose in a life whose
+only prospect is a succession of weary, useless
+years. Handicapped patients sometimes learn<!-- Page 303 --><span class='pagenum'><a name="Page_303" id="Page_303">[303]</a></span>
+occupations that yield a financial return, and
+ability to earn even a little stimulates self respect
+and mental health, whether the money is needed
+or not. The important point, however, is that
+the finished product should have a recognized use.</p>
+
+<p>In addition to enabling the patient to make
+things with his hands, a way should be found if
+possible by which he may contribute to the group
+of people with whom he lives. If a way can be
+discovered for him to do so, the opportunity
+should not be denied him nor should his service
+fail to be noted and appreciated, even if it is
+nothing more than telling a story to a restless
+child.</p>
+
+<h3>CARE OF THE AGED</h3>
+
+<p>At the end of life, as at its beginning, every
+individual especially needs the interest and protection
+of his own family. In ordinary circumstances
+neither a baby nor an aged person can
+be cared for so fittingly or so successfully in any
+other place as he can be in his own home.</p>
+
+<p>With advancing years is to be expected a general
+slowing down of all the powers. In old age
+both body and mind show characteristic changes,
+and particularly changes causing lowered resistance
+and diminished vigor. If the manner of
+living is adapted to these changes, both happiness<!-- Page 304 --><span class='pagenum'><a name="Page_304" id="Page_304">[304]</a></span>
+and usefulness may be prolonged. But so gradually
+do the changes often come that they may
+escape notice for a long time, and the younger
+generation in looking back sometimes realizes
+with regret how much earlier measures might
+have been taken to prolong the usefulness and
+to mitigate the discomforts of aged parents
+and friends.</p>
+
+<p>Old people are keenly sensitive to cold, since
+the circulation gradually becomes less vigorous
+and they take little exercise. Keeping them warm
+both in bed and out adds more perhaps to their
+comfort than any other one measure. They
+should have warm underclothing and soft shawls
+and other extra wraps. A real service will be
+rendered by the person who invents a suitable
+and dignified wrap for old or feeble men, who dislike
+the informality of sweaters and feel disgraced
+by shawls. Old persons should and can be kept
+warm in bed, by providing them with hot water
+bags, with warm night clothes including stockings,
+by using woollen or outing flannel sheets if necessary,
+and by providing a sufficient number of
+light but warm bed covers. It is not always
+understood that many covers do not remedy the
+deficiencies of a thin mattress. If a thick mattress
+or two thin mattresses cannot be provided,
+a thick comforter or even many layers of<!-- Page 305 --><span class='pagenum'><a name="Page_305" id="Page_305">[305]</a></span>
+newspaper should be placed between the mattress
+and the springs, and another thick comforter
+should be placed between the mattress and the
+lower sheet. Rubbing the body with warm olive
+oil often affords great comfort, by improving the
+circulation and thus increasing the sensation of
+warmth, and also by relieving the tendency of the
+skin to become dry and cracked. Poor circulation
+at night may cause cramps in the muscles of
+the legs; the cramps can usually be relieved by
+warmth and gentle rubbing.</p>
+
+<p>Old people frequently wish their rooms to be
+very hot, both by day and by night, even as hot
+as 80° or 85°, but if it is possible to keep them
+warm in any other way the temperature of the
+room should be kept at 70°. Well ventilated
+rooms are highly important for old people as
+for all others of low resistance, and it is entirely
+possible for their rooms to be warm and yet well
+ventilated. Aged persons should be carefully
+guarded from chill, exposure, crowds, and infected
+persons. Like little children they are peculiarly
+susceptible to the respiratory diseases, which
+cause many of the deaths commonly attributed
+to old age.</p>
+
+<p>Digestion usually becomes weaker than in
+earlier years, and less food is needed. It should
+be simple, hot, and divided into four or five meals<!-- Page 306 --><span class='pagenum'><a name="Page_306" id="Page_306">[306]</a></span>
+rather than three. Old people often wake at an
+early hour, and hot nourishment will prevent
+them from growing weak and faint while waiting
+for the family breakfast. Both constipation and
+looseness of the bowels are common ailments in
+old age. So far as possible the bowels should be
+regulated by means of diet; but muscular weakness
+resulting in inability to control the bowels should
+not be mistaken for and treated as diarrhœa.</p>
+
+<p>It is unwise for old people to undertake unaccustomed
+or sudden muscular exertion, since
+the muscular system including the heart muscle
+grows weak and is generally unable to endure
+great strain. The bones, moreover, grow brittle
+and heal with difficulty if broken, so that
+persons of advanced years no matter how active
+should avoid walking on icy pavements, climbing
+on chairs to reach high shelves, and placing themselves
+in other insecure positions. Assistance must
+be tactfully given, however, as active old people
+are inclined to resent it. On the other hand,
+old people should be encouraged to continue
+moderate and safe activities, and to take regular
+exercises suited to their strength. Although increasing
+muscular weakness tends to make most
+old people indolent, it is far better for them both
+in mind and in body to remain as active as they
+can without danger of too great fatigue. At all<!-- Page 307 --><span class='pagenum'><a name="Page_307" id="Page_307">[307]</a></span>
+events, they should be prevented if possible
+from becoming bedridden.</p>
+
+<p>Since in old age sight, hearing, and other special
+senses become less acute, one should remember
+that an old person may not notice the odor
+of escaping gas, the light of a smouldering match,
+or the sound of an approaching motor car, and
+that he must be specially guarded from such
+dangers of every day life. On account of their
+dulled perceptions old people are sometimes
+unjustly considered to be less intelligent than
+they really are. Young people moreover should
+be told, if an aged person is untidy and careless in
+personal habits, that the apparent negligence is
+caused by dulled perceptions and diminished
+muscular control for which old people are no more
+responsible than they are for failing eyesight
+or for inability to hear.</p>
+
+<p>Families should also realize that changes in
+mind and character are beyond an aged person's
+control and that they should not be made the
+cause for remonstrance or arguing. Just as the
+arteries harden with advancing years, as the bones
+become brittle and as other tissues become less
+flexible, so changes are likely to occur in the nervous
+system. It is not surprising when the
+brain substance like other tissues is becoming
+less flexible, that the powers of attention should<!-- Page 308 --><span class='pagenum'><a name="Page_308" id="Page_308">[308]</a></span>
+weaken, that memory for recent events should
+diminish, or that other mental powers should fail.
+Changes in disposition are not uncommon: previously
+controlled persons sometimes become
+querulous and exacting, while excitable and irritable
+persons become more placid. With most
+old people emotions become less intense; feeble old
+people hardly realize great joy or great sorrow, and
+seldom look forward to death with apprehension.</p>
+
+<p>Among the most important changes that occur
+in the nervous system is its gradual loss in power
+to respond to new demands. New habits are
+difficult or impossible to form, and old habits are
+hard to break. Attempts to break the habits
+of a life time are therefore dangerous, and radical
+changes in old people's ways of living are attended
+by risk as well as by unhappiness. Such loss of
+adaptability in the nervous system makes it
+increasingly difficult for old people to assimilate
+new ideas and to understand new points of view.
+The feeling that the world is strange and that the
+next generation has gone on without them accounts
+for the tragic loneliness of many old people.
+Clearly it is for those who are younger and more
+flexible to bridge the gulf between the generations
+by their understanding and their sympathy.</p>
+
+<p>Physical care to whatever extent it is needed
+should be given to all old people as soon as they<!-- Page 309 --><span class='pagenum'><a name="Page_309" id="Page_309">[309]</a></span>
+are unable to care for themselves, and thought
+should be given to adapting their surroundings
+and ways of living to their strength and needs,
+just as they should be adapted to the strength and
+needs of chronic patients. But a warning should
+be given against managing old people too much.
+It is hard for people who have managed their own
+lives successfully for many years to be managed,
+even for their own good. Indeed, it is questionable
+kindness to deprive old people of all freedom
+of action, even if following their own inclinations
+occasionally has disastrous results. Few persons
+would wish to prolong their lives if long life involved
+being thwarted in every desire, and sometimes
+real kindness consists in allowing old people
+to do certain things that are not good for them.
+Keeping them warm and letting them do as they
+please will go far to make old people happy.</p>
+
+<p>Many of the changes in old age reverse the
+developing process of childhood. In youth and
+age extremes meet, and the care of the aged presents
+certain marked similarities to the care of
+little children. Both require simple food, occupations
+suited to their strength, and protection
+from infections, from fatigue, and from nervous
+strain; both are dependent, more or less helpless,
+and for their happiness both need the affectionate
+care of their own families. But in one respect<!-- Page 310 --><span class='pagenum'><a name="Page_310" id="Page_310">[310]</a></span>
+their needs are fundamentally different. In
+childhood formation of proper habits is all important,
+and in caring for children the future effect
+of every word and act must be taken into consideration.
+Old people, on the other hand, since
+they live largely in the past and their habits are
+irrevocably formed, may be indulged without
+harm in ways that would demoralize a child; with
+a clear conscience one may make them happy
+in ways both great and small. This difference
+makes possible one of the greatest pleasures
+that come to one who cares for the helpless and
+the sick, for of all enduring satisfactions few are
+greater than the power to fill with comfort and
+happiness the closing days of life.</p>
+
+<h3>EXERCISES</h3>
+
+<ol>
+<li>What is meant by a physical defect? Name some
+of the most common defects.</li>
+
+<li>Name some permanent injuries to the body caused
+by defective teeth; by diseased or enlarged tonsils and
+adenoids; by faulty posture.</li>
+
+<li>Describe some common symptoms of eye strain in
+children; of enlarged tonsils and adenoids; of deafness.</li>
+
+<li>Name several possible causes of round shoulders,
+and explain why urging a round-shouldered child to hold
+himself erect is seldom enough to make him correct his
+posture.</li>
+
+<li>What measures should be taken to overcome
+nervousness in children?</li>
+
+<li><!-- Page 311 --><span class='pagenum'><a name="Page_311" id="Page_311">[311]</a></span>
+Describe in detail the health work carried on in
+the public schools of your city or town. Considering the
+important part played by uncorrected physical defects
+in causing permanent physical disability among adults,
+do you think in the long run it is cheaper or more expensive
+for a community to spend money in protecting the
+health of school children?</li>
+
+<li>Discuss the particular needs of convalescent and
+of chronic patients.</li>
+
+<li>Explain the effect of activity upon recovery, and
+explain why it is desirable for invalids to have occupation.</li>
+
+<li>What special needs should be provided for in caring
+for old people?</li>
+</ol>
+
+<h3>FOR FURTHER READING</h3>
+
+<ul class="readlist">
+<li>Invalid Occupations&mdash;Tracy.</li>
+
+<li>Occupation Therapy&mdash;Dunton.</li>
+
+<li>Handicrafts for the Handicapped&mdash;Hall and Buck.</li>
+
+<li>When Mother Lets Us Make Toys&mdash;Rich.</li>
+
+<li>Amusements for Convalescent Children&mdash;New York State Department
+of Health, Albany.</li>
+
+<li>Essentials of Medicine&mdash;Emerson, Chapter IX.</li>
+
+<li>Civics and Health&mdash;Allen.</li>
+
+<li>How to Live&mdash;Fisher and Fisk, Chapter III, Section II; and
+Supplementary Notes, Section III.</li>
+
+<li>Health Work in the Schools&mdash;Hoag and Terman.</li>
+
+<li>Medical Inspection of Schools&mdash;Gulick and Ayres.</li>
+
+<li>The Hygiene of the Child&mdash;Terman.</li>
+
+<li>Posture of School Children&mdash;Bancroft.</li>
+</ul>
+
+<p><!-- Page 312 --><span class='pagenum'><a name="Page_312" id="Page_312">[312]</a></span></p>
+
+<h2><span class="sm2">CHAPTER XV</span><br />
+<br />
+QUESTIONS FOR REVIEW</h2>
+
+<p>I. Show how you would:</p>
+
+<ol>
+<li>Make an unoccupied bed. (Notice the number
+of minutes it takes you to do it well.)</li>
+
+<li>Remove all the covers from an unoccupied bed
+and leave the bed to air.</li>
+
+<li>Open a bed to receive a patient.</li>
+</ol>
+
+<p>II. Show how you would:</p>
+
+<ol>
+<li>Change all the linen and remake an occupied
+bed. (How long did it take you?)</li>
+
+<li>Turn a patient from his back to his side, and
+the reverse.</li>
+
+<li>Remove, shake, and readjust a patient's pillows.</li>
+
+<li>Move a patient from one bed to another.</li>
+
+<li>Prepare a weak patient to sit up in a chair, and
+assist him from the bed to the chair.</li>
+
+<li>Assist a weak patient from the chair to the bed.</li>
+
+<li>Arrange pillows and back rest for a patient to
+sit up in bed; and also how you would remove
+the pillows and back rest.</li>
+</ol>
+
+<p>III. Show how you would:</p>
+
+<ol>
+<li>Lift a patient who has slipped down toward the
+foot of the bed, and show what you would do to
+prevent him from slipping down.</li>
+
+<li>Prevent bed covers from resting upon a sensitive
+foot, leg, abdomen, or arm.</li>
+
+<li><!-- Page 313 --><span class='pagenum'><a name="Page_313" id="Page_313">[313]</a></span>
+Describe and demonstrate every device you
+would use and every thing you would do to
+prevent pressure sores.</li>
+
+<li>Arrange pillows to support the arms of a person
+sitting up in bed.</li>
+
+<li>Arrange a table or a substitute for a table to
+support the book or work of a patient sitting
+up in bed.</li>
+
+<li>Arrange the light for a patient who is allowed to
+read in bed.</li>
+</ol>
+
+<p>IV.</p>
+
+<ol>
+<li>Assemble all the articles you would use in giving
+a bed bath. (How long did it take you?)</li>
+
+<li>Show how to give a complete bed bath. (How
+long did it take you? Did you have to stop the
+bath to fetch anything you had forgotten?)</li>
+
+<li>What special care would you give to the mouth
+and teeth? to the finger and toe nails? to the
+hair? to badly tangled hair? How would you
+cleanse the mouth of a helpless patient?</li>
+
+<li>Show how to shampoo the hair of a bed patient.</li>
+
+<li>Show how you would give a bath to a baby.</li>
+
+<li>Show everything that you would do to prepare
+a patient for the night.</li>
+</ol>
+
+<p>V.</p>
+
+<ol>
+<li>Show how to take the temperature, pulse, and
+respiration.</li>
+
+<li>Show how to cleanse a clinical thermometer.</li>
+
+<li>Show how to give a foot bath (<i>a</i>) to a patient
+out of bed, (<i>b</i>) to a patient in bed.</li>
+
+<li>Show how you would give a cool sponge bath
+to a feverish patient.</li>
+
+<li>Show how to give, remove, and cleanse a bed-pan.</li>
+
+<li><!-- Page 314 --><span class='pagenum'><a name="Page_314" id="Page_314">[314]</a></span>
+Show how to fill and apply a hot water bag;
+an ice bag.</li>
+
+<li>Show how to prepare and apply a mustard
+paste; a mustard leaf; a flaxseed poultice; hot
+fomentations; cold compresses.</li>
+
+<li>Show how to measure and administer a fluid
+medicine; pills or tablets.</li>
+
+<li>Show how to prepare and administer a salt and
+water enema to a grown person; to a baby.</li>
+
+<li>Show how to prepare steam inhalations.</li>
+
+<li>Show how to apply an ointment; a liniment.</li>
+</ol>
+
+<p>VI.</p>
+
+<ol>
+<li>Show how you would feed a helpless patient
+who is lying down.</li>
+
+<li>Show how you would feed a patient who is able
+to sit up but unable to use his hands.</li>
+
+<li>Prepare a liquid nourishment tray.</li>
+
+<li>Set a tray for light diet; for full diet.</li>
+
+<li>Show how to place a tray for a patient unable
+to sit up but able to feed himself; for a patient
+sitting up in bed.</li>
+
+<li>What personal care should be given a patient
+just before meals? just after meals?</li>
+
+<li>How would you modify the diet of a patient
+inclined to constipation? to diarrhœa?</li>
+</ol>
+
+<p>VII.</p>
+
+<ol>
+<li>Describe effective household methods for removing
+dust.</li>
+
+<li>Demonstrate the cleaning of a refrigerator.</li>
+
+<li>Show how to ventilate a sick room while protecting
+the patient from direct draughts.</li>
+
+<li>Show how to clean a sick room with a minimum
+of disturbance to the patient.</li>
+
+<li><!-- Page 315 --><span class='pagenum'><a name="Page_315" id="Page_315">[315]</a></span>
+Explain how a patient with communicable
+disease should be isolated.</li>
+
+<li>Demonstrate the daily care of a room occupied
+by a patient with communicable disease.</li>
+
+<li>Explain methods of concurrent disinfection.</li>
+
+<li>Explain methods of terminal disinfection.</li>
+
+<li>Tell how the following should be disinfected:
+discharges from the nose, throat, eyes, ears,
+bowels, bladder, wounds, and sores; bed and
+personal linen; blankets; mattresses; dishes;
+utensils, especially bedpans and urinals; clothing
+and person of the attendant, especially
+the hands; furniture, rugs, and woodwork.</li>
+</ol>
+
+<p>VIII.</p>
+
+<ol>
+<li>Name some of the most obvious symptoms of
+sickness.</li>
+
+<li>Name some symptoms that would lead you to
+take a patient to a doctor; to send for a doctor;
+to send for a doctor in haste.</li>
+
+<li>Name some symptoms that are dangerous to
+neglect even though the patient feels fairly
+well.</li>
+
+<li>What are some of the symptoms of physical
+defects in children? Name some conditions
+that are frequently caused by unremedied
+defects.</li>
+
+<li>Name some diseases commonly ushered in by
+symptoms resembling those of a cold in the head.</li>
+
+<li>What symptoms would lead you to isolate a
+patient?</li>
+
+<li>Give as many illustrations as you can of the
+part played by good and bad habits in determining
+health and sickness.</li>
+</ol>
+
+<p><!-- Page 316 --><span class='pagenum'><a name="Page_316" id="Page_316">[316]</a></span>
+IX.</p>
+
+<ol>
+<li>How would you dress a cut? a burn? a sprain?</li>
+
+<li>What would you do for a person suffering from
+colic? nausea? diarrhœa? chill?</li>
+
+<li>What are the symptoms of shock? heat stroke?
+heat prostration? What treatment would you
+give in each case?</li>
+
+<li>What would you do for a fainting person? for
+a person suffering from nose bleed? from earache?
+from a cinder in the eye?</li>
+
+<li>What course of action would you advise for a
+person troubled with sleeplessness? frequent
+headaches? excessive irritability? unusual depression
+of spirits? unfounded suspicions of other
+persons' motives? a tendency to have the feelings
+hurt easily? inability to control the
+emotions?</li>
+</ol>
+
+<p>X.</p>
+
+<ol>
+<li>Why is it better to prevent sickness than to
+cure it?</li>
+
+<li>Name the essentials of good hygienic conditions
+for babies, for children, for grown people, for
+the aged.</li>
+
+<li>How much of the sickness in the United States
+is preventable?</li>
+
+<li>If part of the sickness is preventable, why is it
+not prevented?</li>
+
+<li>What constitutes adequate care of the sick?</li>
+
+<li>What proportion of the young men in your
+community who were drafted have been rejected
+for physical disability? How many were
+rejected for disabilities that might have been
+prevented?</li>
+</ol>
+
+<p><!-- Page 317 --><span class='pagenum'><a name="Page_317" id="Page_317">[317]</a></span>
+XI. (Answers to the following questions can generally
+be obtained from local health officers.)</p>
+
+<ol>
+<li>What are the duties and powers of your local
+board of health?</li>
+
+<li>How much did your city or town spend per
+person last year on health protection? How
+does this amount compare with the amount
+spent per person for police protection? for fire
+protection?</li>
+
+<li>Who inspects the water supply in your town?
+the milk supply? the food supply?</li>
+
+<li>In your city, what was the number of deaths
+per 100,000 of the population from tuberculosis
+each year for the last five years? from typhoid
+fever?</li>
+
+<li>Is there a tuberculosis sanitarium in your city
+or county? Are nurses employed to supervise
+tuberculosis patients who remain at home?</li>
+
+<li>What provision does your community make for
+patients suffering from other communicable
+diseases?</li>
+
+<li>What measures are taken in your community
+to instruct school children in matters of health?
+to instruct grown persons?</li>
+
+<li>How does your community provide medical
+and nursing care for persons unable to pay
+part or all of the cost of such service?</li>
+</ol>
+
+<p>XII. Explain why the following common beliefs are
+erroneous or unfounded:</p>
+
+<ol>
+<li>That a damp cellar causes diphtheria.</li>
+
+<li>That night air is harmful.</li>
+
+<li>That one should "stuff a cold" and "starve a
+fever."</li>
+
+<li><!-- Page 318 --><span class='pagenum'><a name="Page_318" id="Page_318">[318]</a></span>
+That almost everyone needs a tonic in the spring.</li>
+
+<li>That the health of one's family would be endangered
+if a tuberculosis hospital were placed
+on the next block.</li>
+
+<li>That clearing up the back yard will protect
+the children of a family from infantile paralysis.</li>
+
+<li>That odorless and tasteless water is necessarily
+free from harmful germs.</li>
+
+<li>That all children should have the children's
+diseases, and have them as early as possible.</li>
+
+<li>That boils are a benefit to the system by removing
+impurities from the blood.</li>
+
+<li>That tomatoes cause cancer.</li>
+
+<li>That consumption is inherited.</li>
+
+<li>That dirt breeds disease.</li>
+
+<li>That diseases come up drains.</li>
+
+<li>That if a teaspoonful of medicine does you
+good, a tablespoonful will do you more good.</li>
+
+<li>That instinct teaches a mother how to care
+for her baby.</li>
+
+<li>That low heeled shoes, though suitable for
+boys and men, cause broken arches in women
+and girls.</li>
+
+<li>That in one's own case, the rule that everyone
+needs regular meals, regular hours of sleep, and
+daily exercise out of doors, may be safely
+violated.</li>
+</ol>
+
+<p><!-- Page 319 --><span class='pagenum'><a name="Page_319" id="Page_319">[319]</a></span></p>
+
+<h2>APPENDIX</h2>
+
+<p>The New York City Department of Health has kindly
+permitted us to include the following circulars of information
+issued by the Division of Child Hygiene.</p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+THE CITY OF NEW YORK<br />
+
+Instructions to Parents Regarding the Care of the
+Mouth and Teeth.</h3>
+
+<p>The physical examination of school children shows that in
+many instances the teeth are in a decayed and unhealthy condition.</p>
+
+<p>Decayed teeth cause an unclean mouth. Toothache and
+disease of the gums may result.</p>
+
+<p>Neglect of the first teeth is a frequent cause of decay of the
+second teeth.</p>
+
+<p>If a child has decayed teeth, it cannot properly chew its food.
+Improperly chewed food and an unclean mouth cause bad digestion,
+and consequently poor general health.</p>
+
+<p>If a child is not in good health, it cannot keep up with its
+studies in school. It is more likely to contract any contagious
+disease, and it has not the proper chance to grow into a robust,
+healthy adult.</p>
+
+<p>If the child's teeth are decayed, it should be taken to a dentist
+at once.</p>
+
+<p>The teeth should be brushed after each meal, using a tooth
+brush and tooth powder.</p>
+
+<p>The following tooth powder is recommended:</p>
+
+<ul>
+<li>2 oz. powdered precipitated chalk.</li>
+<li>½ oz. powdered Castile soap,</li>
+<li>1 dram powdered orris root.</li>
+<li>Thoroughly mix.</li>
+</ul>
+
+<p>This prescription can be filled by any druggist at a cost not
+to exceed fifteen cents.</p>
+
+<p><!-- Page 320 --><span class='pagenum'><a name="Page_320" id="Page_320">[320]</a></span></p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+CITY OF NEW YORK<br />
+
+Instructions to Parents Regarding the Care of the
+Nose</h3>
+
+<p>The physical examination of school children shows that in
+many instances they breathe through the mouth because they
+cannot breathe properly or sufficiently through the nose.</p>
+
+<p>This may be due to bad habits in regard to keeping the nose
+clean, or, in a majority of instances, to a growth which is known
+as "adenoids" and which stops up the back of the nose. In
+either case, the air is not breathed through the nose, and the child
+becomes what is known as a "mouth breather."</p>
+
+<p>Constant breathing through the mouth causes the child to
+become pale, restless in its sleep and dull in its actions. The
+child often speaks as though it had a cold in the head. Frequently
+there is an almost constant discharge from the nose.</p>
+
+<p>Mouth breathing renders a child especially liable to contract
+tuberculosis and other infectious diseases; in fact, the child has
+very little resistance to disease of any kind.</p>
+
+<p>Every child should be given a handkerchief, and be taught
+to thoroughly blow the nose several times each day. If, after
+doing this regularly, the child is still unable to breathe properly
+through the nose, it is probable that an adenoid growth is present.
+Such children should be taken to the family physician or to a
+dispensary for further advice and treatment.</p>
+
+<p>Do not wait too long in the hope that the child will outgrow
+the condition, for the effect of adenoid growths persisting throughout
+childhood may injure the person for life.</p>
+
+<p>Have your child's throat and nose examined one month after
+measles, scarlet fever, or diphtheria.</p>
+
+<p><!-- Page 321 --><span class='pagenum'><a name="Page_321" id="Page_321">[321]</a></span></p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+CITY OF NEW YORK<br />
+
+Instructions to Parents on the Care of Children's
+Hair and Scalp</h3>
+
+<p>Children affected with vermin of the head are excluded
+from school. The following directions will cure the condition:</p>
+
+<p>Mix one-half pint of sweet oil and one-half pint of kerosene
+oil. Shake the mixture well and saturate the hair
+with the mixture. Then wrap the head in a large bath
+towel or rubber cap so that the head is entirely covered; the
+head must remain covered from six to eight hours.</p>
+
+<p>(Tincture of larkspur may be used instead of oil mixture.
+The directions for use are the same.)</p>
+
+<p>After removing the towel, the head should be shampooed
+as follows:</p>
+
+<p>To two quarts of warm water add one teaspoonful of
+sodium carbonate (washing soda). Wet the hair with this
+solution and then apply Castile soap and rub the head thoroughly
+about ten minutes. Wash the soap out of the hair
+with repeated washings of clear warm water. Dry the hair
+thoroughly.</p>
+
+<p>Nits: If the head is shampooed regularly each week as
+above described, it will cure and prevent the condition of
+"nits."</p>
+
+<p><!-- Page 322 --><span class='pagenum'><a name="Page_322" id="Page_322">[322]</a></span></p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+CITY OF NEW YORK<br />
+
+DIET FOR CHILD FROM 12TH TO 18TH MONTH</h3>
+
+<h4 class="meal"><span class="smcap">First Meal&mdash;on Rising.</span></h4>
+
+<p>(1) 1 to 2 ounces juice of a sweet orange<br />
+<span class="pad-l">or</span><br />
+Pulp of 6 stewed prunes<br />
+<span class="pad-l">or</span><br />
+1 ounce pineapple juice.</p>
+
+<p>(2) 8 ounces milk with either zwieback, or toasted biscuits or
+stale toasted bread.</p>
+
+<p>Note: Fruit must be given either ½ hour before or ½
+hour after milk.</p>
+
+<h4 class="meal"><span class="smcap">Second Meal&mdash;During Forenoon.</span></h4>
+
+<p>Milk alone or with zwieback.</p>
+
+<h4 class="meal"><span class="smcap">Noon Meal.</span></h4>
+
+<p>(1) 6 ounces soup<br />
+<span class="pad-l">or</span><br />
+3 ounces beef juice.</p>
+
+<p>Note: Soup may be made of chicken, beef or mutton.</p>
+
+<p>(2) Stale bread may be added to the above.</p>
+
+<h4 class="meal"><span class="smcap">Fourth Meal&mdash;Afternoon.</span></h4>
+
+<p>Milk or toasted bread and milk.</p>
+
+<h4 class="meal"><span class="smcap">Evening Meal.</span></h4>
+
+<p>(1) 4 ounces thick gruel mixed with 4 ounces top half milk.
+Taken with zwieback.</p>
+
+<p>Note: Gruel may be made of oatmeal, farina, barley,
+hominy, wheatena, or rice.</p>
+
+<p>(2) Apple sauce<br />
+<span class="pad-l">or</span><br />
+Prune jelly.</p>
+
+<p>Total milk in 24 hours, 1 to 1¼quarts.</p>
+<p>Note: 8 ounces is equal to a half pint.</p>
+
+<p><!-- Page 323 --><span class='pagenum'><a name="Page_323" id="Page_323">[323]</a></span></p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+CITY OF NEW YORK<br />
+
+DIET FOR CHILD FROM 18TH TO 24TH MONTH</h3>
+
+<h4 class="meal"><span class="smcap">Breakfast.</span></h4>
+
+<p>(1) Juice of one sweet orange<br />
+<span class="pad-l">or</span><br />
+Pulp of six stewed prunes<br />
+<span class="pad-l">or</span><br />
+Pineapple juice (fresh or bottled) 1 ounce.</p>
+
+<p>(2) A cereal such as cream of wheat, oatmeal, farina, or hominy
+preparations with top milk (top 16 ounces) sweetened
+or salted. A glass of milk, bread and butter.</p>
+
+<p>Note: If constipated give the fruit ½ hour before breakfast
+with water; if not, they may be given during the
+forenoon.</p>
+
+<p>Raw fruit juice must be given either ½ hour before or ½
+hour after milk.</p>
+
+<h4 class="meal"><span class="smcap">Forenoon.</span></h4>
+
+<p>A glass of milk with two toasted biscuits or zwieback or
+graham crackers.</p>
+
+<h4 class="meal"><span class="smcap">Dinner.</span></h4>
+
+<p>(1) Broth or soup made of beef, mutton, or chicken, and thickened
+with peas, farina, sago or rice<br />
+<span class="pad-l">or</span><br />
+Beef juice with stale bread crumbs; or clear vegetable
+soup with yolk of egg<br />
+<span class="pad-l">or</span><br />
+Egg soft boiled, with bread crumbs, or the egg poached,
+with a glass of milk.</p>
+
+<p>(2) Dessert: apple sauce, prune pulp, with stale lady-fingers
+or graham wafers<br />
+<span class="pad-l">or</span><br />
+Plain puddings: rice, bread, tapioca, blanc-mange, junket
+or baked custard.</p>
+
+<h4 class="meal"><span class="smcap">Supper.</span></h4>
+
+<p>Glass of milk, warm or cold; zwieback and custard or
+stewed fruit.</p>
+
+<p>Total milk in 24 hours, 1½ quarts.</p>
+
+<p><!-- Page 324 --><span class='pagenum'><a name="Page_324" id="Page_324">[324]</a></span></p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+CITY OF NEW YORK<br />
+
+DIET FOR CHILD FROM TWO TO THREE YEARS</h3>
+
+<h4 class="meal"><span class="smcap">Breakfast.</span></h4>
+
+<p>(1) Juice of 1 sweet orange<br />
+<span class="pad-l">or</span><br />
+Pulp of 6 stewed prunes<br />
+<span class="pad-l">or</span><br />
+1 ounce pineapple juice (fresh or bottled)<br />
+<span class="pad-l">or</span><br />
+Apple sauce.</p>
+
+<p>(2) A cereal such as oatmeal, farina, cream of wheat, hominy or
+rice, slightly sweetened or salted as preferred, with the
+addition of top milk (top 16 ounces)<br />
+<span class="pad-l">or</span><br />
+A soft boiled or poached egg with stale bread or toast.</p>
+
+<p>(3) A glass of milk.</p>
+
+<p>Note: If constipated give the fruit ½ hour before breakfast
+with water; if not, they may be given during the
+forenoon.</p>
+
+<p>Milk and raw fruit juice must not be given at same meal.</p>
+
+<h4 class="meal"><span class="smcap">Dinner.</span></h4>
+
+<p>(1) Broth or soup made of chicken, mutton or beef, thickened
+with arrowroot, split peas, rice, or with addition of the
+yolk of an egg or toast squares.</p>
+
+<p>(2) Scraped beef or white meat of chicken, or broiled fish (small
+amount)<br />
+<span class="pad-l">or</span><br />
+Mashed or baked potatoes with fresh peas or spinach or
+carrots.</p>
+
+<p>(3) Dessert: apple sauce, baked apple, rice pudding, junket or
+custard.</p>
+
+<h4 class="meal"><span class="smcap">Supper.</span></h4>
+
+<p>(1) A cereal or egg (if egg is not taken with breakfast) with stale
+bread or toast<br />
+<span class="pad-l">or</span><br />
+Bread and milk or bread and cocoa or bread and custard.</p>
+
+<p>(2) Stewed fruit.</p>
+
+<p><!-- Page 325 --><span class='pagenum'><a name="Page_325" id="Page_325">[325]</a></span></p>
+
+<h3><span class="med">DEPARTMENT OF HEALTH</span><br />
+CITY OF NEW YORK<br />
+
+DIET FOR CHILD FROM THREE TO SIX YEARS</h3>
+
+<h4 class="meal"><span class="smcap">Breakfast.</span></h4>
+
+<p>(1) Fruits: an orange, apple, pear or stewed prunes.</p>
+
+<p>(2) Cereal: oatmeal, hominy, rice or wheat preparations, well
+cooked and salted, with thin cream and sugar<br />
+<span class="pad-l">or</span><br />
+Egg: soft boiled, poached, omelet or scrambled.</p>
+
+<p>(3) Milk or cocoa.</p>
+
+<h4 class="meal"><span class="smcap">Dinner.</span></h4>
+
+<p>(1) Soup: beef, chicken or mutton.</p>
+<p>(2) Meat: chicken or beefsteak or roast beef or lamb chops or
+fish.</p>
+
+<p>(3) Vegetables: spinach or carrots or string beans, peas, cauliflower
+tops, mashed or baked potatoes, beets or lettuce
+(without vinegar)</p>
+<p>Macaroni, spaghetti.</p>
+<p>Bread and butter&mdash;not fresh bread or rolls.</p>
+
+<p>(4) Dessert: custard, rice or bread or tapioca pudding, ice cream
+(once a week) cornstarch pudding (chocolate or other
+flavor) stewed prunes or baked apple.</p>
+
+<h4 class="meal"><span class="smcap">Supper.</span></h4>
+
+<p>(1) Milk toast or graham crackers and milk<br />
+<span class="pad-l">or</span><br />
+A thick soup, as pea, or cream of celery with bread and
+butter<br />
+<span class="pad-l">or</span><br />
+A cereal and thin cream with bread and butter.</p>
+
+<p>(2) Stewed fruit; custard or plain pudding; jam or jelly.</p>
+
+<p><!-- Page 326 --><span class='pagenum'><a name="Page_326" id="Page_326">[326]</a></span></p>
+
+<h2>GLOSSARY</h2>
+
+<p class="center">(For complete definitions of the following words the student is
+referred to general and scientific dictionaries)</p>
+
+<h3>A</h3>
+
+<p><b>Antiseptic.</b>&mdash;A substance which prevents or hinders the
+growth of micro-organisms.</p>
+
+<p><b>Antitoxin.</b>&mdash;A substance that neutralizes the action of a toxin.</p>
+
+<p><b>Aseptic.</b>&mdash;Free from living germs.</p>
+
+<p><b>Axilla.</b>&mdash;The armpit.</p>
+
+<h3>B</h3>
+
+<p><b>Bacillus</b> (pl. bacilli).&mdash;A rod-shaped or elongated bacterium.</p>
+
+<p><b>Bacterial.</b>&mdash;Relating to bacteria.</p>
+
+<p><b>Bactericide.</b>&mdash;An agent having the power to destroy bacteria.</p>
+
+<p><b>Bacteriological.</b>&mdash;Relating to bacteriology.</p>
+
+<p><b>Bacteriology.</b>&mdash;The science dealing with microorganisms.</p>
+
+<p><b>Bacterium</b> (pl. bacteria).&mdash;A unicellular vegetable micro-organism.</p>
+
+<h3>C</h3>
+
+<p><b>Carrier.</b>&mdash;An apparently healthy person who harbors pathogenic
+germs in his body.</p>
+
+<p><b>Coccus</b> (pl. cocci).&mdash;A bacterium of spherical or nearly spherical
+shape.</p>
+
+<p><b>Counter-irritant.</b>&mdash;A substance or agent which if applied to
+the skin causes irritation and thereby relieves an abnormal
+condition in another part of the body.</p>
+
+<h3>D</h3>
+
+<p><b>Degeneration.</b>&mdash;A deterioration in cells or tissues of the body
+so that they become less able to perform their proper functions.</p>
+
+<p><b>Degenerative.</b>&mdash;Pertaining to degeneration.</p>
+
+<p><!-- Page 327 --><span class='pagenum'><a name="Page_327" id="Page_327">[327]</a></span>
+<b>Deodorant.</b>&mdash;An agent that destroys odors.</p>
+
+<p><b>Digestive Tract.</b>&mdash;The entire alimentary canal, including the
+mouth, Å“sophagus, stomach, and the small and large intestines.</p>
+
+<p><b>Diplococcus.</b>&mdash;A form of coccus in which two individuals
+remain attached after cell division has taken place.</p>
+
+<p><b>Disinfect.</b>&mdash;To destroy the germs of disease.</p>
+
+<p><b>Disinfectant.</b>&mdash;An agent that destroys the germs of disease.</p>
+
+<p><b>Disinfection.</b>&mdash;The process of destroying the germs of disease.</p>
+
+<h3>E</h3>
+
+<p><b>Emetic.</b>&mdash;A substance used to induce vomiting.</p>
+
+<p><b>Enema.</b>&mdash;An injection of fluid into the rectum.</p>
+
+<h3>F</h3>
+
+<p><b>Fecal.</b>&mdash;Pertaining to feces.</p>
+
+<p><b>Feces.</b>&mdash;Matter discharged from the bowels; bowel movement.</p>
+
+<p><b>Fermentation.</b>&mdash;Decomposition produced in an organic substance
+by the action of certain living agents.</p>
+
+<p><b>Fission.</b>&mdash;The process by which a cell divides into two parts.</p>
+
+<p><b>Flagellum</b> (pl. flagella).&mdash;A long hair-like appendage, by the
+action of which certain micro-organisms are enabled to move.</p>
+
+<p><b>Flex.</b>&mdash;To bend at a joint.</p>
+
+<p><b>Fomentation.</b>&mdash;<a href="#Stupe">See <i>Stupe</i>.</a></p>
+
+<h3>G</h3>
+
+<p><b>Gastric Juice.</b>&mdash;The fluid secreted by the glands of the
+stomach.</p>
+
+<p><b><a name="Germ" id="Germ">Germ.</a></b>&mdash;A minute unicellular organism, either animal or
+vegetable; a micro-organism; a microbe.</p>
+
+<p><b>Germicide.</b>&mdash;An agent having the power to kill germs.</p>
+
+<h3>H</h3>
+
+<p><b>Host.</b>&mdash;An animal or plant in or upon which another organism
+lives.</p>
+
+<p><!-- Page 328 --><span class='pagenum'><a name="Page_328" id="Page_328">[328]</a></span></p>
+
+<h3>I</h3>
+
+<p><b>Immune.</b>&mdash;Not susceptible to a particular disease; also, a person
+who is not susceptible to a particular disease.</p>
+
+<p><b><a name="Immunity" id="Immunity">Immunity.</a></b>&mdash;The state in which an individual is not susceptible
+to a particular disease.</p>
+
+<p><b>Immunize.</b>&mdash;To render immune.</p>
+
+<p><b>Incubation.</b>&mdash;The interval between exposure to an infectious
+disease and the first appearance of symptoms.</p>
+
+<p><b>Infect.</b>&mdash;To communicate disease germs.</p>
+
+<p><b>Infection.</b>&mdash;An agent by which disease may be communicated
+from one individual to another; also, an infectious disease.</p>
+
+<p><b>Inoculate.</b>&mdash;To introduce any biological product directly into
+the tissues of the body.</p>
+
+<p><b>Inoculation.</b>&mdash;The process of inoculating.</p>
+
+<p><b>Intestinal Tract.</b>&mdash;The small and large intestines.</p>
+
+<h3>M</h3>
+
+<p><b>Microbe.</b>&mdash;<a href="#Germ">See <i>Germ</i>.</a></p>
+
+<p><b>Micro-organism.</b>&mdash;<a href="#Germ">See <i>Germ</i>.</a></p>
+
+<p><b>Mucus.</b>&mdash;The substance secreted by mucous membranes.</p>
+
+<p><b>Mucous Membranes.</b>&mdash;The membranes lining certain cavities
+of the body, especially the digestive and respiratory tracts.</p>
+
+<h3>N</h3>
+
+<p><b>Nutrient.</b>&mdash;One of several chemical groups to which the essential
+constituents of food belong.</p>
+
+<h3>O</h3>
+
+<p><b>Organic.</b>&mdash;Derived from or relating to an organism.</p>
+
+<p><b>Organism.</b>&mdash;An individual that is or has been alive.</p>
+
+<h3>P</h3>
+
+<p><b>Parasite.</b>&mdash;An individual that lives in or upon another
+individual.</p>
+
+<p><b>Pasteurization.</b>&mdash;The process of pasteurizing.</p>
+
+<p><!-- Page 329 --><span class='pagenum'><a name="Page_329" id="Page_329">[329]</a></span>
+<b>Pasteurize.</b>&mdash;To subject milk to a temperature of 142°-145°
+Fahrenheit for thirty minutes.</p>
+
+<p><b>Pathogenic.</b>&mdash;Disease-producing.</p>
+
+<p><b>Pertussis.</b>&mdash;Whooping-cough.</p>
+
+<p><b>Proteid.</b>&mdash;One of the complex nitrogenous substances constituting
+the essential parts of animal and vegetable tissues.</p>
+
+<p><b>Protozoön</b> (pl. protozoa).&mdash;An animal organism composed of
+a single cell.</p>
+
+<p><b>Pus.</b>&mdash;The fluid product of inflammation; matter.</p>
+
+<p><b>Putrefaction.</b>&mdash;Decomposition of nitrogenous organic matter
+brought about by micro-organisms and accompanied by a foul
+odor.</p>
+
+<h3>R</h3>
+
+<p><b>Resistance.</b>&mdash;<a href="#Immunity">See <i>Immunity</i>.</a></p>
+
+<p><b>Respiratory Tract.</b>&mdash;The air passages, including the nose,
+mouth, larynx, trachea, bronchial tubes, and lungs.</p>
+
+<h3>S</h3>
+
+<p><b>Saprophyte.</b>&mdash;A vegetable organism that lives on decaying
+organic matter.</p>
+
+<p><b>Sarcina.</b>&mdash;Literally, a bundle. Applied to bacteria grouped
+in bundles or packets.</p>
+
+<p><b>Septic.</b>&mdash;Putrefying or decomposing; infected by pus-producing
+bacteria.</p>
+
+<p><b>Sequela.</b>&mdash;A disease or unhealthy condition following another
+disease or unhealthy condition.</p>
+
+<p><b>Serum.</b>&mdash;The fluid which separates from the clot after blood
+has coagulated; especially, that containing an antitoxin.</p>
+
+<p><b>Sewage.</b>&mdash;Any substance containing urine or fecal matter;
+also, the substance which passes through sewers.</p>
+
+<p><b>Spirillum</b> (pl. spirilla).&mdash;A variety of bacteria having spirally
+twisted cells.</p>
+
+<p><b>Spore.</b>&mdash;A resting stage, characterized by great resistance,
+into which certain germs enter when conditions become unfavorable
+for their growth.</p>
+
+<p><!-- Page 330 --><span class='pagenum'><a name="Page_330" id="Page_330">[330]</a></span>
+<b>Sputum.</b>&mdash;Spit; expectoration.</p>
+
+<p><b>Staphylococcus.</b>&mdash;A variety of bacteria that group themselves
+in masses resembling bunches of grapes.</p>
+
+<p><b>Sterile.</b>&mdash;Free from living germs; aseptic.</p>
+
+<p><b>Sterilization.</b>&mdash;The process of rendering sterile.</p>
+
+<p><b>Sterilize.</b>&mdash;To render sterile.</p>
+
+<p><b>Streptococcus.</b>&mdash;A variety of bacteria that arrange themselves
+in chains.</p>
+
+<p><b><a name="Stupe" id="Stupe">Stupe.</a></b>&mdash;A cloth wrung out of hot water and applied to the
+surface of the body.</p>
+
+<p><b>Susceptible.</b>&mdash;Lacking resistance to a disease.</p>
+
+<p><b>Susceptibility.</b>&mdash;The condition in which resistance to a disease
+is low.</p>
+
+<h3>T</h3>
+
+<p><b>Tetrad.</b>&mdash;A variety of bacteria that arrange themselves in
+groups of four.</p>
+
+<p><b>Tissue.</b>&mdash;A collection of cells having the same function.</p>
+
+<p><b>Toxin.</b>&mdash;A poison produced by the action of micro-organisms.</p>
+
+<h3>U</h3>
+
+<p><b>Unicellular.</b>&mdash;Composed of a single cell.</p>
+
+<p><b>Uterus.</b>&mdash;The womb.</p>
+
+<h3>V</h3>
+
+<p><b>Vaccinate.</b>&mdash;To inoculate with a poison in order to bring about
+immunity to a disease.</p>
+
+<p><b>Vaccine.</b>&mdash;Any substance which if introduced into the body
+causes the formation of protective substances.</p>
+
+<p><b>Vomitus.</b>&mdash;Vomited substances.</p>
+
+<p><!-- Page 331 --><span class='pagenum'><a name="Page_331" id="Page_331">[331]</a></span></p>
+
+<h2>INDEX</h2>
+
+<h3>A</h3>
+
+<ul>
+<li>Abdomen, <a href="#Page_68">68</a></li>
+
+<li>Abdominal binder, <a href="#Page_68">68</a></li>
+
+<li>Action of drugs, <a href="#Page_200">200</a></li>
+
+<li>Adenoids, <a href="#Page_284">284</a></li>
+
+<li>Aged, care of, <a href="#Page_303">303</a></li>
+
+<li>Ailments and emergencies, <a href="#Page_257">257</a></li>
+
+<li>Air, <a href="#Page_72">72</a></li>
+
+<li>Alcohol, <a href="#Page_160">160</a></li>
+
+<li>Appliances,
+<ul>
+  <li>bed cradles, <a href="#Page_173">173</a></li>
+  <li>bedpans, <a href="#Page_176">176</a></li>
+  <li>rubber utensils, <a href="#Page_138">138</a></li>
+</ul>
+</li>
+
+<li>Applications, local, <a href="#Page_220">220</a>
+<ul>
+  <li>cold, dry, <a href="#Page_231">231</a></li>
+  <li>cold, moist, <a href="#Page_235">235</a></li>
+  <li>hot, dry, <a href="#Page_225">225</a>
+<ul>
+    <li>bricks, <a href="#Page_226">226</a></li>
+    <li>flannel, <a href="#Page_226">226</a></li>
+    <li>salt or sand, <a href="#Page_226">226</a></li>
+    <li>water bags, <a href="#Page_225">225</a></li>
+</ul>
+</li>
+  <li>hot, moist, <a href="#Page_227">227</a>
+<ul>
+    <li>fomentations, <a href="#Page_229">229</a></li>
+    <li>poultices, <a href="#Page_227">227</a></li>
+    <li>stupes, <a href="#Page_229">229</a></li>
+</ul>
+</li>
+</ul>
+</li>
+
+<li>Attendant, <a href="#Page_127">127</a></li>
+</ul>
+
+<h3>B</h3>
+
+<ul>
+<li>Bacteria, <a href="#Page_1">1</a>, <a href="#Page_4">4</a>, <a href="#Page_5">5</a>
+<ul>
+  <li>bacilli, <a href="#Page_5">5</a></li>
+  <li>coccus, <a href="#Page_4">4</a></li>
+  <li>effects produced by, <a href="#Page_3">3</a></li>
+  <li>entrance into the body, <a href="#Page_9">9</a></li>
+  <li>food of, <a href="#Page_2">2</a></li>
+  <li>immunity, <a href="#Page_13">13</a></li>
+  <li>in food, <a href="#Page_19">19</a></li>
+  <li>in water, <a href="#Page_19">19</a></li>
+  <li>methods of study, <a href="#Page_1">1</a></li>
+  <li>motion, <a href="#Page_5">5</a></li>
+  <li>origin of communicable diseases, <a href="#Page_3">3</a></li>
+  <li>parasites, <a href="#Page_3">3</a>, <a href="#Page_8">8</a></li>
+  <li>saprophytes, <a href="#Page_2">2</a></li>
+  <li>shape, <a href="#Page_4">4</a></li>
+  <li>spirillum, <a href="#Page_4">4</a></li>
+  <li>spores, <a href="#Page_7">7</a></li>
+  <li>structure and development, <a href="#Page_4">4</a></li>
+  <li>where found, <a href="#Page_8">8</a></li>
+</ul>
+</li>
+
+<li>Bacteriology, <a href="#Page_1">1</a></li>
+
+<li>Baths, <a href="#Page_42">42</a>, <a href="#Page_154">154</a>
+<ul>
+  <li>bed, <a href="#Page_156">156</a></li>
+  <li>cleansing, <a href="#Page_171">171</a></li>
+  <li>cold tub, <a href="#Page_97">97</a>, <a href="#Page_171">171</a></li>
+  <li>daily, <a href="#Page_24">24</a></li>
+  <li>foot, <a href="#Page_165">165</a></li>
+    <li>mustard, <a href="#Page_165">165</a></li>
+  <li>hot, <a href="#Page_97">97</a></li>
+  <li>infant's, <a href="#Page_78">78</a></li>
+  <li>sitz, <a href="#Page_176">176</a></li>
+  <li>tub, <a href="#Page_154">154</a></li>
+</ul>
+</li>
+
+<li>Bed cradles, <a href="#Page_173">173</a></li>
+
+<li>Bedmaking, <a href="#Page_132">132</a></li>
+
+<li>Bedpan, <a href="#Page_176">176</a></li>
+
+<li>Bed-rooms, care of, <a href="#Page_84">84</a></li>
+
+<li>Beds, <a href="#Page_132">132</a>
+<ul>
+  <li>care of, <a href="#Page_134">134</a></li>
+  <li>dimensions, <a href="#Page_133">133</a></li>
+  <li>rubber pillow cases, <a href="#Page_138">138</a></li>
+  <li>rubber sheets, <a href="#Page_138">138</a></li>
+  <li>selection of, <a href="#Page_132">132</a></li>
+  <li>wooden, <a href="#Page_132">132</a></li>
+</ul>
+</li>
+
+<li>Bed sores, <a href="#Page_169">169</a></li>
+
+<li>Birth registration, <a href="#Page_63">63</a></li>
+
+<li>Blankets, <a href="#Page_140">140</a></li>
+
+<li>Bleeding, <a href="#Page_272">272</a></li>
+
+<li>Blindness, <a href="#Page_33">33</a></li>
+
+<li>Breast feeding, <a href="#Page_73">73</a></li>
+
+<li>Bruises, <a href="#Page_276">276</a></li>
+
+<li>Brush burn, <a href="#Page_278">278</a></li>
+
+<li>Burns, <a href="#Page_277">277</a>, <a href="#Page_278">278</a></li>
+</ul>
+
+<h3>C</h3>
+
+<ul>
+<li>Cancer, <a href="#Page_111">111</a></li>
+
+<li>Carriers, <a href="#Page_17">17</a></li>
+
+<li>Charts, <a href="#Page_10">10</a>, <a href="#Page_246">246</a></li>
+
+<li>Chickenpox, <a href="#Page_236">236</a></li>
+
+<li>Childhood, <a href="#Infancy">see Infancy</a>, <a href="#Page_60">60</a></li>
+
+<li>Children, care of, <a href="#Page_280">280</a>
+<ul>
+  <li>with adenoids, <a href="#Page_284">284</a></li>
+  <li>with defective hearing, <a href="#Page_285">285</a></li>
+  <li>with defective teeth, <a href="#Page_286">286</a></li>
+  <li>with enlarged tonsils, <a href="#Page_284">284</a></li>
+  <li>with eyestrain, <a href="#Page_284">284</a></li>
+  <li>with incorrect posture, <a href="#Page_286">286</a><!-- Page 332 --><span class='pagenum'><a name="Page_332" id="Page_332">[332]</a></span></li>
+  <li>with physical defects, <a href="#Page_283">283</a></li>
+  <li>with predisposition to nervousness, <a href="#Page_292">292</a></li>
+</ul>
+</li>
+
+<li>Chills, <a href="#Page_270">270</a></li>
+
+<li>Chronic patients, care of, <a href="#Page_299">299</a></li>
+
+<li>Circulars of information, <a href="#Page_318">318</a>
+<ul>
+  <li>Department of Health, City of New York, <a href="#Page_318">318</a>
+<ul>
+    <li>care of hair and scalp, <a href="#Page_321">321</a></li>
+    <li>care of mouth and teeth, <a href="#Page_318">318</a></li>
+    <li>care of nose, <a href="#Page_320">320</a></li>
+    <li>diet of child twelfth to eighteenth month, <a href="#Page_322">322</a></li>
+    <li>diet of child eighteenth to twenty-fourth month, <a href="#Page_323">323</a></li>
+    <li>diet of child two to three years, <a href="#Page_324">324</a></li>
+    <li>diet of child three to six years, <a href="#Page_325">325</a></li>
+</ul>
+</li>
+</ul>
+</li>
+
+<li>Cleaning room, <a href="#Page_126">126</a></li>
+
+<li>Cleanliness, personal, <a href="#Page_41">41</a></li>
+
+<li>Clothing, <a href="#Page_47">47</a>
+<ul>
+  <li>disinfection of, <a href="#Page_95">95</a></li>
+  <li>of infants, <a href="#Page_68">68</a></li>
+</ul>
+</li>
+
+<li>Coccus, <a href="#Page_4">4</a></li>
+
+<li>Cold applications, <a href="#Page_220">220</a></li>
+
+<li>Cold, prevention of common, <a href="#Page_241">241</a></li>
+
+<li>Colic, <a href="#Page_266">266</a></li>
+
+<li>Compresses, cold, <a href="#Page_232">232</a></li>
+
+<li>Constipation, <a href="#Page_52">52</a>, <a href="#Page_193">193</a>, <a href="#Page_266">266</a></li>
+
+<li>Convalescents, care of, <a href="#Page_294">294</a></li>
+
+<li>Convulsions, <a href="#Page_260">260</a></li>
+
+<li>Counter irritants, <a href="#Page_233">233</a></li>
+
+<li>Croup, <a href="#Page_271">271</a></li>
+</ul>
+
+<h3>D</h3>
+
+<ul>
+<li>Degenerative diseases, <a href="#Page_20">20</a>, <a href="#Page_24">24</a></li>
+
+<li>Development of child, <a href="#Page_64">64</a></li>
+
+<li>Diaper, <a href="#Page_69">69</a></li>
+
+<li>Diarrhœa, <a href="#Page_266">266</a></li>
+
+<li>Diphtheria, <a href="#Page_245">245</a></li>
+
+<li>Disinfectants, <a href="#Page_251">251</a></li>
+
+<li>Disinfection, <a href="#Page_248">248</a></li>
+
+<li>Drainage, <a href="#Page_40">40</a></li>
+
+<li>Draughts, <a href="#Page_32">32</a></li>
+
+<li>Dust, effect upon health, <a href="#Page_36">36</a></li>
+</ul>
+
+<h3>E</h3>
+
+<ul>
+<li>Ear, disorders affecting, <a href="#Page_268">268</a></li>
+
+<li>Emergencies, <a href="#Page_257">257</a></li>
+
+<li>Enemata, <a href="#Page_210">210</a>
+<ul>
+  <li>directions for giving, <a href="#Page_210">210</a></li>
+  <li>for baby, <a href="#Page_212">212</a></li>
+</ul>
+</li>
+
+<li>Environment, <a href="#Page_29">29</a></li>
+
+<li>Eruptive diseases, <a href="#Page_236">236</a></li>
+
+<li>Excreta, disinfection of, <a href="#Page_249">249</a></li>
+
+<li>Excretions, <a href="#Page_52">52</a></li>
+
+<li>Expectoration, <a href="#Page_249">249</a></li>
+
+<li>Eye, ailments, <a href="#Page_267">267</a>
+<ul>
+  <li>compresses for, <a href="#Page_232">232</a></li>
+  <li>foreign bodies in, <a href="#Page_267">267</a></li>
+</ul>
+</li>
+
+<li>Eyestrain, <a href="#Page_284">284</a></li>
+</ul>
+
+<h3>F</h3>
+
+<ul>
+<li>Fainting, <a href="#Page_259">259</a></li>
+
+<li>Fatigue, <a href="#Page_53">53</a>, <a href="#Page_106">106</a>, <a href="#Page_181">181</a></li>
+
+<li>Feeding of infants, <a href="#Page_73">73</a></li>
+
+<li>Filtration of water, <a href="#Page_50">50</a></li>
+
+<li>Flies, as carriers of disease germs, <a href="#Page_38">38</a></li>
+
+<li>Floors, <a href="#Page_120">120</a></li>
+
+<li>Fomentations, <a href="#Page_229">229</a></li>
+
+<li>Food, <a href="#Page_35">35</a>, <a href="#Page_48">48</a>, <a href="#Page_188">188</a>
+<ul>
+  <li>classification of, <a href="#Page_48">48</a></li>
+  <li>for children, <a href="#Page_78">78</a></li>
+  <li>for infants, <a href="#Page_72">72</a></li>
+</ul>
+</li>
+
+<li>Foot bath, <a href="#Page_165">165</a></li>
+
+<li>Fumigation, <a href="#Page_254">254</a></li>
+
+<li>Furniture, <a href="#Page_120">120</a></li>
+</ul>
+
+<h3>G</h3>
+
+<ul>
+<li>Garbage, <a href="#Page_37">37</a></li>
+
+<li>Glossary, <a href="#Page_326">326-330</a></li>
+
+<li>Growth of child, <a href="#Page_64">64</a></li>
+</ul>
+
+<h3>H</h3>
+
+<ul>
+<li>Habits, <a href="#Page_82">82</a></li>
+
+<li>Hair, care of, <a href="#Page_163">163</a></li>
+
+<li>Handkerchiefs, <a href="#Page_239">239</a></li>
+
+<li>Hands, <a href="#Page_11">11</a>, <a href="#Page_12">12</a>, <a href="#Page_43">43</a>, <a href="#Page_250">250</a></li>
+
+<li>Headache, <a href="#Page_257">257</a></li>
+
+<li>Heat, application of, <a href="#Page_220">220</a>
+<ul>
+  <li>exhaustion, <a href="#Page_264">264</a></li>
+</ul>
+</li>
+
+<li>Heating, <a href="#Page_54">54</a></li>
+
+<li>Heredity, <a href="#Page_27">27</a></li>
+
+<li>Hiccough, <a href="#Page_265">265</a></li>
+
+<li>House, cleanliness of, <a href="#Page_33">33</a></li>
+
+<li>Humidity, <a href="#Page_31">31</a></li>
+
+<li>Hygiene, oral, <a href="#Page_44">44</a>
+<ul>
+  <li>personal, <a href="#Page_19">19</a>, <a href="#Page_28">28</a></li>
+</ul>
+</li>
+</ul>
+
+<h3>I</h3>
+
+<ul>
+<li>Immunity, <a href="#Page_13">13</a></li>
+
+<li><a name="Infancy" id="Infancy">Infancy</a> (and childhood), hygiene of, <a href="#Page_60">60</a>
+<ul>
+  <li>air, fresh, <a href="#Page_72">72</a></li>
+  <li>baths, <a href="#Page_78">78</a></li>
+  <li>care of eyes, <a href="#Page_80">80</a>
+<ul>
+    <li>of mouth, <a href="#Page_81">81</a></li>
+    <li>of nostrils, <a href="#Page_81">81</a></li>
+    <li>of genital organs, <a href="#Page_81">81</a></li>
+</ul>
+</li>
+  <li>clothing, <a href="#Page_68">68</a></li>
+  <li>cry, significance of, <a href="#Page_82">82</a></li>
+  <li>diet, <a href="#Page_74">74</a>
+<ul>
+<li><!-- Page 333 --><span class='pagenum'><a name="Page_333" id="Page_333">[333]</a></span>
+    mother's milk, danger of substitutes, <a href="#Page_72">72</a></li>
+    <li>water, <a href="#Page_75">75</a></li>
+    <li>weaning, <a href="#Page_75">75</a></li>
+</ul>
+</li>
+  <li>excretions, <a href="#Page_67">67</a></li>
+  <li>exercise, <a href="#Page_83">83</a></li>
+  <li>growth and development, <a href="#Page_64">64</a>, <a href="#Page_65">65</a>
+<ul>
+    <li>length at birth, <a href="#Page_64">64</a>
+<ul>
+      <li>increase, <a href="#Page_65">65</a></li>
+</ul>
+</li>
+    <li>muscular development, <a href="#Page_64">64</a></li>
+    <li>special senses, <a href="#Page_66">66</a></li>
+    <li>speech, <a href="#Page_66">66</a></li>
+    <li>teeth, <a href="#Page_66">66</a></li>
+    <li>weight at birth, <a href="#Page_64">64</a>
+<ul>
+      <li>increase, <a href="#Page_65">65</a></li>
+</ul>
+</li>
+</ul>
+</li>
+  <li>habits, <a href="#Page_82">82</a></li>
+  <li>mortality, <a href="#Page_61">61</a></li>
+  <li>nursing bottles, <a href="#Page_75">75</a></li>
+    <li>nipples, <a href="#Page_75">75</a></li>
+  <li>play, <a href="#Page_84">84</a></li>
+  <li>pulse, <a href="#Page_96">96</a></li>
+  <li>respiration, <a href="#Page_99">99</a></li>
+  <li>sleep, <a href="#Page_70">70</a></li>
+  <li>toys, <a href="#Page_85">85</a></li>
+</ul>
+</li>
+
+<li>Infection, <a href="#Page_1">1</a>, <a href="#Page_43">43</a></li>
+
+<li>Inflammation, <a href="#Page_220">220</a></li>
+
+<li>Inhalation, <a href="#Page_213">213</a></li>
+
+<li>Insects, <a href="#Page_38">38</a>, <a href="#Page_270">270</a></li>
+
+<li>Insect bites and stings, <a href="#Page_270">270</a></li>
+
+<li>Inunction, <a href="#Page_214">214</a></li>
+
+<li>Isolation, duration of, <a href="#Page_247">247</a></li>
+
+<li>Ivy poisoning, <a href="#Page_270">270</a></li>
+</ul>
+
+<h3>K</h3>
+
+<ul>
+<li>Kitchens, <a href="#Page_34">34</a></li>
+</ul>
+
+<h3>L</h3>
+
+<ul>
+<li>Light, <a href="#Page_33">33</a>, <a href="#Page_124">124</a></li>
+
+<li>Linen, <a href="#Page_251">251</a></li>
+
+<li>Lysol, <a href="#Page_251">251</a></li>
+</ul>
+
+<h3>M</h3>
+
+<ul>
+<li>Malaise, <a href="#Page_106">106</a></li>
+
+<li>Mattress, <a href="#Page_135">135</a>
+<ul>
+  <li>care of, <a href="#Page_136">136</a></li>
+</ul>
+</li>
+
+<li>Measles, <a href="#Page_246">246</a></li>
+
+<li>Medicines and remedies, <a href="#Page_200">200</a>
+<ul>
+  <li>action of drugs, <a href="#Page_200">200</a></li>
+  <li>amateur dosing, <a href="#Page_202">202</a></li>
+  <li>enemata, <a href="#Page_210">210</a></li>
+  <li>inhalation, <a href="#Page_213">213</a></li>
+  <li>inunction, <a href="#Page_214">214</a></li>
+  <li>patent remedies, <a href="#Page_205">205</a></li>
+  <li>sprays and gargles, <a href="#Page_213">213</a></li>
+  <li>suppositories, <a href="#Page_209">209</a></li>
+</ul>
+</li>
+
+<li>Medicines, administration of, <a href="#Page_206">206</a></li>
+
+<li>Menstruation, profuse, <a href="#Page_275">275</a></li>
+
+<li>Mental condition, <a href="#Page_104">104</a>-<a href="#Page_112">112</a></li>
+
+<li>Microorganisms, <a href="#Page_9">9</a></li>
+
+<li>Milk, <a href="#Page_51">51</a>
+<ul>
+  <li>pasteurization, <a href="#Page_51">51</a></li>
+</ul>
+</li>
+
+<li>Mouth, care of, <a href="#Page_160">160</a>
+<ul>
+  <li>wash, <a href="#Page_182">182</a></li>
+</ul>
+</li>
+
+<li>Mustard paste, <a href="#Page_233">233</a>
+<ul>
+  <li>leaves, <a href="#Page_233">233</a></li>
+</ul>
+</li>
+</ul>
+
+<h3>N</h3>
+
+<ul>
+<li>Nausea, <a href="#Page_265">265</a></li>
+
+<li>Nipple, bottle, <a href="#Page_77">77</a>
+<ul>
+  <li>care of, <a href="#Page_77">77</a></li>
+</ul>
+</li>
+
+<li>Non-communicable diseases, <a href="#Page_20">20</a></li>
+
+<li>Nosebleed, <a href="#Page_274">274</a></li>
+</ul>
+
+<h3>P</h3>
+
+<ul>
+<li>Pain, <a href="#Page_105">105</a></li>
+
+<li>Parasites, <a href="#Page_3">3</a>, <a href="#Page_4">4</a>, <a href="#Page_8">8</a></li>
+
+<li>Patent remedies, <a href="#Page_205">205</a></li>
+
+<li>Patient, care of,
+<ul>
+<li><ul>
+    <li>with communicable disease, <a href="#Page_236">236</a></li>
+    <li>with colds and slight infections, <a href="#Page_238">238</a></li>
+    <li>with more serious infections, <a href="#Page_242">242</a></li>
+</ul></li>
+  <li>changing sheet, <a href="#Page_147">147</a></li>
+  <li>changing, <a href="#Page_146">146</a></li>
+  <li>lifting, <a href="#Page_146">146</a></li>
+  <li>mouth, <a href="#Page_160">160</a></li>
+  <li>moving, <a href="#Page_152">152</a></li>
+</ul>
+</li>
+
+<li>Personal hygiene, <a href="#Page_19">19</a></li>
+
+<li>Pillows, <a href="#Page_137">137</a>
+<ul>
+  <li>covers, <a href="#Page_138">138</a>, <a href="#Page_140">140</a></li>
+</ul>
+</li>
+
+<li>Poisonous drugs, <a href="#Page_215">215</a></li>
+
+<li>Posture, <a href="#Page_286">286</a></li>
+
+<li>Poultices, <a href="#Page_227">227</a>, <a href="#Page_228">228</a></li>
+
+<li>Prenatal care, <a href="#Page_62">62</a></li>
+
+<li>Prickly heat, <a href="#Page_269">269</a></li>
+
+<li>Protozoa, <a href="#Page_8">8</a></li>
+
+<li>Public agencies, <a href="#Page_107">107</a></li>
+
+<li>Public sanitation, <a href="#Page_19">19</a></li>
+
+<li>Pulse, <a href="#Page_96">96</a></li>
+
+<li>Purification of water, <a href="#Page_50">50</a></li>
+
+</ul>
+
+<h3>Q</h3>
+
+<ul>
+<li>Quarantine, termination of, <a href="#Page_252">252</a></li>
+</ul>
+
+<h3>R</h3>
+
+<ul>
+<li>Records, <a href="#Page_107">107</a></li>
+
+<li>Recreation, <a href="#Page_55">55</a></li>
+
+<li>Rectum, <a href="#Page_93">93</a></li>
+
+<li>Respiration, <a href="#Page_99">99</a></li>
+
+<li>Rest, <a href="#Page_53">53</a></li>
+
+<li>Rooms, <a href="#Page_27">27</a></li>
+</ul>
+
+<p><!-- Page 334 --><span class='pagenum'><a name="Page_334" id="Page_334">[334]</a></span></p>
+
+<h3>S</h3>
+
+<ul>
+<li>Saprophytes, <a href="#Page_2">2</a></li>
+
+<li>Scalds, <a href="#Page_277">277</a></li>
+
+<li>Scarlet fever, <a href="#Page_246">246</a></li>
+
+<li>Sewage, <a href="#Page_39">39</a></li>
+
+<li>Sheets, <a href="#Page_137">137</a>, <a href="#Page_138">138</a>, <a href="#Page_142">142</a></li>
+
+<li>Shock, <a href="#Page_261">261</a></li>
+
+<li>Sick-room, model, <a href="#Page_118">118</a></li>
+
+<li>Sleep, <a href="#Page_55">55</a>, <a href="#Page_70">70</a></li>
+
+<li>Sleeplessness, <a href="#Page_258">258</a></li>
+
+<li>Small-pox, <a href="#Page_246">246</a></li>
+
+<li>Special senses in sickness, <a href="#Page_101">101</a></li>
+
+<li>Spores, <a href="#Page_7">7</a></li>
+
+<li>Sprains, <a href="#Page_275">275</a></li>
+
+<li>Sprays and gargles, <a href="#Page_213">213</a></li>
+
+<li>Stimulants, in emergency work, <a href="#Page_263">263</a></li>
+
+<li>Stupes, <a href="#Page_229">229</a></li>
+
+<li>Styes, <a href="#Page_267">267</a></li>
+
+<li>Sunstroke, <a href="#Page_264">264</a></li>
+
+<li>Suppositories, <a href="#Page_209">209</a></li>
+
+<li>Symptoms, <a href="#Page_88">88</a></li>
+</ul>
+
+<h3>T</h3>
+
+<ul>
+<li>Teeth, <a href="#Page_45">45</a>, <a href="#Page_160">160</a>
+<ul>
+  <li>defective, <a href="#Page_286">286</a></li>
+  <li>treatment, <a href="#Page_46">46</a></li>
+</ul>
+</li>
+
+<li>Temperature, <a href="#Page_92">92</a>
+<ul>
+  <li>method of taking, <a href="#Page_92">92</a></li>
+  <li>normal, <a href="#Page_95">95</a></li>
+</ul>
+</li>
+
+<li>Temperature of baths, <a href="#Page_79">79</a>, <a href="#Page_155">155</a>
+<ul>
+  <li>of house, <a href="#Page_30">30</a>, <a href="#Page_124">124</a></li>
+  <li>sponging for, <a href="#Page_177">177</a></li>
+  <li>variations, <a href="#Page_114">114</a>, <a href="#Page_206">206</a></li>
+</ul>
+</li>
+
+<li>Thermometer, clinical, care of, <a href="#Page_92">92</a></li>
+
+<li>Tonsils, enlarged, <a href="#Page_284">284</a></li>
+
+<li>Tuberculosis, <a href="#Page_27">27</a>-<a href="#Page_107">107</a></li>
+</ul>
+
+<h3>U</h3>
+
+<ul>
+<li>Urine, <a href="#Page_103">103</a></li>
+</ul>
+
+<h3>V</h3>
+
+<ul>
+<li>Vaccination, <a href="#Page_13">13</a>, <a href="#Page_25">25</a></li>
+
+<li>Ventilation, <a href="#Page_29">29</a>, <a href="#Page_123">123</a></li>
+
+<li>Vomiting, <a href="#Page_265">265</a></li>
+</ul>
+
+<h3>W</h3>
+
+<ul>
+<li>Water, <a href="#Page_49">49</a>
+<ul>
+  <li>filtration, <a href="#Page_50">50</a></li>
+</ul>
+</li>
+
+<li>Weaning, <a href="#Page_75">75</a></li>
+
+<li>Weight, <a href="#Page_65">65</a>
+<ul>
+  <li>loss of, <a href="#Page_64">64</a></li>
+</ul></li>
+
+<li>Whooping cough, <a href="#Page_246">246</a></li>
+
+<li>Wounds, <a href="#Page_272">272</a></li>
+</ul>
+
+<div class="tn">
+<h2>Transcriber's Note:</h2>
+
+<p>Punctuation errors (e.g. missing period at end of sentence, missing
+quotation marks, etc.) and letters printed upside down have been
+corrected without note. Except where noted, inconsistencies in
+hyphenation, capitalization, and spelling (e.g. travelling and
+traveling) have not been changed. The original index had numerous
+errors, such as references to terms that do not appear in the text.
+Except where noted below, it has been left as printed.</p>
+
+<p>The following corrections were made:</p>
+
+<ul>
+<li><a href="#Page_viii">p. viii</a>: Records, 105. to Records, 107. (under Chapter IV)</li>
+
+<li><a href="#Page_ix">p. ix</a>: Care of the Patients with Communicable Diseases to Care of
+Patients with Communicable Diseases (under Chapter XII)</li>
+
+<li><a href="#Page_ix">p. ix</a>: Care of liver, 251. to Care of linen, 251. (under Chapter XII)</li>
+
+<li><a href="#Page_15">p. 15</a>: innoculation to inoculation (Vaccination and inoculation have
+saved thousands of lives.)</li>
+
+<li><a href="#Page_16">p. 16</a>: principle to principal (principal causes which diminish
+resistance), to match cited text</li>
+
+<li><a href="#Page_37">p. 37</a>: gerns to germs (through which disease germs)</li>
+
+<li><a href="#Page_40">p. 40</a>: From "<cite>The Human Mechanism</cite>." to <cite>From "The Human Mechanism."</cite>
+(to match format of other captions)</li>
+
+<li><a href="#Page_41">p. 41</a>: perferably to preferably (preferably, chloride of lime.)</li>
+
+<li><a href="#Page_77">p. 77</a>: runnnig to running (thoroughly cleansed under running water)</li>
+
+<li><a href="#Page_82">p. 82</a>: symptons to symptoms (other symptoms of distress)</li>
+
+<li><a href="#Page_96">p. 96</a>: thay to they (taken together they are)</li>
+
+<li><a href="#Page_108">p. 108</a>: 8:30 to 8:30 a.m.</li>
+
+<li><a href="#Page_111">p. 111</a>: develope to develop (may develop into cancer)</li>
+
+<li><a href="#Page_115">p. 115</a>: missing degree symbol added (At noon his temperature was 101°)</li>
+
+<li><a href="#Page_132">p. 132</a>: illnes to illness (unless his illness is slight)</li>
+
+<li><a href="#Page_136">p. 136</a>: servicable to serviceable (makes a serviceable cover)</li>
+
+<li><a href="#Page_150">p. 150</a>: paitent to patient (ready for the patient.)</li>
+
+<li><a href="#Page_150">p. 150-151</a>: removed duplication of text in captions for Fig. 14 and Fig.
+15 (<span class="smcap">Changing the Draw Sheet</span>, and <span class="smcap">Changing a Patient
+from One Bed to Another</span>)</li>
+
+<li><a href="#Page_161">p. 161</a>: erroneous italics removed from "patient" and "her" (even a
+patient unable to sit up can brush her teeth)</li>
+
+<li><a href="#Page_167">p. 167</a>: added missing "bath" (to give a cool sponge bath)</li>
+
+<li><a href="#Page_175">p. 175</a>: ahould to should (the protection of the abdomen should)</li>
+
+<li><a href="#Page_177">p. 177</a>: expecially to especially (if it is especially difficult or
+undesirable)</li>
+
+<li><a href="#Page_177">p. 177</a>: patients' to patient's (between the patient's back and the pan;)</li>
+
+<li><a href="#Page_178">p. 178</a>: deoderant to deodorant (a properly kept pan needs no deodorant)</li>
+
+<li><a href="#Page_183">p. 183</a>: invarably to invariably (casual visitors almost invariably
+offend)</li>
+
+<li><a href="#Page_189">p. 189</a>: nurtients to nutrients (pancreatic juice acts upon all three
+nutrients)</li>
+
+<li><a href="#Page_195">p. 195</a>: solied to soiled (is always superior to soiled linen.)</li>
+
+<li><a href="#Page_205">p. 205</a>: appy to apply (apply even more strongly to using patent
+medicines.)</li>
+
+<li><a href="#Page_211">p. 211</a>: 166 to 176 (the directions on page 176.)</li>
+
+<li><a href="#Page_216">p. 216</a>: selzer to seltzer (seltzer aperient)</li>
+
+<li><a href="#Page_226">p. 226</a>: slighest to slightest (there is the slightest possibility of
+scalding)</li>
+
+<li><a href="#Page_227">p. 227</a>: accidently to accidentally (see that the switch is not
+accidentally)</li>
+
+<li><a href="#Page_228">p. 228</a>: cohers to coheres (when the mixture coheres)</li>
+
+<li><a href="#Page_229">p. 229</a>: annoint to anoint (anoint it with vaseline)</li>
+
+<li><a href="#Page_233">p. 233</a>: dicharge to discharge (If there is discharge from the eye,)</li>
+
+<li><a href="#Page_242">p. 242</a>: chould to should (visitors should be rigidly)</li>
+
+<li><a href="#Page_245">p. 245</a>: himelf to himself (safeguard the patient himself.)</li>
+
+<li>Table between <a href="#Page_246">pp. 246-247</a>: diappearance to disappearance (Two weeks
+after onset and one week after disappearance)</li>
+
+<li>Table between <a href="#Page_246">pp. 246-247</a>: pa-patient to patient (after child last saw patient.)</li>
+
+<li><a href="#Page_250">p. 250</a>: If to It (It may be necessary to provide two bedpans)</li>
+
+<li><a href="#Page_266">p. 266</a>: 216 to 193 (discussed on pages 193 and 52.)</li>
+
+<li><a href="#Page_280">p. 280</a>: etter to better (no better place)</li>
+
+<li><a href="#Page_300">p. 300</a>: attenom, to attention (constant attention must be given)</li>
+
+<li><a href="#Page_300">p. 300</a>: rotion to room, (hygiene of the sick room,)</li>
+
+<li><a href="#Page_301">p. 301</a>: salutory to salutary (making the salutary small adjustments)</li>
+
+<li><a href="#Page_308">p. 308</a>: querelous to querulous (sometimes become querulous)</li>
+
+<li><a href="#Page_329">p. 329</a>: Putrifying to Putrefying (Putrefying or decomposing)</li>
+
+<li><a href="#Page_331">p. 331</a>: bed-cradles to bed cradles (Index sub-entry, under "Appliances")</li>
+
+<li><a href="#Page_331">p. 331</a>: Bed-cradles to Bed cradles (Index entry)</li>
+
+<li><a href="#Page_331">p. 331</a>: Bed-sores to Bed sores (Index entry)</li>
+
+<li><a href="#Page_331">p. 331</a>: Brushburn to Brush burn (Index entry)</li>
+
+<li><a href="#Page_332">p. 332</a>: Foot-bath to Foot bath (Index entry)</li>
+
+<li><a href="#Page_333">p. 333</a>: Microörganisms to Microorganisms (Index entry)</li>
+
+<li><a href="#Page_333">p. 333</a>: Pre-natal to Prenatal (Index entry)</li>
+
+<li><a href="#Page_334">p. 334</a>: oss to loss (Index entry for "Weight, loss of")</li>
+</ul>
+</div>
+
+<p><a name="redcross-table"></a></p>
+<div class="bigtable">
+
+<p class="smcap center">New York State Department of Health<br />
+<span class="med">Communicable Diseases Among Children</span><br />
+Rules for Isolation and Exclusion from School</p>
+
+<p class="fl"><span class="smcap">Herman M. Biggs, M.D.</span><br />
+<span class="pad-l">Commissioner</span></p>
+
+<p class="fr center">Issued by the<br />
+Division of Public Health Education</p>
+
+<table rules="all" frame="hsides" cellpadding="2" summary="NY Dept. of Health's rules for isolating
+children with communicable diseases">
+
+<thead>
+<tr class="mid">
+<th class="smcap" rowspan="3">Disease</th>
+<th class="smcap" rowspan="3">Principal Signs and Symptoms</th>
+<th class="smcap" rowspan="3">Method of Infection</th>
+<th class="smcap" colspan="5">Exclusion from School</th>
+<th class="smcap" colspan="5">Duration of Exclusion from Date of Onset</th>
+<th rowspan="3">Remarks</th>
+</tr>
+
+<tr class="mid">
+<th rowspan="2">Patient</th>
+<th class="sm" colspan="2">OTHER CHILDREN OF SAME HOUSEHOLD</th>
+<th class="sm" colspan="2">OTHER SCHOOL CHILDREN ESPECIALLY EXPOSED</th>
+<th rowspan="2">Patient</th>
+<th class="sm">PATIENT GOES TO HOSPITAL</th>
+<th class="sm" colspan="2">PATIENT REMAINS ISOLATED AT HOME</th>
+<th rowspan="2">Children exposed at school</th>
+</tr>
+
+<tr class="mid">
+<th>Non-<br />immunes</th>
+<th><a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>Immunes</th>
+<th>Non-<br />immunes</th>
+<th><a name="FNanchor_3_3b" id="FNanchor_3_3b"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>Immunes</th>
+<th>Other children of the same household</th>
+<th>Other children who remain at home</th>
+<th>Children who leave household as soon as disease is discovered</th>
+</tr>
+</thead>
+
+<tfoot>
+<tr class="no-bb"><td colspan="14">
+<a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3">[3]</a> Immunes are those who have had the diseases or in smallpox, who have been successfully vaccinated within a year.
+</td></tr>
+
+<tr class="no-bb"><td colspan="14">
+<span class="smcap">Disinfection:</span> The cleansing and disinfection of the person includes washing the entire body and the hair with soap and water; thorough brushing of the teeth; rinsing the mouth; gargling the throat, and douching and spraying the nose with an antiseptic
+solution; and finally, a complete change of clothing (or a change of underwear and a thorough shaking and brushing of the outer garments out of doors before these are put on again). (<a href="#Page_247"><i>Facing p. 247</i></a>)
+</td></tr>
+</tfoot>
+
+<tbody>
+<tr>
+<th>CHICKENPOX</th>
+<td>Rarely begins with fever. Rash appears on second day as small pimples,
+which in about a day become filled with clear fluid. This fluid becomes
+yellow colored, a crust forms and the scab falls off in about 14 days.
+Successive crops of papules appear until tenth day.</td>
+<td>Contact with discharges from nose and throat of a patient.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Until all scabs are shed and disinfection of person; at least 12 days.</td>
+<td colspan="3">Exclude if non-immune until 21st day after child last saw patient.</td>
+<td>Exclude from school if non-immune during 11th to 22d days after child
+last saw patient.</td>
+<td>A mild disease and seldom any after effects.</td>
+</tr>
+
+<tr><th>DIPHTHERIA</th>
+<td>Onset may be rapid or gradual. The back of the throat, tonsils, or
+palate may show patches. The most pronounced symptom is sore throat.
+There may be hardly any symptoms at all.</td>
+<td>Contact with discharges from nose and throat, occasionally by drinking
+infected milk.</td>
+<td align="center">Yes</td> <td align="center">Yes</td> <td align="center">Yes</td>
+<td align="center">Yes</td> <td align="center">Yes</td>
+<td> Until patient is recovered and has two cultures from throat and nose
+which contain no diphtheria bacilli; cultures not to be taken until 9
+days from date of onset. Disinfection of person. </td>
+<td colspan="3"> Until two cultures at least 24 hours apart are reported negative. Those
+showing diphtheria bacilli should not necessarily be immunized unless
+symptoms appear.</td>
+<td></td>
+<td> Very dangerous, both during attack and from after effects. When
+diphtheria occurs in a school all children suffering from sore throat
+should be excluded and the health officer notified. The medical school
+inspector or health officer should take cultures from all inflamed
+throats and noses. There is great variation of type, and mild cases are
+often not recognized, but are as infectious as severe cases. There is
+frequently no immunity from further attacks.</td>
+</tr>
+
+<tr>
+<th>MEASLES</th>
+<td>Begins like cold in the head, with running nose, sneezing, inflamed and
+watery eyes and fever. Mulberry-tinted spots appear about the third day;
+rash first seen behind the ears, on forehead and face. The rash varies
+with heat; may almost disappear if the air is cold, and come out again,
+with warmth.</td>
+<td>Contact with discharges from nose and throat of a patient.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Until recovery and disinfection of person; at least 7 days from onset.</td>
+<td colspan="3">Exclude non-immunes until 15th day after child last saw patient.</td>
+<td>If non-immune exclude from school during 8th to 15th day after child
+last saw patient. </td>
+<td>After effects often severe. Period of greatest risk of infection three
+days, before and after the rash appears. Great variation in type of
+disease. Dangerous in children under 2 years of age. During an outbreak
+all children having a temperature over 99°F. should be sent home and the
+health officer notified.</td>
+</tr>
+
+<tr>
+<th>MEASLES
+(LIBERTY)</th>
+<td>Illness usually slight. Onset sudden. Lymph nodes in back of neck
+enlarged. Rash often first thing noticed; no cold in head. Usually have
+fever, sore throat, and the eyes may be inflamed. Rash sometimes
+resembles measles and scarlet fever, variable.</td>
+<td>Same as above.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Until recovery and disinfection of person; at least 8 days.</td>
+<td colspan="3">Exclude if non-immune until 22d day after child last saw patient.</td>
+<td>Exclude from school if non-immune during 11th to 22d days after child
+last saw patient.</td>
+<td>After effects slight. Regulations strict, because frequently confused
+with scarlet fever.</td>
+</tr>
+
+<tr>
+<th>MUMPS</th>
+<td>Onset may be sudden, beginning with sickness and fever, and pain about
+the angle of the jaw. The parotid glands become swollen and tender.
+Opening the mouth is accompanied by pain.</td>
+<td>Same as above.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Two weeks after onset and one week after disappearance of swelling and
+after disinfection of person.</td>
+<td colspan="3">Exclude 15th to 22d day after child last saw patient.</td>
+<td>Exclude from 15th to 22d day after child last saw patient.</td>
+<td>Seldom leaves after effects. Very infectious. Inflammation of genital
+organs of male or female may occur.</td>
+</tr>
+
+<tr>
+<th>POLIOMYELITIS</th>
+<td>Onset sudden, fever, excitable, pain on bending neck forward, pain on
+being handled, headache, vomiting. Sometimes sudden development of
+weakness of one or more muscle groups.</td>
+<td>Contact with discharge from nose, throat or bowels of a patient or
+carrier.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td>
+<td align="center">Yes</td><td align="center">Yes</td>
+<td>Until patient is recovered. Disinfection of person at least 21 days.</td>
+<td>14 days from time child last saw patient.</td>
+<td>Until 14 days after quarantine raised.</td>
+<td>14 days from time child last saw patient.</td>
+<td></td>
+<td>Disease is most communicable in the early stages. After effect is
+paralysis of certain muscle groups, transitory or permanent. Death is
+due usually to paralysis of respiratory muscles.</td>
+</tr>
+
+<tr>
+<th>SCARLET
+FEVER</th>
+<td>The onset is usually sudden, with headache, fever, sore throat, and
+often vomiting. Usually within twenty-four hours the rash appears as
+fine, evenly diffused, and bright red dots under skin. The rash is seen
+first on the neck and upper part of chest, and lasts three to ten days,
+when it fades and the skin peels in scales, flakes, or even large
+pieces.</td>
+<td>Discharges from nose and mouth, suppurating glands or ears of a patient.
+Milk may convey infection.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td>
+<td align="center">Yes</td>
+<td>At least 30 days and until discharges have ceased and disinfection of
+person.</td>
+<td>Seven days from time child last saw patient.</td>
+<td>Until seven days after quarantine has been raised.</td>
+<td>Seven days from time child last saw patient.</td>
+<td></td>
+<td>Dangerous both during attack and from after effects. Great variation in
+type of disease. Slight attacks are as infectious as severe ones. Many
+mild cases not diagnosed and many concealed. A second attack is rare.
+When scarlet fever occurs in a school, all cases of sore throat should
+be sent home and health officer notified. Most fatal in children under
+ten years.</td>
+</tr>
+
+<tr>
+<th>SMALLPOX</th>
+<td>Onset sudden usually with fever and severe backache. About third day
+upon subsidence of constitutional symptoms red shot-like pimples, felt
+below the skin, and seen first about the face and wrists most on exposed
+surfaces, develop. They form little blisters and after two days more
+become filled with yellowish matter. Scabs form which begin to fall off
+about the fourteenth day.</td>
+<td>All discharges of a patient and particles of skin or scabs.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Recovery and disinfection of person at least 14 days.</td>
+<td>Exclude if non-immune until 21st day after child last saw patient, or 7
+days successful vaccination and disinfection of person.</td>
+<td>Exclude if non-immune until 20 days after quarantine has been raised or
+7 days after successful vaccination and disinfection of person.</td>
+<td>Exclude if non-immune until 21st day after child last saw patient, or 7
+days after successful vaccination and disinfection of person.</td>
+<td>Exclude 20 days unless they have been successfully vaccinated within 1
+year in which case they may return at once.</td>
+<td>Peculiarly infectious. When smallpox occurs in connection with a school
+or with any of the children's homes all persons exposed must be
+vaccinated or quarantined for a period of 20 days. Cases of modified
+smallpox in vaccinated persons, may be, and often are, so slight as to
+escape detection. Fact of existence of disease may be concealed. Mild or
+modified smallpox is as infectious as severe type.</td>
+</tr>
+
+<tr>
+<th>SORE THROAT,
+ACUTE, SEPTIC</th>
+<td>Begins with sore throat and weakness. Throat diffusely reddened and may
+show patches like diphtheria.</td>
+<td>Discharges from nose and mouth of a patient.</td>
+<td align="center">Yes</td><td align="center">No</td><td align="center">No</td>
+<td align="center">No</td><td align="center">No</td>
+<td>Until recovery.</td>
+<td colspan="3"></td><td></td>
+<td>Often leads to serious results, affections of heart, kidneys, etc. Very
+apt to occur in epidemics due to milk contaminated by a patient
+suffering from the disease.</td>
+</tr>
+
+<tr>
+<th>WHOOPING
+COUGH</th>
+<td>Begins with cough which is worse at night. Symptoms may at first be very
+mild. Characteristic "whooping" cough develops in about 2 weeks, and the
+spasm of coughing sometimes ends with vomiting.</td>
+<td>Discharges from nose and mouth of a patient.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Eight weeks or until 1 week after last characteristic cough and
+disinfection of person.</td>
+<td colspan="3">Fourteen days provided no cough develops.</td>
+<td></td>
+<td>After effects often very severe and disease causes great debility.
+Relapses are apt to occur. Second attack rare. Specially infectious for
+first week or two. If a child vomits after a paroxysm of coughing, it is
+probably suffering from whooping cough. Great variation in type of
+disease. Often fatal in young children.</td>
+</tr>
+</tbody>
+</table>
+</div>
+
+<div style='display:block;margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***</div>
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+This eBook, including all associated images, markup, improvements,
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diff --git a/README.md b/README.md
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+Project Gutenberg (https://www.gutenberg.org) public repository for
+eBook #32250 (https://www.gutenberg.org/ebooks/32250)
diff --git a/old/32250-8.txt b/old/32250-8.txt
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+The Project Gutenberg EBook of American Red Cross Text-Book on Home
+Hygiene and Care of the Sick, by Jane A. Delano and Anne Hervey Strong and American Red Cross
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: American Red Cross Text-Book on Home Hygiene and Care of the Sick
+
+Author: Jane A. Delano
+        Anne Hervey Strong
+        American Red Cross
+
+Release Date: May 4, 2010 [EBook #32250]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***
+
+
+
+
+Produced by Heiko Evermann, Fox in the Stars, S.D., and
+the Online Distributed Proofreading Team at
+https://www.pgdp.net
+
+
+
+
+
+
+
+
+
+AMERICAN RED CROSS TEXT-BOOK
+
+ON
+
+HOME CARE OF THE SICK
+
+***
+
+DELANO
+
+
+
+
+  AMERICAN RED CROSS
+
+  TEXT-BOOK
+
+  ON
+
+  HOME HYGIENE
+
+  AND
+
+  CARE OF THE SICK
+
+  BY
+
+  JANE A. DELANO, R. N.
+
+  Chairman of the National Committee, Red Cross Nursing Service; Director,
+  Department of Nursing, American Red Cross; Late Superintendent
+  of the Nurse Corps, U. S. A.; of the Training Schools
+  for Nurses, Bellevue Hospital, New York City; and of the
+  Training School for Nurses, Hospital of the University
+  of Pennsylvania, Philadelphia
+
+  REVISED AND REWRITTEN
+
+  BY
+
+  ANNE HERVEY STRONG, R. N.
+
+  Professor of Public Health Nursing, Simmons College, Boston
+
+  _This is the Second Edition of the American Red Cross
+  Text-book in Elementary Hygiene and Home Care of
+  the Sick by Jane A. Delano and Isabel McIsaac._
+
+  PREPARED FOR AND ENDORSED BY
+
+  THE AMERICAN RED CROSS
+
+  PHILADELPHIA
+  P. BLAKISTON'S SON & CO.
+
+  1012 WALNUT STREET
+
+
+COPYRIGHT, 1918, BY AMERICAN RED CROSS
+
+THE MAPLE PRESS YORK PA
+
+
+
+
+PREFACE
+
+
+To the woman who wishes to protect her family from preventable diseases
+and is anxious to fit herself in the absence of a trained nurse to give
+intelligent care to those who are sick, this revision of the Red Cross
+text-book on Elementary Hygiene and Home Care of the Sick is
+particularly directed. It should appeal to men and to women who are
+interested in maintaining the health of their neighborhoods and
+communities and in affording effective coöperation to the public health
+authorities. To teachers wishing to impart protective health information
+to high school pupils, the book also should be useful as a class text as
+well as a guide.
+
+The war, which has caused the withdrawal from private practice of
+thousands of physicians and graduate nurses, makes it peculiarly
+important to the nation for every adult to have sound knowledge as to
+how to prevent contagion and epidemics, especially by precautionary
+attention to home and local sanitation. With nurses becoming more
+difficult to secure, the safety of the family demands that some member
+in each household know enough about elementary nursing to make a patient
+comfortable and to carry out accurately the instructions of the
+physician.
+
+The work of revision, based upon the latest knowledge of hygiene,
+sanitation and methods of home-nursing has been done by Miss Anne Hervey
+Strong, Professor of Public Health Nursing, Simmons College, under the
+personal direction of the author and the National Committee on Red Cross
+Nursing Service. The material has been painstakingly read by Dr. H. W.
+Rucker and Dr. Taliaferro Clarke of the United States Public Health
+Service, and Lieutenant Colonel Clarence H. Connor, Medical Corps,
+United States Army. Indebtedness to Dr. H. M. McCracken, President of
+Vassar College and Director of the Red Cross Junior Membership, for his
+valuable suggestion as to adapting the book for high school use as well
+as for the assistance rendered by his Department, also is gladly
+acknowledged.
+
+J. A. D.
+
+
+ACKNOWLEDGMENT
+
+I wish to express my gratitude to those who have so kindly helped in the
+work of preparing the present edition. Thanks are especially due to
+Professor Isabel Stewart, Miss Anna C. Jamme, Professor Curtis M.
+Hilliard, Professor Maurice Bigelow, Miss Katharine Lord, Miss Josephine
+Goldmark, and Miss Evelyn Walker.
+
+A. H. S.
+
+
+
+
+CONTENTS
+
+
+  PREFACE                                                            v
+
+  INTRODUCTION                                                      xi
+
+  CHAPTER I
+
+                                                                  PAGE
+
+  CAUSES AND PREVENTION OF SICKNESS                                  1
+
+     Communicable diseases, 1. Micro-organisms and bacteria,
+     1. Parasites, 3. Structure and development of parasites,
+     4. Bacteria, 4. Shape, 4. Size, 5. Motion, 5.
+     Multiplication, 5. Spores, 7. Distribution, 8. Protozoa,
+     8. Visible parasites, 8. Transmission of pathogenic
+     organisms, 9. Defenses of the body, 12. Immunity, 13.
+     Vaccination and inoculation, 15. Carriers, 17.
+     Non-communicable diseases, 20. Physical examinations, 22.
+
+  CHAPTER II
+
+  HEALTH AND THE HOME                                               27
+
+     Heredity, 27. Hygiene of environment and person, 28.
+     Ventilation, 29. Lighting, 32. Cleanliness of houses, 33.
+     Garbage, 37. Insects, 38. Sewage, 39. Personal
+     cleanliness, 41. Oral hygiene, 44. Treatment of teeth,
+     46. Clothing, 47. Food, 48. Elimination, 52. Rest and
+     fatigue, 53. Sleep, 55. Recreation, 55.
+
+  CHAPTER III
+
+  BABIES AND THEIR CARE                                             60
+
+     Growth and development, 64. Average size, 64. Muscular
+     development, 65. Development of special senses, of
+     speech, of teeth, 66. Normal excretions, 67. Clothing,
+     68. Sleep, 70. Fresh air, 72. Diet, 72. Intervals of
+     feeding, 73. Water, 75. Weaning, 75. Nursing bottles and
+     nipples, 75. Tables of diet, 78. Bathing, 78. Eyes, 80.
+     Mouth, 81. Nostrils, 81. Genital organs, 81. Development
+     of habits, 82. Exercise, 83. Play and toys, 85.
+
+  CHAPTER IV
+
+  INDICATIONS OF SICKNESS                                           88
+
+     Objective symptoms, 92. Temperature, 92. Pulse, 96.
+     Respiration, 99. General appearance, 100. Special senses,
+     101. Voice, tongue, throat, gums, 102. Cough, 103.
+     Appetite, 103. Excretions, 103. Loss of weight, 104.
+     Sleep, 104. Mental conditions, 104. Subjective symptoms,
+     105. Pain, 105. Records, 107. Tuberculosis, cancer and
+     mental illness, 107. Tuberculosis, 109. Cancer, 111.
+     Mental illness, 112.
+
+  CHAPTER V
+
+  EQUIPMENT AND CARE OF THE SICK ROOM                              117
+
+     Choice of a sick room, 118. Furnishing, 120. Ventilation,
+     123. Heating, 124. Lighting, 124. Cleaning, 126. The
+     attendant, 127.
+
+  CHAPTER VI
+
+  BEDS AND BEDMAKING                                               132
+
+     Bedsteads, 133. Mattresses, 135. Care of the mattress,
+     136. Pillows, 136. Protection of the mattress and
+     pillows, 137. Rubber sheets and pillow-cases, 138.
+     Sheets, 139. Draw sheets, 139. Pillow covers, 140.
+     Blankets, 140. Comforters and quilts, 141. Counterpanes,
+     141. Bedmaking, 141. To make an unoccupied bed, 143. To
+     change a patient's pillows, 146. Lifting a patient in
+     bed, 146. To turn a patient in bed, 147. To change sheets
+     while patient is in bed, 147. To move patient from one
+     bed to another, 150.
+
+  CHAPTER VII
+
+  BATHS AND BATHING                                                154
+
+     Cleansing baths, 154. Bed bath, 156. Care of the mouth
+     and teeth, 160. Care of the hair, 163. To wash the hair
+     of a bed patient, 164. Hot foot-baths, 165. Cool sponge
+     bath, 166.
+
+  CHAPTER VIII
+
+  APPLIANCES AND METHODS FOR THE SICK-ROOM                         169
+
+     Devices to give support, 172. Bedpans, 176. Daily routine
+     in the sick-room, 179. Time for visitors, 182.
+
+  CHAPTER IX
+
+  FEEDING THE SICK                                                 187
+
+     The digestive process, 188. Feeding the sick, 191. Liquid
+     diet, 192. Semi-solid diet, 192. Light or convalescent
+     diet, 193. Full diet, 193. Serving food for the sick,
+     195. To feed a helpless patient, 197.
+
+  CHAPTER X
+
+  MEDICINES AND OTHER REMEDIES                                     200
+
+     Action of drugs, 200. Amateur dosing, 202. Patent
+     remedies, 205. Administration of medicine, 206.
+     Suppositories, 209. Enemata, 210. Sprays and gargles,
+     213. Inhalation, 213. Inunction, 214. Household medicine
+     cupboard, 215.
+
+  CHAPTER XI
+
+  APPLICATION OF HEAT, COLD AND COUNTER-IRRITANTS                  220
+
+     Inflammation, 220. Hot applications, 225. Dry heat, 225.
+     Moist heat, 227. Stupes or hot fomentations, 229. Cold
+     applications, 231. Dry cold, 231. Moist cold, 232. Cold
+     compresses for the eyes, 232. Counter-irritants, 233.
+     Mustard paste, 233. Mustard leaves, 234.
+
+  CHAPTER XII
+
+  CARE OF PATIENTS WITH COMMUNICABLE DISEASES                      236
+
+     Incubation period, 238. Care of patients with colds or
+     other slight infections, 238. Care during more serious
+     infections, 242. Children's diseases, 246. Rules for
+     isolation and exclusion from school, 247. Disinfection,
+     248. Care of nose and throat discharges, 249. Care of
+     discharges from the bowels and bladder, 249. Bath water,
+     250. Care of the hands, 250. Care of utensils, 251. Care
+     of linen, 251. Disinfection of the person, 252.
+     Termination of quarantine, 252. Terminal disinfection,
+     253. Fumigation, 254.
+
+  CHAPTER XIII
+
+  COMMON AILMENTS AND EMERGENCIES                                  257
+
+     Conditions in which the nervous system is involved, 257.
+     Headache, 257. Sleeplessness, 258. Fainting, 259.
+     Convulsions, 260. Shock, 261. Stimulants, 263. Sunstroke
+     and heat exhaustion, 264. Conditions in which the
+     digestive tract is affected, 265. Nausea and vomiting,
+     265. Hiccough, 265. Diarrhoea, 266. Constipation, 266.
+     Colic, 266. Conditions in which the eyes or ears are
+     affected, 267. Styes, 267. Foreign bodies in the eye,
+     267. Disorders affecting the ears, 268. Conditions in
+     which the skin is affected, 269. Prickly heat, 269.
+     Insect bites and stings, 270. Ivy poisoning, 270. Other
+     emergencies, 270. Chills, 270. Croup, 271. Bleeding, 272.
+     Treatment of slight wounds, 272. Nose bleed, 274. Profuse
+     menstruation, 275. Other injuries, 275. Sprains, 275.
+     Bruises, 276. Burns and scalds, 277. Brush burn, 278.
+
+  CHAPTER XIV
+
+  SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS,
+  CHRONICS, AND THE AGED                                           280
+
+     Children, 281. Physical defects, 283. Eye-strain, 284.
+     Enlarged tonsils and adenoids, 284. Defective hearing,
+     285. Defective teeth, 286. Posture, 286. Predisposition
+     to nervousness, 292. Convalescent patients, 294. Chronic
+     patients, 299. Care of the aged, 303.
+
+  CHAPTER XV
+
+  QUESTIONS FOR REVIEW                                             312
+
+  APPENDIX                                                         319
+
+     Circulars of information issued by Division of Child
+     Hygiene, New York Department of Health.
+
+  GLOSSARY                                                         326
+
+  INDEX                                                            331
+
+
+
+
+INTRODUCTION
+
+
+Health and sickness, at all times momentous factors in the welfare of
+our nation, now as never before are matters of vital importance. To win
+its victories both in peace and in war, the nation needs all its
+citizens with all their powers, and it is a matter of more than passing
+interest that, as conservative estimates show, at least three persons
+out of every hundred living in the United States are constantly
+incapacitated by serious sickness. In 1910 these seriously sick persons
+numbered more than 3,000,000. Even more significant, perhaps, is the
+fact that at least half of our national sickness could be prevented if
+knowledge and resources that we now possess were fully utilized.
+
+The problem of sickness is by no means peculiar to our own day and
+generation. It has been a medical, a religious, and a social problem in
+every age. From the time of Job its meaning has baffled philosophers;
+from his day to ours thoughtful men have devoted their lives to
+searching for causes and cures. Yet before the middle of the last
+century little progress was made, either in scientific treatment or in
+prevention of disease.
+
+The invention of the microscope first made possible a real
+understanding of sickness. Through the microscope a new world was
+revealed,--a world of the infinitely small, swarming with tiny forms of
+animal and vegetable life. No one, however, appreciated the significance
+of these hitherto invisible plants and animals until the latter part of
+the 19th century, when the great French savant, Pasteur, proved that
+little vegetable forms, now called bacteria, cause putrefaction and
+fermentation, and also certain diseases of animals and man. Pasteur's
+discoveries were carried still further by other scientists, with the
+result that bacteriology has revolutionized medicine, agriculture, and
+many industries, and has made possible the brilliant achievements of
+modern sanitary science. For the first time in history the prevention of
+epidemics has become possible, and sickness is no longer regarded as a
+punishment for sin.
+
+Actual care of the sick, both in homes and in hospitals, has always been
+one of the responsibilities of women. The first general public hospital
+was built in Rome in the 4th century after Christ by Fabiola, a
+patrician lady. There she nursed the sick with her own hands, and from
+her day to ours extends an unbroken line of devoted women, handing down
+through the centuries their tradition of compassionate nursing service.
+It remained for Florence Nightingale, however, to give to the training
+its technical and scientific foundation, and thus to found the
+profession of nursing. As a result of her work, effectiveness was added
+to the spirit of service, that spirit which inspires the modern nurse no
+less than in an earlier day it inspired the Sisters of Charity who died
+nursing the wounded on the battlefields of Poland.
+
+But different generations have different needs, and to meet them the
+spirit of service must manifest itself in widely varying ways. The sick
+need care today no less than they did when St. Elizabeth bathed the feet
+of the lepers; but such limited service, however beautiful, is no longer
+enough. Today we serve best by preventing sickness. Cure of sickness and
+alleviation of suffering must never be neglected; not in cure, however,
+but in prevention lies the hope of modern sanitary science, of modern
+medicine, and of modern nursing.
+
+Nearly every woman at some time in her life is called upon to assist in
+caring for the sick. Indeed, approximately 90% of all sick persons in
+the United States are cared for at home, even in cities where hospital
+facilities are good. Moreover, every woman is largely responsible for
+maintaining her own health, and few escape responsibility at some time
+for maintaining the health of others. For such responsibility most women
+are poorly prepared. Every year in our own country thousands of persons,
+many of them babies and children, die merely because someone, in many
+cases a woman, is fatally ignorant of the laws governing sickness and
+health.
+
+Only prolonged and careful training, such as good hospital
+training-schools afford, can furnish the skill and judgment required in
+nursing persons who are seriously ill. Upon the trained nurse the modern
+practice of medicine makes great and ever-increasing demands: a nurse
+must perform complicated duties, meet critical situations, and carry out
+a wide variety of measures based on scientific principles which she must
+understand. Good will and sympathy are no longer enough; amateur
+nursing, even when performed with the best intentions, may involve grave
+dangers for those who are seriously ill.
+
+On the other hand, although it is true that a little knowledge is a
+dangerous thing, it is no less true that total ignorance may be more
+dangerous still. For instance, in cases of incipient, slight, or chronic
+illness, and in certain emergencies a little knowledge may be safer far
+than no knowledge at all; and no one, surely, should be ignorant of the
+principles of hygiene.
+
+The American Red Cross, recognizing the part that women can and should
+play in preventing sickness and in building up the health and vigor of
+the nation, has added to its larger patriotic services this elementary
+course of instruction in hygiene and home care of the sick. The lessons
+are not intended to take the place of a nurse's training, and procedures
+requiring technical skill are necessarily omitted. The object of the
+book is to supply a little knowledge of sickness, which though limited
+may yet be safe. The book is also designed to set forth some general
+laws of health; to make possible earlier recognition of symptoms; to
+teach greater care in guarding against communicable disease; and to
+describe some elementary methods of caring for the sick, which, however
+simple, are essential to comfort, and sometimes indeed to ultimate
+recovery.
+
+
+FOR FURTHER READING
+
+A History of Nursing--Dock and Nutting, Volume I.
+
+The Life of Florence Nightingale--Cook.
+
+The Life of Pasteur--Vallery-Radot.
+
+The House on Henry Street--Wald.
+
+Public Health Nursing--Gardner, Part I, Chapters I-III.
+
+Origin and Growth of the Healing Art--Berdoe.
+
+Medical History from the Earliest Times--Withington.
+
+Under the Red Cross Flag--Boardman.
+
+Report on National Vitality--Fisher, (Bulletin 30 of the Committee of
+One Hundred on National Health. Government Printing Office, Washington).
+
+
+
+
+CHAPTER I
+
+CAUSES AND PREVENTION OF SICKNESS
+
+
+Diseases of two kinds have long been recognized: first, those
+transmitted directly or indirectly from person to person, like smallpox,
+measles, and typhoid fever; and second, diseases like heart disease and
+apoplexy, which are not so transmitted. These two classes are popularly
+called "catching" and "not catching;" the former are the infectious or
+communicable diseases, and the latter the non-infectious or
+non-communicable. The term contagious, formerly applied to diseases
+supposed to be spread only by direct contact, is no longer an accurate
+or useful term.
+
+
+THE COMMUNICABLE DISEASES
+
+The invention of the microscope, as we have seen, revealed the existence
+of innumerable little plants and animals, so small that even many
+millions crowded together are invisible to the naked eye. These tiny
+living creatures are called micro-organisms or germs. The plant forms
+are called bacteria (singular, bacterium), and the animal forms
+protozoa (singular, protozoön). The common belief that all or even most
+bacteria are harmful is quite unfounded. As a matter of fact, while not
+less than 1500 different kinds of micro-organisms or germs are known,
+only about 75 varieties are known to produce disease.
+
+Most bacteria belong to the class of micro-organisms called saprophytes,
+which find their food in dead organic matter, both animal and vegetable,
+and cannot flourish in living tissues. These saprophytes act upon the
+tissues of dead animals and vegetables, and resolve them into simpler
+substances, which are then ready to serve as nourishment for plants
+higher in the vegetable kingdom. Thus the processes which we know as
+fermentation and putrefaction are due to the action of saprophytes.
+Higher plants in turn furnish food for men and animals, and so the food
+supply is used over and over in different forms, making what is known as
+the _food cycle_. If it were not for bacterial activities vegetation
+would be robbed of its supply of nourishment, and plant life would
+speedily end; destruction of plant life would deprive the animal kingdom
+of food and thus all life would become extinct. The saprophytes are
+consequently essential to the existence of both animals and vegetables.
+
+There are, however, other organisms called _parasites_, which can exist
+in living tissues of animals or vegetables. The organisms at whose
+expense the parasites live are called their _hosts_. Parasites not only
+contribute nothing to their hosts, but generally harm them by producing
+poisonous substances or depriving them of food. Some parasites are able
+to lead a saprophytic existence also, but as a rule they live at the
+expense of animal or plant life. Pathogenic, or disease-producing, germs
+belong to the group of parasites. The pathogenic germs which find
+favorable soil in the body produce poisons called toxins. These poisons
+or toxins interfere with the bodily functions, and thus cause what we
+know as communicable disease. Communicable diseases are caused by
+specific germs only: that is, a certain disease cannot develop unless
+its particular germs are present; the germs of typhoid for instance, can
+cause typhoid fever only, and not tuberculosis or other disease.
+
+A number of diseases are caused by micro-organisms that are now well
+known. Chief among these diseases are colds, septicæmia (blood
+poisoning), influenza, pneumonia, diphtheria, typhoid fever,
+tuberculosis, whooping cough, Asiatic cholera, bubonic plague,
+meningitis, tetanus ("lock jaw"), leprosy, gonorrhoea, syphilis,
+relapsing fever, typhus fever, glanders, and anthrax. Micro-organisms
+not yet identified probably cause the communicable diseases whose origin
+is not known with certainty. These include infantile paralysis,
+smallpox, scarlet fever, measles, mumps, chicken-pox, Rocky Mountain
+spotted fever, yellow fever, hydrophobia (rabies), foot-and-mouth
+disease. We can hardly doubt that the intensive laboratory research now
+in progress will reveal in the near future the specific germs of these
+diseases also.
+
+
+STRUCTURE AND DEVELOPMENT OF PARASITES
+
+The group of parasites consists of two general classes, the vegetable,
+and the animal. In the former class belong the bacteria, and in the
+latter the protozoa. The two classes are not sharply differentiated, but
+in general the vegetable parasites are less highly organized than the
+animal.
+
+
+BACTERIA
+
+SHAPE.--Bacteria are composed of single cells and are consequently
+called unicellular organisms. Under the microscope individual cells are
+seen to differ in size, shape, and structure. In shape bacteria show
+three different types; the rod-shaped (bacillus), the spherical
+(coccus), and the spiral (spirillum). The organisms causing typhoid
+fever for example are a variety of bacilli, those causing pneumonia are
+cocci, while those causing Asiatic cholera are spirilla.
+
+[Illustration: FIG. 1.--BACILLI OF VARIOUS FORMS. (_Williams._)]
+
+SIZE.--Bacteria vary greatly in size. Average rod-shaped bacteria are
+about 1/25000 of an inch long, but there are undoubtedly organisms so
+small that they cannot be seen, even by means of the strongest
+microscopes we now possess.
+
+[Illustration: STAPHYLOCOCCI. STREPTOCOCCI. DIPLOCOCCI. TETRADS.
+SARCINÆ. FIG. 2.--(_Williams._)]
+
+MOTION.--The power of motion in certain species of bacteria is due to
+hair-like appendages called flagella. These flagella by a lashing
+movement somewhat resembling the action of oars enable the organisms to
+move through fluids.
+
+MULTIPLICATION.--After bacteria have fully developed, each cell divides
+into two equal parts; the process of division is called fission. Each
+of these two parts rapidly grows into a full-sized organism. Then
+fission again takes place, so that four bacteria replace the original
+one. In each of the four, fission occurs again, and so the process of
+multiplication continues. As bacteria develop they group themselves in
+characteristic ways. Some, like the streptococci, arrange themselves in
+chains; the diplococci, in pairs; the tetrads, in groups of four; others
+in packets called sarcinæ, and still others, the staphylococci, form
+masses supposed to resemble bunches of grapes.
+
+[Illustration: FIG. 3.--SPIRILLA OF VARIOUS FORMS. (_Williams._)]
+
+[Illustration: FIG. 4.--BACTERIA SHOWING FLAGELLA. (_Williams._)]
+
+Under favorable conditions fission occurs rapidly; in some types a new
+generation may appear as often as every 15 minutes. Enormous
+multiplication would result if nothing occurred to check the process.
+But in nature such increase never continues unhindered, and bacteria,
+acting upon their food substances, produce acids and other materials
+injurious to themselves. Furthermore, lack of proper food, moisture, or
+favorable temperature, and competition with other organisms tend to
+prevent their unrestricted growth and multiplication.
+
+[Illustration: FIG. 5.--BACTERIA WITH SPORES. (_Williams._)]
+
+SPORES.--Most bacteria die if conditions become unfavorable to their
+growth, but some enter into a resting stage. This stage is characterized
+by the development of round or oval glistening bodies called spores,
+which are of dense structure and possess an extraordinary power to
+withstand heat, chemicals, and unfavorable surroundings. Except in rare
+instances a single cell produces but one spore. As soon as favorable
+conditions of temperature, moisture, and food supply are restored, the
+spore develops into the active form of the germ; it may, however, remain
+dormant for months or years. Spore formation, however, occurs in only a
+very few varieties of pathogenic bacteria.
+
+DISTRIBUTION.--Bacteria are very widely distributed in nature; they are
+in fact found practically everywhere on the surface of the earth. They
+are present in plants and water and food; on fabrics and furniture,
+walls and floors; and they are found in great numbers on the skin, hair,
+many mucous surfaces, and other tissues of the body.
+
+
+PROTOZOA
+
+The protozoa are the lowest group of the animal kingdom. Like bacteria
+they are composed of single cells so small as to be visible only under
+the microscope. They play an important part in causing certain diseases
+of man, especially in the tropics. Among the well-known human diseases
+of protozoan origin are malaria, amoebic dysentery, and
+sleeping-sickness. Protozoa also cause several wide-spread and serious
+plagues of domestic animals.
+
+
+VISIBLE PARASITES
+
+A few diseases are caused by parasites large enough to be seen with the
+naked eye. One of the most important is hookworm disease. This disease
+is caused by a tiny worm which penetrates the victim's skin and
+ultimately finds its way into the intestine. Other diseases also are
+caused by parasitic worms, such as tapeworms, pinworms, and trichinæ.
+The latter are acquired as a result of eating infected meat,
+particularly infected pork that has not been thoroughly cooked.
+
+
+TRANSMISSION OF PATHOGENIC ORGANISMS
+
+Pathogenic or disease producing organisms need for their development
+food, moisture, darkness, and warmth, conditions that exist within the
+human body. When one or more of these factors is unfavorable,
+development of germs is checked; if unfavorable conditions are extreme
+or long continued, the organisms begin to die. It is difficult to say at
+exactly what moment they will die if deprived of moisture or exposed to
+extremes of temperature or other unfavorable conditions, just as it
+would be impossible to state at exactly what moment a collection of
+house plants would all be dead if water were withheld, or if the room
+temperature were greatly reduced.
+
+Most pathogenic organisms, however, do not flourish long outside the
+body, and owe their continued existence to a fairly direct transfer
+from person to person. They gain access to the body through mucous
+surfaces such as the respiratory and digestive tracts, and through
+breaks in the skin, such as cuts, abrasions, and the bites of certain
+insects. They leave the body chiefly in the nasal and mouth discharges,
+as in coughing, sneezing, and spitting, in the urine and bowel
+discharges, and in pus or "matter."
+
+[Illustration: FIG. 6. (_L. H. Wilder._)]
+
+The problem of controlling communicable diseases, consequently, lies in
+preventing the bodily discharges of one person from travelling directly
+into the body of another. If a person is not expelling pathogenic germs,
+it is clear that he cannot pass diseases on to others. But both
+pathogenic and harmless germs follow the same routes from person to
+person, so that safety as well as decency lies in preventing so far as
+possible all exchanges of bodily discharges.
+
+There are five routes by which the bodily discharges most frequently
+travel from one person to another. Four of these routes of infection are
+called public, because in most cases efforts of individuals alone are
+not sufficient to control them. The public routes are water, milk, food,
+and insects. The fifth, or private route, includes all means by which
+fresh discharges of one person are passed to another, as when nose and
+mouth discharges are carried in coughing, sneezing, and kissing, or when
+bowel and bladder discharges are carried by the hands. These five routes
+in a given case differ greatly in relative importance, but the fifth, or
+direct route plays an immense part, although its importance in causing
+sickness has only lately been recognized. It cannot be too strongly
+emphasized that the chief agent in the spread of human diseases is man
+himself, and the human hand is the great carrier of disease germs both
+to and from the body. If unclean hands could be kept away from the
+orifices of the body, particularly the mouth, many diseases would soon
+cease to exist.
+
+
+Defenses of the Body
+
+In view of all the dangers from disease-producing germs it may seem
+surprising that the human race has not long ago succumbed to its
+invisible enemies. But the body has various defenses by means of which
+it may prevent invasion, or successfully combat its enemies in case they
+do gain access.
+
+The unbroken skin is usually impassable to bacteria. Virulent organisms
+are often found upon the skin of perfectly healthy persons, where they
+appear to be harmless unless an abrasion occurs which affords entrance
+into the deeper tissues. Most bacteria breathed in with the air cling to
+the moist surfaces of the air-passages and never reach the lungs.
+
+Mucous membranes lining the mouth and other cavities of the body would
+prove favorable sites for the growth of bacteria if the mucus secreted
+by them were not frequently removed. The mouth of a healthy person may
+contain bacteria of many kinds, but the saliva has a slight disinfectant
+power and serves as a constant wash to the membranes. The normal gastric
+(stomach) juice is decidedly unfavorable to the growth of bacteria,
+although it does not always kill them; they often pass through the
+stomach and are found in large numbers in the intestines. Other bodily
+secretions, such as the tears and perspiration, tend to discourage
+bacterial growth.
+
+Tissues of the body vary greatly in their power to resist invading
+germs, so that the route by which germs enter influences the severity of
+their effects. Typhoid bacilli and the spirilla of Asiatic cholera when
+taken with food or water produce far more serious disturbances than when
+injected under the skin; infections from pus germs through an abrasion
+of the skin may result in a slight local disturbance, while the same
+amount introduced into a deeper wound might cause a fatal infection.
+Certain germs nourish in certain tissues only; even tuberculosis, which
+attacks practically all tissues, has its favorite locations.
+
+IMMUNITY.--In addition to its mechanical defenses against disease, the
+body shows a varying degree of _immunity_, or the power possessed by
+living organisms to resist infections. Immunity or resistance is the
+opposite of susceptibility. It is exceedingly variable, being greater or
+less in different people and under different conditions, but the exact
+ways in which it is brought about are still in many cases far from
+clear.
+
+Immunity may be _natural_ or _acquired_. By natural immunity is meant
+an inherited characteristic by which all individuals of a species are
+immune to a certain disease. The natural immunity of certain species of
+animals to the diseases of other animals is well known. Man is immune to
+many diseases of lower animals, and they in turn are immune to many
+diseases of man. Cattle, for instance, are immune to typhoid and yellow
+fever, while man shows high resistance to rinderpest and Texas fever;
+both, however, are susceptible to tuberculosis, to which goats are
+immune. There are all gradations of immunity within the same species.
+Moreover, certain individuals have a personal immunity against diseases
+to which others of the same race or species are susceptible.
+
+Immunity may be _acquired_ in several ways. It is commonly known that
+one attack of certain communicable diseases renders the individual
+immune for a varying length of time, and sometimes for life. Among these
+diseases are smallpox, measles, whooping-cough, scarlet fever, infantile
+paralysis, typhoid fever, chicken-pox, and mumps; erysipelas and
+pneumonia on the other hand appear to diminish resistance and to leave a
+person more susceptible to later attacks.
+
+Again, in some cases immunity may be artificially acquired by
+introducing certain substances into the body to increase its
+resistance. Examples of this method include the use of antitoxin as a
+protection against diphtheria, of sera in pneumonia and other
+infections, and vaccination against smallpox and typhoid fever whereby a
+slight form of the disease is artificially induced. Laboratory research
+goes on constantly, and doubtless many more substances will eventually
+be discovered that will reduce human misery as vaccines and antitoxin
+have already reduced it.
+
+Vaccination and inoculation have saved thousands of lives. Smallpox,
+once more prevalent than measles, was the scourge of Europe until
+vaccination was introduced. During the 18th century it was estimated
+that 60,000,000 people died of it, and at the beginning of the 19th
+century one-fifth of all children born died of smallpox before they were
+10 years old. In countries where vaccination is not practised the
+disease is as serious as ever; in Russia during the five years from
+1893-97, 275,502 persons died of smallpox, while in Germany where
+vaccination is compulsory, only 8 people died of it during the year
+1897. Death rates from diphtheria and typhoid fever have been greatly
+reduced by the use of antitoxin and antityphoid vaccine. Thus in New
+York State in 1894, before antitoxin was generally used, 99 out of every
+100,000 of the population died of diphtheria, while only 20 out of
+100,000 died of it in 1914. In 1911 a United States Army Division of
+more than 12,000 men camped at San Antonio, Texas, for four months. All
+of these men were vaccinated against typhoid fever and only a single
+case occurred during the summer, although conditions of camp life always
+tend to spread the disease.
+
+While many and various factors tend to lower resistance rather than to
+increase it, the idea that these factors act equally in all kinds of
+infection is erroneous.
+
+      "The principal causes which diminish resistance to
+      infection are: wet and cold, fatigue, insufficient or
+      unsuitable food, vitiated atmosphere, insufficient sleep
+      and rest, worry, and excesses of all kinds. The mechanism
+      by which these varying conditions lower our immunity must
+      receive our attention, for they are of the greatest
+      importance in preventive medicine. It is a matter of common
+      observation that exposure to wet and cold or sudden changes
+      of temperature, overwork, worry, stale air, poor food,
+      etc., make us more liable to contract certain diseases. The
+      tuberculosis propaganda that has been spread broadcast with
+      such energy and good effect has taught the value of fresh
+      air and sunshine, good food, and rest in increasing our
+      resistance to this infection.
+
+      "There is, however, a wrong impression abroad that because
+      a lowering of the general vitality favors certain diseases,
+      such as tuberculosis, common colds, pneumonia, septic and
+      other infections, it plays a similar rôle in all
+      communicable diseases. Many infections, such as smallpox,
+      measles, yellow fever, tetanus, whooping-cough, typhoid
+      fever, cholera, plague, scarlet fever, and other diseases,
+      have no particular relation whatever to bodily vigor. These
+      diseases often strike down the young and vigorous in the
+      prime of life. The most robust will succumb quickly to
+      tuberculosis if he receives a sufficient dose of the
+      virulent micro-organisms. A good physical condition does
+      not always temper the virulence of the disease; on the
+      contrary, many infections run a particularly severe course
+      in strong and healthy subjects, and, contrariwise, may be
+      mild and benign in the feeble. Physical weakness,
+      therefore, is not necessarily synonymous with increased
+      susceptibility to all infections, although true for some of
+      them. In other words, 'general debility' lowers resistance
+      in a specific, rather than in a general, sense."--(Rosenau:
+      Preventive Medicine and Hygiene, pp. 403 and 404.)
+
+
+CARRIERS
+
+Well persons who carry in their bodies pathogenic germs but who
+themselves have no symptoms of disease are called carriers. Thus typhoid
+carriers have typhoid bacilli in the intestinal tract, while they
+themselves show no symptoms of typhoid fever; diphtheria carriers have
+bacilli of diphtheria in the throat or nose, but have themselves no
+symptoms of diphtheria, and so on. It has now been proved that many
+patients harbor bacteria for weeks, months, or even years following an
+infection, and are dangerous distributors of disease; also, some
+healthy individuals without a history of illness harbor living bacteria
+which may infect susceptible persons in the usual ways. Transmission by
+healthy carriers goes far to explain the occurrence of diseases among
+persons who have apparently not been exposed. This explanation has
+greatly clarified the whole problem of the spread of communicable
+diseases. Carriers, unfortunately, exist in large numbers, and render
+the ultimate control of disease exceedingly difficult. They can usually
+be identified by bacteriological tests. To some extent they can be
+supervised; food handlers at least should be legally obliged to submit
+to physical examinations, and should be licensed only when proved free
+from communicable disease.
+
+Diseases are also spread by persons suffering from them in a form so
+mild or so unusual that they pass unrecognized. These persons are known
+as "missed" cases. Carriers of disease and "missed" cases go freely
+about the community, handling food, using common drinking cups,
+travelling in crowded street cars, standing in crowded shops; in various
+ways coming into close contact with other people, coughing and sneezing
+and kissing their friends no less often than normal individuals. It is
+consequently clear that the bodily discharges of supposedly normal
+persons may be hardly less a menace than those of persons known to be
+infected.
+
+Diseases that depend for transmission upon milk, water, food, and
+insects may be controlled by public action, that is, by specific
+measures taken by a large group of people in order to protect the
+individual. Such action constitutes _public sanitation_. There is,
+however, a large group of diseases, chiefly sputum-borne, that cannot be
+controlled except by individual action. Such individual action
+constitutes a large part of _personal hygiene_.
+
+The whole problem of controlling infections sounds simple, depending as
+it does for the most part upon unpolluted water, milk, and food,
+extermination of certain insects, and cleanliness in personal behaviour.
+In practice the problem is not so easy. Public sanitation has performed
+miracles in the past, and will do much in the future; behaviour,
+however, will continue to be influenced by many factors, social and
+economic as well as personal. Ignorance of the laws of health is an
+obstacle to progress, but in modern conditions even the instructed may
+be unable to control their ways of living and working. Indeed, such
+control is at present limited to the privileged few. On the ignorant and
+the poor, those least able to bear it, society loads the heaviest burden
+of sickness. Only when ignorance and poverty are abolished, as one day
+they will be, can the final stage be reached in the fight for public
+health.
+
+
+THE NON-COMMUNICABLE DISEASES
+
+In this group is included a great variety of maladies. Of some the
+causes are known, while in the case of others, origin, prevention, and
+remedy are still obscure. Here belong defects in structure of the body,
+both hereditary and acquired; insanity and other nervous diseases; new
+growths, like tumors and cancer; disturbances of bodily processes, as
+malnutrition and gout; and the important class of degenerative diseases,
+like arteriosclerosis, in which tissues become hardened and fibrous and
+hence less able to perform their normal functions.
+
+The degenerative diseases are playing a menacing part in national
+health. The average length of life in the United States has shown a
+marked increase it is true, during the last 40 years. But this gain
+represents chiefly the saving of life through prevention of communicable
+diseases, especially among babies and children; among people who have
+passed the 30th year on the other hand, death rates are actually
+increasing. This increase is most marked after the age of 45, and is
+caused chiefly by the increase of cancer, and of degenerative diseases
+of the heart, blood vessels, and kidneys. Degeneration of tissues is
+normally a condition typical of old age, and in aged persons it may
+occur in any tissue. There is no elixir of youth, and for old age there
+is no cure. But the important facts in this connection are that
+degenerative changes now occur prematurely, and that among a vast number
+of people, in various classes of society and various occupations, the
+vital organs show a marked tendency to break down after the age of 45.
+
+This condition is not inevitable. Before the beginning of the present
+war, death rates at all ages were decreasing in England, Sweden, and
+other European countries. In America also degenerative diseases can be
+checked or prevented to a large extent, and it is highly important that
+their causes should be generally understood.
+
+The two groups following include some of the probable causes:
+
+1. Conditions of life which result in continued overwork, and mental
+overwork in particular; worry, excitement, insufficient recreation and
+exercise, and other kinds of nervous strain typical of modern life,
+especially in cities.
+
+2. Irritating substances in the body, including poisonous substances
+resulting from infectious diseases, and from syphilis in particular;
+poisons from chronic infections, alcohol, and industrial poisons such
+as lead and other metals; overeating and improper eating, especially of
+meat and other proteins, and rich or highly seasoned food; faulty
+digestion, constipation, and imperfect elimination through the
+kidneys.--(See Dr. A. E. Shipley, in bulletin of the N. Y. City Dept. of
+Health, Feb., 1915.)
+
+The importance of early recognition cannot be overemphasized. In many of
+these troubles the symptoms are not pronounced, and the victims have no
+knowledge of their condition until they happen to be examined for life
+insurance, or until the disease is far advanced. And even when they
+realize that trouble exists, as for example constipation or overwork,
+most people absolutely fail to realize how serious the consequences may
+be. The first step toward remedy is periodic complete physical
+examination by a competent physician, in order to learn in time how to
+prevent these degenerative diseases, if present, from growing worse. The
+custom of undergoing an annual physical examination is becoming more
+common, and "such a course, conservatively estimated, would add 5 years
+to the average life of persons between 45 and 50."--(Winslow.)
+
+      "Recently, we have been making examinations of the
+      employees of whole institutions, large banks and other
+      industrial concerns in New York City, and we find almost
+      the same conditions there. Out of 2000 such examinations
+      among young men and women of an average age of 33, just in
+      the early prime of life, men and women supposedly picked
+      because of their especial fitness for work, only 3.14% were
+      found free of impairment or of habits of living which are
+      obviously leading to impairment. Of the remaining persons,
+      96.69% were unaware of impairment; 5.38% of the total
+      number examined were affected with chronic heart trouble;
+      13.10% with arteriosclerosis; 25.81% with high or low blood
+      pressure; 35.65% with sugar, casts or albumen in the urine;
+      12.77% with combination of both heart and kidney disease;
+      22.22% with decayed teeth or infected gums; 16.03% with
+      faulty vision uncorrected.... The fact of greatest import,
+      however, was that impairment, sufficiently serious to
+      justify the examiner in referring the examinee to his
+      family physician for medical treatment, was found in 59% of
+      the total number of cases, while 37.86% were on the road to
+      impairment because of the use of "too much alcohol," or
+      "too much tobacco," constipation, eye-strain, overweight,
+      diseased mouths, errors of diet, and so forth....
+
+      "And what is the cause of this appalling increase, in the
+      United States, of these and other degenerative diseases? I
+      believe it can be shown to the satisfaction of any
+      reasonable person that the increase is largely due to the
+      neglect of individual hygiene in United States....
+
+      "If a man were suddenly afflicted with smallpox or typhoid
+      fever or any other acute malady, he would lose no time in
+      getting expert advice and applying every known means to
+      save his life. But his life may be threatened just as
+      seriously, though possibly not so imminently, by
+      arteriosclerosis, heart disease, or Bright's disease, and
+      he will do nothing to prevent the encroachment of these
+      diseases until it is too late, but will continue to eat as
+      he pleases, drink as he pleases, smoke as he pleases, or
+      overwork, and worry himself into a premature
+      grave."--("Conservation of Life at Middle Age," Prof.
+      Irving Fisher, Am. Journal of Public Health, July, 1915.)
+
+Periodic physical examinations are as necessary for children as for
+adults, in order to detect physical defects. These defects are known to
+have such an immense bearing upon health that routine examinations of
+all children have become an integral part of the work of enlightened
+public schools.
+
+Prevention of degenerative disease, then, as well as of the enormous
+numbers of preventable accidents and injuries, depends in large measure
+upon proper living conditions and proper personal habits. The infectious
+diseases, according to Dr. Hill, cost us annually at least 10 billion
+dollars in addition to the loss of life, and he adds: "The infectious
+diseases in general radiate from and are kept going by women."--(Hill--
+New Public Health, p. 30.) Women, it is true, can prevent many of the
+infections, but they can do still more, for hygienic habits to be
+effective must be acquired early, and mothers and teachers, because they
+have practically the entire control of children, have the power to
+prevent many cases of degenerative as well as of communicable disease.
+
+
+EXERCISES
+
+1. Distinguish between communicable and non-communicable disease.
+
+2. Describe the part played by micro-organisms in causing disease.
+
+3. Describe the structure of bacteria and their method of
+multiplication.
+
+4. In what ways are pathogenic germs transmitted from person to person?
+
+5. Upon what preventive measures does the control of communicable
+diseases depend?
+
+6. What is meant by immunity?
+
+7. Against what diseases may immunity be acquired artificially? How has
+the practice of immunizing affected death rates from communicable
+diseases?
+
+8. What factors tend to lower resistance? Do they act equally in the
+case of all diseases?
+
+9. Define a carrier, and explain the importance of carriers in the
+spread of disease.
+
+10. Name some of the characteristics and causes of degenerative
+diseases.
+
+11. Whom do the degenerative diseases most commonly affect?
+
+12. Describe methods that should be employed to prevent degenerative
+diseases.
+
+
+FOR FURTHER READING
+
+The New Public Health--Hill, Chapters I-IX.
+
+Health and Disease--Roger I. Lee, Chapters XV-XXIV.
+
+Principles of Sanitary Science and the Public Health--Sedgwick, Chapters
+I, II, III.
+
+Scientific Features of Modern Medicine--Frederic S. Lee, Chapters II,
+IV-VI.
+
+Disease and Its Causes--Councilman, Chapter I.
+
+Preventive Medicine and Hygiene--Rosenau.
+
+Publications of the Life Extension Institute--25 West 45th Street, New
+York City.
+
+
+
+
+CHAPTER II
+
+HEALTH AND THE HOME
+
+
+Of all the considerations that determine health, heredity is the one
+unalterable factor. Although certain characteristics are obviously
+hereditary,--complexion, height, and mental and physical traits in great
+variety,--yet in the past heredity has been little understood. In
+consequence it has served too often as a scape goat for faults and
+failings not beyond an individual's control. Our first clear
+understanding of the principles underlying heredity resulted from
+experiments made by Mendel, an Austrian monk, during the last century,
+and it is now possible to predict with a high degree of accuracy the
+inheritance of certain characteristics.
+
+Many diseases, formerly considered hereditary because their actual
+causes were unknown, are now known to be communicable. Thus, it is now
+understood that tuberculosis is not hereditary, although little children
+may be infected by tuberculous parents. No germ diseases are inherited
+in the strict sense of the word; but a baby may be infected with
+syphilis before birth if his father or his mother has the disease.
+
+It is true, however, that certain tissue weaknesses of the body seem to
+be hereditary, and in consequence one family is more susceptible to
+digestive disorders, another to diseases of the lungs, a third to
+deafness, and so on. Moreover, general low vitality may be inherited. It
+should be emphasized, however, that hereditary weakness does not
+inevitably lead to disease. Many persons have succeeded in preventing
+the development of active disease by guarding against strain in
+directions where they are weak by inheritance.
+
+Of all tissue weaknesses that may be inherited, defects of the nervous
+system are the most serious. Nervous disorders of every degree of
+severity, from slight nervous instability even to insanity, may result
+when these tissues are defective; but it is now a recognized fact that
+nervous disorders in many cases can be prevented from developing.
+Feeblemindedness, another condition due to defective tissue, is known to
+be inherited in the majority of cases, and in all cases it is incurable.
+
+
+HYGIENE OF ENVIRONMENT AND PERSON
+
+By environment is meant everything outside the body that affects it;
+taken in its complete meaning the word might include everything that is
+or ever was in the whole universe. It is possible to consider here a few
+only of the many environmental and personal factors affecting the health
+of individuals.
+
+The home constitutes the important part of environment for most persons,
+and for children in particular, since they spend the greater part of
+their time in or about it, and get there the foundation on which their
+health in later years depends. For persons employed away from home,
+industrial and occupational hygiene is hardly less important; but those
+subjects are too extensive to be considered here.
+
+Most people live where they must, and few have any part in planning the
+construction of their own houses. In choosing a house, however, one
+should remember that rooms where sunshine never enters are unfit for
+continued occupation. For children in particular fresh air and sunshine
+are essential, and it may be economy in the end to pay a comparatively
+high rent for an apartment having sunshine during at least a part of the
+day. Ignorance and carelessness, unfortunately, can spoil the best
+living conditions, and sometimes even in the country fresh air and
+sunshine are excluded from sleeping and living rooms.
+
+VENTILATION.--Ventilation has a direct bearing on health, although,
+contrary to former belief, the actual amount of oxygen in the air is not
+ordinarily the most important factor; even badly ventilated rooms
+contain more than enough oxygen to support life. The factors of prime
+importance in ventilation are temperature, humidity, air movement, and
+the number of persons in a given space since the greater the distance
+from one another the less is the probability that diseases will be
+spread.
+
+Room temperature should not be above 70° F. and, except for the aged or
+sick, it is better to be between 60° and 65°. Some moisture in the air
+is desirable; the amount needed is from 50% to 55% of the total moisture
+that the air can hold at a given temperature. We have no apparatus to
+decrease humidity in the air of houses, and in summer we are obliged to
+endure humidity, if excessive, no matter how uncomfortable we may be.
+But in winter the air in most houses is too dry, so that the mucous
+membranes of the nose and throat often become irritated and susceptible
+to infection. Most heating systems, particularly in small buildings,
+make no provision for supplying moisture. Keeping water in open dishes
+on or near radiators is often recommended, and would greatly improve the
+condition of the air, if people remembered to keep the dishes filled.
+
+The following is a simple but effective device to increase humidity:
+Roll an ordinary desk blotter into a cone about 8 inches in diameter at
+the base, and keep it constantly submerged for about one inch in a dish
+of water. The water rises to the top of the blotter and a large surface
+for evaporation is thus afforded.
+
+[Illustration: FIG. 7.]
+
+Stagnant air is harmful. Air should be in constant though not
+necessarily perceptible motion. Air about the body, if motionless, acts
+like a warm moist blanket, preventing the passage of heat from the body.
+
+The three factors, heating, humidity, and air motion, must be considered
+together. Every person requires each hour about 3000 cubic feet of air,
+and the problem of heating and ventilating is that of providing this
+amount in gentle motion, at a temperature of about 65° F., and of
+humidity from 50-55%. Higher temperatures and stagnant air cause
+disinclination to work, headache, nausea, restlessness, or sleepiness,
+and if continued are likely to result in loss of appetite, and anemia.
+The tuberculosis movement has clearly shown the benefits both for the
+sick and the well of living in the open air, and has caused great and
+beneficial changes within a generation. The more time spent in the open
+air the better; since however most persons who work must spend the
+greater part of the day indoors, ventilation is a matter of great
+importance.
+
+Although fresh air enthusiasts are still too few, yet some go to the
+extreme and think that because cool air in motion is good, the colder
+the air and more violent the motion the better. On the contrary,
+chilling the whole body or a part of the body lowers resistance.
+Draughts of air have no bad effects upon persons in good health,
+particularly those accustomed to changes in temperature. But draughts
+are likely to be injurious to aged or sick persons and babies, by
+diminishing their resistance to such infections as common colds and
+pneumonia. It should be remembered that draughts or cold alone cannot
+cause colds; the specific germs must be present.
+
+LIGHTING.--Amount and direction of light are physiologically important.
+Defects of the eyes, too prolonged use, and insufficient light are the
+commonest causes of eye strain. Most eye defects can be relieved by
+glasses. Children's eyes should be examined upon entering school, and as
+often afterward as the oculist advises. Prolonged use causes fatigue of
+the eyes, especially when the illumination is poor; within limits, the
+amount of light needed depends on the nature of the work. Light should
+come from the left side of right handed people; never from the front.
+Light reflected from snow, sand, glazed white paper of books, or other
+bright surfaces is fatiguing from its intensity, and from the unusual
+angle at which it enters the eyes. Too much light is harmful, and
+probably causes some of the effects, such as nausea and headache,
+commonly attributed to poor ventilation.
+
+Almost all blindness is preventable, and blindness due to industrial
+accidents and processes is no exception to this rule. Surely no
+individual precautions or legal measures are too great in order to guard
+against this saddest of all physical defects.
+
+CLEANLINESS OF HOUSES.--A clean, well-cared for house is desirable from
+every point of view, but certain kinds of cleanliness affect health more
+than others.
+
+The most scrupulous care should be exercised wherever food is stored or
+prepared. The kitchen is in reality a laboratory; in it either
+intelligently or ignorantly are formed chemical compounds which have a
+far-reaching effect upon family health. From the standpoint of health no
+other room in the house is so important. It should be bright, airy, and
+easy to clean. In cleaning kitchen tables and woodwork water should not
+be allowed to soak into cracks and dark corners, carrying with it
+particles of food for the nourishment of bacteria and insects. Linoleum,
+if used to cover the floor, should be well fitted at the edges to
+prevent water from running underneath. There should be neither cracks
+nor crevices in wall or floor, and no dark corners or out-of-the-way
+cupboards in which dust, food particles, and moisture can accumulate.
+Such conditions not only attract mice and roaches, but furnish favorable
+soil for the development of moulds and fungi which by their growth
+affect food deleteriously. Waging a constant warfare against the
+development of bacteria constitutes a large part of good housekeeping.
+
+All cooking utensils should be thoroughly washed, scalded, and dried
+before they are put away; the use of carelessly washed dishes is bad.
+Enameled or agate ware which has begun to chip should be discarded.
+Dish-cloths and towels should be washed and boiled after using, and if
+possible dried in the sun.
+
+Every place in which food is kept should have constant care. The
+refrigerator is particularly important. Its linings should be
+water-tight, and the drain freely open at all times; otherwise the
+surrounding wood will become foul and saturated with drainings. At least
+once a week it should be entirely emptied and cleaned in the following
+way: The racks should be thoroughly washed in hot soapsuds to which a
+small amount of washing soda has been added, rinsed in boiling water,
+dried and placed in the sun and air. All parts of the refrigerator
+should be washed in the same manner, especially grooves and projections
+where food or dirt may lodge. The drainpipe should be flushed, the whole
+interior rinsed again with plain hot water, thoroughly dried with a
+clean cloth, and left to air for at least an hour. The drainage pan
+should be washed and scalded frequently. Food showing the slightest
+evidence of spoiling should be removed from the refrigerator at once.
+
+Even more attention should be paid to the hands of the cook. They should
+be washed always before handling food, and always after visiting the
+toilet, using the handkerchief, or otherwise coming in contact with
+nose, mouth, or other bodily secretions. Theoretically coughing and
+sneezing ought not to occur in the neighborhood of food, especially of
+food to be eaten raw; and persons with coughs, colds, or other
+communicable disease, however slight, ought not to handle food. If this
+rule were observed in practice, more persons would go hungry, but fewer
+would be sick.
+
+Thorough cleaning of rooms involves soap, water, sunshine, air, and
+elbow grease, just as it did before germs were discovered. Cleaning
+means actually removing dirt and dust, not merely stirring it up to
+settle again; consequently dry sweeping and dusting are ineffectual.
+Vacuum cleaning, and sweeping and dusting with damp or "dustless" mops
+and dusters are good. Deodorants and disinfectants do not take the place
+of ordinary cleanliness.
+
+Dust does not carry living disease germs to an appreciable extent; the
+fact is now well established that diseases formerly thought to be
+transmitted by dust or even supposed to travel directly through the air,
+are carried on tiny particles of moisture and mucus expelled in coughing
+and sneezing. This mode of transmission is called droplet or spray
+infection; it is one of the most active agents in spreading certain
+kinds of communicable diseases.
+
+Nevertheless dust in motion is harmful; it irritates the lining
+membranes of the nose, throat, bronchial tubes, and lungs, even causing
+tiny wounds through which disease germs enter. Thus tuberculosis is
+especially prevalent among stone cutters, felt workers, and others
+engaged in dusty trades. Metallic dust is especially harmful, because it
+is harder and sharper than dust from organic substances like wool and
+cotton. Furthermore, presence of dust indicates a low standard of
+cleanliness. People who tolerate it generally tolerate uncleanliness in
+other forms, more serious though less apparent.
+
+Cleaning would not be so great a problem if most houses were not
+littered with such dust catchers as carpets, so-called ornaments, carved
+and upholstered furniture, banners, draperies, and a vast collection of
+articles that can only be classified as Christmas presents. In actual
+practice things that are difficult or expensive to clean seldom are
+cleaned; carpets for example are considered unhygienic, not because they
+cannot be cleaned, but because they are not. William Morris' advice to
+exclude from houses all articles not known to be useful or believed to
+be beautiful would, if followed, add years to the lives of housekeepers.
+
+GARBAGE, has little bearing on health, except in so far as it affords a
+breeding place for flies. If it contains disease germs it may be
+dangerous, but statistics show that garbage handlers, although they can
+hardly be called especially careful, are not more subject to sickness
+than other men of their class. Garbage disposal is chiefly a question of
+preventing a public nuisance; it is a matter of cleanliness and public
+decency.
+
+INSECTS.--Flies, cockroaches, and other scavenging insects may carry
+disease germs on their feet and thus infect food on which they walk.
+Typhoid, cholera, dysentery, and other diseases have been carried by
+flies. Flies are always a menace, and should not be tolerated; moreover,
+the thought of their coming to food directly from manure piles and privy
+vaults is disgusting. Houses should be thoroughly screened in the fly
+season, but it is better to destroy the nuisance at its source. The
+chief breeding places of flies are garbage cans and manure piles. If
+the garbage can is water tight, closely covered, frequently emptied, and
+thoroughly cleaned, flies will not develop in it; about ten days must
+elapse from the time when the egg is laid until the insect is ready to
+fly. Fly traps to fit on the garbage can are useful. Manure should be
+screened and removed frequently, or it can be treated chemically.
+Methods for treating it are given in "Preventive Medicine and
+Hygiene."--Rosenau, p. 255, and in Bulletin No. 118, of the U. S. Dept.
+of Agriculture, July 14, 1914.
+
+[Illustration: FIG. 8.--A FLY WITH GERMS (GREATLY MAGNIFIED) ON ITS
+LEGS. (_U. S. Dept. Agri._)]
+
+Other diseases carried by insects are malaria and yellow fever, each by
+a special species of mosquito; typhus fever, by lice; and bubonic
+plague, by rat fleas. Various diseases less common in this country are
+carried by other insects. Even when mosquitoes are not carrying disease
+germs their bites may be harmful since they are often rubbed, especially
+by children, until the skin is broken, and various infections may enter
+through the wounds. Insects of every kind, rats, mice, and vermin should
+be excluded from houses.
+
+SEWAGE.--Discharges from the bowels and bladder contain various germs,
+and constitute one of the most important routes by which germs of
+typhoid fever, cholera and certain other diseases travel from person to
+person. Keeping sewage out of the water supply is consequently of great
+importance. Where a system of sewage disposal exists, the responsibility
+of making the system adequate and thus safeguarding public health rests
+upon the community as a whole. Communities ordinarily get just as much,
+or just as little typhoid fever as they are willing to endure.
+
+[Illustration: FIG. 9.--HOW A WELL MAY BE POLLUTED. (_From "The Human
+Mechanism."_ Copyright by Theodore Hough and William T. Sedgwick. Ginn
+and Company, publishers. Used by permission.)]
+
+In places having no system of drainage privies must be used. They can be
+made harmless, as army camps prove, but they require scrupulous care.
+Fecal matter must be prevented from draining into wells and other water
+supplies, and must be screened from flies. The privy should be located
+at a distance from the well. The minimum distance that is safe depends
+in each case upon the nature of the soil and the direction of the
+natural drainage. Even when the privy is situated below the well on
+sloping ground, drainage may still occur from the privy to the well;
+however, a well-made, properly located pit privy is safe unless it is
+near a limestone formation. The dry earth system is satisfactory in
+places having an efficient public scavenger system; in this system pails
+or cans are used to receive the discharges, which are then covered with
+sand, ashes, earth or, preferably, chloride of lime. The buckets are
+frequently emptied and the contents buried at least one foot below the
+surface of the ground. The objection to this method for more extended
+use is that proper care of the cans is a disagreeable duty of which most
+households soon tire.
+
+PERSONAL CLEANLINESS.--The main functions of the skin are three: to
+protect underlying tissues, to excrete waste matter, and to regulate
+bodily heat by checking or allowing the evaporation of perspiration.
+After perspiration has evaporated solid matter is left upon the skin,
+and oily matter also is deposited on it by the glands that keep the
+skin lubricated. Removing these and other materials at least once a day
+is desirable to improve the bodily tone and sense of well-being. Real
+cleanliness is impossible without frequent use of warm water and soap.
+
+Cold baths are stimulating, though not very efficacious for cleansing
+purposes. They are valuable tonics if properly used, but delicate or
+elderly persons should use them only by a physician's advice. Chilly
+feelings or depression following should be the signal for any person to
+discontinue cold bathing or swimming in cold water.
+
+Warm baths are soothing in their effects, and are appropriate at bed
+time, particularly for persons inclined to sleeplessness. Very hot
+baths, especially if prolonged, may be harmful, and should not be taken
+often.
+
+There is no clear connection between general cleanliness and disease.
+Frequent bathing does not protect a person from any particular disease,
+except in so far as bathing necessarily includes washing the hands. If
+typhoid germs for example have actually been swallowed, a clean bodily
+exterior is of no avail in preventing typhoid fever or in diminishing
+its severity. The same is true of other diseases.
+
+But it is impossible to emphasize unduly the importance of clean hands.
+Hands are prime offenders in distributing fresh bodily secretions, and
+germs both innocent and harmful. All health authorities agree on this
+point.
+
+      "Perhaps 90% of all infections are taken into the body
+      through the mouth. They reach the mouth in water, food,
+      fingers, dust, and upon the innumerable objects that are
+      sometimes placed in the mouth. The fact that the great
+      majority of infections are taken by way of the mouth gives
+      scientific direction to personal hygiene. Sanitary habits
+      demand that the hands should be washed after defecation and
+      again before eating, and fingers should be kept away from
+      the mouth and nose, and that no unnecessary objects should
+      be mouthed. All food and drink should be clean or
+      thoroughly cooked. These simple precautions alone would
+      prevent many a case of infection."--(Rosenau: Preventive
+      Medicine and Hygiene, p. 366.)
+
+As Dr. Chapin says:
+
+      "Probably the chief vehicle for the conveyance of nasal and
+      oral secretion from one to another is the fingers. If one
+      takes the trouble to watch for a short time his neighbors,
+      or even himself, unless he has been particularly trained in
+      such matters, he will be surprised to note the number of
+      times that the fingers go to the mouth and the nose. Not
+      only is the saliva made use of for a great variety of
+      purposes, and numberless articles are for one reason or
+      another placed in the mouth, but for no reason whatever,
+      and all unconsciously, the fingers are with great frequency
+      raised to the lips or the nose. Who can doubt that if the
+      salivary glands secreted indigo the fingers would
+      continually be stained a deep blue, and who can doubt that
+      if the nasal and oral secretions contain the germs of
+      disease these germs will be almost as constantly found upon
+      the fingers? All successful commerce is reciprocal, and in
+      this universal trade in human saliva the fingers not only
+      bring foreign secretions to the mouth of their owner, but
+      there exchanging them for his own, distribute the latter to
+      everything that the hand touches. This happens not once,
+      but scores and hundreds of times during the day's round of
+      the individual. The cook spreads his saliva on the muffins
+      and rolls, the waitress infects the glasses and spoons, the
+      moistened fingers of the peddler arrange his fruit, the
+      thumb of the milkman is in his measure, the reader moistens
+      the pages of his book, the conductor his transfer tickets,
+      the "lady" the fingers of her glove. Every one is busily
+      engaged in this distribution of saliva, so that the end of
+      each day finds this secretion freely distributed on the
+      doors, window sills, furniture and playthings in the home,
+      the straps of trolley cars, the rails and counter and desks
+      of shops and public buildings, and indeed upon everything
+      that the hands of man touch. What avails it if the
+      pathogens do die quickly? A fresh supply is furnished each
+      day."--(Chapin: The Sources and Modes of Infection, p.
+      188.)
+
+ORAL HYGIENE.--Cleanliness and proper care of the mouth and teeth can
+hardly be over emphasized. Their bearing upon health is direct. Long ago
+it was recognized that persons with decayed or missing teeth frequently
+suffered from dyspepsia, a natural result of inability to masticate
+properly, but only within recent years has it been realized that decayed
+teeth give rise to many other diseased conditions. Bacteria are
+constantly present in the mouth. If the mucus of the mouth is not
+removed, it forms a sticky coat upon the surfaces of the teeth and gums.
+In this bacteria collect, and pus or matter may also be formed, which,
+if carried by the blood to other parts of the body, may cause digestive
+troubles, rheumatism, and diseases of heart and kidneys. (See Dr. T. B.
+Hartzell, Health News, Oct., 1915, "The Importance of Mouth Hygiene and
+How to Practise it.")
+
+To keep the mouth and teeth healthy they must have:
+
+1. Proper use.
+
+2. Proper care.
+
+3. Proper treatment.
+
+1. Teeth, like other parts of the body, need exercise. Foods that
+require a considerable amount of chewing should be included in the diet.
+Such food is needed by children as soon as their first teeth have come,
+but care must be exercised to see that the food is actually chewed
+before it is swallowed.
+
+2. A good brush should be provided. The stiffness of the bristles should
+be regulated according to the individual. The brush should be
+thoroughly rinsed after using, and discarded as soon as it is worn.
+Dental floss is generally needed to remove particles that have lodged
+between the teeth.
+
+Brushing the teeth by passing the bristles across them is not
+efficacious. They should be brushed not across but with the cracks, as a
+good housewife sweeps a floor.
+
+      "In the light of recent investigation conducted by some of
+      the leading students of mouth hygiene, the most effective
+      way to use the toothbrush is to place the bristles of the
+      brush firmly against the teeth, applying firm pressure, as
+      though trying to force the bristles between the teeth,
+      using a slight rotary or scrubbing motion.... After a
+      little practice the user of this method will be surprised
+      at the results obtained. Care should be used to go over all
+      the surfaces of the teeth in this manner."--(See Dr. W. G.
+      Ebersole. "The Importance of Mouth Hygiene and How to
+      Practice it," Health News, Oct., 1915.)
+
+After brushing the teeth, the mouth should be rinsed by forcing lukewarm
+water about the teeth, using all the force that can be brought to bear
+by the cheeks, lips, and tongue.
+
+3. TREATMENT.--The teeth, including the first teeth of children, should
+be inspected by a competent dentist at least twice a year. Periodic
+cleansing by a dentist, and early attention to small cavities, may
+prevent serious ill health and impairment of the body, as well as the
+acute suffering generally accompanying treatment of advanced dental
+defects.
+
+CLOTHING.--Clothing was originally used for purposes of ornament. Desire
+for protection from cold and dampness came later. The amount of clothing
+required varies greatly according to individual needs and habits, but it
+is increasingly recognized that light clothing is best, provided that
+the wearer is really protected from cold. Clothing should be porous in
+order to allow ventilation of the body, supported so far as possible
+from the shoulders, and clean and well aired. Dampness favors the growth
+of germs which may cause irritation of the skin.
+
+Clothing should not constrict the body or hamper its movements. Perhaps
+the worst health menace for which clothing is to blame comes from the
+high heeled shoes on which many women prefer to limp through life. From
+the health standpoint shoes are of great importance. Bad shoes are
+responsible for many cases of flat feet, whose muscles have degenerated
+through non-use, and for much so-called "rheumatism," which is merely
+the protest of abused muscles. Bad shoes also, by distorting the feet,
+prevent comfortable walking, which is the only out-of-door exercise
+readily available for the vast majority of people; and still worse, the
+resulting unnatural position of the body sometimes has serious
+consequences by bringing injurious strains on other muscles and organs.
+
+FOOD.--Two distinct problems are encountered here: the problem of
+nutrition, and the problem of preventing sickness. Nutrition, or proper
+feeding, is a subject beyond the scope of this book; it is nevertheless
+one of the most important, if not the most important, factor in
+maintaining health. Food preparation and care of children, the two most
+important functions of the home, are unfortunately relegated to the
+least intelligent and least interested members of most households in
+which servants are employed.
+
+Most American families eat too much protein food, such as meat and eggs.
+Excess of protein probably leads to degeneration of tissues, and plays a
+part in causing the degenerative diseases already mentioned. Habit is
+important here as in other ways of living, but cereals and vegetables
+should in large measure make up the diet of sedentary persons and indeed
+of everyone in warm weather.
+
+The amount of food required in 24 hours depends on many factors: age,
+height, weight, occupation, season, and habit. Underweight and
+overweight are both abnormal conditions; probably the latter is the more
+easily remedied. Both require the advice of a physician. Rapid reduction
+of weight involves certain dangers, especially for persons with weak
+hearts.
+
+Food may cause sickness either because it is in itself harmful, or
+because it carries disease germs. Meat from diseased animals should be
+destroyed before it reaches the market, but bacterial activities in food
+originally wholesome may form in it poisonous substances.
+
+The chief diseases known to be carried by food, water, or milk are
+typhoid fever, paratyphoid, dysentery and other diarrhoeal diseases,
+scarlet fever, diphtheria, septic sore throat, and tuberculosis. The
+sole problem here is to keep human and animal excretions out of food,
+water, and milk. Since thorough cooking kills disease germs, danger
+arises chiefly from raw foods. All fruits and vegetables eaten raw
+should first be thoroughly washed.
+
+Water is essential to health. At least three pints should be taken
+daily, the amount varying somewhat according to diet, exercise,
+temperature, and so forth. Most persons drink too little water.
+
+Cities and towns should of course have public supplies of pure water.
+Contamination of water, when it occurs, is caused chiefly by sewage
+from cesspools, privies, and drains. All well or spring water must be
+constantly watched and Boards of Health are always ready to examine
+samples of water and to report whether it is safe to drink. At the
+present time a porcelain filter is the only satisfactory kind for a
+household, but many domestic filters are so badly cared for that in
+actual practice they are worse than none. Danger from a filter
+containing an accumulation of impurities is greater than the danger from
+most ordinary water supplies. Boiling water for ten minutes kills all
+pathogenic germs, but this method is inconvenient on a large scale and
+is not practical for continued family use.
+
+Every effort should be made to insure a regular supply of pure water in
+every house. It is not satisfactory to have two kinds, one for drinking
+and one for other purposes, since mistakes are sure to be made,
+especially by children. Some families who use only bottled or filtered
+water for drinking purposes habitually run the risk involved in using
+impure water from the tap for cleaning the teeth.
+
+Freezing destroys most germs, but ice is not necessarily free from
+bacterial life, and should be used in drinking water only when known to
+be free from impurities. Neither does freezing milk or cream
+necessarily kill germs that may be contained in it.
+
+Raw milk plays so important a part in the spread of disease that its
+fitness for human consumption is open to serious question. Certified
+milk, where obtainable, is safe but expensive. Boiled milk is safe, but
+changed in taste and to some extent in quality. If milk is heated to
+142°-145° F. and kept at that temperature for 30 minutes all disease
+germs in it are killed. This process, called pasteurization, renders
+milk safe. The objection is sometimes made that continued use of
+pasteurized milk for infants causes scurvy, but in New York City where
+over 90 per cent. of the milk is pasteurized no increase in scurvy has
+been noticed, while a large diminution in deaths of infants from
+diarrhoeal diseases has resulted, as in all cities where pasteurization
+is required.
+
+The following is a simple method for pasteurizing a quart bottle of
+milk. If the directions are exactly followed the milk will be
+pasteurized at the end of the process; no thermometer need be used. To
+prevent the bottle from breaking, it is first warmed by placing it for a
+few minutes in a pail of warm water.
+
+      "From the results of the experiments it was concluded that
+      any housewife can pasteurize a one quart bottle of milk by:
+
+      1. Boiling 2½ quarts of water in a large agate saucepan;
+      or better
+
+      2. Boiling 2 quarts of water in a 10 pound tin lard pail,
+      placing the slightly warmed bottle from the ice chest in
+      it, covering with a cloth and setting in a warm place. At
+      the end of one hour the bottle of milk should be removed
+      and chilled promptly. The water must be boiled in the
+      container in which the pasteurization is to be
+      done."--(Ruth Vories, in "Health News," Sept., 1916.)
+
+ELIMINATION.--Careful attention should be paid to elimination through
+the bowels and kidneys. Constipation is responsible for many common
+ailments; among them are headache, disinclination to work, irritable
+temper, and lowered resistance. If long continued, constipation becomes
+serious both from congestion and displacement of pelvic organs, and from
+absorption over a considerable time of even small amounts of the
+poisonous substances resulting from decomposition of food in the large
+intestine. The bowels can best be regulated by diet, water, exercise,
+and habit. The habitual use of cathartic and laxative drugs is most
+unwise, because they tend to aggravate the trouble. Moreover the
+habitual and continued use of injections and "internal baths" is
+harmful, and would not be considered necessary if bran and coarse flour
+and vegetables were substituted for concentrated foods. Greed, laziness,
+and lack of intelligence lead most persons suffering with constipation
+to prefer pills to the restraints demanded by hygienic living. The habit
+of evacuating the bowels at a regular time, if established in early
+childhood and rigidly adhered to, will prevent constipation among most
+healthy people. Any person who thinks drugs necessary should consult a
+physician, and be prepared to follow the régime he advises over a
+considerable period of time and at the cost of some self-denial.
+
+For healthy people, voiding urine presents no difficulty if a sufficient
+amount of water is taken; but some persons reduce the amount of liquid
+taken in order to escape the inconvenience of urination. This practice
+is harmful, and may involve insufficient cleansing of the entire system.
+If frequent urination disturbs sleep, liquids may be withheld during the
+evening; but the total amount of water taken in 24 hours should not be
+diminished.
+
+REST AND FATIGUE.--A fatigued person is a poisoned person. Muscular
+exertion burns the fuel constituents of the body, as we recognize by the
+greater heat generated within us during muscular exertion. Waste
+products, resulting from this burning process, accumulate if not
+removed, and clog the body in somewhat the same way that ashes and
+cinders clog a furnace. The fatigued person remains fatigued,
+consequently, until the accumulations of waste matter are removed by the
+normal action of the lungs, skin, and kidneys.
+
+Fatigue is caused by both mental and physical work, and when excessive,
+affects the nervous system most disastrously. The body can and should
+respond to occasional extra drafts on strength and endurance; its
+flexibility and power of adjusting to varying conditions may even be
+stimulated thereby. But even slight fatigue, if continued and especially
+if associated with anxiety or worry, has caused many nervous and mental
+breakdowns.
+
+Work carried beyond the point of normal fatigue requires a
+proportionately longer time for recovery. For example, if the point of
+fatigue has been reached by a certain finger muscle after 15
+contractions, and if half an hour is required to rest it completely, one
+might suppose that one hour would rest it after 30 contractions. This is
+not so, however; after 30 contractions 2 hours are required, or 4 times
+as much rest for twice the amount of work, if continued beyond the point
+of fatigue. Laboratory experiments and experience alike show that this
+principle holds true in other forms of fatigue. Thus the output of
+factories has been shown in many instances to be greater, other things
+being equal, when operatives work 8 hours a day than when they work
+longer. Excessive hours in any kind of work are the poorest economy.
+
+Fatigue is increased in direct proportion not only to muscular exertion
+but also to the amount of speed, complexity, responsibility, monotony,
+noise, and confusion involved in an occupation. Ability to bear fatigue
+differs greatly with different people, as ability varies to bear other
+kinds of strain. Rest at night and on Sunday, and the annual vacation
+should be enough to keep a person in good condition. If not, there is
+probably something wrong with the worker's health, the nature of his
+work, or his adaptation to his particular kind of work. This statement
+is not only true of persons regularly employed, but of those living at
+home, including children in school, women in "society," and especially
+mothers of families.
+
+SLEEP.--A sufficient amount of sleep is essential to health, but
+individual requirements vary widely. Each person should know and regard
+his own need, and children and young people should be obliged to go to
+bed early. Ability to sleep is largely habit; good habits should be
+formed and continued. Sleep-producing drugs should never be taken,
+except by a doctor's prescription.
+
+RECREATION.--Owing to the speed, complexity, and worry of modern life
+among all classes, and to the monotony of work in industry, recreation
+has become a matter of vital importance for everyone. Some muscular
+activity, preferably in the open air, is needed by every healthy person.
+Recreation should be as unlike the regular occupation as possible: going
+to the theatre, for example, is not the best exercise for sedentary
+workers employed all day in artificially lighted offices. The element of
+pleasure is essential. Hoisting dumb-bells purely from conscientious
+motives is seldom beneficial, and is generally soon abandoned.
+
+The part played by habit in matters of health is often overlooked.
+Although the body adjusts itself to widely varying conditions and even
+to unfavorable ones, the importance of forming desirable habits cannot
+be overemphasized. Sudden or radical changes in living, however,
+particularly among people no longer young, may play havoc. New and
+violent systems of exercise, weight reduction, and food fads forced on
+families by enthusiastic discoverers involve considerable risk.
+
+Many elements enter into health; in no single one is found hygienic
+salvation. Temptation always exists to emphasize one element at the
+expense of others. For instance, people who insist upon overventilating
+rooms regardless of others' comfort may themselves be utterly careless
+in regard to necessary sleep, and more than one fastidiously clean
+person has disregarded the highly unclean condition of constipation. To
+maintain sound health only a rational program will suffice: properly
+balanced work and play, sleep and food and all other elements must be
+included in due proportion. And over-anxious health seekers might well
+remember that health is not so much an end in itself, as a means to a
+happy and productive life; even in concern over health, it is possible
+for him that saveth his life to lose it.
+
+
+EXERCISES
+
+1. Explain the difference between an hereditary disease and hereditary
+susceptibility to a disease. How may hereditary susceptibility to a
+disease be combatted?
+
+2. What are the essentials of good ventilation?
+
+3. What is the proper temperature for a living room? What are the
+effects of higher temperatures? Of lower temperatures?
+
+4. Describe methods for maintaining household cleanliness.
+
+5. Discuss the importance from the point of view of health, of dust; of
+insects; of garbage; of sewage.
+
+6. What principles should guide one in deciding whether a certain water
+supply is safe to use for drinking purposes? What are the dangers of
+impure water? How can impure water be rendered safe?
+
+7. What diseases may be carried by milk? How can milk be rendered safe?
+
+8. Explain the health aspects of personal cleanliness.
+
+9. What care should be given the teeth and mouth? Why?
+
+10. What bad results frequently follow constipation? How should
+constipation be remedied?
+
+11. Name seven factors that are important in causing fatigue. Why is it
+uneconomical to continue work, either physical or mental, beyond the
+point of fatigue?
+
+12. What facilities for recreation, especially in the open air, does
+your community provide for little children? For school children? For
+working boys and girls? For grown people?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Introduction and Chapters I, III-V,
+VII-IX.
+
+How to Live--Fisher and Fisk, Chapters I, III-V.
+
+The Human Mechanism--Hough and Sedgwick, Chapters V, XXII-XXIX.
+
+Disease and Its Causes--Councilman, Chapters X, XII.
+
+Fatigue and Efficiency--Goldmark, Chapters II, III.
+
+Preventive Medicine and Hygiene--Rosenau.
+
+A Manual of Personal Hygiene--6th Edition, Edited by Walter L. Pyle.
+
+Four Epochs of a Woman's Life--Galbraith.
+
+Hygiene and Physical Culture for Women--Galbraith.
+
+The Home and Its Management--Kittredge.
+
+Exercise and Health--F. C. Smith, Supplement 24 to the Public Health
+Reports, Government Printing Office, Washington.
+
+The Sanitary Privy--Farmers' Bulletin 463, United States Department of
+Agriculture, Government Printing Office, Washington.
+
+Safe Disposal of Human Excreta at Unsewered Homes--Lumsden, Stiles and
+Freeman, Bulletin 68, Public Health Reports, Government Printing Office,
+Washington.
+
+The Disposal of Human Excreta and Sewage of the Country Home--New York
+State Department of Health, Albany.
+
+Milk and Its Relation to Public Health--Bulletin 56, Hygienic
+Laboratory, Government Printing Office, Washington.
+
+Milk and Its Relation to Health--New York State Department of Health,
+Albany.
+
+Other Publications of the United States Public Health Service and of the
+Departments of Health of the different states and cities.
+
+
+
+
+CHAPTER III
+
+BABIES AND THEIR CARE
+
+
+The principles of hygiene are fundamentally the same for young and old.
+The applications, however, differ at different ages. From the time when
+physical growth and development are complete until changes due to old
+age appear, an individual commonly has greater resistance than at other
+ages, and is able in consequence to endure unfavorable conditions of
+life with more success.
+
+Babies, on the other hand, are exceedingly sensitive to their
+environment. Surroundings that are even slightly unfavorable are likely
+to make babies sick. In order to remain healthy, they must have exactly
+the right kind of food, in the right quantities and at the right times;
+their sleep, exercise, and clothing must be carefully regulated; they
+must be protected from careless handling, from nervous strain, and above
+all, from the many kinds of infection to which they are peculiarly
+susceptible. The life of a baby fortunately can be controlled almost
+completely; when properly regulated it offers, therefore, an unequalled
+opportunity to see how hygienic principles work out in actual practice.
+
+The primitive mother's instinct to nourish and protect and succor her
+helpless child was the original form of nursing. Instinct alone,
+unfortunately, has never accomplished much in preserving health. The
+human race has now had an experience in the care of infants that extends
+over thousands of years. Yet today we are still, on the whole, less
+successful in keeping babies alive than we are in raising domestic
+animals; we still allow society to continue, like a modern Herod, in its
+ruthless career of slaughtering the innocents.
+
+About 14 babies out of every 100 born in the registration area[1] of the
+United States die before reaching the age of one year, while in some of
+our industrial cities as many as 25 out of every 100 born die before
+they are a year old. Most of these deaths are preventable. Thus, in a
+few American cities, the death rates have been so reduced that fewer
+than 10 babies out of every 100 die before completing the first year;
+while in Dunedin, New Zealand, as a result of the work of the Society
+for the Health of Women and Children, the infant death rate has been so
+reduced that in 1912 only about 4 out of every 100 babies died before
+they were a year old.
+
+While ignorant mothers, who may or may not be uneducated women, and
+contaminated milk, are as a matter of fact, chiefly responsible for our
+high infant death rates, yet as we have already seen, every factor in
+the environment has its effect upon a baby. This fact has led Sir Arthur
+Newsholme, an eminent English authority, to say:
+
+      "Infant Mortality is the most sensitive index we possess of
+      social welfare. If babies were well born and well cared
+      for, their mortality would be negligible. The infant death
+      rate measures the intelligence, health, and right living of
+      fathers and mothers, the standards of morals and sanitation
+      of communities and governments, the efficiency of
+      physicians, nurses, health officers, and educators."
+
+Care of the child should begin at the earliest possible moment: that is,
+nearly nine months before he is born. Care before birth, for want of a
+better name, is called prenatal care of the mother. Every woman who
+thinks that she is pregnant should put herself at once under the care of
+a competent physician, so that he can make the necessary examinations as
+early as possible. If she follows his advice in regard to hygiene and
+proper regulation of her life, she may be free from anxiety, and may
+justly expect that her delivery will be a safe and normal process.
+
+A demonstration of the value of prenatal care was recently made by the
+Boston District Nursing Association. During the year 1915 prenatal care
+was given to 751 expectant mothers in 5 wards of the city; each woman
+attended a pregnancy clinic, where she was under the care of an
+experienced obstetrician, and was visited at intervals by a nurse who
+kept careful watch of her general condition and gave necessary advice
+and encouragement. In consequence the death rate among the babies whose
+mothers had prenatal care was only half as great, through the whole
+first year of life, as the death rate of babies in the same wards whose
+mothers had not had prenatal care. Moreover, the rate of still-births
+was only half as great as the rate among the general population of
+Boston. If prenatal care can save so many lives, surely it ought to be
+available for every pregnant woman in the land, including even that
+generally neglected class of people who are neither very rich nor very
+poor.
+
+Each baby's birth should be recorded by the registrar of births, and
+parents should make sure that registration has been attended to in the
+city or town where they live. In some states birth registration is
+already obligatory, but in any case it is required by the child's own
+interest. For instance, in later life it may be necessary for him to
+prove the date and place of birth in order to establish, among other
+things, his right to vote and to inherit property, and to settle the
+question of his liability to military service. Moreover, complete and
+accurate birth registration is needed by every community because it is
+essential to such reforms as reducing infant mortality and abolishing
+child labor.
+
+
+GROWTH AND DEVELOPMENT
+
+Statements in regard to growth and development are based on observations
+of many children. It should be remembered that the following figures
+represent averages only, and that healthy children may vary from them
+considerably without giving cause for alarm.
+
+AVERAGE SIZE.--The average weight of a baby at birth is from 7 to 7½
+lbs. and the average length is about 20 inches, but it is not unusual
+for a child to weigh anywhere from 5 to 10 pounds at birth and to
+measure from 16 to 22 inches in length. During the first week of life a
+baby loses slightly in weight. After the first week a healthy baby
+should gain from 4 to 8 ounces a week until he is six months old; after
+that time the weekly gain is less. The weight at birth will usually
+double during the first five months, and treble during the first year.
+Consequently, a baby weighing 7 pounds at birth may be expected to weigh
+14 pounds when five months old, and 21 pounds when a year old. Weight is
+one of the most important indications of a baby's condition. He should
+be weighed every week during the first 6 months, once in two weeks
+during the second 6 months, and once a month throughout the 2nd year.
+
+MUSCULAR DEVELOPMENT.--A baby at birth is helpless, and during the first
+few months he has little muscular control. During the third month he
+ordinarily begins to lift his head, and he can usually hold it up
+without support by the time he is 3 months old; when 7 to 8 months old
+he sits erect and begins to play with toys. From this time a baby makes
+rapid progress; he attempts to stand on his feet, begins to creep, and
+by the time he is 14 months old he is usually able to stand alone, or
+even to walk a few steps. He is usually running about without difficulty
+when fifteen or sixteen months old.
+
+Babies should never be urged to walk or to bear their weight on their
+feet. If healthy they are generally eager to go about unaided, and like
+to investigate their surroundings without assistance. If walking is
+unusually delayed, a physician should be consulted.
+
+DEVELOPMENT OF SPECIAL SENSES.--A new-born baby is unable to
+distinguish objects, but the eyes are sensitive to light and need
+careful protection. Hearing, although undeveloped at birth, soon becomes
+acute; consequently the child should stay in a quiet room. When six or
+eight weeks old he notices objects, and at three months old he welcomes
+his mother when he is hungry. A month or two later he begins to
+distinguish between familiar and unfamiliar faces, and to show approval
+or disapproval.
+
+DEVELOPMENT OF SPEECH.--A baby six or seven months old begins
+consciously to utter sounds, and usually can say a few unconnected words
+by the time he is a year old. The average child, however, does not begin
+to form sentences of more than two or three words until he is about two
+years old.
+
+DEVELOPMENT OF TEETH.--The so-called milk teeth are twenty in number;
+they are followed by thirty-two permanent teeth. The two lower front
+teeth (central incisors) generally appear when a child is from five to
+nine months old, and in from one to three months later the four upper
+front teeth (upper incisors) appear. All the first or milk teeth should
+have come through by the time a child is two and a half years old, but
+wide variations occur both in the time and order of appearance and
+should occasion no uneasiness if the child seems well. Unusual
+conditions of any sort should be referred to the physician; it is a
+great mistake to attribute all illness at this time to teething.
+
+The first of the permanent teeth appear when a child is about six years
+old. Mothers sometimes mistake the first permanent molars for temporary
+teeth, a mistake that frequently leads to neglect and even extraction of
+highly important teeth. All but the last four molars, sometimes called
+wisdom teeth, should be through by the time a child is fifteen. The
+wisdom teeth may not appear before the 20th or even the 25th year.
+
+NORMAL EXCRETIONS.--A new-born baby should have one or two bowel
+movements during the first twenty-four hours; the first bowel movements
+are sticky and almost black in color. After the baby begins to nurse,
+three to four movements a day are not unusual, and throughout infancy
+and childhood as well as adult life there should be one or two
+evacuations of the bowels daily. The character of the stools is more
+important than the number. While the baby is taking milk only, the
+movements should be soft, yellow in color, and nearly odorless. Change
+in frequency of the movements, or appearance of undigested food or curds
+of milk in the stool, should be carefully noted and if continued,
+reported to a physician; they may be the first signs of serious
+digestive trouble.
+
+The urine of an infant should be odorless and colorless. It should be
+voided at least once during the first twenty-four hours, and much more
+frequently after the baby begins to nurse. Marked diminution in the
+amount of urine should be reported to a doctor.
+
+Efforts should be made early to develop habits of regularity in the
+evacuation of the bladder and bowels. If taken up regularly most
+children learn to use a chamber for bowel movements by the time they are
+three months old. Normal children, if properly trained, usually have no
+bladder discharge during the night after they are 18 months old, and
+they learn even earlier to indicate a desire to urinate during the day
+time.
+
+CLOTHING.--The amount and weight of a baby's clothing should depend upon
+the season; but garments worn next to the skin, except the diaper,
+should be wholly or partly of wool, the lightest weight in summer and
+heavier weight in winter. During the first few weeks a baby's abdomen
+should be supported by a flannel binder about six inches wide, applied
+snugly but not tightly enough to restrict either the abdomen or chest
+walls. It may be replaced later by a loosely fitting knitted band worn
+for warmth only. Such a band is especially necessary if there is
+tendency to diarrhoea, but in no case should it be discarded before
+the 18th month. All garments except the diaper and first flannel binder
+should hang from the shoulders, and should fit loosely but well.
+
+Clothing for babies should be of soft materials and should be simply
+made. Even the first clothes should not be very long. The weight of very
+long clothing is an unnecessary burden, and prevents free movements of
+the legs. At night an entire change of clothing should be made, and a
+nightgown of warmer material substituted for the petticoat and slip.
+Most children are dressed too warmly indoors, but in low temperatures
+they need to be well protected.
+
+Diapers should be soft and absorbent. It may be necessary to wash new
+diapers several times before using in order to make them soft enough.
+Care should be taken not to apply them too tightly, or in such a way as
+to cause pressure on the genitals. They should be changed during the day
+whenever wet or soiled, and at night when the baby is taken up to be
+fed. Proper care of diapers is highly important, however laborious. They
+should be well washed, boiled, and thoroughly dried before they are used
+a second time. Diapers that have been wet but not soiled should not be
+dried and used again before being washed. Much work can be saved if
+pads of loosely woven absorbent material are used inside the diaper to
+receive discharges. The pads can be burned, but even if washed the labor
+is less than washing full sized diapers. Like all other infant's
+garments, diapers should be washed with pure white soap and without
+starch. Waterproof material used to cover the diaper is almost sure to
+irritate the baby's skin, and is consequently harmful.
+
+SLEEP.--During his first few weeks a normal baby sleeps about
+nine-tenths of the time, and should be left undisturbed except for
+necessary care. He should sleep in a crib, bassinet or basket protected
+from light and drafts; in no circumstances should a baby sleep in the
+bed with his mother or any other person. Pillows are unnecessary for
+babies, and indeed for older children, but if used they should be thin
+and firm.
+
+The amount of sleep necessary gradually diminishes, but during all the
+years of growth a child needs more sleep than an adult. The amount of
+sleep required daily is approximately as follows:
+
+  First month                  18 to 20 hours
+  Second to sixth month        16 to 18 hours
+  Sixth month to one year      14 to 15 hours
+  One to two years             13 to 14 hours
+  Two to four years            11 to 12 hours
+
+After this time a child should sleep at least ten hours out of the
+twenty-four. During the first year a nap in the middle of the forenoon
+and another in the afternoon are desirable. A child who is inclined to
+sleep so long that his nap interferes with his night's sleep, should be
+waked from his nap, but at the same hour every day. When a child is a
+year old, one nap during the day is often sufficient, if he is doing
+well, but the habit of taking a nap at some time during the day should
+be continued through the fifth year if possible, or even later.
+
+Babies should not be rocked or otherwise coaxed to go to sleep; they
+should be made comfortable and then left alone. They learn to go to
+sleep by themselves as soon as they are convinced that sleep is expected
+of them, and that no unfounded objections on their part will be
+regarded. Continued inability to sleep normally usually indicates
+discomfort or poor general condition, and should be taken up with the
+doctor. Pacifiers and thumb-sucking should not be allowed, since they
+lead to changes in the shape of the jaw with resulting imperfect
+adjustment of the teeth. Soothing syrup and like medicines should never
+be given to a baby; death or permanent injury has resulted from their
+use. It is impossible to emphasize too strongly the danger of giving
+them even a single time.
+
+FRESH AIR.--All that has been said about the importance of fresh air
+for adults applies with even greater force to infants and children.
+During his first month especially a baby is susceptible to draughts;
+nevertheless, the room should be well ventilated and its temperature
+kept between 68° and 70° F. during the day, and at about 65° F. at
+night. Even in cold weather the room should be well aired two or three
+times a day; the baby should be removed to another room while the
+windows are open. After the baby is three or four months old the windows
+may be left open at night provided the outside temperature does not fall
+below freezing. A healthy baby two or three weeks old may be taken
+out-of-doors for a short time in mild weather; when he is three months
+old he may be taken out-of-doors even in winter on bright sunny days.
+The time spent out-of-doors should be gradually increased until the baby
+stays out the greater part of the day; but he should not be exposed to
+storms, wind, flying dust, dampness, extremes of temperature, or
+insects. The eyes should not be covered by veils, but they should be
+shielded from the direct rays of the sun at all times.
+
+DIET.--A baby, in order to thrive, must have suitable food, given at
+regular intervals. During the first few months of life no other food
+can take the place of mother's milk. Breast-fed babies are more robust
+than bottle-fed babies; more than this, they are less likely to contract
+infectious diseases or to suffer from digestive disorders. The number of
+bottle-fed babies who die every year is three times as great as the
+number of breast-fed babies who die. Many mothers do not understand the
+risk involved in weaning small babies; and so every year many little
+lives are lost, and lost needlessly. When poverty forces nursing mothers
+to wean their babies and seek work outside their homes, one can only say
+that a society which tolerates such a waste of infant life is indeed
+regardless of its own welfare.
+
+Special conditions, of course, may make it undesirable for a mother to
+nurse her baby. No one but the physician is competent to decide this;
+not even neighbors, grandmothers, other members of the family, or the
+mother herself. Where artificial feeding must be used, it should be
+carefully adapted to the individual child, and in consequence it must be
+prescribed by the doctor. Patent foods, notwithstanding the claims on
+their printed labels, should be used only under his advice.
+
+INTERVALS OF FEEDING.--Little milk is secreted during the first two days
+after the birth of a child. The baby should, nevertheless, be put to
+the breast as soon as he has had his first bath, if the mother is
+sufficiently rested. Always before and after nursing the mother's
+nipples should be washed in water that has been boiled. Nursing should
+be repeated at intervals of six hours during the first two days.
+
+The following schedule for the feeding of healthy babies is given by
+Holt in "Care and Feeding of Infants." (1917.)
+
+
+SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR
+
+  ------------------+--------+----------+----------+-----------+--------
+                    |        |          |          |           |
+                    |Interval|   Night  | No. of   | Quantity  |Quantity
+       Age          |between | feedings,| feedings,|  for one  | for 24
+                    |meals by|  6 p.m.  | in 24    |  feeding  | hours
+                    |  day   |    to    | hours    |           |
+                    |        |  6 a.m.  |          |           |
+  ------------------+--------+----------+----------+-----------+--------
+                    |  Hours |          |          |   Ounces  | Ounces
+  2d to 7th day     |    3   |     2    |     7    |    1-2    |  1-14
+  2d and 3d weeks   |    3   |     2    |     7    |    2-3½   | 14-24
+  4th to 6th week   |    3   |     2    |     7    |    3-4    | 21-28
+  7th week to 3 mos.|    3   |     2    |     7    |   3½-5    | 25-35
+  3 to 5 months     |    3   |     1    |     6    |   4½-6    | 27-36
+  5 to 7 months     |    3   |     1    |     6    |   5½-6½   | 33-39
+  7 to 12 months    |    4   |     1    |     5    |    7-8½   | 35-43
+  ------------------+--------+----------+----------+-----------+--------
+
+During the period when seven feedings are given in 24 hours the
+following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m.,
+6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when
+the number of feedings is reduced from seven to six. Food should be
+given on exact schedule time; the baby if asleep should be waked for
+any meal except the one due at 2 a.m.
+
+WATER.--Pure boiled water should be given regularly even to a young
+baby. He is often satisfied with a little warm water if he is fretful
+between the hours of nursing. Water may be given from a cup, a spoon, or
+a bottle; it is desirable, however, for the baby to learn to drink from
+a cup before the period of weaning begins.
+
+WEANING.--Ordinarily, a baby should be fed from the breast until he is
+seven months old, either exclusively or with the exception after the
+second month of one bottle-feeding in twenty-four hours. This exception
+will do the baby no harm and may be a great relief to his mother.
+Partial breast-feeding should continue if possible through the ninth
+month, but every baby should be entirely weaned by the time he is one
+year old. It may be necessary, if either the baby or the mother is not
+thriving, to change the food before the ninth month; but it is desirable
+not to make the change in hot weather. Healthy babies, it should be
+remembered, increase in weight constantly, and steady gain in weight is
+the best indication that a baby's food is suitable.
+
+NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy glass,
+cylindrical in shape, without angles or corners to make cleaning
+difficult. The number of bottles provided should be two or three more
+than the number of feedings given in 24 hours.
+
+Short black rubber nipples which slip over the neck of the bottles
+should be selected. They should be of such a shape that they can easily
+be turned inside out; a nipple turner costs little, and is well worth
+the price. Nipples should be discarded when they become soft or when the
+opening grows so large that the milk runs in a stream rather than drop
+by drop.
+
+As soon as the baby has finished his meal, the bottle should be removed
+from his mouth, rinsed in clear hot water, and left standing filled with
+cold water until a convenient time for boiling all the bottles to be
+used during the next 24 hours. Sufficient time must be allowed for the
+bottles to cool thoroughly between the time when they are boiled and the
+time when they are refilled. When it is time to boil the bottles they
+should be placed in an agate or other suitable kettle, covered with
+water, and boiled vigorously for three minutes. A cloth placed in the
+bottom of the kettle will help to prevent the bottles from breaking.
+After the bottles have been removed from the boiling water, they should
+be stoppered at once, either with rubber stoppers or plugs of sterile
+cotton. The stoppers, if used, should be boiled with the bottles;
+sterile cotton may be purchased by the package.
+
+An easy and satisfactory method to care for rubber nipples is the
+following: Provide as many nipples as the number of feedings given in 24
+hours, and another, if desired, to be used in case of accident; provide
+also two cups of ordinary white enamel, each one large enough to hold
+all the nipples at once. One cup should have a cover; the other should
+not. To avoid mistakes it is well to have the cups different in shape.
+As soon as each feeding is finished the nipple should be thoroughly
+cleansed under running water by scrubbing it inside and out with a
+nipple brush. The nipple thus cleansed is placed in the cup without a
+cover. When all the nipples have been used, cleansed, and collected in
+the uncovered cup, they are transferred into the other cup; water is
+added, the cup is covered and its contents are boiled for three minutes.
+The nipples remain covered in the boiled water until needed; they are
+removed one by one for the successive feedings. Care must be used in
+removing a nipple to take it by the rim, not to touch other nipples
+during the process and not to dip the fingers into the water. The best
+way is to remove them by means of a glass rod, which is boiled with the
+nipples and kept with them in the cup when not in use. There are
+several advantages of this method of caring for nipples: it is easy; it
+reduces to a minimum the necessary handling of the nipples after
+boiling; and it reduces the probability of using the wrong nipple, since
+boiled nipples are always in one kind of receptacle and used nipples in
+another. It also prevents the too common practice of continuing to keep
+nipples in a supposedly antiseptic solution long after the solution has
+become badly soiled.
+
+TABLES of diet for children over one year of age may be found in the
+Appendix, page 322.
+
+BATHING.--Usually the cord has separated and the navel has entirely
+healed by the time a baby is 10 days old. After this time a daily tub
+bath should be given; it should be given not less than one hour after
+feeding. The temperature of the room should be from 70-72°, measured by
+a thermometer placed in the part of the room where the bath is to take
+place. In order to avoid chilling or tiring the baby the bath should be
+given quickly, without confusion or interruption; success can be
+achieved by using even a moderate amount of foresight. Before undressing
+the baby everything to be used should be collected and placed within
+easy reach,--clean clothing, soft towels, 2 wash cloths, pure white
+soap, powder, absorbent cotton, etc. The bath tub should last of all be
+filled with water, and its temperature tested by means of a bath
+thermometer. The temperature of the water should be from 98° to 100°.
+After the baby is three months old slightly cooler water should be
+splashed over his chest, back, neck, and arms just after he is removed
+from the tub, and as he grows older the temperature of his cool splash
+can be reduced. Children who become accustomed to cool water in this way
+take kindly to their cold showers later.
+
+The baby's face should be washed first and dried carefully, while his
+body is still covered. Next the head should be washed; a little soap
+should be used, but it must on no account enter the eyes. Next the
+entire body should be soaped with the hand; and then the baby should be
+placed gently in the bath, his head and shoulders supported by the
+attendant's left hand and forearm. Care should be taken to rinse off all
+the soap. The baby should not stay in the tub more than 2 or 3 minutes;
+after he has been removed from the tub he should be wrapped at once in a
+soft bath towel. He should be dried gently but thoroughly by patting
+with soft, warm towels rather than by rubbing. Folds of the skin should
+be dried with special care. A little powder may be applied, but a baby
+who is kept both clean and dry will not need much powder, if any. The
+baby should next be quickly dressed, with as little turning and moving
+as possible. Clothing should be drawn on over the feet instead of over
+the head, and the petticoat should be placed inside the slip so that the
+two garments may go on simultaneously.
+
+EYES.--Secretion accumulating in the corners of a baby's eyes should be
+removed by means of a bit of absorbent cotton moistened in boiled water.
+The secretion should be wiped away gently; a different piece of cotton
+should be used for each eye, and a piece that has been used should not
+be put back into the water. Further than this, eyes in a normal
+condition do not need cleansing.
+
+Every person who handles a baby should be very sure that her hands are
+clean; she should be doubly sure before she touches his eyes, since a
+baby's eyes are peculiarly susceptible to infection from any source.
+More than a quarter of all totally blind persons in the United States
+became blind by infection of the eyes at birth. Blindness of the new
+born can be prevented in practically all cases if the doctor uses a
+preparation of silver in the baby's eyes immediately after birth. This
+treatment is effective and entirely safe.
+
+If at any time the eyelids look red or swollen, or if a drop of matter
+appears between the lids, the physician should be summoned at once.
+Total blindness may result if treatment is delayed even a few hours.
+
+MOUTH.--The mouth should be rinsed after feeding by giving the baby a
+teaspoonful of boiled water. Until the teeth come it does not require
+other cleansing, and attempts to clean it may injure the delicate
+membranes that line it. Indeed, except in an emergency, fingers should
+not be inserted into a baby's mouth. The teeth when they appear should
+be cleaned by means of a soft tooth-brush.
+
+NOSTRILS.--The nostrils need no cleaning other than removal of mucus
+that can easily be reached by means of a piece of cotton. If a little
+vaseline is placed in the nostrils on a small piece of absorbent cotton
+in the early morning, collections of mucus will usually be softened so
+that they can be removed easily at bath time.
+
+GENITAL ORGANS.--The genital organs of girl babies should be gently
+washed twice a day, using absorbent cotton, and tepid water. Treatment
+other than cleanliness is ordinarily unnecessary. Vaseline may be
+applied if the genitals are slightly reddened; any discharge or abnormal
+appearance should be reported to the doctor. In the case of boy babies
+the foreskin should be gently drawn back twice a week after immersion in
+the tub; after the parts have been gently washed with absorbent cotton,
+it should be drawn forward again. No force should be employed in
+retracting the foreskin; the physician should be consulted if it cannot
+be retracted easily.
+
+THE DEVELOPMENT OF HABITS.--During his first few months crying is a
+child's only means of expression, and he quickly learns to make
+effective use of his limited opportunities. It is important for the
+mother to distinguish between crying caused by pain, illness, or hunger,
+and crying caused by temper. These cries are more or less distinctive,
+but no one can be sure in every case just what a crying baby is
+attempting to express.
+
+A cry caused by hunger is fretful and often interrupted by sucking the
+thumb; it ceases when the child is fed. A cry caused by indigestion is
+similar; the child is relieved for a short time by feeding, but soon
+begins to cry again. If he has acute pain, such as earache, the cry is
+sharp, repeated at frequent intervals and accompanied by other symptoms
+of distress, such as restlessness, contraction of the features, and
+drawing up the legs. In serious illness the cry is usually feeble,
+fairly constant except when the child is asleep, and exaggerated by
+slight causes.
+
+A limited amount of crying is useful exercise for a baby, and should not
+distress his mother unduly. Moreover, crying may be merely the
+expression of a wish to be taken up, to be played with, carried about or
+otherwise amused, to be given a pacifier, or to be indulged in other bad
+habits. If not indulged in these ways he may cry from temper. The cry of
+temper is loud and violent, accompanied by vigorous kicking or by
+holding the body rigid. Proper treatment of the baby may prevent many
+months of discomfort, and spare him the formation of his first bad
+habit. All other possible causes for crying should be eliminated. If the
+child continues to cry when he is warm and dry and comfortable, "It
+should simply be allowed to cry it out. This often requires an hour and
+in extreme cases two or three hours. A second struggle will seldom last
+more than ten or fifteen minutes and a third will rarely be necessary"
+(Holt). Gas may form in the child's stomach during prolonged crying. It
+is consequently permissible to take him up after 15 minutes, and hold
+him erect; he generally expels gas at once, and immediately experiences
+relief. As soon as he is relieved, he should go back to his crib.
+
+EXERCISE.--Exercise is essential to the development of the body, but
+during the first few weeks warmth and quiet are so important that a baby
+should not be disturbed except for necessary care. His position,
+however, should be changed occasionally; if he lies on the same side
+constantly the soft bones of the head may become misshapen from
+pressure. As the baby grows older he needs more exercise, and he may be
+given an opportunity for it by removing his outer clothing and placing
+him on a bed in a warm room for a short time each day. Unnecessary
+handling is not good for a baby at any age.
+
+After he becomes more active, he may play on a mattress or thick blanket
+placed on the floor. The blanket should be covered with a washable pad
+or rubber cloth and clean sheet, and the whole should be surrounded by a
+fence at least two feet high. In such an enclosure a baby may safely be
+left to play if protected from draughts and cold. Elevated pens that can
+be folded when not in use are more convenient but more expensive than
+the home-made arrangement. As soon as a child begins to run about he
+takes ample exercise, and he may even need to be guarded from too great
+fatigue, especially toward bedtime. Games and play should be adapted to
+the age of the child and sufficiently varied to exercise all portions of
+the body; but they should not be too violent nor too prolonged. Some
+supervision of children's play is necessary, but they should be given as
+much freedom as possible and allowed to develop their own initiative.
+
+PLAY AND TOYS.--The desire for play does not develop until a child is
+about six months old. At this age toys that can be washed, such as those
+of hard or soft rubber, should be selected. A baby instinctively carries
+everything to his mouth,--first his thumb, then playthings, and later
+whatever he may find, no matter how unsuitable. For his safety and
+protection this habit should be overcome as soon as possible, and he
+must learn to put nothing in his mouth except food and drink. Relatives
+are nearly always tempted to give too many and too fragile toys; they
+merely teach a child to be destructive and constantly to expect
+something new. Toys are the first possessions of which a child is
+conscious, and through them many desirable qualities may be developed:
+neatness and order, gentleness and a feeling of protection toward the
+helpless doll or Teddy bear, and unselfishness in sharing special
+treasures with playmates. Later the child may be given pets and made
+responsible for their care; but animals should not be subjected to
+unintentional cruelties from small children.
+
+
+EXERCISES
+
+1. What two factors are chiefly responsible for the deaths of babies
+under a year old? What other factors contribute? In your city or town
+what is the number of deaths per 1000 births of babies under one year
+old?
+
+2. Why is birth registration important to an individual? to a
+community? Is it required by law in your city?
+
+3. What is the average weight of babies at birth? Describe the rate at
+which they should gain.
+
+4. At what age may a normal child be expected to sit erect? to stand? to
+walk? to speak? When should his first teeth appear? his permanent teeth?
+
+5. Describe normal bowel movements of a baby.
+
+6. How should a young baby be dressed?
+
+7. Describe a baby's bath and toilet.
+
+8. Describe the surroundings that are suitable for a baby.
+
+9. What is the best food for a healthy baby? Why?
+
+10. Describe in detail a good daily program for a healthy baby four
+months old.
+
+11. What habits are desirable for a baby to form, and how may he be
+trained so that he will form them?
+
+12. Name all the indications that would tell you when a baby was not
+thriving, and in each case tell what you would do about it.
+
+
+FOR FURTHER READING
+
+The Care and Feeding of Children--Holt.
+
+The Care and Feeding of the Baby--Truby King.
+
+The Baby's First Two Years--R. M. Smith.
+
+The Care and Feeding of Children--J. L. Morse.
+
+Preventive Medicine and Hygiene--Rosenau, Section III, Chapter II.
+
+Pamphlets:
+
+  Prenatal Care, Mrs. Max West.
+
+  Infant Care, Mrs. Max West.
+
+  Child Care, Mrs. Max West. Published by the Children's Bureau,
+  United States Department of Labor, Washington, D. C. (Free on
+  request.)
+
+The Care of the Baby--Supplement No. 10 to the Public Health Reports,
+1913, Government Printing Office, Washington, D. C.
+
+Your Baby: How to Keep It Well--New York State Department of Health,
+Albany.
+
+Publications of the American Association for the Study and Prevention of
+Infant Mortality--1211 Cathedral Street, Baltimore, Md. (Free on
+request.)
+
+Publications of the National Committee for the Prevention of
+Blindness--130 East 22d Street, New York City. (Free on request.)
+
+
+FOOTNOTES:
+
+[1] An area including about two-thirds of the population of the United
+States.
+
+
+
+
+CHAPTER IV
+
+INDICATIONS OF SICKNESS
+
+
+By indications of sickness we mean all evidences of deviation from a
+normal physical condition. They may be apparent only to the person in
+whom they occur, or to a second person only, or to both. These
+deviations, commonly called the symptoms of sickness, are always
+important to notice, whether the conditions they indicate are serious or
+not.
+
+Early symptoms of sickness are often slight; hence they easily pass
+unnoticed. Yet a slight trouble, easily checked in its early stages,
+may, if neglected, grow into a serious or even fatal disorder: just as a
+burning match, which anyone could extinguish instantly, may kindle a
+fire beyond the power of an entire city to control.
+
+It is important, then, to notice even slight symptoms of sickness,
+first, in order to determine the nature of the trouble, and second, in
+order to institute treatment as early as possible. It is, however,
+hardly less important to observe symptoms accurately during the entire
+course of an illness. A patient's progress can be determined only by
+careful comparison between present and past conditions.
+
+Many symptoms can be detected only by methods requiring scientific
+apparatus as well as the knowledge and skill of a physician, but very
+pronounced symptoms are generally evident to anyone. The neighbors do
+not need to be told when a person has advanced tuberculosis; neither is
+an expert required to see that something ails a man with a broken leg.
+Furthermore less pronounced symptoms may often be clearly seen by any
+observant person, even by those not specially trained. Accordingly it is
+important for every woman who has charge of others, sick or well, to
+form the habit of noticing unusual appearances of any kind. This habit
+is one that most people must take pains to acquire, because people
+generally see only the things that their own experience in life has
+taught them to see. An added difficulty is the fact that when illness
+begins it is not a trained observer, but the untrained sufferer or
+untrained member of his family who decides whether to send for the
+doctor and thus to set in motion the machinery for treatment and cure.
+
+All the training and experience of a physician are required in order to
+decide what symptoms indicate, and to prescribe proper remedies.
+Diagnosis, or the process of determining the nature of illness from the
+symptoms observed, is often exceedingly difficult; it must take into
+consideration not one symptom only but the presence or absence of a
+number of symptoms. Untrained persons who attempt to make diagnoses are
+frequently led astray by the fact that actual causes of trouble may be
+situated far from the places where symptoms are felt or observed. For
+instance, the real cause of headache may lie in a region far removed
+from the head; and so-called heart-burn, which is caused by disordered
+digestion, has nothing to do with the heart. Again, an early symptom of
+tuberculosis of the hip joint is pain under the knee; a mother is
+clearly not doing the best thing when she assumes that any pain in a
+joint means rheumatism, and therefore doses her suffering child with the
+medicine that "helped" his rheumatic grandfather. No untrained person is
+equipped to make a diagnosis, and still less to prescribe medicine or
+treatment.
+
+Symptoms, like all other forms of discomfort, tend to trouble a patient
+in proportion to the amount of attention that he gives them. Hence, in
+order to avoid calling his attention to them unnecessarily they should
+be observed so far as possible without his knowledge; when it is
+unavoidable for him to realize what is going on, observation should be
+made a matter of routine, so that his interest may not be especially
+excited. For instance, everyone who has seen the routine medical
+inspection of school children realizes how little attention the children
+themselves give to the process, apparently regarding it merely as one of
+the many inexplicable proceedings of grown people. On the other hand,
+children who know their symptoms are over-anxiously watched soon learn
+to watch themselves and to exaggerate every little ache and pain.
+
+Symptoms may be divided into two classes: first, objective symptoms, or
+those that can be noted by an observer, like cough, pulse rate, or color
+of the skin; and second, the subjective symptoms, which are apparent
+only to the person affected, like pain and fatigue. The success of any
+woman who cares for the sick depends to a large extent upon her
+quickness and accuracy in noticing and reporting these symptoms and
+their variations. It should be remembered that pronounced symptoms are
+not the only ones of importance: even slight symptoms that continue over
+an appreciable length of time may be of very great importance. A brief
+description of some important symptoms follows, in order to help persons
+without technical training to describe the symptoms as well as to
+observe them.
+
+
+OBJECTIVE SYMPTOMS
+
+TEMPERATURE.--Bodily heat is produced by slow burning of food materials,
+which goes on for the most part in actively working muscles and glands.
+Heat thus generated is distributed by the blood to all parts of the
+body, but the surface of the body is generally cooler than the interior.
+In health the body temperature varies only a few degrees, no matter how
+much the temperature of its surroundings varies; consequently a
+temperature is abnormal if it is higher or lower than the usual
+temperature of a healthy person.
+
+The temperature is taken by means of a clinical thermometer placed
+either in the mouth, the rectum, or the armpit (axilla).
+
+[Illustration: FIG. 10.--CLINICAL THERMOMETER.]
+
+To take the mouth temperature, first wash the thermometer, using cold
+water and absorbent cotton or clean soft cloth. Next shake it until the
+mercury thread registers 96° or below. It is well before purchasing a
+thermometer to see whether it can be shaken down easily. Next place the
+thermometer in the patient's mouth, with its bulb under his tongue; he
+must then keep his lips closed until it is removed. Leave the
+thermometer in his mouth for two minutes. Then remove the thermometer,
+read the temperature and record the result. Clean the thermometer at
+once, using first cold water and soap, and then alcohol, 70%.
+
+The mouth temperature of a healthy person is about 98.6° F. This
+statement holds true if the person has been sitting with his mouth shut
+for a little while before his temperature is taken; but a hot bath,
+breathing through the mouth, eating or drinking, and so forth may cause
+marked temporary changes.
+
+The temperature in the rectum generally varies less than the temperature
+in the mouth unless it is taken when the rectum contains fecal matter.
+The temperature should be taken by rectum in babies and young children,
+restless, drowsy, or delirious patients, patients who cannot be trusted
+to keep the thermometer under the tongue, mouth breathers, and in any
+patients who have difficulty in keeping the mouth shut. The temperature
+is normally about half a degree higher in the rectum than in the mouth.
+
+In order to take a temperature by rectum, adults generally find it more
+convenient to lie on the side and prefer, if they are able, to insert
+and hold the thermometer themselves; but the attendant should be
+certain that they can do so without breaking the thermometer. Rectal
+thermometers should be lubricated with oil or vaseline before using;
+they should be inserted about two inches, left in three minutes, and
+cleansed in the same way as the mouth thermometer. A thermometer used to
+take rectal temperatures should never be used in the mouth.
+
+In taking the temperature of a baby place him on his back, hold him
+firmly with his legs elevated, and carefully insert the bulb of the
+thermometer, well oiled, for about one inch. Keep the child quiet, and
+hold the thermometer in place three minutes. Great importance should not
+be attached to a slight fever of short duration. The temperature of a
+child is much more easily affected by slight causes than that of an
+adult, and rectal temperatures between 97.5° and 100.5° should not cause
+anxiety unless continued.
+
+Temperatures taken in the axilla are less accurate than those taken by
+mouth or rectum. Consequently the method is less often used. The axilla
+should first be wiped; then the thermometer should be inserted and held
+for 5 minutes by pressing the arm tightly against the chest wall. The
+temperature in the axilla is normally about half a degree lower than in
+the mouth.
+
+The temperature varies somewhat according to the time of day. It is not
+unusual for the mouth temperature of persons who are entirely healthy to
+be as low as 97° in the early morning, or as high as 99° in the late
+afternoon, and probably most people's temperatures vary as much as a
+degree during the twenty-four hours. Even greater variations that are
+not long continued have little if any significance in people who feel
+well.
+
+Decided variations either above or below normal are highly important
+symptoms. A temperature below 98° is called subnormal, and one above
+99.5° is called fever. The number of degrees of fever does not
+necessarily bear a direct relation to the severity of an illness. Thus,
+it does not follow that one person is twice as sick as another, because
+his temperature is twice as many degrees above normal. All symptoms,
+including variations in temperature, must be considered in connection
+with one another, and it is generally impossible to state the
+significance of any one symptom taken by itself.
+
+The temperature should be taken once or twice a day as a matter of
+routine in almost every form of illness, and oftener when the patient's
+condition requires it. Also it should be taken as a matter of routine
+whenever there is indication of beginning sickness; especially when
+there is headache, pain, sore throat, coated tongue, cough or cold,
+chill, vomiting, diarrhoea, or rash. It is not a good plan to take
+one's own temperature oftener than necessary, or indeed anyone's;
+certainly not a baby's, since frequent use of the thermometer may
+irritate the rectum.
+
+PULSE.--Each time the heart beats, blood is forced out from the heart
+into the arteries, thus causing an expansion of the arterial walls. This
+expansion, called the pulse, can be felt in some places where arteries
+lie close to the surface of the body. The character of the pulse beat
+and its rate, or the number of times the beat occurs each minute, give
+information about the heart and blood vessels; taken together they are
+perhaps more important than any other one symptom.
+
+[Illustration: FIG. 11.--TAKING THE PULSE AT THE WRIST. NOTE THE
+POSITION OF ARM. (_From "Elementary Nursing Procedures," California
+State Board of Health._)]
+
+The pulse rate varies much more than the temperature. It differs in
+different individuals and at different ages, and it often shows great
+temporary changes, especially during exercise or eating, or as a result
+of excitement, fear, or other emotion. Definite statements in regard to
+normal pulse rates are hard to make, because different individuals
+though in perfect health show marked variations; we generally say,
+however, that the pulse rate of a normal man at rest is about 72 a
+minute, and that of a normal woman is about 80 a minute. At birth the
+pulse is quickest; it may then be from 124 to 144. From the 6th to the
+12th month it may be from 105 to 115 a minute, and from 90 to 105
+between the 2d and 6th years. About the time of puberty it reaches the
+adult rate, and during old age it may be decidedly slower than the adult
+rate.
+
+What we chiefly want to know about the pulse is
+
+1. Its rate, or number of beats per minute,
+
+2. Its force,--whether weak or strong,
+
+3. Its rhythm,--whether regular or irregular.
+
+Much practice is necessary before the pulse rate can be counted with any
+degree of accuracy, and wide experience with both normal and abnormal
+pulses is required in order to judge its strength, rhythm, or other
+characteristics.
+
+The pulse may be felt most conveniently on the thumb side of the front
+of the wrist. The pulse should be counted while the patient is lying
+down, and the watch used must have a second hand. To count the pulse,
+one should place two or three fingers (not the thumb) on the patient's
+wrist, and after the pulse has been felt distinctly for a few beats, the
+exact time by the second hand of the watch should be noticed and the
+counting begun immediately. It is generally best to count for half a
+minute, multiply the result by two to get the rate for a whole minute,
+and then to repeat for another half minute. The two results should agree
+within two beats, if the patient is quiet. A greater variation than two
+beats may mean that the pulse rate is varying, but when it is counted
+by inexperienced persons the apparent difference is generally the result
+of inaccurate counting, and it may be necessary to count two or three
+times more. The force of the pulse varies also in different individuals;
+it is, however, important to notice when it grows stronger or weaker in
+the same person. Normally the pulse-beat is regular like the ticking of
+a clock; it is called irregular if a few rapid or slow beats are
+followed by others of a different rate. During sickness the pulse should
+be counted whenever the temperature is taken, or oftener; and the result
+should be written down at once. The pulse of a sick person often shows
+changes both in rate and character; these changes are generally
+important and should be noticed.
+
+RESPIRATION.--Variations in the rate and character of respiration or
+breathing should be noticed. The normal rate of respiration for an adult
+at rest is 16 to 20 each minute, but it may be much faster, especially
+during muscular exercise. In babies the rate is about 30 to 35 a minute,
+and 20 to 25 in little children. The respirations, especially of babies,
+can best be counted during sleep by placing the hand lightly on the
+chest or abdomen. Since the respiration rate is partly under a person's
+control, it is almost sure to alter if the patient knows it is being
+counted; hence when the patient is awake it is better to keep one's
+fingers on his wrist, to place his hand upon his chest, and then to
+count the rise and fall of the chest while apparently counting the
+pulse. Sometimes it is possible to count the respirations merely by
+watching the rise and fall of the nightgown or bed clothes. The
+respiration is usually counted for a full minute. A watch with a second
+hand must be used, and the result should be recorded immediately.
+
+In certain forms of sickness breathing may become rapid, especially if
+the lungs or air passages are affected. In addition to the rate anything
+unusual about the breathing should be noticed whether it seems difficult
+or painful; if noisy, whether the sound is like snoring, or wheezing, or
+sighing, and so on.
+
+GENERAL APPEARANCE.--Any unusual expression of the face should be noted;
+whether it is drawn, pinched, anxious, excited, or dull and stupid; and
+also, whether the face is thin, swollen, or puffy under the eyes. The
+condition and appearance of the skin are significant: the skin may be
+dry, moist and clammy, hot or cold; its color, and the color of the face
+especially, may be flushed or pale or slightly yellow or blue. A bluish
+tinge about the nose, tips of the fingers, or the feet should be
+specially noticed. Reddened or discolored areas on any part of the body
+may be important, and also eruptions, rashes, swellings, or sores. It
+should be noticed whether the abdomen is normal or whether it is
+distended and hard.
+
+Strength or weakness is indicated to some extent by the way the patient
+moves, and by his ability to walk, stand, sit, hold up his head, feed
+himself, or turn in bed without assistance. The position he habitually
+takes is sometimes significant; in heart affections, for instance, he
+may be unable to lie down, in pleurisy he ordinarily lies on the
+affected side, and during abdominal pain he generally draws the knees
+up.
+
+SPECIAL SENSES.--The special senses are frequently disturbed in
+sickness. The eyes may be blood-shot; the patient may be over-sensitive
+to light, or see spots floating before the eyes, or he may be unable to
+see at all. The pupils of the eyes may be unusually large or small, or
+one may be large while the other is small. Swelling, redness, or
+discharge from the eyes should be noticed. Hearing and touch and smell
+may be impaired; or they may be abnormally acute, and cause real
+suffering. Taste may be impaired, especially when the nose is affected
+or when the mouth is not clean. Discharge from the nose or ears should
+be reported. Not only discharge, but also trouble of any kind, such as
+pain, tenderness, or swelling, is important if situated in or near the
+ears.
+
+THE VOICE is often much altered in sickness. It may be weak, hoarse, or
+whispered. Speech may be clear or thick, or the ability to speak may be
+entirely lost; in extreme weakness speaking is generally difficult, and
+may be impossible. Moaning, groaning, and other unusual sounds should be
+noted. A loud, sharp cry at night with or without waking, if a repeated
+occurrence, may be an early symptom of some diseases of children.
+
+THE TONGUE in health is red and moist; when extended it is somewhat
+pointed and can be held steadily. In sickness it may be cracked, dry and
+parched, or if the patient is not properly cared for, it may be covered
+with white, yellow, or brown coating; in many exhausting illnesses it is
+flabby and trembling. In scarlet fever the tongue is often a vivid red
+color, and is then called strawberry tongue. The odor of the breath may
+be foul from decay or neglect of the teeth, from indigestion,
+constipation, nasal catarrh, or special diseases.
+
+THE THROAT and tonsils are sometimes red and swollen as in simple sore
+throat; or they may be covered by white patches.
+
+THE GUMS may be swollen, tender, or bleeding. A collection of sticky
+brownish material may appear on the teeth and gums of neglected
+patients.
+
+COUGH when present may be: dry, or accompanied by expectoration;
+painful, frequent, loud, or whooping; and worse by day or by night. The
+sputum may be yellow, white, gray, rusty, blood-streaked, dark, or
+frothy. The amount of sputum should be noticed as well as its
+appearance.
+
+APPETITE or absence of appetite should be noted, and also the amount of
+food actually eaten by a patient; the amount eaten is frequently not the
+same as the amount carried to him on a tray.
+
+If VOMITING occurs, the color, consistency, amount, and general
+appearance of the vomitus should be noted; if its appearance is unusual
+the vomitus should be saved for the doctor's inspection.
+
+EXCRETIONS.--The number of bowel movements is important, and also their
+character. The consistency of the feces may be hard, soft or fluid;
+their color may be any shade of brown, yellow or green, from black to
+clay color. They should be saved for the doctor to see if appearance or
+odor is unusual.
+
+THE URINE in health is clear, amber colored, and slightly acid. From 30
+to 50 ounces should be excreted in 24 hours; the amount varies, however,
+especially according to the amount of fluid taken. It is important to
+notice whether the urine is scanty or greatly increased in amount, dark
+or pale, clear or cloudy, and whether sediment is deposited after
+standing. It is essential that urine should be voided in sufficient
+amount; the necessity for watching its quantity is frequently overlooked
+in the home care of the sick. Frequency of urination should also be
+noted. Inability to urinate, particularly where the urine has previously
+been scanty, is serious if continued; it should be reported to the
+doctor without delay. Inability to control the bladder and bowels are
+also symptoms to be reported.
+
+LOSS OF WEIGHT is significant in both adults and children, and failure
+of babies and children to gain in weight is a danger signal.
+
+SLEEP.--The number of hours a patient sleeps should be noticed and
+recorded as accurately as possible. The word of the patient on this
+subject is not sufficient evidence. Character of sleep should also be
+noted, whether it is quiet or restless, and whether the patient sleeps
+lightly or is difficult to arouse.
+
+MENTAL CONDITIONS.--It is important to watch carefully the mental
+condition of a patient; whether, for example, he is normal, or
+depressed, irritable, restless, apathetic, dull, excited, wandering,
+delirious, or unconscious. Hasty judgment of mental conditions should
+be avoided, but close attention to them is necessary.
+
+
+SUBJECTIVE SYMPTOMS
+
+PAIN is the most important subjective symptom and should never be
+disregarded. Bodily pain does not occur in persons who are in all
+regards physically and mentally well; hence pain is a sign that
+something, small or great, is out of order.
+
+      "Of all symptoms pain is the one which interests patients
+      the most. We here emphasize the truth, too little
+      understood, that pain is an unpleasant sensation, nothing
+      more, and is _never_ imagined. Imagination may be its
+      cause, but the pain thus produced hurts just as truly as
+      pain produced by a real disease. Pain is only a phenomenon
+      of consciousness; it is always real, even that felt in a
+      dream. If the patient is too unconscious to feel it, there
+      simply is no pain, no matter how badly the person's body is
+      injured." (Emerson: Essentials of Medicine, p. 356.)
+
+One should remember that no possible method exists to measure the
+intensity of pain exactly, or to describe its quality accurately.
+Therefore in describing pain, it is best to use the patient's own
+language. Four points should especially be observed, (1) its location;
+(2) its character, which may be dull or sharp, stabbing, throbbing or
+continuous, slight or severe; (3) the time at which it is worst; certain
+diseases, for instance, are characterized by more severe pain at night;
+(4) it should be noticed whether the pain is relieved or increased by
+change of position, eating or drinking, heat or cold, or the like. Pain
+may be felt in a part far from the place where the trouble really lies;
+thus a dislocated shoulder causes pain in the elbow.
+
+Pain is always a danger signal, although the significance is not always
+so great as the sufferer thinks. The more attention a patient gives to
+his pain, the more severe it always becomes, therefore his attention
+should not be called to it unnecessarily. A good observer, however, can
+get much information by noticing the patient's expression, position,
+motions, etc., without constantly asking him how he feels. Although many
+persons overestimate pain, others persistently disregard it, either
+because they are unwilling to take the necessary measures to remedy it,
+or because they wish to appear heroic. Both courses of action are
+mistaken; everyone should realize the folly and danger of bearing pain
+if it is possible to remove the cause.
+
+Nausea, fatigue and malaise are other subjective symptoms; malaise is
+the name given to a general feeling of physical discomfort not
+restricted to any one part of the body. All three are abnormal when
+there is not apparent or sufficient cause.
+
+RECORDS.--An accurate record should be kept of the patient's symptoms,
+medicine, diet, treatment, etc., so that the doctor may have a
+continuous record, and so that another person taking charge temporarily
+may know just what has been done for the patient. The record must be
+written; otherwise details cannot be remembered exactly. It should be as
+simple and concise as possible; it is the place for facts, not for
+opinions, and if inaccurate it is worse than none. It is better not to
+keep the record in the patient's room, for the patient should not see
+his own record, nor hear its contents discussed. The doctor usually
+writes his orders on the record sheet itself, or on a separate sheet to
+be attached to the record for reference. Blank record forms can be
+purchased, but a form that is made at home is entirely satisfactory. An
+example of a daily record sheet follows.
+
+
+                                  RECORD
+
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+   Date |  Hour    |Tem.|Pulse|Resp.|   Diet and     |B.M.|Urine|Remarks
+        |          |    |     |     |   medicine     |    |     |
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+  1916  |          |    |     |     |                |    |     |
+  Jan. 1|4 p.m.    |100°| 76  | 24  |Medicine        |    |     |
+        |5 p.m.    |    |     |     |                | 1  |oz.  |
+        |          |    |     |     |                |    |vii  |
+        |6 p.m.    |    |     |     |Supper:         |    |     |
+        |          |    |     |     | Baked potato,  |    |     |
+        |          |    |     |     | toast, fruit,  |    |     |
+        |          |    |     |     | tea.           |    |     |
+        |8 p.m.    |    |     |     |Medicine        |    |     |Sponge
+        |          |    |     |     |                |    |     |bath.
+        |9:30 p.m. |    |     |     |                |    |     |Asleep.
+  Jan. 2|3 a.m.    |    |     |     |                |    |oz.  |
+        |          |    |     |     |                |    |ix   |
+        |8 a.m.    |99° | 74  | 22  |Medicine        |    |     |Patient
+        |          |    |     |     |                |    |     |slept
+        |          |    |     |     |                |    |     |most
+        |          |    |     |     |                |    |     |of the
+        |          |    |     |     |                |    |     |night.
+        |8:30 a.m. |    |     |     |Breakfast:      |    |     |
+        |          |    |     |     | Cereal, orange,|    |     |
+        |          |    |     |     | toast, coffee. |    |     |
+        |9:30 a.m. |    |     |     |Bath.           |    |     |
+        |11:30 a.m.|    |     |     |                |    |     |Sat up
+        |          |    |     |     |                |    |     |1 hour.
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+
+TUBERCULOSIS, CANCER, AND MENTAL ILLNESS.--As we have seen, early
+symptoms of sickness are always important; yet it seems worth while to
+mention particularly the early symptoms of tuberculosis, cancer, and
+mental disorders, because each of these diseases, though curable in
+many cases when taken in the early stages, is serious and often fatal
+if neglected. Certain facts relating to their cause and prevention
+should be known to everyone. Tuberculosis, long our greatest cause of
+death, is gradually growing less; but cancer and mental disease are now
+on the increase.
+
+TUBERCULOSIS.--Every year tuberculosis causes the death of about 150,000
+people in the United States. It is caused by the bacillus tuberculosis,
+a germ which may attack any tissue of the body, although it most
+frequently affects the lungs of grown people, and the bones and glands
+of children. The disease is not inherited, but susceptibility to it
+appears to be; it is readily communicated from person to person. The
+germ of tuberculosis is so widely distributed that probably few persons
+over 30 years of age have not been infected with it at some time,
+although the infection may have been too slight to be noticed. Indeed,
+most people have probably been infected many times, though without
+serious results.
+
+Tuberculosis is spread chiefly in two ways: (1) through any bodily
+discharges from infected persons, especially through the nose and mouth
+discharges; (2) through milk from infected cows. The ways by which the
+disease is spread indicate methods of prevention. Milk, especially for
+children, should either be pasteurized or should come from cows that
+have been tested and proved to be free from the disease. Other methods
+of prevention include avoiding any and all bodily discharges of infected
+persons, and increasing bodily resistance as far as possible. Good food,
+sufficient rest and fresh air are not only important preventives, but
+also the most efficacious means of cure. Persons who suffer from
+insufficient food, exposure, bad housing, long hours, and bad conditions
+of work are especially susceptible to tuberculosis, and thus it is
+rightly called a disease of poverty.
+
+Early symptoms of tuberculosis include cough, hoarseness, loss of
+appetite, pain in the side, loss of weight, getting tired easily,
+feeling run down, rise in temperature in the afternoon, night sweats,
+expectoration, and spitting blood. No one, nor even several, of these
+symptoms necessarily indicates the presence of tuberculosis; on the
+other hand, even the cough is not necessarily present when tuberculosis
+actually exists. When one or more of these symptoms appears and
+continues, a thorough examination should be made by a doctor;
+examination can do no harm, certainly, if tuberculosis is not found, and
+if it is, immediate treatment is of the greatest importance. No known
+drug or medicine is a cure for tuberculosis. Successful treatment
+depends on taking the disease in time and in following the doctor's
+advice unremittingly.
+
+CANCER.--The cause of cancer is not known. All the evidence, however,
+goes to show that it is neither communicable nor hereditary. Cancer may
+occur on the skin, stomach, or other organs; in women it most commonly
+occurs in the breast or uterus (womb). In both sexes it occurs most
+frequently after 40 years of age. No known medicine will cure cancer;
+salves and ointments have no effect. Radium and _x_-ray should not be
+relied upon if the cancer can be removed by operation. Safety consists
+in removing the growth entirely, and complete removal is possible only
+in the early stages.
+
+Early diagnosis is consequently of the greatest possible importance, and
+an examination can do no harm in any case. Warts and moles on the skin
+may develop into cancer, and should be removed if they show signs of
+irritation. Loss of appetite and weight, any disturbance of the stomach
+or intestines, and sores that refuse to heal should lead a person to
+consult a physician; the same is true of any lump in the breast, and of
+irregular or persistent bleeding from the uterus in women over forty.
+The fact that pain is not present in cancer until the late stages leads
+many persons to neglect the trouble until it is too far advanced for
+operation. Time is all-important; hope depends on operation in the early
+stages when there is a very great probability of permanent cure.
+
+MENTAL ILLNESS.--Insanity, like cancer, is increasing. Like both cancer
+and tuberculosis, hope lies in prevention and early treatment; and like
+them both, in its early symptoms it is too often unrecognized or
+neglected.
+
+Many people are surprised to learn that known, avoidable causes are
+responsible for the condition of about 50% of the insane patients now
+under treatment. Chief among these known causes is a communicable germ
+disease called syphilis, to which is due the disease called paresis, or
+"softening of the brain." About 25% of patients admitted to hospitals
+for the insane are there from the effects of habitual use of alcohol,
+even in "moderate" quantities. Other cases of insanity result from
+diseases of the heart, arteries, and kidneys, and still others have been
+traced to the poisons of tuberculosis, typhoid, diphtheria, and other
+communicable diseases. Prevention of insanity caused by these diseases
+depends upon prevention or complete cure of the diseases themselves.
+
+Still other causes of insanity are known. Hereditary nervous weakness
+may predispose to insanity, and for such persons, those whose nervous
+resistance is naturally not very great, the stress of living may prove
+too much. Mental breakdowns are rarely caused by overwork unless
+accompanied by worry or bad hygienic conditions, but they result not
+infrequently from bad mental habits.
+
+      "The average person, little realizes the danger of brooding
+      over slights, injuries, disappointments, or misfortunes, or
+      of an unnatural attitude towards his fellowmen, shown by
+      unusual sensitiveness or marked suspicion. Yet all these
+      unwholesome and painful trains of thought, may if persisted
+      in and unrelieved by healthy interests and activities, tend
+      towards insanity. Wholesome work relieved by periods of
+      rest and simple pleasures and an interest in the affairs of
+      others, are important preventives of unwholesome ways of
+      thinking. We should train ourselves not to brood, but to
+      honestly face personal difficulties."--(Why Should Anyone
+      Go Insane?, by Folks and Ellwood.)
+
+Prevention of insanity consequently depends chiefly upon avoiding
+alcohol and communicable diseases, especially syphilis; upon good
+hygiene, self-control, and avoidance of bad mental habits; and upon
+adopting a program of living and working that will not overtax one's
+nervous strength. Sleeplessness, unusual nervous fatigue following
+slight exertion, and diminished power to control the emotions, are among
+the danger signals. And when a person becomes unusually depressed or
+morose, excited or irritable, suspicious, unreasonable, or "queer," it
+is probable that expert medical advice should be obtained as quickly as
+possible.
+
+
+EXERCISES
+
+1. What is a symptom? Why are early symptoms especially important?
+
+2. Distinguish between objective and subjective symptoms.
+
+3. Tell all you can about normal and abnormal variations in the body
+temperature. What symptoms would lead you to take a person's
+temperature?
+
+4. Describe the method of taking temperatures.
+
+5. How should you cleanse a clinical thermometer? What are the dangers
+of neglecting to cleanse it properly?
+
+6. Describe both normal and abnormal pulse and respiration.
+
+7. Discuss the significance and importance of pain.
+
+8. Describe early symptoms of tuberculosis, cancer, and mental illness.
+What is the first step to be taken when any one of these symptoms
+appears?
+
+9. What symptoms of all those mentioned in this chapter did you notice
+in the last sick person with whom you had anything to do?
+
+10. What are the essentials of a good daily record? The following is an
+account that a mother gave of the first twenty-four hours of a child's
+illness. Make a chart for the patient, and include in it all the
+information the mother gave. Which do you consider more useful, your
+chart or the narrative?
+
+"Yesterday, October 10th, Johnny came home from school about half past
+three, and said he was too cold to play outdoors. He lay down and slept
+till about five, when he vomited a large amount of undigested food. I
+took his temperature and found that it was 103.8°, pulse 126, and
+respiration 28. At 10 that night his temperature was 102.5°, pulse 116,
+and respiration the same as before. The next morning at 8 he had a
+temperature of 100.6°, pulse 114, respiration 24. At noon his
+temperature was 101°, pulse 118, respiration 24; and at 4 o'clock his
+temperature was 100.6°, pulse 122, respiration 22. The doctor came at 6
+o'clock yesterday afternoon; according to his orders I put Johnny to
+bed, gave him half a tablespoonful of castor oil at 6.30, and a special
+gargle. His throat was red and sore and he seemed to feel very
+miserable. The doctor took a culture from the child's throat. At 8.15
+and again at 8.50 he had fluid bowel movements. At 9.30 he had a glass
+of milk, after which he slept until 6 a.m. when his bowels moved again
+and urine was passed. He passed eight ounces of urine at noon and four
+ounces at 3.30. He drank a glass of water at 6 this morning, and at 6.30
+I gave him a cup of hot broth. At 8 he had a glass of milk, but at 10 he
+refused everything but a glass of water. At 1.30 he had a large dish of
+ice cream. He had a cool sponge bath last night at 9, and a cleansing
+bath this morning at 8.45. This morning his throat was still sore but
+not so red, and I saw that he gargled every half hour when he was awake.
+This afternoon he seems brighter and asked for his harmonica, so his
+throat is probably more comfortable."
+
+
+FOR FURTHER READING
+
+Essentials of Medicine--Emerson, Chapters XVI, XVII.
+
+The Human Mechanism--Hough and Sedgwick, Chapter XII.
+
+Notes on Nursing--Florence Nightingale, Pages 105-136.
+
+Why Worry?--Walton.
+
+Those Nerves--Walton.
+
+Tuberculosis: Its Cause, Cure, and Prevention--Otis.
+
+Publications of the National Association for the Study and Prevention of
+Tuberculosis--105 East 22d Street, New York City. (Pamphlets free on
+request.)
+
+Publications of the National Committee for Mental Hygiene--50 Union
+Square, New York City. (Pamphlets free on request.)
+
+Publications of the Mental Hygiene Committee of the State Charities Aid
+Association--105 East 22d Street, New York City. (Pamphlets free on
+request.)
+
+Publications of The American Society for the Control of Cancer--25 West
+45th Street, New York City. (Pamphlets free on request.)
+
+
+
+
+CHAPTER V
+
+EQUIPMENT AND CARE OF THE SICK ROOM
+
+
+Adequate care of the sick consists to a large extent in rendering their
+physical and mental surroundings as favorable as possible. Obviously, a
+sick person, since his strength is already depleted, needs not only to
+have his resistance increased in all possible ways, but also to have all
+his remaining strength conserved by eliminating every unnecessary tax
+upon it. In sickness even slight fatigue, chill, or nervous strain,
+insufficient ventilation, or improper feeding, may become factors of
+immense importance. Nothing is trivial if it affects the welfare and
+comfort of a patient.
+
+Even when perfect provision for the care of the sick is out of the
+question, every effort should be made to insure as satisfactory
+arrangements as possible. Ideal conditions are seldom found except in
+buildings originally planned for the sick; yet in many houses a few
+simple changes will produce excellent results. Of course, it is not
+necessary in every case to adopt all the following suggestions. Common
+sense must be the guide. For instance, in illness that is slight and
+likely to be of short duration, a patient may be more distressed than
+benefited by radical changes in his surroundings. Except when certain
+essentials are concerned, great consideration should be given to a
+patient's preferences; yet on the other hand it is not reasonable to
+make an entire family miserable in order to gratify some slight whim.
+
+CHOICE OF A SICK ROOM.--A south or east exposure is generally best for a
+sick room. A south room may be undesirable in very hot weather, but
+sunshine during a part of the day is essential. The room should be
+quiet, near the bath room, and well removed from odors from the kitchen.
+It should be situated so that good ventilation is possible. It is
+desirable though not necessary for it to have more than one window; in
+summer the windows must be thoroughly screened. It should be possible to
+open the window without exposing the patient to a direct current of air,
+and to open the door without placing him in full view of all who pass
+through the hall.
+
+It is essential for the patient to have a room to himself. Unless he
+needs care or help or watching at night, not even the person caring for
+him should sleep in the room. Neither should the rest of the family
+keep their possessions in the sick room. Closets opening into the room,
+bureaus, and chiffoniers should be emptied of the belongings of other
+members of the family, to prevent people from tiptoeing into the sick
+room at all hours to remove garments. The sick room should for the time
+belong exclusively to the patient, and resulting inconvenience should be
+borne by well members of the family.
+
+Every possible precaution should be taken to exclude from a sick room
+unnecessary noises of all kinds; flapping curtains, squeaky doors and
+rocking chairs, heels without rubber, creaking corsets, noisy
+petticoats, ticking clocks, refractory bureau drawers, and rustling
+newspapers are among the everyday sounds that irritate the nerves of
+sick and well alike. Ordinary out-of-door noises do not usually disturb
+the sick, except when the country patient is brought to the city, or the
+reverse; but nearby and generally avoidable noise is the kind that
+distracts and harasses nervous patients.
+
+Whispering is an annoying sound and should not be allowed, either in the
+patient's room or just outside the door. Whatever the subject of
+conversation may be, the patient thinks that he is under discussion.
+Anything undesirable for him to hear should be settled well out of his
+hearing, and in speaking to him there is no possible objection to an
+ordinary well modulated voice.
+
+Usually a person's own room is more restful and less disturbing than a
+strange place, but if it serves as a work room as well as a bed room, it
+may easily be the worst place during sickness. The sight of a desk piled
+high with papers or a basket overflowing with accumulations of family
+mending may actually delay recovery; even the room itself may constantly
+suggest work, and work necessarily left undone. The essential thing to
+remember is that mental rest is no less important than physical, and
+every effort should be made to secure them both.
+
+FURNISHING.--Superfluous articles add to the care of a sick room, and in
+consequence they should be removed at the outset. All the furnishings
+that remain should be easy to clean, but it is not necessary for a sick
+room to look bare and desolate.
+
+The woodwork as in any other room should have a hard finish, and angles
+and corners that harbor dust should be as few as possible. Hard wood
+floors without cracks are best from the point of view of cleanliness and
+convenience. A few light, washable rugs make the best floor covering,
+but very small rugs on highly polished floors slide easily and are
+decidedly dangerous. Carpets diminish noise, but are objectionable from
+every other point of view.
+
+In furnishing houses people ought to realize more frequently than they
+do how greatly nervous fatigue may be increased by ill chosen wall
+coverings. Plain papers or tinted walls are best for bed rooms and the
+color should not be harsh or striking; soft gray, green, or buff is
+good. The design is no less important than the color; a design that on
+casual inspection appears quite harmless may become an instrument of
+torture to a person unable to escape from it for a single hour. Weak or
+nervous patients sometimes become quite exhausted from attempting to
+follow an intricate pattern, or from counting over and over a design
+that is frequently repeated on the wall. If the patient sees grotesque
+faces and figures in the design the paper is more objectionable still.
+
+Necessary furniture includes the bed, which will be discussed in detail
+later, a small table to stand by the head of the bed, a dresser, two
+chairs, and a wall thermometer. If the patient is able to sit up three
+chairs are needed, of which one should be an armchair with a high back.
+No rocking chair should be allowed in the room unless the patient
+himself prefers to sit in one; no one else should be allowed to rock in
+the room, since the motion is almost always annoying to patients.
+Elaborate, carved, or upholstered furniture is unsuitable in a sick
+room, but if it must be used it should have washable covers.
+
+Other desirable articles of furniture are a couch, screen, foot-stool
+and a second, larger table. In few cases, if any, is anything further
+really necessary, although patients frequently desire special articles
+to which there can be no objection.
+
+Most ornaments add much work and little beauty, and have no place in a
+sick-room. No heavy unwashable curtains or hangings should be allowed,
+but simple washable curtains and clean white covers for the tables and
+dresser are desirable. Pictures, if suitable, give much pleasure, but
+must be used with discretion. It goes without saying that the subjects
+should be pleasant, but not everyone realizes that complicated subjects
+are undesirable and that pictures of people or things in motion should
+be avoided; patients are sometimes worried to see motion that is forever
+incomplete.
+
+Flowers give great pleasure to the sick by adding color and variety and
+interest to their surroundings. They should be carefully tended and
+given fresh water daily. Fading flowers and forlorn plants should be
+removed from the sick room, and those having strong, heavy odors should
+not even be admitted. They do not need to be very many or very
+expensive; indeed, a potted plant or a few cut flowers are often more
+acceptable than the great masses of costly flowers that are daily
+brought to the private wards of hospitals.
+
+VENTILATION.--A patient needs fresh air certainly as much as a well
+person, and probably even more. His room should be thoroughly ventilated
+night and day. A fireplace makes the problem easier, but in most cases
+an open window is the main dependence. It should be possible to open
+windows at the top as well as at the bottom, and the patient may be
+protected from a direct draught by a screen, or by a sheet stretched
+along the side of the bed and fastened at the head and foot by tying it
+around the posts.
+
+Ventilating a room without subjecting the patient to draughts is not
+always easy. One method is to insert a board three or four inches high
+under the lower sash so that air is admitted between the two sashes.
+Another way to ventilate without causing a draught is to remove one or
+two panes of glass and tack cheese cloth over the opening; or to tack
+cheese cloth to the lower edge of the upper window casing and to the
+upper edge of the upper sash, after the sash has been lowered about a
+foot. Once or twice a day the room should be thoroughly aired by opening
+windows and doors until the air has been completely changed. The
+patient, including his head, must be well-covered during the process.
+An electric fan is useful in summer, but it should not be close enough
+to the bed for the patient to feel air blowing upon him.
+
+HEATING.--Great care should be taken to maintain a suitable temperature
+in the sick-room, and for this purpose a thermometer in the room is a
+necessity. Between 65° and 68° is generally the best temperature, and
+hot water bags and extra covers may be given if the patient is chilly.
+During a bath or other treatment in which the patient is more or less
+exposed the temperature should be 70°. The temperature at night may be
+lower; how low will depend largely on the patient's condition and on
+what must be done for him during the night. Hot water, steam heat, or
+electricity is best for the sick room. Gas or oil stoves should never be
+used except in emergencies, and then for a short time only.
+
+LIGHTING.--Sunlight is one of the most powerful disinfectants, and for
+this reason if for no other it is needed in every sick room. Sunless
+rooms, moreover, even if they were wholesome, are too depressing to a
+patient's spirits for use except perhaps in hot summer days. Ordinary
+well-regulated light is best in a sick room, and except in a few
+diseases, especially those in which the eyes are affected, it is
+undesirable to darken the room or to encourage in any way an appearance
+of gloom. The patient's eyes, however, should be protected from bright
+lights shining directly upon them; in this connection it is well to
+remember that lights and their reflections strike differently upon the
+eyes of a person lying down from the way in which they strike the eyes
+of persons sitting or standing, and a light that seems agreeable to the
+attendant may therefore be painful to the patient.
+
+Almost all persons sleep best in dark rooms, and in most cases it is
+undesirable for a sick room to be lighted at night. The attendant,
+however, must be able to see what she is doing and generally needs a
+shaded candle, small night light, or electric flash. It should be
+possible to see the patient clearly in case of need, otherwise serious
+changes in his condition occurring in the night may pass unnoticed.
+
+A reading lamp on the bedside table is desirable for patients allowed to
+read, but reading in bed even with a well-regulated light is fatiguing,
+and should not be continued for long uninterrupted periods. A pocket
+flash light is safer than matches and a candle for patients who wish to
+consult their watches in the night; indeed, matches in the hands of
+patients always involve risk. Some patients find twilight a time of
+great depression. In such a case it had best be shortened by drawing
+the shades early, turning on the lights, and remembering not to leave
+him alone.
+
+CLEANING.--The sick-room should be kept thoroughly clean at all times,
+and the less dust stirred up in doing so the better. Dry sweeping or
+dusting should not be allowed. Ordinary brooms should be dampened or
+covered with damp cloths, and dust cloths should be dampened also; but
+dustless mops and dusters are still better. Vacuum cleaning is very
+desirable; the noise, which is its only disadvantage, is not a serious
+objection in most cases. The cleaning of rooms after a communicable
+disease will be considered later.
+
+A sick room must be kept tidy as well as clean. The effect of order is
+quieting, but it should be maintained whether the effect upon the
+patient is apparent or not. Food and medicine should not be kept in the
+sick-room, and all used dishes, tumblers, soiled linen, etc., should be
+removed at once. Unnecessary articles should not be found in the room at
+any time; every necessary article should be kept in its place, and its
+place should be a good one.
+
+Maintaining order in the room does not mean that patients should be made
+uncomfortable. All patients, especially old people, want certain
+possessions within reach, and their wishes should be considered in spite
+of the fact that the æsthetic effect is generally far from good. For
+instance, a perfectly smooth bed is undesirable if in order to make it
+smooth the patient must be tucked in so tightly that he is
+uncomfortable. And it would be a mistake to remove an old man's
+newspapers before he has read them, even if he persists in strewing them
+all over the floor.
+
+THE ATTENDANT.--One person and one person only should carry the entire
+responsibility for the patient. She should plan for him as well as care
+for him, should see the doctor and take the doctor's orders. Confusion
+and innumerable mistakes result when several members of the family
+attempt to do the talking and directing.
+
+The attendant should wear washable dresses with sleeves that can be
+rolled up, washable aprons, and shoes with rubber heels. All her
+clothing should be comfortable. She should be neat in appearance,
+scrupulously clean in person, and should keep her finger nails short and
+smooth. Jewelry, especially rings and chains that rattle, and finery of
+any sort are all out of place in a sick-room.
+
+The attendant must learn that her own sleep, her diet, and her
+out-of-door exercise are essential to the patient's well-being hardly
+less than to her own. An amateur nurse often considers that going
+without food and sleep is a proof of her devotion. In a passion of
+self-sacrifice she neglects herself utterly for the first few days, and
+as a consequence is quite useless at a later period when her services
+may be most needed. An exhausted, sleepy nurse, trained or untrained, is
+wholly unfit to be trusted with medicines and doctor's orders, to note
+changes in the patient's condition, or to give him kindly attention.
+Efficiency and fatigue have never pulled together since the world began,
+and no one can do good work when suffering from lack of sleep and rest.
+
+The person, then, who genuinely wishes to give her patient the best
+possible care should not make a martyr of herself. She should go out of
+doors daily; both fresh air and occasional absence from the patient are
+essential to her physical and mental well-being. Moreover, she will be
+showing her patient the greatest kindness in the long run if during her
+recreation time she thinks of him as little as possible. Indeed, she
+need not consider herself inhuman if she has a thoroughly good time.
+
+On the other hand, a person who is responsible for the care of a patient
+must be made to realize that she and she only is ultimately responsible
+during the entire 24 hours of every day. Being responsible for a patient
+does not mean that she should be with him every minute, or do everything
+herself: it does mean that she should plan so effectively that
+everything necessary is done, either by herself or by another competent
+person. When she goes away for even half an hour, she should appoint
+someone else to be responsible in her place and to her when she comes
+back. She must consequently make very clear just what she wants done. If
+there is medicine, nourishment, or treatment to be given, she can easily
+make a list, with the time for each, and ask that each item be crossed
+off the list as soon as the work has been done. She should not forget to
+ask for the list when she returns.
+
+What is really needed is a little executive ability. As Florence
+Nightingale said:
+
+      "It is impossible in a book to teach a person in charge of
+      the sick how to _manage_, as it is to teach her how to
+      nurse. Circumstances must vary with each different case.
+      But it is possible to press upon her to think for herself.
+      Now what does happen during my absence? I am obliged to be
+      away on Tuesday. But fresh air, or punctuality is not less
+      important to my patient on Tuesday than it was on Monday.
+      Or: At 10 p.m. I am never with my patient; but quiet is of
+      no less consequence to him at 10 than it was at 5 minutes
+      to 10. Curious as it may seem, this very obvious
+      consideration occurs comparatively to few, or, if it does
+      occur, it is only to cause the devoted friend or nurse to
+      be absent fewer hours, or even fewer minutes from her
+      patient--not to arrange so as that no minute and no hour
+      shall be for her patient without the essentials of her
+      nursing."--(Notes on Nursing.)
+
+It is exceedingly difficult to care for members of one's own family or
+to be cared for by them. Too much or too little is almost invariably
+expected by one person or the other, and where great affection is
+involved not only is the strain increased on both sides, but often harm
+results from too great unselfishness on either side or both. But
+sometimes the reverse is true, and then one should remember that normal
+behavior may be impossible for the sick. During weakness and pain,
+irritability and unreasonableness are as characteristic as other
+symptoms, and it is as foolish to demand a normal mental state from a
+sick person as it would be to demand a normal temperature. For a
+cheerful, reasonable, and unselfish patient--and there are surprisingly
+many--one should be devoutly thankful, but patience and pity should be
+given no less to those whose tortured nerves cause suffering to others
+as well as to themselves.
+
+Every woman who cares for the sick should remember that she is the
+patient's chief if not his only link with the normal world, and that his
+plight is pitiful indeed if she is complaining or irritable or
+unwilling. Anyone who cares for the sick should remember also that she
+is necessarily in a most intimate relation with the patient, and that
+such enforced intimacy calls for extra consideration on her part, and
+for the most scrupulous respect for confidential matters. It is
+inexcusable even for members of the patient's family to discuss with one
+another the patient's private concerns, or his queer or unreasonable or
+annoying ways. During sickness the skeletons in most people's mental
+closets walk forth, and anyone who misuses special opportunities to know
+intimate affairs can only be classed with eavesdroppers and village
+gossips.
+
+
+EXERCISES
+
+1. What are the essentials of a good sick room as to:
+
+  (_a_) Situation and exposure.
+  (_b_) Lighting and heating.
+  (_c_) Furnishing.
+  (_d_) Ventilation.
+
+2. How may a sick room be ventilated without exposing the patient to
+draughts?
+
+3. How should the bed be placed in relation to doors, windows, and
+walls?
+
+4. How should a sick room be cleaned?
+
+5. What in general are the duties of the attendant?
+
+6. Make a plan of your own bedroom, and show what changes, if any, would
+be desirable if it were to be used as a sick room.
+
+
+FOR FURTHER READING
+
+Notes on Nursing--Florence Nightingale, Pages 1-63, 84-105.
+
+
+
+
+CHAPTER VI
+
+BEDS AND BEDMAKING
+
+
+The common saying that the best bed for an invalid is his own bed
+contains an element of truth. Taking from a patient his own accustomed
+bed, even when a better is substituted, sometimes disturbs him greatly
+and makes him feel that he is indeed very ill. Nevertheless, a suitable
+bed is essential to the proper care of a helpless person, and no patient
+should continue to use an unsuitable one, unless his illness is slight
+and also likely to be of very short duration.
+
+Besides being comfortable, a bed suitable for the sick must be clean and
+easy to keep in a sanitary condition. The springs should be firm, and
+the mattress should be elastic and should give an even support without
+lumps and hollows. The bed covers should be clean, light, and warm; the
+pillows should be sufficient in number not only to make the head and
+shoulders comfortable, but also any other part of the body in need of
+support. Moreover, the bed should be so placed and of such a kind that
+the work of caring for the patient may be rendered as easy for the
+attendant as possible. In every household at least one bed suitable for
+a sick person should be available in case of need.
+
+BEDSTEADS.--Beds of white enameled iron, brass, or brass and iron
+combined are most easily kept clean, and are the best in every way. The
+frame should be strong enough to stand firmly, yet not so heavy that it
+is hard to move. It should have as few angles as possible, and all its
+joints should be smooth and well finished. The springs should be made of
+wire stretched tightly on a metal frame that fits smoothly into the head
+and foot pieces. Large castors should be used; they may be removed from
+the foot if the bed moves too easily.
+
+A bed to be used in sickness should have the following
+dimensions--length, 6 ft. 6 in., height 24 to 26 inches, width, 36
+inches. If a bed is either too high or too low the labor of lifting and
+moving the patient is greatly increased. If the bed is too narrow the
+patient is insecure. If the bed is too wide, its center is difficult or
+impossible to reach without leaning or kneeling upon it; and if too
+short, it will prove uncomfortable for a tall person. A bed that is too
+low may be raised on four heavy boxes of the same height; or still
+better, upon heavy wooden blocks which any carpenter can easily make,
+and which are well worth a little trouble to obtain. In the top of each
+block a hollow should be made into which the leg of the bed will fit
+after the castor has been removed. A broad firm stool or a low chair may
+be provided for a patient who has difficulty in getting in and out of a
+high bed.
+
+Beds with complicated attachments for moving patients are not
+recommended for family use. They are expensive, likely to get out of
+order, seldom needed, and generally unsatisfactory. In some surgical
+cases a bed with a firm, flat surface is necessary. Such a surface may
+be secured by placing between the mattress and springs two boards
+slightly separated, or one wide board with holes bored in it to afford
+ventilation.
+
+Wooden beds are undesirable: they are difficult to keep clean, they
+readily absorb moisture and odors, they cannot well be disinfected, and
+their solid frames prevent a free circulation of air. Moreover, it is
+almost impossible to render fit for use again a wooden bed into which
+vermin have once made their way. Folding beds and lounges even of the
+best type are unhygienic, usually too low for the patient's comfort, and
+often insecure.
+
+A bedstead should be wiped frequently with a damp cloth; if it is of
+enameled iron it may be washed with soap and water. The springs may be
+cleansed with a stiff brush dipped in kerosene oil. Excessive use of
+water upon the springs is likely to make them rust.
+
+MATTRESSES.--Various substances are used in the manufacture of
+mattresses, but nothing has yet been found that is as satisfactory as
+curled hair. It is light and clean and elastic, it does not readily
+absorb odors, and it is easily renovated. Although hair is more costly
+than other materials, a hair mattress may be used almost indefinitely if
+it is occasionally made over.
+
+Felt or cotton mattresses are firm, but heavy, difficult to keep clean,
+and likely to absorb odors. A useful mattress made from straw is
+sometimes found in country districts. Such a bed is thoroughly hygienic,
+for the worn straw may be burned and the tick washed and refilled with
+clean straw; but straw beds are generally hard and lumpy. The least
+desirable of all mattresses is the old fashioned feather bed, and it
+should never be used if a better can by any possibility be obtained; but
+a feather bed should not be arbitrarily taken away from an old person
+accustomed to its use, unless his welfare is really at stake.
+
+A mattress made in two sections is unnecessary for a single bed; indeed,
+a mattress made in one piece is more easily kept in place if the
+patient is restless. A good quality of blue and white ticking makes a
+serviceable cover for both mattress and pillows since its color is not
+likely to run.
+
+CARE OF THE MATTRESS.--A mattress should be brushed frequently with a
+whisk broom, especially around the tufts and edges. If a patient is long
+confined to bed, a fresh one should occasionally be substituted so that
+the regular mattress may be removed, well brushed, beaten with a carpet
+beater, and left exposed to the sun and air for a day or two. A mattress
+that is badly soiled should be sent to a cleaner and made over; it
+cannot be cleaned properly at home. It is generally possible to remove
+blood stains, if they have not soaked through the ticking, by applying a
+thick cream made from raw starch and cold water. When the starch becomes
+dry it should be brushed away, and the application should be repeated
+until the stain has disappeared. For the best results the starch should
+be applied before the stain is dry.
+
+PILLOWS.--One patient can use an almost unlimited number of feather
+pillows. Some should be soft and others firm, some large and some small;
+but pillows that are very large and thick are less useful than a greater
+number of smaller ones. It is well to have several small pillows of
+varying size and thickness to support different parts of the body.
+
+Hair pillows are often acceptable in warm weather, and they are also
+desirable for patients with high fever or excessive perspiration. Rubber
+air pillows are a convenience in traveling and add much to the comfort
+of a patient when he first goes out in a carriage or motor car, but air
+pillows are not sufficiently durable for general use.
+
+If a pillow tick becomes soiled, the feathers may be transferred to a
+clean tick by making an opening about six inches long in the end of each
+pillow, sewing the ticks together, and then shaking the feathers from
+one tick to the other. The soiled tick can then be washed. If the
+feathers themselves have become soiled they should be renovated by a
+cleaner. Pillows, like mattresses, should be frequently brushed, sunned,
+and aired. They should not be held in the mouth while a clean
+pillow-case is adjusted.
+
+PROTECTION OF THE MATTRESS AND PILLOWS.--In all cases of sickness the
+mattress must be adequately protected. Neglect is inexcusable and may
+cause expense and trouble as well as discomfort to the patient.
+
+The following may be used to protect the mattress or pillows: large
+quilted pads, small pads of cotton batting covered with old muslin or
+cheese cloth, slip covers for the mattress, rubber sheets and
+pillow-cases, old blankets and quilts that may be washed easily. Heavy
+wrapping paper, builders' paper, and newspapers serve well in
+emergencies, or for a short time.
+
+RUBBER SHEETS AND PILLOW-CASES.--Soft rubber cloth, single or double
+faced, is most frequently used when it is necessary to protect the bed
+from discharges. It may be purchased by the yard. Rubber sheets should
+not be used unless they are really necessary. They are hot and
+uncomfortable, and increase the tendency to perspire. When used, a
+rubber sheet should be 1 yard wide or wide enough to reach from the
+lower edge of the pillows down to the patient's knees, and long enough
+so that it can be tucked in securely on both sides of the bed. Rubber
+sheets may be cleaned by laying them on a flat surface and washing on
+both sides with soap and water, using a small brush if necessary. After
+rinsing they should be wiped, and when thoroughly dry they should be
+rolled rather than folded, to prevent the rubber from breaking.
+
+Rubber pillow-cases are used for a patient who perspires profusely, or
+who has a discharge of any kind from the head or neck, and also when
+substances which may wet or stain the pillow are applied to the head.
+They should be put on next to the pillow, securely fastened with tapes,
+snap hooks, or buttons, and covered with the regular pillow slip.
+
+Rubber sheets and pillow-cases are not durable. They should be used
+carefully, and frequently examined for holes or worn places by holding
+them up to the light. Even a pin hole near the center may render a
+rubber sheet or pillow-case as useless as a sieve.
+
+SHEETS.--Sheets of ample proportions are necessary for comfort, and
+important for sanitary reasons as well. For a bed of the dimensions
+mentioned in this lesson sheets should be three yards long, and two
+yards wide. A safe rule for any bed is to have the sheets one yard
+longer and one yard wider than the mattress. A sheet of these dimensions
+is large enough to be tucked under the sides and foot of the mattress,
+while at least twelve inches are left to fold over the blankets at the
+top. Cotton sheets are as good as linen for general use, or even better,
+and are far less expensive.
+
+DRAW SHEETS are used to cover rubber sheets, and to protect beds when
+the rubbers are not used. In hospitals special draw sheets are usually
+provided, but an ordinary sheet folded answers every purpose. New and
+expensive sheets should not be used for draw sheets, since they are
+more likely than other sheets to become stained. Draw sheets should be
+wide enough to extend about four inches beyond the rubber sheet at the
+top and bottom.
+
+PILLOW COVERS.--Pillow covers are generally made of cotton, but persons
+who can afford the cost frequently prefer linen, especially in hot
+weather. Unless fastened with buttons or tapes, a pillow case should be
+several inches longer than its pillow. It should be wide enough to slip
+on easily, but not so wide that it wrinkles or allows the pillow to
+turn. If it is too small the pillow will become hard and uncomfortable.
+These small things, unimportant as they are to the well, may cause much
+discomfort to a restless or nervous patient.
+
+BLANKETS.--All wool blankets are both light and warm, and are
+consequently the most comfortable bed covering. But unless they can be
+dry cleaned frequently, it is better to select blankets made from one
+part wool and two parts cotton. Blankets containing equal parts of wool
+and cotton are warmer, but are more injured by washing. Very light
+blankets of wool or outing flannel are useful in summer. Double blankets
+should always be cut in two and bound at the ends, since single blankets
+are easier than double blankets to handle and wash. Patients are
+frequently too warmly covered by day. Too much warmth is enervating, it
+causes the patient to perspire, and makes him restless and more
+susceptible to draughts and to changes of temperature. Two light
+blankets are warmer and more comfortable than one heavy blanket.
+
+COMFORTERS AND QUILTS.--Heavy cotton comforters are burdensome without
+being correspondingly warm. Eiderdown quilts or those padded with wool
+are good for a patient who sleeps out of doors, or whose room is kept at
+a low temperature. Bed covers that cannot be laundered readily should be
+protected by basting on both sides of the top a wide piece of muslin or
+linen, which can be removed and washed.
+
+COUNTERPANES.--White dimity counterpanes are desirable, since they are
+light in weight, easily laundered, and inexpensive. A heavy counterpane
+is uncomfortable at any time, and still more uncomfortable in sickness.
+If a light spread is not available, a sheet makes a good substitute. A
+counterpane should be wide enough to cover the sheets and blankets at
+the sides when the bed is open, and long enough to protect the bedding
+at the top and bottom.
+
+
+BED MAKING
+
+All methods of making beds for the sick are based upon a few underlying
+principles. The aim in every case is to obtain the following results
+with the least expenditure of time and labor: first, to secure comfort
+for the patient, and to eliminate all causes of friction, irritation, or
+pressure upon his skin; next to keep the covers firmly in place, so
+that the bed will not easily become disarranged; then to protect the
+mattress, and last, to secure as good an appearance as possible.
+
+[Illustration: FIG. 12.--THE DRAW SHEET IN PLACE. (_From "Elementary
+Nursing Procedures," California State Board of Health._)]
+
+TO MAKE AN UNOCCUPIED BED, proceed as follows: remove the pillows and
+covers one at a time, and place them on chairs, near an open window if
+possible. Brush the mattress and then set it up on its ends to air, or
+turn it back over the foot board. Wipe the bedstead with a damp cloth.
+Replace the mattress after it has aired, turning it from side to side
+and from end to end on alternate days. Cover the mattress, unless it is
+enclosed in a slip cover, with a white quilted pad or an old blanket,
+and then spread the lower sheet over the mattress, so that the middle
+fold of the sheet lies upon the center of the mattress in a straight
+line from the head of the bed to the foot. Tuck the sheet under, first
+at the top and then at the bottom, drawing it so that it is firm and
+tight. If the sheet is of proper length tuck fourteen or sixteen inches
+under at the top, but take care to cover the mattress at the foot also.
+Next tuck the sheet under at the side, folding its corners to make a
+neat finish like an envelope. Place the rubber sheet, if it must be
+used, across the bed, with its upper edge where the lower edge of the
+pillows will come. A draw sheet somewhat wider than the rubber sheet is
+needed next; an ordinary sheet, folded once the long way of the sheet,
+may be used, with the fold toward the head of the bed. Tuck both rubber
+and draw sheet securely under the mattress at the side. In some cases
+the rubber sheet may be placed next to the mattress, and covered by the
+mattress pad and lower sheet. Place the draw sheet as directed, whether
+the rubber is used or not. After the lower, rubber, and draw sheets have
+been adjusted on one side of the bed, go to the opposite side, draw them
+over smoothly, and tuck them under the mattress as tightly as possible.
+
+Next spread the upper sheet over the bed so that its upper edge reaches
+to the upper edge of the mattress, and its middle crease lies over the
+middle line of the mattress, and place it right side down, so that the
+smooth side of the hem will be uppermost when the sheet is turned over
+the blankets. Place the blankets so that their upper edges lie a little
+higher than the place where the lower edge of the pillow will come, and
+tuck them in firmly at the bottom and sides. If the blankets are not
+long enough to tuck in at the foot, place the lower blanket as directed
+and the upper blanket five or six inches lower than the first. When
+tucked in, the upper blanket holds the lower one in place fairly well.
+Place the counterpane evenly and smoothly, tuck it under at the foot,
+turn its corners neatly, turn its upper edge under the upper edge of the
+blankets and fold the upper sheet down over the whole. Last of all,
+shake the pillows and place them neatly on the bed.
+
+[Illustration: FIG. 13.--THE CLOSED BED. (_From "Elementary Nursing
+Procedures," California State Board of Health._)]
+
+Practice is necessary before it is possible to make a bed quickly and
+well, and a certain amount of proficiency in making an unoccupied bed
+should be acquired before undertaking to make a bed with a patient in
+it. One should learn to work in an orderly way, without confusion,
+unnecessary motion, or jarring of the bed.
+
+TO CHANGE A PATIENT'S PILLOWS.--Stand preferably on the right side of
+the bed and slip the left arm under the patient's shoulders, supporting
+his head in the hollow of the arm. Raise him slightly and remove the
+pillows one at a time with the right hand, drawing them outward on the
+left side of the bed. Place a small pillow under his head. Shake the
+pillows, change the cases if necessary, and replace them on the left
+side of the bed, ready to be drawn back into position. Raise the patient
+as before, remove the small pillow and draw the others into place. It is
+sometimes better to hold the patient on the upper pillow while removing
+and replacing the under one.
+
+LIFTING A PATIENT IN BED.--Patients tend to slip down toward the foot of
+the bed, and they should be raised if unable to help themselves. To
+raise the patient, instruct him to flex his knees and to press his feet
+firmly upon the bed; place one arm under his shoulders, as when
+changing pillows, the other arm under the thighs, and lift him upward
+without jerking. The lifting can be done more easily by two people, and
+with less discomfort to the patient: if he is entirely helpless two
+people are necessary. Two people should proceed as follows: Let _A_
+place her left arm under the patient's head and shoulders as before, her
+right arm under the small of his back; let _B_ place her right arm also
+under the small of his back and her left arm under his thighs, and at a
+signal let them lift together. In this way the weight is so evenly
+distributed that a heavy person can be lifted without great difficulty.
+
+TO TURN A PATIENT IN BED.--A patient may be turned toward or away from
+you. In turning a patient toward you, place one hand over his farther
+shoulder and the other over his hip, and turn him toward you. Then flex
+his knees slightly. To turn a patient from you, pass one hand as far as
+possible under the shoulders, and the other as far as possible under the
+thighs. Then raising the patient slightly, draw him back toward you,
+turning him at the same time, and then flex the knees. Lastly place a
+pillow firmly against his back to support it.
+
+TO CHANGE THE SHEETS WHILE THE PATIENT IS IN BED proceed as follows:
+First collect the fresh linen and place it conveniently near the bed.
+Then draw the bedclothes from beneath the mattress, raising the mattress
+meanwhile with one hand to prevent jarring the bed. Remove first the
+spread and then the upper blanket if there are two, fold each once and
+place it on a chair. Hold the remaining blanket in place with one hand,
+while with the other you draw the upper sheet out from under it; then
+fold the edges of the blanket up over the patient to keep them out of
+the way. The upper sheet, unless soiled, may be folded once and used
+again as a draw sheet. Next remove all the pillows, unless the patient
+prefers to keep one. Then move the patient toward one side of the bed
+and turn him on his side so that he faces the edge nearest him. Roll the
+draw sheet and rubber sheet together if both are to be removed, or
+separately if the rubber sheet is to remain on the bed; then roll the
+bottom sheet throughout its entire length, and bring the three sheets,
+all rolled as flat and as tightly as possible, close to the patient's
+back. Pleat about half of the fresh lower sheet lengthwise and place the
+pleated portion as close as possible to the rolled soiled sheets. Tuck
+in the other half of the fresh sheet at the top, bottom and side, draw
+the rubber sheet if it is to be replaced back over the fresh lower
+sheet, arrange the fresh draw sheet in place, tuck it in at the side,
+and roll its free portion close to the patient's back. The fresh side of
+the bed is then ready for the patient. Lift his feet back over the
+rolled sheets keeping his knees flexed, then turn him back over the
+rolled sheets on to the fresh smooth part, remove the soiled sheets and
+arrange the fresh ones in place on the side where the patient has just
+been lying. Be careful to keep him well covered with the blanket. After
+the lower sheets are in place and firmly tucked in, spread above the
+blanket the fresh upper sheet, and over the sheet spread the second
+blanket. Hold the sheet and blanket in place with one hand while using
+the other hand to draw out the first blanket from beneath the sheet. In
+this way the patient is constantly covered by a blanket. Place the
+blanket just removed above the other and finish the bed according to the
+directions given for an unoccupied bed, using special care, however not
+to draw the covers too tightly over the patient's feet.
+
+[Illustration: FIG. 14.--CHANGING THE DRAW SHEET. (_From Pope "Home Care
+of the Sick," American School of Home Economics, Chicago._)]
+
+TO MOVE A PATIENT FROM ONE BED TO ANOTHER.--On the fresh bed have the
+lower sheets in place but not the upper covers. Place the two beds close
+together side by side, and draw one mattress a little over the place
+where the two sides meet. Loosen the draw sheet under the patient, roll
+it on both sides close to the body and draw him gently over by means of
+this sheet, moving his shoulders at the same time. If the beds are
+unequal in height, use firm pillows or folded blankets to make an
+inclined plane.
+
+[Illustration: FIG. 15.--CHANGING A PATIENT FROM ONE BED TO ANOTHER.
+(_From Pope "Home Care of the Sick," American School of Home Economics,
+Chicago._)]
+
+If the beds differ greatly in height and indeed in most cases, it is
+better to carry the patient from one bed to the other. At least two
+people are needed; one alone should never attempt to carry anyone
+heavier than a small child. One method for lifting is as follows: Let
+two bearers, _A_ and _B_ stand on the same side of the bed. If the
+patient is to be moved into the right side of the fresh bed let both
+bearers stand on the right side of the occupied bed; if he is to go into
+the left side of the fresh bed, let them both stand on the left side of
+the occupied bed. Let _A_ place one arm under the patient's shoulders
+and her other under the small of his back, while _B_ places one arm
+under his hips and the other just below his knees. Draw the patient to
+the edge of the bed, instruct him to place his arms about the shoulders
+of _A_ and to hold the body rigid, and then lift together at a given
+signal, keeping his weight well up on the chests of the bearers.
+
+Whenever a patient must be turned, lifted, carried, or moved in any way,
+let him know beforehand just what you intend to do so that he may not be
+startled, and also that he may coöperate if possible. Grasp him firmly
+but gently, avoid pinching the skin, and move him steadily and
+smoothly, avoiding jerks and false starts. Do not attempt alone more
+than your strength is amply sufficient to accomplish, and endeavor at
+all times to handle the sick with the utmost gentleness and
+consideration.
+
+
+EXERCISES
+
+1. Describe a bedstead and mattress suitable for a sick person's use,
+and tell why they are to be preferred.
+
+2. How should the bedstead be cared for? the mattress? the pillows?
+
+3. How should a mattress and pillows be protected?
+
+4. Describe in detail the bed covers that are desirable for use in
+sickness.
+
+5. Name the results that a good method of bedmaking aims to secure.
+
+6. Describe the method of making an unoccupied bed.
+
+7. How should one change the pillows of a helpless patient?
+
+8. Describe the way in which you would lift and turn a patient in bed.
+
+9. Describe the method of changing sheets and remaking a bed while the
+patient is in it.
+
+10. Why are beds and bedmaking considered so important in the care of
+the sick?
+
+
+FOR FURTHER READING
+
+Notes on Nursing--Florence Nightingale, Pages 79-84.
+
+
+
+
+CHAPTER VII
+
+BATHS AND BATHING
+
+
+Bathing is necessary in sickness no less than in health. It stimulates
+and equalizes the circulation, is soothing in feverish conditions, is
+refreshing to most people, and by affording a certain amount of exercise
+it lessens the fatigue of lying in bed. Moreover, without frequent
+bathing it is impossible to keep the skin in good condition, since
+scales of dead skin, oily matter, and solid substances left by
+perspiration collect on the surface of the body when a person is lying
+still in bed as well as when he is leading an active life. The common
+belief that sick people are likely to catch cold from bathing is quite
+unfounded; every patient, unless his condition is such that the doctor
+orders otherwise, should have one complete cleansing bath each day. In
+addition to the regular cleansing bath other kinds are often prescribed
+as medical treatment.
+
+
+CLEANSING BATHS
+
+A _tub bath_ if allowed by a patient's condition, is the most
+satisfactory kind, but special precautions must be taken to guard her
+from fatigue and chill. The bath room and everything to be used should
+be made ready before she leaves her bed. Necessary clothing and toilet
+articles should be collected and arranged conveniently, a chair covered
+with a blanket and also a bath mat should be placed beside the tub, and
+the temperature of the bath room should be regulated so that it is about
+70° F., or a little lower if the room is likely to become overheated as
+the bath proceeds. The bath water should be drawn last. Its temperature,
+tested by a thermometer, should be between 96° and 100° at the
+beginning, and may be increased if desirable.
+
+If the patient is weak, wash and dry her face, neck, and ears, and if
+necessary cut the finger and toe nails before she leaves the bed, in any
+case before she enters the tub. As soon as the patient has left the bed,
+strip it and leave it to air; then assist her into the bath room and
+help her carefully into the tub. Do not allow her to stay in the water
+more than ten minutes at most, and stop the bath at once if she shows
+the slightest sign of faintness, dizziness, exhaustion, difficult
+breathing, marked change of color, or other unusual symptom. Indeed, if
+the patient is weak or her reaction to the bath uncertain, as when she
+takes her first tub bath after an illness, someone should always be
+within call to help the attendant in case of need. A faint, heavy
+patient in a bath tub is an impossible load for one person to handle.
+
+While the patient is in the tub, soap her well, brush her finger and toe
+nails, rinse, and rub her to stimulate the circulation. Then help her
+from the tub, seat her in the chair, draw the blanket closely about her
+from neck to feet, dry her with warm towels, exposing the body as little
+as possible, and, if she is to return to bed, put on a fresh night gown,
+and wrapper and slippers. Next place the lower sheet, the draw sheet,
+and one pillow on the bed as quickly as possible, help the patient into
+bed, keeping her well covered with a blanket, and finish making the bed.
+If she seems chilly, give a hot water bag and hot drink and leave the
+blanket next her in place. After the patient has been made comfortable,
+clean the tub and put the bath room in order.
+
+Even patients supposedly able to take tub baths without assistance
+should not lock the bath room door nor be left alone a long time.
+
+BED BATH.--Practice is essential in order to give a bed bath skillfully.
+The aim is to make the patient thoroughly clean and thoroughly dry,
+without chilling, fatiguing, or exposing her, without making the bed
+damp, and without unnecessary haste or delay. One method of giving a
+bed bath follows, but any method that accomplishes these aims is likely
+to be satisfactory.
+
+First see that the room is about 70° F. and likely to remain so, and
+exclude draughts. Collect everything to be used, including a blanket to
+cover the patient, an old blanket or large bath towel to protect the
+bed, at least two other towels, one a bath towel and the other a face
+towel, two wash cloths, soap, nail brush, powder, alcohol, comb and
+brush, nail file, scissors, etc.; fresh bed and personal linen; a large
+basin containing water at 105°, a jug of hotter water, and a slop jar.
+Remove the upper bed clothes except one blanket, which should cover the
+patient constantly during the bath, and spread them where they will air;
+remove all the pillows but one, and place the bath blanket under the
+patient as the under sheet is placed in bed making. If a bath blanket is
+not used, keep the bath towel under the part that is being bathed by
+moving the towel from place to place.
+
+Next remove the night gown in the following way: Let the patient lie on
+her back, with her knees flexed; draw the gown up as far as possible,
+then raise or get her to raise her hips so that the gown may be drawn up
+above the waist. Next raise her head and shoulders with one arm and draw
+the night gown up to the neck with the other; remove one sleeve, draw
+the gown over the head and then off the other arm.
+
+[Illustration: FIG. 16.--WASHING A PATIENT WITHOUT EXPOSURE. (_Sanders
+"Modern Methods in Nursing."_)]
+
+The patient is now ready for the bath. Wet the wash cloth thoroughly,
+but hold it gathered in the hand so that it will not drip. Wash the
+face, neck, and ears first, dry them thoroughly, and next, using the
+second wash cloth, wash the arms and hands, chest and abdomen, giving
+particular attention to the armpits and navel. Raise the blanket
+slightly with one hand to keep it from becoming damp, but expose the
+patient as little as possible; the arms and legs need not remain covered
+while being washed. Dry each part thoroughly before washing the next.
+Next turn the patient on her side and wash the back, the buttocks, and
+upper part of the thighs; give special attention to the fold between the
+buttocks. Then turn the patient on her back, and wash the thighs, legs,
+and feet. If it is important to move the patient as little as possible,
+leave the back until last so that the under sheet may be changed without
+turning her again. Cut the toe nails if necessary before washing, and
+clean them carefully afterward. Unless there is a reason to the
+contrary, wash the hands and the feet in the basin, first protecting the
+bed with a towel, newspaper, or clean wrapping paper. Be sure to clean
+well between the toes, and to dry the feet thoroughly; they may need
+some friction. Throughout the bath empty and refill the basin as
+necessary.
+
+Wash the genital region last. Let the patient lie upon her back with
+knees flexed and separated, or upon one side with the knees flexed and
+one slightly raised. Patients who are able may take this part of the
+bath themselves with whatever assistance may be necessary. The
+attendant, however, must either do it herself or make sure that the
+patient does it thoroughly. To neglect a helpless patient is always
+unkind, and no less unkind when the motive is a mistaken sense of
+modesty. If discharge from the genitals is present use absorbent cotton,
+or clean, soft old cloth to wash the parts, and burn it afterward. It is
+sometimes desirable to place the patient on a bedpan and rinse the parts
+by a gentle stream of warm water poured from a jug. After the attendant
+has completed this part of the bath she should wash her own hands
+thoroughly.
+
+After the bath rub the patient with alcohol. If a complete alcohol rub
+is impossible, at least rub the points where pressure comes, especially
+the back. After the rub apply a little toilet powder if the patient
+desires it. When the toilet is complete remove the bath blanket, remake
+the bed and put the room in order.
+
+CARE OF THE MOUTH AND TEETH.--In sickness the mouth and teeth require
+more than ordinary attention; indeed, the condition of a patient's mouth
+is a fair index to the quality of the care she is receiving. If the
+patient can brush her own teeth she should do so in the morning, at
+night, and after meals. At those times the attendant, without waiting to
+be asked, should bring her a towel, tooth-brush, cup of tepid water,
+tooth paste or powder, and a small basin or dish to receive the used
+water. The process is generally more thorough when the patient does it
+herself, and even a patient unable to sit up can brush her teeth
+successfully if the nurse holds the powder and cup of water, and
+provides a basin shallow enough for the patient to use by turning her
+head to one side.
+
+[Illustration: FIG. 17.--THE NURSE ASSISTING THE PATIENT IN BRUSHING THE
+TEETH. (_From "Elementary Nursing Procedures," California State Board of
+Health._)]
+
+The attendant must cleanse the mouth of a patient who is unable to do it
+herself. If this cleansing is neglected, a dark tenacious substance
+collects upon the teeth and gums, composed chiefly of food particles,
+bacteria, mouth secretions, and worn out cells of the mucous membrane.
+Once formed it is difficult to remove, hence the mouths of all patients
+and especially those who have fever, must receive proper care from the
+very beginning of illness. Cotton swabs are convenient for cleansing the
+mouth; they are made by winding a small piece of absorbent cotton upon a
+match or wooden tooth-pick.
+
+To cleanse the mouth of a helpless patient, take to the bedside the
+mouth wash prescribed by the doctor, a towel to protect the bedclothes,
+several swabs, and a receptacle for used swabs; the latter should be a
+strong paper bag or several thicknesses of newspaper. Clean the tongue,
+gums, teeth, and spaces between the teeth gently but thoroughly, using
+especial care if the gums are tender. Dip only clean swabs in the
+solution, discard each one after using it once, and burn it afterward.
+Let the patient rinse her mouth after cleansing it if she is strong
+enough. If the mouth is very dry, encourage her to drink more water.
+Notify the doctor if the gums and tongue crack or bleed since he may
+wish to order a special mouth wash. Cold cream or boracic ointment may
+be used if the lips are dry and cracked.
+
+False teeth should be thoroughly brushed and cleansed, and kept in cold
+water if taken out during the night.
+
+CARE OF THE HAIR.--Long hair, if neglected, becomes tangled and matted
+in a surprisingly short time. Unless the patient is actually in a dying
+condition she is not too sick to have it properly attended to at least
+once a day. Before combing the hair protect the pillow with a towel;
+then part the hair in the middle from the forehead to the nape of the
+neck, and draw it to either side. Begin to comb at the ends, holding the
+strand of hair firmly in one hand placed between the head and the comb;
+in this way tangles can be removed without hurting. After combing and
+brushing the hair, braid it in two braids, beginning near the ears; draw
+it as tightly or loosely near the head as the patient prefers, but
+remember that tight braids mean fewer tangles. If the hair is heavy or
+badly tangled the patient may be too much fatigued to have it all combed
+at one time; in this case braid the part that has been finished and
+complete the work later.
+
+TO WASH THE HAIR OF A BED PATIENT.--The hair of a patient can be
+successfully washed in bed if sufficient care is taken not to chill or
+tire the patient, or to wet the bed. The following articles are needed:
+one small jug of strong soap suds made by dissolving a pure soap in hot
+water, one large jug of hot water at about 112° F., one jug of cold
+water, a slop jar or foot tub, one long rubber sheet or piece of enamel
+cloth, and several towels including at least one bath towel. Let the
+patient lie as near the edge of the bed as possible. Roll one small
+towel lengthwise, place it below the hair at the back of the neck, bring
+it up above the ears to the forehead and pin tightly, in order to catch
+water that might wet the face and neck. Next make a kind of trough of
+the large rubber by rolling its long edges inward for a few inches.
+Place this across the bed under the patient's head so that her neck
+rests on the lower roll. Raise by means of pillows the end of the rubber
+trough that lies toward the middle of the bed, in order to prevent water
+from running into the bed or collecting under the patient's head. Let
+the other end of the rubber extend over the edge of the bed down into
+the slop jar or foot tub, which may be placed on a chair or stool. Then
+wash the hair and scalp with the soap solution, and rinse them
+thoroughly with water from the large jug. Squeeze as much water as
+possible from the hair, remove the rubber and substitute a heavy bath
+towel, and rub and fan the hair until dry. A shampoo in bed is tiring.
+Do not attempt it unless the patient is strong enough to stand not only
+the shampoo itself, but also a complete change of bed clothing, which
+will almost certainly be necessary if the attendant has been careless or
+clumsy in the slightest degree.
+
+HOT FOOT BATHS properly speaking are medical treatment, but they are
+taken by many persons to relieve colds, headache, or insomnia. Let the
+patient sit, well wrapped, with her feet in water at about 105°, and
+then increase the temperature gradually by adding hotter water. Take
+care to add hot water slowly and not to pour it directly upon the
+patient's feet or ankles; otherwise she may be scalded. Mustard may be
+added to the bath water in the proportion of one tablespoonful of
+mustard to each gallon of water. If mustard is to be used make it into a
+smooth paste with cold water, thin the paste with warm water, and when
+thin enough to pour easily add it to the bath water and stir well. The
+bath may continue for 10 to 20 minutes, and the feet should be dried
+afterward without friction. The patient should go to bed at once; she
+should not wander about, clearing away her foot bath, doing forgotten
+things, getting herself chilled, and losing all the good effects.
+
+A foot bath may be given easily to a patient in bed. Bring to the
+bedside a blanket, a towel, the tub filled with water, and something
+with which to protect the bed; this may be a rubber sheet, bath towel,
+old blanket folded, or several thick clean newspapers. Loosen the upper
+covers at the foot of the bed, fold them back above the patient's knees,
+and cover her legs and feet with the extra blanket making it overlap the
+bed clothing so that it will not slip. Flex the patient's knees, put the
+bed protector under her feet, place the tub on the side of the bed,
+raise the legs and feet with one hand and arm, and slide the tub into
+place with the other, raising the elbow in such a way that it keeps the
+blanket out of the water. Lower the feet slowly into the water, fold the
+towel, and place it over the edge of the tub in order to protect the
+patient's knees from the cold rim; then tuck the blanket closely about
+the tub and legs and proceed as before. After the bath use the towel,
+unless it is wet, to receive the feet when they are withdrawn from the
+tub. Remove the tub, dry the feet thoroughly, cover them warmly, and
+remake the bed.
+
+COOL SPONGE BATH.--For feverish patients doctors often order cool sponge
+baths. In order to give a cool sponge bath, first protect the bed
+thoroughly, but leave the patient uncovered except for a towel laid over
+the hips. Use cool water, or cool water and alcohol, and have the wash
+cloth as wet as it can be without dripping. Bathe the body without
+friction, using long, light strokes, and leave each part wet until the
+bath has been completed. Do not use soap. Sponge in this way the arms,
+legs, chest, and back, but not the abdomen, for ten to twenty minutes,
+giving special attention to the neck and inner side of the arms and
+legs, because in those places large blood vessels lie nearer the surface
+of the body. After finishing the bath dry the body by patting it gently
+with towels.
+
+Take the patient's pulse occasionally during the bath, and stop the bath
+at once if the patient's pulse grows weaker, if she shivers violently,
+or if her face, fingers, or toes turn a bluish color. Babies react
+rapidly to cool sponging; for a baby use tepid water, sponge for five
+minutes only, and watch the child closely during the bath.
+
+
+EXERCISES
+
+1. What may a bath be expected to accomplish in addition to cleansing?
+
+2. In giving a tub bath, what precautions should be taken to avoid
+chilling the patient? to avoid tiring the patient?
+
+3. What symptoms would lead you to think that a tub bath was not
+agreeing with a patient? What should you do in such a case?
+
+4. Name six essentials of a skillfully given bed bath.
+
+5. What preparations should be made and what articles assembled before
+beginning a bed bath?
+
+6. Describe the method of bathing a patient in bed.
+
+7. What care should the mouth and teeth of every sick person receive?
+How should such care be given to a patient who is helpless?
+
+8. Describe the daily care of a patient's hair, and tell how a shampoo
+may be given to a patient in bed.
+
+9. How should you give a mustard foot bath to a patient in bed?
+
+10. When and how should you give a cool sponge bath?
+
+
+FOR FURTHER READING
+
+The Human Mechanism--Hough and Sedgwick, Chapter XI.
+
+
+
+
+CHAPTER VIII
+
+APPLIANCES AND METHODS FOR THE SICK-ROOM
+
+
+Patients who are confined to bed even for a few days often suffer
+acutely from muscular tension, from pressure, and from fatigue due to
+lack of exercise. Indeed, many a sick person is surprised to find that
+the bed which had seemed so infinitely desirable can change into a place
+of torment after a few short days of illness. "Bed-weariness" is hard to
+bear in any case of illness, but it is doubly hard for persons who are
+really helpless.
+
+Unless the patient is an experienced sufferer he often has no idea what
+should be done to make him comfortable; while an equally inexperienced
+helper, though full of good will, is often discouraged to find that the
+arrangement she had thought perfect soon fails to satisfy her restless
+patient. But if she is willing to devote thought and ingenuity to
+removing small annoyances, she can do many things to alleviate his
+misery.
+
+BED SORES, or pressure sores, are caused by continued pressure upon the
+skin. The weight of the body, or of a part of the body, if it comes for
+a long time upon one place finally interferes with the circulation in
+the tissues on which the part rests, and consequently interferes with
+the nutrition of the affected part. Any tissue to which the blood is not
+bringing all its necessary food supply tends to lose its tone, to become
+weak, and if the condition persists, to break down altogether.
+
+The direct cause of bed sores then is pressure, and pressure is
+aggravated by moisture, wrinkles in the bed clothes, crumbs or other
+hard particles, lack of cleanliness, friction of any kind, or by rough,
+careless handling. Bed sores occur most often over bony prominences,
+such as the end of the spine, elbows, heels, shoulders, hips, ankles,
+and knees, but they may form anywhere, even on the ears or back of the
+head. They are more likely to appear on thin, aged, or depleted
+patients. These painful and serious sores can be prevented almost always
+by faithful care. When they occur, they result in the great majority of
+cases purely from negligence, and a person who knows the danger and yet
+through carelessness allows one to develop upon a patient may justly
+feel herself disgraced.
+
+Prevention of bed sores depends upon keeping the skin dry and clean and
+upon relieving pressure by special devices and by turning the patient
+frequently. The parts where pressure comes should be washed at least
+twice daily with warm water and soap, rubbed frequently with alcohol to
+improve the circulation and to keep up the tone of the skin, and
+powdered with a little good toilet powder. Much powder is likely to do
+harm by collecting in hard, irritating particles. The bed should be kept
+constantly dry and smooth, and free from crumbs, lumps, wrinkles, or
+other inequalities. Prolonged pressure should be relieved by turning the
+patient often,--once every waking hour is not too often if the body is
+emaciated,--and by pillows, pads, and rings.
+
+Small pillows or thick pads of cotton should be placed under the
+patient's back and shoulders, between the knees and ankles when he lies
+on his side, and in other places where sores are likely to develop.
+Rubber rings are useful, but few patients like them for a long time.
+They should not be inflated more than necessary to raise the affected
+part from the bed; if much inflated, they are uncomfortable and may do
+harm. The ring may be covered with a muslin pillow case, or it may be
+wound smoothly with long strips of bandage or old muslin. Ordinary
+cotton batting wound with strips of muslin may be made into rings and
+used to remove pressure from heels, elbows, or other parts. These cotton
+rings are less heating than pads, and give better support.
+
+The first sign of a bed sore is either redness of the skin or a dark
+discoloration like a bruise. Every point where a bed sore may form
+should be inspected daily. If the slightest symptom of a sore appears,
+the patient must not lie on the affected part, and every effort should
+be made to keep the skin from breaking; vigorous rubbing at this stage
+is dangerous, and will by no means make up for previous neglect. The
+condition should be reported to the doctor at once. If in spite of all
+efforts the skin does break, a peculiarly difficult kind of open wound
+results which must be treated and dressed according to the doctor's
+directions.
+
+DEVICES TO GIVE SUPPORT.--The variety and number of pillows one patient
+can use is almost unlimited. A weak patient when lying on his side
+should have his back supported by a pillow. When he lies on his back a
+pillow should be placed under his knees to lessen muscular tension, and
+if he may be raised in bed, several pillows are needed to support him
+comfortably. A back rest is useful for a patient who can sit up in bed.
+Satisfactory back rests of several types can be purchased, or one may be
+improvised from a straight chair placed on the bed bottom side up, so
+that its legs lie against the head of the bed and its back forms an
+inclined plane. Back rest and chair alike should be covered by several
+pillows to make them comfortable, and other pillows should be used to
+support the patient's arms.
+
+A person who is sitting up in bed always tends to slip down toward the
+foot. This tendency may be corrected by using a foot rest, knee pad, or
+pillow. A hard pillow may be placed in the bed at the foot for the
+patient to brace his feet against; or a short board, well padded, may be
+arranged as follows for the feet to rest against: Fasten ropes to the
+board, as the ropes of a swing are fastened to the seat; set the padded
+board on edge at a convenient point below the patient's feet, and hold
+it in place by tying the ropes of the "swing" to the head of the bed. A
+pillow may be used in the same way, either at the feet or under the
+knees, by folding it over a long strip of muslin, the ends of which are
+then tied to the sides of the bed, brought up to the head, and there
+tied to prevent slipping. A cylindrical cushion six or eight inches in
+diameter and as long as an ordinary pillow, stuffed with firm material,
+may also be used for this purpose. It should be held in place by strips
+of strong muslin or ticking sewed to the ends of the cushion and tied to
+the head of the bed. The cushion should have a washable cover.
+
+[Illustration: FIG. 18.--SHOWING FOOT-SLING FOR SUPPORTING PATIENT IN
+THE UPRIGHT POSITION. (_Sanders "Modern Methods in Nursing."_)]
+
+Supports called _bed cradles_ are used to keep the weight of the bed
+covers from sensitive parts of the body, generally the feet or abdomen.
+They are semi-circular pieces of wood or iron fastened together so that
+they will stand up. A satisfactory cradle may be improvised as follows:
+Cut a barrel hoop in two, cross the halves at right angles and tie them
+together firmly; place the cradle over the affected part under the bed
+clothes. A smaller cradle may be made by taking sections that are less
+than half of the barrel hoop. If used for one foot only, the cradle
+should be small enough not to interfere with the motion of the other
+foot; if used for both feet, it should be large enough to allow some
+freedom of motion. Since the cradle leaves an air space, the feet should
+be wrapped in a piece of soft flannel. A cradle used for the protection
+of the abdomen should extend a little beyond the body on each side.
+
+[Illustration: FIG. 19.--ADJUSTABLE BED REST.]
+
+Adjustable tables are convenient for patients who are able to sit up in
+bed. These tables are supported on one side only so that they may extend
+over the bed. Another kind of bedside table has short legs and stands
+directly on the bed. Such a table can easily be made at home from a wide
+board with supports six or eight inches high nailed to each end. A lap
+board supported by heavy books may serve for temporary use. Indeed,
+home-made substitutes are often as good as expensive apparatus or even
+better. If sick-room appliances must be bought, it is well to remember
+that simple standard designs are best. Complicated apparatus is soon out
+of order, and is generally a trial both to the patient and to those who
+must adjust it. Persons taking care of chronic patients may often obtain
+valuable suggestions in regard to appliances by consulting a visiting
+nurse or the superintendent of the local hospital.
+
+[Illustration: FIG. 20.--ADJUSTABLE TABLE.]
+
+BEDPANS are utensils to receive bowel and bladder discharges of patients
+lying in bed. Enamel bedpans are better than porcelain, although more
+expensive. The shape known as the "Perfection" is best for general use.
+A "slipper" bedpan, although harder to clean and ordinarily less
+comfortable, may be preferable if it is especially difficult or
+undesirable to raise the patient. The square or douche pan is preferred
+by some people, and is especially useful when the quantity of discharge
+is large, as after an injection.
+
+When a patient asks for the bedpan it should be brought if possible
+without a moment's delay, not only because no other form of neglect
+makes a patient realize her helplessness more acutely, but also because
+the desire to use it often passes quickly and delay may encourage the
+habit of constipation. If the patient does not ask for the bedpan, the
+attendant should offer it at suitable times. Bedpans should be warmed
+before use. An easy way to warm one is to let hot water run over it; the
+outside should afterward be dried.
+
+To place the bedpan, first flex the patient's knees and push the night
+gown up; place one hand under the patient's hips, raise them slightly,
+and with the other hand slip the pan into place. If the patient is
+entirely helpless two persons are needed to lift her. Place a pad or
+folded cloth between the patient's back and the pan; then lower the
+patient gently. Before removing the pan, bring toilet paper, water and
+two pieces of soft old muslin or gauze. A patient, if able, prefers to
+use the toilet paper without assistance; her hands should afterward be
+thoroughly washed. If she is unable, the attendant must do everything
+needed. After the patient has been cleaned as thoroughly as possible
+with paper raise her hips with one hand and then remove the pan; it is
+important to raise her first because the skin often adheres and may be
+injured if the pan is suddenly pulled away; carelessness in managing the
+bedpan has caused more than one bed sore. Then remove the pan with one
+hand and cover at once. Turn the patient, if helpless, on her side, wash
+the parts with one piece of old muslin, thoroughly dry them with the
+other, and either burn or thoroughly wash both pieces afterward.
+
+Empty the bedpan and clean it at once; ordinarily one can clean it
+without wetting or soiling the hands. Use cold water first, removing all
+adhering solid particles with a tightly rolled piece of toilet paper. Do
+not use a brush for this purpose. After using cold water, rinse the pan
+thoroughly in hot water, and at least once a day wash it well in hot
+soapsuds. Directions for disinfecting the pan will be given later, but
+remember that a properly kept pan needs no deodorant solution. Glass
+urinals should be provided for men, and kept clean in the same way.
+Contents of both bedpan and urinal should always be carefully inspected;
+neither should be emptied in the dark.
+
+
+DAILY ROUTINE IN THE SICK-ROOM
+
+Obviously the routine of a patient's day must vary according to her
+condition, her preferences, and the amount of time the attendant has to
+give her. The temperature, pulse, and respiration must be taken and all
+medicine, nourishment, and treatment given at the exact times ordered,
+but the attendant should learn whether or not the doctor wishes her to
+wake the patient for food or treatment. Good management in the sick-room
+depends upon foresight and planning, and therefore it is well to keep in
+mind the following suggestions:
+
+Vitality is lowest in the early morning, hence baths and treatments,
+especially if they are fatiguing or painful, should if possible be left
+until after breakfast. Patients often wake early and wait, weak and
+miserable, for the day to begin. A hot drink at this time may give
+relief and enable the patient to sleep again. Even though breakfast time
+is near, nourishment should be given as soon as the patient wakes. She
+may not admit that she is hungry, but her nourishment should not be
+delayed until the family breakfast is ready, or still worse, finished.
+
+Before breakfast the bedpan should be offered, the patient's face and
+hands should be washed, her teeth brushed, her hair tidied, the bed
+straightened, and the room put in order. These services should require a
+few minutes only. The room if properly arranged at bed time needs only a
+little attention now unless untidy work has gone on during the night;
+disorder in a sick-room is as unnecessary in the early morning as at any
+other time.
+
+After the patient has finished her breakfast she may rest, or if
+allowed, read her mail or the newspaper while the attendant prepares for
+her day's work; about an hour after breakfast the patient should be
+bathed, unless she prefers her bath in the evening. After the bath some
+form of light nourishment should be given, even to a patient who has
+regular meals. If a patient is able to sit up in a chair, the best time
+for her to do so is generally just after the bath and toilet have been
+completed; but if she feels tired she had better wait until afternoon.
+The bed room can be better aired and cleaned if it is possible to take
+her into another room; and she herself generally profits by a change of
+scene.
+
+The doctor should definitely state when and for how long a patient may
+sit up for the first time after an illness, and an amateur who may be
+ignorant of the dangers involved should not assume the responsibility of
+deciding. When a patient is to sit up for the first time, put on her
+stockings, slippers, and wrapper before she leaves the bed. Arrange an
+arm chair with pillows in the seat and at the back, bring it close to
+the bedside and cover it with a large blanket unfolded. The chair may
+face either the head or the foot of the bed. Help the patient to a
+sitting position on the extreme edge of the bed, with her feet hanging
+down. Next, standing in front of her and supporting her well, let her
+slip down until she stands upon her feet, then let her turn, and gently
+lower her into the chair. See that the patient while sitting up is
+warmly covered, and that her foot-stool, pillows, etc., are adjusted
+comfortably. Move her chair so that the outlook may be as interesting as
+possible, and at least a little different from the view from the bed.
+Most patients like to look out of the window; children and old people
+enjoy it particularly.
+
+If the patient shows signs of fatigue, she should go back to bed even
+before the appointed time. To help her back to bed, reverse the process
+of helping her out. A footstool may be needed if the bed is high, or
+two people to lift her if she is weak or heavy. When a patient is in bed
+no one should ever sit on the bed, lean against it, use it as a table
+for folding linen, making pads, etc., take hold of the bed posts in
+passing, or touch the bed unnecessarily in any way.
+
+The best time for visitors is the last of the morning or the early
+afternoon. A judicious visitor may do an immense amount of good,
+especially to a chronic patient; indeed, she may be the only ray of
+light in a dark day. Subjects of conversation should be pleasant, but
+not too stimulating or exciting. The visitor should be prepared to carry
+the burden of the conversation, to drop topics skillfully that seem to
+involve fatigue or excitement, and either to go or to stop talking if
+the patient seems tired. Visitors should remember to talk naturally and
+cheerfully on ordinary topics, and to avoid excessive sympathy and
+labored attempts to cheer the patient. They should also remember that
+few patients bear well even the mildest forms of teasing. The patient's
+room is not the place to discuss personal or family troubles; yet it is
+only too often chosen for such purposes, probably because the complainer
+knows that in it an audience is always to be found.
+
+Visitors not belonging to the family should not be present in the
+sick-room during treatment of any kind, unless their help is required;
+neither, as a rule, should they stay during the patient's meals. A
+member of the family may stay with advantage if the patient tires of
+eating alone, but casual visitors almost invariably offend by undue
+urging if the patient's appetite is poor, or by facetious remarks if it
+is good.
+
+Ordinarily only one visitor should be admitted at a time, since a weak
+patient may be tired merely by looking from one to another. If it is
+desirable to limit the call, the attendant should tell the visitor
+beforehand how long to stay, or arrange a signal for the visit to end.
+To announce baldly in the sick-room that the patient is tired and the
+visitor must go, will only elicit aggrieved protests from both. In
+illness lasting only a day or two all visitors should be discouraged;
+during colds, because they are communicable; during general fatigue,
+headaches, digestive upsets, and painful menstruation, because rest and
+quiet are highly desirable. Visitors at such times too frequently give
+injudicious sympathy, and may actually delay the recovery of patients
+who enjoy playing the rôle of interesting invalid.
+
+The time when a trustworthy visitor is present may be the best time for
+the attendant to rest. The patient should be told when the attendant is
+going, and approximately when she will return. It is a mistake to slip
+away while the patient sleeps; she seldom fails to wake before the time
+scheduled and to resent the desertion. Surprises of any kind, pleasant
+or unpleasant, are seldom good for patients.
+
+Toward the end of the afternoon the patient is probably tired,
+especially if she has not slept during the day. When fever is present
+her headache and restlessness increase as the day goes on, but it should
+be remembered that uncomfortable beds and too heavy covers cause much of
+the restlessness attributed to fever. Rubbing the back and legs with
+alcohol, giving a tepid sponge bath, remaking the bed or changing her
+position may help to soothe her.
+
+The evening should be kept free from excitement, and every possible
+effort should be made to encourage sleep. It is a mistake to think that
+a better night results from keeping a sleepy patient awake all the
+evening; sick people should sleep when they can. Just before bedtime the
+attendant should prepare her own cot, and then make the following
+preparations for the patient to sleep: wash the patient's face and hands
+or give a sponge bath if it is desired, brush the hair, change the night
+gown, brush crumbs from the bed, tighten the sheets or remake the bed if
+necessary, rub the back and other pressure points with alcohol, shake
+the pillows, give liquid nourishment, preferably hot, cleanse the mouth,
+and give the bedpan. See that the patient's feet are warm, the bed
+covers right, the room ventilated properly and in good order, and the
+light extinguished or arranged for the night. If the patient is inclined
+to be wakeful a hot foot bath may help her, or sponging the entire
+length of the spine for fifteen minutes, using very hot water and long
+downward quiet strokes. No conversation should be encouraged during
+preparations for the night. Patients in bed all day often lose the habit
+of sleeping at the regular time, and lie awake far into the night from a
+vague feeling that someone else is coming or something further is to be
+done for them. Consequently last of all ask the patient if she wants
+anything more; if not, say good-night, go out and stay out, at least
+until she has had a chance to go to sleep. She is thus helped to realize
+that nothing further is likely to happen, and that it is time to go to
+sleep.
+
+Toward morning the patient grows weaker. More bed covers will probably
+be needed, and they may often be added without waking her. Night at the
+best is a dreary time for the sick. Pain and weariness and
+discouragement are less bearable in the darkness; nervous fears and
+morbid fancies defy control. Never is kindness more needed or more
+appreciated than it is by those who lie awake and watch for the morning.
+
+
+EXERCISES
+
+1. Name all the causes, direct and indirect, of pressure sores.
+
+2. Why are pressure sores generally more serious than injuries of equal
+extent to the skin of a well person?
+
+3. Where are pressure sores most likely to occur and what are their
+symptoms?
+
+4. What measures should be employed to prevent pressure sores?
+
+5. Describe ways to support a person lying down in bed.
+
+6. Describe ways to support a person sitting up in bed.
+
+7. How may the weight of the bedclothes be removed from any particular
+part of the body?
+
+8. How should a bedpan be cared for?
+
+9. Describe in detail a day's routine either of yourself the last time
+you were ill in bed, or of another patient personally known to you.
+Could the plan of the day have been improved, and if so, in what ways?
+
+
+
+
+CHAPTER IX
+
+FEEDING THE SICK
+
+
+Substances used for food are generally grouped into three classes,
+called the three nutrients. The nutrients are: first, the proteids or
+nitrogenous substances, which are found in meat, fish, eggs, milk,
+cheese, peas, beans, etc.; second, the carbohydrates, which include
+sugars and starch; and third, the fats, which are found in butter, oil,
+the fat of meat, etc. In addition to the nutrients, water and certain
+mineral salts are essential to life, while some indigestible material
+like the fibre of vegetables is needed to give bulk and to stimulate the
+action of the intestines.
+
+The nutrients furnish the body with materials for growth, and for repair
+of tissues worn out by use; they also furnish fuel substances from which
+the body obtains its heat and its energy. All three nutrients can serve
+as fuel, but the proteids alone can furnish materials for growth and
+repair of tissues. In order to be used by the body for any purpose,
+nutrients must first go through a series of complicated changes known as
+digestion, which renders them soluble so that they can soak through the
+walls of the intestine.
+
+
+THE DIGESTIVE PROCESS
+
+Digestion begins in the mouth. There the food is crushed and its fibres
+separated by the teeth, it is moistened by the saliva, and substances in
+the saliva begin a chemical action upon the starch. Chewing should be
+sufficient to reduce the food to a soft mass well moistened with saliva.
+Slow eating is desirable, but the emphasis should be placed on thorough
+chewing. For instance, long intervals between bites are of no special
+benefit if mouthfuls of food are washed down by swallows of water.
+
+After it has been swallowed, the food passes into the stomach and
+remains there for a variable length of time, while it undergoes further
+preparation for absorption. It is moved about by the contraction of the
+muscular walls of the stomach, so that it becomes mixed with the stomach
+juices and more thoroughly softened. Some digestion of proteids goes on
+in the stomach, and a little absorption through the walls.
+
+Little by little the food is discharged from the stomach into the small
+intestine, and the most important part of digestion then begins. It is
+acted upon chemically by a fluid flowing into the intestine from an
+organ called the pancreas; this pancreatic juice acts upon all three
+nutrients and is of great importance in the digestive process. The bile
+and other juices that flow into the intestine perform important
+functions also.
+
+The food masses are moved along by rhythmic contractions of the
+intestine, and absorption goes on when the food has been so changed that
+it can soak through the intestinal walls into the blood and lymph
+vessels. The small intestine is about 20 feet long, and consequently
+affords a large surface for absorption, as does also the large
+intestine, into which the small intestine opens. The blood and lymph
+carry the digested food substances to all parts of the body, and thus
+the different tissues are provided with the materials they need for
+growth, repair, and energy. Excess of food substances may be stored as
+fat or expelled from the body.
+
+As the blood and lymph go through the tissues they take from the tissues
+the refuse, or the part that remains after the fuel substances have been
+consumed. This refuse from the tissues may be likened to the ashes from
+a furnace; it is finally eliminated from the body through the kidneys
+and lungs, and to some extent through the skin and bowels. The part of
+the food that is not digested of course never soaks through the
+intestinal walls; it merely passes through the small and large
+intestines and is finally expelled as feces or bowel movements. The
+characteristic odor of fecal matter results from the action of bacteria
+upon it while in the large intestine.
+
+It must be remembered that the body is not nourished merely by
+swallowing food: in order to nourish the body food must also be
+digested, absorbed, and made use of by the tissues. Many factors may
+operate both in health and in sickness to render food indigestible. It
+may be originally unsuited to the human digestive apparatus, or spoiled,
+or poor in quality, or badly cooked. But even when wholesome in itself
+it may be ill-adapted to a particular person at a particular time; thus
+it may be too great in amount, or eaten at improper hours. Moreover a
+person's own idiosyncrasy or manner of living or fatigue or illness may
+render it especially indigestible for him.
+
+Experiments have shown that pain, fear, worry, and other unpleasant
+emotions actually stop the action of the digestive juices and check
+muscular contractions of the small intestine. Furthermore, even the
+absence of pleasant anticipation of food has been shown to delay
+digestion for hours. Thus scientific knowledge confirms our common
+experience that such mental states seriously interfere with digestion.
+The converse is also true. Agreeable taste and odor of food, or even
+pleasurable thought of it, start the secretion of digestive fluids. It
+is a common saying that the mouth waters at the prospect of inviting
+food, but it is less well known that appetizing food does actually start
+the stomach juices also. A person who understands the physiological
+effect that the emotions have upon digestion is in a far better frame of
+mind to cope successfully with the difficulties of feeding the sick than
+one who considers sick persons' likes and dislikes entirely irrational.
+
+
+FEEDING THE SICK
+
+Nourishing the sick is not always an easy problem, but its importance
+can hardly be overestimated. Indeed, proper feeding in many illnesses
+makes the difference between life and death. The actual amount of
+nourishment needed in sickness is often less than in health, but it may
+be just as great, or even greater if the illness causes increased tissue
+waste. Yet the digestive process of a sick person must be rendered as
+little laborious as possible, all foods ordinarily difficult to digest
+must be eliminated, certain others must be withheld or restricted
+according to the nature of the sickness, and in addition one may have to
+deal with an appetite that is capricious, diminished, or totally absent.
+
+Diet for the sick is often a part of medical treatment; in such cases
+the doctor will prescribe special diets and his orders must be carefully
+carried out. Except for special diets, food for the sick is generally
+divided into four classes: first, liquid or fluid diet; second,
+semi-solid diet; third, light or convalescent diet; and lastly, full
+diet. These diets are not very sharply distinguished.
+
+LIQUID DIET generally includes milk, eggnog, albumen water, broths,
+soup, beef juice, thin gruel, and beverages. Liquid diet makes least
+demand upon the digestive powers, because it consists of food already
+dissolved and therefore nearer the condition in which it can be
+absorbed. Moreover, it is less likely than other foods to contain excess
+of fat, improperly cooked starches, and other indigestible material.
+Liquids must be given at regular intervals and at shorter intervals than
+solid foods; 6 to 8 ounces every two or three hours is not too much if
+the patient can take it. The doctor usually specifies the amount and the
+interval. Some patients will take more nourishment at one time if the
+interval is slightly increased.
+
+SEMI-SOLID DIET includes all fluids and in addition soft milk toast,
+soft cooked eggs, well cooked cereal, custards, ice cream and ices,
+junket, and gelatine jellies. Liquid or semi-solid diet is commonly
+given in acute fevers because digestive juices and other fluids of the
+body are then diminished, and also because their digestion places a
+minimum of work upon a system already burdened with bacterial poisons.
+
+LIGHT OR CONVALESCENT DIET generally means a simple mixed diet. In
+addition to the articles in the two preceding diets it includes oysters,
+chicken, baked potatoes, most fruits except bananas, simple desserts,
+white fish, and other meats and vegetables added judiciously until full
+diet is reached. Fried foods should not be included.
+
+FULL DIET means an unrestricted menu, but even from full diets
+especially indigestible foods should be excluded. The principles of
+feeding sedentary persons as described in manuals of dietetics apply to
+patients who are obliged to be inactive although not really ill, as for
+example, a patient suffering from a broken leg. Ordinarily in such
+cases, as in other kinds of illness, the appetite is greatly diminished,
+but a word of warning should be given against overfeeding patients whose
+meals are their chief interest. Such patients are only too likely to
+interpret full diet as anything they desire in any quantity at any time
+of day or night, and then to attribute their discomfort and irritability
+to their illness rather than to overeating.
+
+Constipation is especially stubborn in sickness, since the patient is
+deprived of his usual exercise and variety of food. So far as possible
+the bowels should be regulated by diet. Laxative foods include most
+vegetables with a large amount of fibre, coarse cereals and flour, oils
+and fats, and most fruits and fruit juices. Unfortunately many laxative
+foods are difficult for sick persons to digest and must therefore be
+used with caution. A glass of hot or cold water or orange juice an hour
+before breakfast may be helpful, and at bed time hot lemonade, oranges,
+prunes, figs, or other fruit if allowed.
+
+It is essential for patients to drink water freely, and it should be
+given between meals and also between liquid nourishments. Persons
+inexperienced in the care of the sick frequently make the mistake of
+bringing water only when a patient asks for it.
+
+Many acute illnesses begin with fever, headache, sore throat, and
+especially among children with vomiting, diarrhoea, and other digestive
+disturbances. In such cases all food should be withheld until the doctor
+comes, but boiled water, hot or cold, should be given freely. Efforts to
+tempt the appetite are then mistaken; few people are injured and many
+are benefited by omitting food even for 24 hours at the beginning of an
+acute illness, and with few exceptions a doctor can be found in a
+shorter time.
+
+SERVING FOOD FOR THE SICK.--Food for the sick should always be most
+carefully prepared and of the best quality, and in addition it should be
+as inviting, as varied, and as well served as possible. Neglect in these
+respects is inexcusable. Even slight carelessness in preparing or
+serving food may arouse disgust and thus banish permanently some
+valuable article from the dietary.
+
+Trays, dishes, tray cloths, and napkins for the patient must be
+absolutely clean and as attractive as possible. Cracked or chipped
+dishes should not be used. Individual sets of dishes for the sick may be
+purchased, and their convenience makes them well worth their price.
+Paper napkins may be used in many cases to save laundry work; clean
+white paper is always superior to soiled linen.
+
+Before the tray is brought to the bedside, everything should be arranged
+so that the patient can eat in comfort. It is bad management to let the
+soup cool while the patient's pillows and table are being adjusted. In
+setting the tray great care should be devoted to placing the articles
+conveniently, and to the appearance and garnishing of the food. Careful
+serving requires more thought, but little if any more actual time than
+slovenly serving. Dishes should not be so full that food is spilled in
+transit; hot dishes should be covered; hot dishes should reach the
+patient hot, and cold dishes cold. Liquid nourishment in a glass or cup
+should be served on a small tray or plate covered with a doily. Neither
+glass nor cup should be held by the rim.
+
+It is not uncommon to overload trays and to serve everything at once in
+order to save steps, but a patient is ordinarily more interested in a
+meal that is served in courses unless very long intervals elapse
+between. Moreover, if the meal is served in courses he is not tempted to
+eat dessert first and then to refuse the rest of the meal. If food is
+given sufficiently often it is safer to err on the side of serving too
+little at a time rather than too much, since the sight of large amounts
+of food is often disgusting.
+
+The patient's likes and dislikes should be considered as far as
+possible, but most patients should not be consulted about their menus
+beforehand. Great variety in one meal is not necessary; it should be
+introduced by varying successive meals. An article that has been
+especially disliked should not be served a second time, unless it can be
+disguised beyond a possibility of detection. An article of food to which
+a patient objects should be removed at once; one may appear disappointed
+if it seems wise, but should never argue. When patients persistently
+refuse necessary nourishment a difficult situation is presented;
+persuasion and every form of ingenuity must be used, and the doctor's
+coöperation enlisted. When, for example, a strict milk diet is ordered
+for a patient who announces that he never takes milk in any
+circumstances the situation may seem hopeless but it is not necessarily
+so.
+
+TO FEED A HELPLESS PATIENT.--Helpless and weak patients must be assisted
+to eat or drink. A napkin should first be placed under the patient's
+chin. The attendant should place her hand under the pillow, raise the
+head slightly, and hold the glass to his lips with her other hand. An
+ordinary tumbler can be used by a patient lying down if it is not more
+than a quarter full, or a special feeding cup may be purchased. Bent
+glass tubes may be used for cool liquids; they should be washed
+immediately after use. A child who can sit up sometimes takes more
+nourishment if it is given through a soda water straw.
+
+If the patient must be fed with a spoon care should be taken that the
+liquid is not too hot, but the attendant should not blow upon it to cool
+it. It should be given from the point of a spoon placed at right angles
+to the lips, and plenty of time between mouthfuls should be allowed. A
+swallow should not be given at the moment when the patient is drawing
+the breath in. Great patience is required if a helpless person is to be
+fed acceptably. The attendant should sit by the bedside rather than
+stand, should present at least the appearance of having unlimited time,
+and should endeavor not to deprive the patient in any way of the
+satisfaction he may derive from his nourishment.
+
+
+EXERCISES
+
+1. What needs of the body do food substances supply?
+
+2. Give an outline of the digestive process.
+
+3. Describe the effect of different mental states upon digestion, and
+give examples of the ways by which a knowledge of these effects may be
+utilized in feeding patients.
+
+4. Why is the problem of nourishing the body of especial importance in
+sickness?
+
+5. Name the four ordinary classes of diet for the sick, and mention all
+the articles you can belonging to each class.
+
+6. Why is constipation a common ailment among patients confined to bed,
+and what attempts should be made to overcome it by the diet?
+
+7. Why is it necessary for sick persons to drink water freely, and what
+efforts should the attendant make to encourage them to do so?
+
+8. Describe the proper serving of a patient's tray.
+
+9. How should helpless patients be assisted to eat?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Chapter II.
+
+The Human Mechanism--Hough and Sedgwick, Chapters VIII, XIII, XIX.
+
+Notes on Nursing--Florence Nightingale, Pages 63-79.
+
+How to Live--Fisher and Fisk, Chapter II.
+
+Bodily Changes in Pain, Hunger, Fear and Rage--Cannon, Chapter I.
+
+Food for the Invalid and the Convalescent--Winifred S. Gibbs.
+
+Practical Dietetics--Pattee, Chapters IV, V.
+
+Feeding the Family--Rose.
+
+Diet in Health and Disease--Friedenwald and Ruhrah.
+
+Feeding Children from Two to Seven Years Old--New York City Department
+of Health.
+
+American Red Cross Text Book on Home Dietetics--Ada Z. Fish.
+
+Emergency Cooking--Pamphlet 708, American Red Cross.
+
+War Diet in the Home--Pamphlet 706, American Red Cross.
+
+Red Cross Conservation Food Course for Children and Special
+Classes--Pamphlet 705, American Red Cross.
+
+
+
+
+CHAPTER X
+
+MEDICINES AND OTHER REMEDIES
+
+
+ACTION OF DRUGS.--Modern medical practice increasingly emphasizes diet,
+baths, exercises, and other hygienic measures in the treatment of
+sickness. Drugs are given far less than they were a generation ago; yet
+medicines are still the most familiar of all remedies, and the most
+abused by those who persist in treating themselves. Misuse of medicine
+even by intelligent people is astonishingly common.
+
+Problems of sickness and health would be enormously clarified if the
+uses and limitations of drugs were more generally understood. Many
+people still believe that every disease can be cured by a drug if only
+the doctor is clever or lucky enough to think of the right one to give.
+Such beliefs result naturally enough from centuries of faith in charms
+and magic, and occasionally are confirmed by remarkable cures apparently
+brought about by drugs, but really pure coincidence or the result of
+suggestion.
+
+It is a fact that a few medicines are known which if rightly used
+actually do cure certain diseases. An example of their action is the
+curative effect of quinine in malaria. Such medicines, unfortunately,
+are few. In the great majority of cases medicines do not cure disease;
+their beneficial action is ordinarily indirect and is due to their power
+either to increase or to check certain processes within the body.
+
+It is here that the abuse of drugs comes in. Disordered bodily processes
+give rise to symptoms of disease; and it is the symptoms of disease, not
+the disease itself, that trouble the patient. A patient with typhoid,
+for example, is not conscious of the toxins in his blood, but of
+headache, weakness, and fever; the man with eyestrain is not aware of an
+imperfectly shaped lens, but of headache and indigestion. What the
+patient wants is to have his symptoms relieved; in some cases they can
+be controlled by drugs, and the sufferer then considers himself cured.
+But the original condition persists: it may in the meantime be
+improving, but it may on the other hand be growing worse.
+
+Not infrequently it is best to check symptoms, and to check them by
+means of drugs. When they should be checked, only a thoroughly trained
+physician is qualified to decide. The question is not one for amateurs,
+since the whole practice of medicine, including the prescription of
+drugs, constantly becomes more nearly an exact science. People should
+obtain and follow expert advice in regard to health as they would in
+regard to other affairs of life. The constant self-dosing practised by
+thousands of people is harmful and unintelligent; it is, however, no
+less irrational to go to the other extreme and refuse to take medicine
+prescribed by a competent doctor.
+
+AMATEUR DOSING.--Amateur dosing either of oneself or of others is
+dangerous in more ways than one. In the first place, time is lost.
+Moreover, symptoms are characteristic; checking or altering them
+increases the difficulty of finding the real trouble. The man with
+eyestrain who takes one drug to stop his headache and another to "cure"
+his stomach, is simply delaying the time when properly adjusted glasses
+will relieve both. In this case the result may not be serious; but such
+a loss of time in finding the trouble and beginning proper treatment
+might prove fatal in the case of tuberculosis.
+
+Another objection to amateur prescription of medicine is the fact that
+most drugs have more than one effect. In addition to their main action
+they have others, subordinate or ordinarily less marked. These minor
+effects may be serious in some cases. Many headache remedies, for
+example, affect the heart; a dose that is harmless for a normal person
+may be strong enough to injure seriously a person with a weak heart. A
+doctor, and a doctor only, is competent to decide when and in what
+quantity medicines will be beneficial, because he alone understands both
+the condition of the patient and all the possible effects of the drug.
+
+In no circumstances should medicine prescribed for one person be taken
+by another. This rule seems obvious enough; yet every day people pass on
+their pet remedies to friends. Some medicines deteriorate after
+standing, and others grow stronger; nevertheless, medicine supposed to
+have cured a cough or a tonic supposed to have strengthened some member
+of the family after an attack of grippe is cheerfully administered
+months later to another member of the family, who, to make matters
+worse, may differ in age, strength, and probably in the nature of his
+sickness. Drugs are expensive, and it is considered economical to use
+them up; measured by lost time and impaired health such practices may be
+anything but thrifty.
+
+Cathartics, tonics, and various drugs to relieve pain and sleeplessness
+are among the remedies most commonly taken without medical advice.
+Enough has already been said about constipation to indicate proper
+hygienic treatment, but another warning should be given against
+habitual use of cathartics. Many of these drugs are irritating; even
+when not irritating, they are harmful, since the body depends more and
+more upon the drug to do for it what it should be enabled to do for
+itself, by remedying the original cause of the trouble. Licorice powder,
+cascara, saline cathartics such as Seidlitz powders and Rochelle Salts
+and some others are harmless for occasional use, if occasional is not
+too liberally interpreted.
+
+Tonics are poor substitutes for proper diet, rest, and fresh air. Using
+them may be likened to beating a tired horse; the horse goes faster, but
+he is not really stronger. In some emergencies the horse must go faster
+and there is nothing to do but beat him, and in some cases the tonic
+should be given; these, however, are cases for a doctor to decide.
+People persist in taking tonics because they are unwilling or unable to
+rest, or otherwise to change their ways of living.
+
+Medicines to stop pain or to induce sleep are probably the most
+pernicious of all self-prescribed remedies, for they add to other
+dangers the possibility of forming drug habits. These habits are so
+insidious and so powerful that it is not safe to take habit-forming
+drugs even once except by a doctor's direction. In short periods of time
+strong people, apparently firm in will and character, have acquired
+habits from supposedly moderate use of drugs like morphine, cocaine, and
+alcohol. No one, no matter how sure of his own self-control, can afford
+to run so grave a risk.
+
+PATENT REMEDIES.--Objections to self dosing in general apply even more
+strongly to using patent medicines. The ingredients of patent medicines
+are ordinarily unknown, so that using them is unintelligent at best.
+Sometimes they contain habit-forming or other harmful drugs. In other
+cases the ingredients are innocent enough, but totally unable to bring
+about the results claimed for them. The old story about a powerful
+remedy discovered by accident and thus unknown to the medical profession
+deceives only the ignorant or credulous; with our present knowledge of
+chemistry and physiology powerful remedies are not discovered in that
+way.
+
+Even to these comparatively harmless patent preparations there are two
+serious objections. One is the loss of time, during which the patient
+may grow worse. The other is that money is obtained under false
+pretenses; fraud is a common element in the success of patent remedies.
+One of the least harmful, a substance called "Murine" may be taken as an
+example[2]. This substance was widely advertised at one time as a
+"positive cure for sore eyes." Analysis showed it to be a solution of
+borax, which cost about five cents a gallon to prepare. It sold for one
+dollar an ounce, or at the rate of $128.00 a gallon. Although it could
+not bring about the wonderful cures advertised, it was practically
+harmless, and buyers of "Murine" must have been injured chiefly in
+pocket. But with "cancer cures" and "consumption cures" it is a
+different story. Early treatment of these diseases is essential to
+recovery; delay in many cases means robbing the sufferer of his only
+chance of life. No drugs are now known that will cure these diseases,
+and it seems incredible that anyone should be willing to practise such
+cruel deception upon ignorant people merely for the sake of making
+money.
+
+ADMINISTRATION OF MEDICINE.--Medicines may be introduced into the body
+in a number of ways. In the majority of cases they are swallowed and
+finally carried to the tissues by the blood just as digested food is
+carried.
+
+Except in rare emergencies no medicine should be given to a sick person
+without the doctor's order. The prescribed dose should be accurately
+measured in a medicine glass having a scale to show the number of
+teaspoonfuls. When measuring medicine, think only of what you are doing;
+neither talk nor listen to conversation. First read the label on the
+bottle. Next, shake the bottle, if the medicine is liquid, in order to
+mix the contents thoroughly. Then remove the cork with the second and
+third fingers, and hold it between them while pouring, thus keeping the
+cork clean and protecting the contents of the bottle. Hold the medicine
+glass on a level with the eyes, and in the other hand hold the bottle,
+with the side bearing the label uppermost to avoid soiling it; pour out
+the dose, measuring exactly, wipe the bottle, replace the cork, and
+again read the label on the bottle.
+
+Most medicines should be diluted with a little water. Pills and capsules
+should not be presented to patients in the attendant's fingers, but on a
+saucer or teaspoon. Acids and medicines containing iron should be taken
+through a glass tube kept for medicine exclusively. Tubes and glasses
+should be washed at once after use, and neither they nor the bottles
+should stay in the patient's room. If a dose is omitted for any reason,
+do not increase the next dose; give the regular dose at the next regular
+time.
+
+Serious mistakes in giving or taking drugs are far too common, and no
+precautions are too great to guard against them. Never use medicine from
+a box or bottle that has no label. Never take or give another person a
+medicine selected in the dark, even though you have positive knowledge
+that there is no other bottle or box of medicine in the whole house; in
+just such circumstances the fatal mistakes occur.
+
+A few things can be done to make medicines more palatable. The water
+used to dilute the dose and to be taken after it should be very cold.
+Holding the nose is helpful. A piece of cracker, a peppermint, or a
+slice of lemon or orange, if allowed, may be taken afterward. Giving
+disagreeable medicine in ordinary food, as lemon juice, orange juice, or
+milk, and giving bitter powders in jam or jelly, is unwise because it
+sometimes results in life long dislike for a useful article of diet.
+Where food is given directly after the dose to take away its taste, the
+association of dislike seems to be formed less frequently.
+
+The taste of castor oil is so disgusting that it often causes vomiting,
+but if skillfully given the oil need not be tasted by a patient who is
+willing to coöperate. Its way of sticking to the tongue and teeth
+constitutes the chief difficulty; the object therefore is to prevent it
+from sticking by swallowing the dose all at once. To administer the oil,
+wet the inside of a medicine glass or large spoon with very cold water,
+and leave a little water in the bottom. Pour the required dose in slowly
+and cover it with more cold water. Let the patient hold in his hand
+something to take away the taste,--cracker, bread, peppermint, or
+whatever is allowed; for castor oil water is not very effectual. Then
+direct him to hold his nose, open his mouth, and hold his breath;
+caution him to let the oil run down without swallowing until all has
+been taken, and afterward to chew the cracker, continuing to hold his
+nose until he has swallowed the cracker. When the patient understands
+and is ready, pour the dose in quickly as far back as possible, taking
+care not to spill the last drop on the lips. This process may seem
+unduly troublesome, but when castor oil is needed it is badly needed and
+efforts to make it stay down are worth while. The following method also
+effectually disguises the taste of castor oil: place in a glass a
+teaspoonful of baking soda, add the prescribed dose of oil and then the
+juice of half a lemon. Mix all together thoroughly and let the patient
+take the mixture while it is effervescing. This method may be used
+unless the patient is not allowed soda and lemon juice. Castor oil may
+be bought in capsules, but on account of their size many people find the
+capsules impossible to swallow.
+
+SUPPOSITORIES.--Sometimes medicines are given through the rectum. For
+this purpose they are combined with cocoa butter or other material, and
+made into small cones called suppositories. They melt at a low
+temperature and should be kept on ice until needed. A suppository
+should be lubricated with vaseline, and inserted very gently as far as
+the finger can be introduced, while the patient is lying on the back or
+left side.
+
+ENEMATA.--An injection of a fluid into the rectum is called an enema.
+(Plural, enemas, or enemata.) Enemas are generally used to cause
+evacuation of the bowels.
+
+For a simple purgative enema one of the following is generally used:
+plain water; or a solution of common salt in the proportion of one
+teaspoonful of salt to one pint of water; or soap suds made with a white
+soap such as castile or ivory. Unless otherwise ordered the temperature
+of the enema should be between 105° and 110° F.
+
+To give an enema, one should proceed as follows: First protect the bed
+by placing under the patient's hips a rubber sheet, covered by a draw
+sheet or large towel. Let the patient lie on the back, with the knees
+flexed and head low. Bring to the bedside a commode or bedpan, and
+lastly the solution contained in a fountain syringe having a long rubber
+tube, stopcock and short hard rubber nozzle. The bag of the syringe may
+be hung on the bed post or elsewhere, but it should not be more than
+three feet at most above the patient's head. Lubricate the nozzle with
+vaseline either from a tube, or removed from a jar by means of a piece
+of toilet paper; never dip the nozzle itself into a vaseline jar. Let
+the solution flow into the bedpan until it runs warm and smoothly; a
+jerky flow means presence of air bubbles which cause pain if injected
+into the bowels. Unless the patient is able to do it herself, gently
+insert the nozzle, and at the same time start the flow. Force must not
+be used in inserting the nozzle, and the flow should be gentle; if the
+solution goes in rapidly the patient may be unable to retain it. If
+there is a desire to expel the enema as soon as the injection has begun,
+shut off the current and wait a minute, meanwhile making gentle pressure
+upon the patient's abdomen with one hand; then lower the bag a little
+and begin again. A grown person should take from two to four pints, and
+a child from one to two pints. After the enema is finished give the
+bedpan immediately; the enema will, however, be more effective if
+retained a few minutes. The bedpan should be given and removed according
+to the directions on page 176. Sometimes an enema is expelled with such
+violence that it soils the upper sheet; to protect the covers a rubber
+sheet may be spread over the patient's knees and legs. Since an enema
+sometimes causes nausea or faintness, a patient should be watched
+constantly during the process.
+
+To give an enema to a baby one may use a small syringe having a soft
+rubber bulb with a nozzle directly attached, or the ordinary fountain
+syringe with the small, hard rubber tip designed for infants. The enema
+should be given in a warm room free from draughts, and the baby must be
+warmly covered throughout the process. First cover the lap with a pad or
+folded blanket. Upon the blanket place a warmed rubber sheet, and over
+the rubber a warm diaper. Hold the baby on your lap, so that he lies on
+his back with his knees drawn up. Hold his feet or legs firmly in your
+left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that
+all the air is expelled from the syringe, and then proceed as already
+directed. A baby will take from two or three ounces up to half a pint or
+even more, according to the size of the child. After the injection is
+finished place a small vessel under the baby's hips, and hold it until
+the fluid has been expelled, keeping the child well covered all the
+time.
+
+After being used, the nozzle of a fountain syringe should be washed with
+soap and water, boiled, dried and put away in a clean place. Inserting
+the nozzle into the bag of the syringe immediately after withdrawing it
+from the rectum is a filthy but not uncommon practice. The syringe
+should be kept clean inside and out; it should be washed in hot
+soapsuds, rinsed in clean hot water, drained, and when thoroughly dry
+wrapped in a clean towel or tissue paper. The ordinary fountain syringe
+hanging for months by a dirty string on a hook in the bath room is an
+unpleasant and generally an unclean object.
+
+SPRAYS AND GARGLES.--Several other methods of administering medicines
+are occasionally employed. Some remedies may be applied directly to the
+throat by gargles, and to the nose and throat by sprays. The throat may
+be cleansed by gargling with a solution of a teaspoonful of baking soda
+or common salt in a glass of warm water. Nose sprays should not be used
+except under medical advice, and it is well to remember that if the
+mouth washes, gargles, and sprays advertised to be disinfectants were
+really strong enough to kill germs, they would be too harsh for common
+or continued use. The nozzles of nose and throat sprays should be boiled
+immediately after use. A surprising number of families who have
+progressed far beyond common drinking cups and towels, continue to use a
+common nose spray without even washing the nozzle. Children while they
+are well should be taught to gargle the throat; a child with a sore
+throat and an aching head is in a poor condition to learn anything.
+
+INHALATION or breathing in, is another method used to introduce drugs
+into the membranes of the nose, throat, and lungs. Smelling salts are an
+example of substances used for inhalation; they are used to stimulate
+persons who are faint. They should not be placed close to the nostrils,
+nor used at all when the patient is totally unconscious.
+
+Inhalations of steam are often used in asthma, croup, and bronchitis.
+Special croup kettles are made for the purpose, but an ordinary pitcher
+half full of boiling water may be used instead. The patient's head
+should be held closely over the pitcher, and a towel should be adjusted
+around the top covering the patient's nose and mouth, but admitting just
+enough air to make it possible for him to breathe. If a drug is ordered
+it should be added to the water.
+
+INUNCTION, or rubbing a substance into the skin, is sometimes ordered
+for delicate babies and children. After the skin of the abdomen has been
+washed with warm soapy water and thoroughly dried, the substance
+ordered, generally olive oil or cod liver oil, should be applied by
+means of a circular movement of the palm of the hand. The oil should be
+warm and the rubbing continued until it is absorbed.
+
+Ointments are also applied by inunction. A small quantity at a time
+should be rubbed in, using a circular motion. If an ointment is ordered
+to be applied where the skin is broken, the ointment should be spread
+upon gauze and applied without friction. Liniments are rubbed in in the
+same way as ointments. In many cases rubbing accomplishes more than the
+ointment or liniment itself, so that this part of the treatment must not
+be slighted.
+
+HOUSEHOLD MEDICINE CUPBOARD.--In every household a small cupboard is
+needed for medical and surgical supplies. Glass shelves are desirable,
+because they show when dirty and are easily cleaned, but a wooden
+cupboard can easily be lined with clean paper or white enamel cloth held
+in place with thumb tacks. Dirty, stained shelves should not be
+tolerated. The cupboard should be kept locked and the key put well out
+of the reach of children. In the cupboard should be kept medicines in
+daily use; they should not be paraded on family dinner tables.
+
+Poisonous drugs should have rough glass bottles and conspicuous labels.
+All medicine bottles should be kept well corked, since evaporation may
+take place and the remaining solution, by becoming stronger, may be
+dangerous to use in the ordinary amount. Pills and tablets sometimes
+deteriorate by standing, and may become so hard that they pass through
+the stomach and intestines without dissolving. It is best to buy drugs
+and surgical supplies in small quantities; when it is cheaper to buy
+more at a time the druggist should be asked whether they will
+deteriorate or not.
+
+Almost every family needs to keep on hand some cathartics, some
+disinfectants, some material for first aid, and a few simple appliances.
+Most families have certain other needs peculiar to themselves, and for
+those who live at a distance from drug stores a greater quantity and
+variety may be required. Elaborate equipment and extensive supplies of
+medicines are neither economical nor necessary for household use.
+
+Castor oil, Rochelle or other laxative salts, and two grain cascara
+tablets ordinarily constitute a sufficient supply of cathartics. The
+dose of castor oil is one or two teaspoonfuls for a baby up to a
+tablespoonful for an adult. Rochelle salts and seltzer aperient are
+given dissolved in water; the ordinary dose is from one to four
+teaspoonfuls. Seidlitz powders come in two packets, one white and one
+blue. The contents of the packets should first be dissolved in separate
+glasses each filled about a quarter full of water. One solution should
+then be poured into the other and the mixture taken while it is
+effervescing. Cascara tablets are generally given in one to ten grain
+doses.
+
+A small bottle of tincture of iodine and one of 70% alcohol should be
+kept for disinfecting. Neither one is for internal use. The iodine is
+used to disinfect small wounds and abrasions of the skin. It is applied
+with cotton swabs and several swabs should be made and kept on hand in a
+box or envelope. Alcohol is used to disinfect thermometers and other
+instruments that cannot be boiled, for rubbing, and may also be used for
+disinfecting the skin. A 90% solution is sometimes used for rubbing; it
+need not be bought until needed. Denatured and wood alcohol are poisons
+and should be used in households only in spirit lamps; they are not safe
+for other purposes.
+
+First aid materials may include two gauze bandages two and one-half
+inches wide and two bandages one inch wide, one American Red Cross First
+Aid Outfit, a small package of absorbent cotton, a roll of old muslin, a
+package of adhesive plaster one inch wide, boracic ointment, picric acid
+gauze or other application for burns, safety pins, and a pair of
+scissors.
+
+For use in cases of fainting or exhaustion it is well to keep aromatic
+spirits of ammonia on hand. Its bottle should have a rubber stopper. The
+dose is one-half to one teaspoonful, in a quarter to half a glass of
+water. Hot coffee and tea are also good stimulants, but the time
+necessary to prepare them makes it desirable to have aromatic ammonia
+on hand. Household or ordinary ammonia must not be used as a substitute.
+
+Olive oil, mustard, and baking soda may be brought from the kitchen when
+needed. It is assumed that vaseline, cold cream, hand lotion, talcum
+powder, and other toilet preparations will also be available.
+
+Only a few appliances are necessary. Among them are a medicine glass, a
+teaspoon, clinical thermometer, hot water bag, fountain syringe, and an
+alcohol lamp in houses without gas or electric stoves. It is better not
+to buy other appliances until they are needed, particularly rubber goods
+since they deteriorate rapidly.
+
+
+EXERCISES
+
+1. Why is it dangerous for persons without medical training to prescribe
+medicines? What is the especial danger of dosing oneself?
+
+2. What is meant by a habit-forming drug? Name all you can, and tell why
+they are peculiarly dangerous.
+
+3. What are the special objections to patent medicines?
+
+4. What precautions should be taken in order to administer medicine
+accurately? What precautions to avoid giving wrong medicines?
+
+5. How may some disagreeable medicines be made more palatable?
+
+6. Tell how to prepare and give a soapsuds enema.
+
+7. How should a fountain syringe be cared for? a throat spray?
+
+8. Describe methods for giving steam inhalations.
+
+9. Describe the equipment and care of a household medicine cupboard.
+
+10. What drugs is it well for a family to keep on hand? What appliances?
+What materials for first aid?
+
+11. How many drugs in addition to those prescribed by a physician have
+you or your family on hand at the present time? How many do you consider
+really necessary? Are any of these medicines used to remedy troubles
+that might be cured by sufficient attention to rest, exercise, diet, and
+fresh air?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Chapter VI.
+
+How to Live--Fisher and Fisk, Supplementary Notes, Sections IV, V.
+
+Scientific Features of Modern Medicine--Frederic S. Lee, Chapters III,
+VIII.
+
+The Human Mechanism--Hough and Sedgwick, Chapter XX.
+
+The Conquest of Nerves--Courtney.
+
+Primitive Psychotherapy and Quackery--Lawrence, Chapters I-V.
+
+Nostrums and Quackery--American Medical Association. (See especially
+"Cancer Cures" and "Consumption Cures.")
+
+
+FOOTNOTES:
+
+[2] See "Nostrums and Quackery," p. 445.
+
+
+
+
+CHAPTER XI
+
+APPLICATION OF HEAT, COLD, AND COUNTER-IRRITANTS
+
+
+INFLAMMATION.--A process called inflammation sometimes occurs in tissues
+that have been injured or invaded by bacteria. Although painful, it is
+nevertheless one of the reparative processes of the body, and therefore
+beneficial. Common examples of inflammation are boils, sore throat, and
+the swollen, painful condition resulting from sprains and fractures.
+Characteristic symptoms of inflammation are heat, redness, swelling, and
+pain.
+
+When a tissue has been invaded by bacteria, nearby blood vessels dilate,
+thus bringing an increased supply of blood to the affected part. This
+extra supply serves to wash away the offending substance, and at the
+same time it brings more white blood corpuscles, one function of which
+is to destroy bacteria. From the increased supply of blood the affected
+part becomes red and hot, and so much blood may come that the vessels
+further on are unable to carry it away fast enough. Some of the fluid
+part of the blood is then forced out into the tissues, and the part
+becomes swollen. Distension of the tissues and pressure on the nerve
+endings cause pain, and the injured part now exhibits the characteristic
+symptoms of inflammation.
+
+[Illustration: FIG. 21.--"THE HISTORY OF A BOIL." This figure represents
+a cross-section of normal skin. Note the surface layer, or cuticle, and
+the "true skin," or cutis. In the cutis one sees that the blood
+capillaries are just wide enough for the blood-cells to pass through "in
+single file." The skin has just been pricked by a dirty pin. On the
+point of this pin were several poisonous germs which were deposited at
+_a_. (_From Emerson's "Essentials of Medicine."_)]
+
+[Illustration: FIG. 22.--"THE HISTORY OF A BOIL" (continued). The poison
+from these germs diffuses through the cutis. The capillaries dilate. The
+leucocytes force their way through the walls of the capillaries and
+travel towards these germs. Note the dumb-bell shape of the leucocytes
+as they pass through the minute holes in the capillary walls, and their
+pseudopods as they travel towards their common destination, attracted by
+the poison from the germs. The skin in this region is now swollen, red,
+hot, and painful. (_From Emerson's "Essentials of Medicine."_)]
+
+At this point, if the injury begins to heal or the bacterial infection
+to yield, the extra blood supply is gradually carried off, the blood
+vessels resume their normal size, and the tissues return to their usual
+condition. If, however, the infection does not yield so quickly, more
+and more white blood corpuscles assemble and pass through the walls of
+the tiny blood vessels into the tissues. Here the struggle continues.
+Some bacteria and some white blood corpuscles are killed, and substances
+are formed which liquify these dead cells and also some cells of the
+surrounding tissues. The resulting fluid is called pus or matter, and in
+the case of a boil we then say it has come to a head. If the infection
+occurs near a cavity or near the surface of the body, the pus may escape
+by breaking through at the point of least resistance, and may carry most
+of the poisons along with it. If the pus finds no outlet it may be
+gradually absorbed by the blood stream, and healing may result without
+discharging. On the other hand, the germs may make their way into the
+circulation, thus causing the serious condition known as blood
+poisoning.
+
+[Illustration: FIG. 23.--"THE HISTORY OF A BOIL" (continued). The
+migration of leucocytes has continued until now they form a dense mass
+surrounding the germs. The poison of the germs has killed all the
+leucocytes and also all the cutis immediately around them, and now
+digestive fluids from the dead leucocytes is turning the whole dead mass
+into liquid pus. The boil has "come to a head." There is a little lump
+on the skin and through its thin covering of cuticle can be seen the
+yellow pus. (_From Emerson's "Essentials of Medicine."_)]
+
+Inflammation may be treated by means of hot applications, cold
+applications, or counter-irritants. The effect of heat is to dilate the
+vessels and hence to increase the flow of blood to the injured part.
+This increased blood supply makes the reparative process go on more
+vigorously, and also makes it possible for the accumulated fluid to be
+more rapidly carried away. Moist heat softens the tissues so that pus,
+if formed, can escape more easily.
+
+[Illustration: FIG. 24.--"THE HISTORY OF A BOIL" (concluded). The boil
+has finally ruptured. The liquid pus has escaped carrying with it the
+germs and most of their poisons; the migration of leucocytes has
+stopped; the capillaries are returning to normal size and now new tissue
+will grow and fill up this hole. (_From Emerson's "Essentials of
+Medicine."_)]
+
+Cold acts in just the opposite way. It decreases the size of the blood
+vessels so that less blood comes to cause pain and swelling; at the same
+time it diminishes the number of white blood corpuscles and the
+nutritive substance brought by the blood. The nature and location of the
+infection determine whether heat or cold is to be preferred.
+
+Counter-irritants, of which mustard is an example, have a complicated
+action. A counter-irritant affects the blood circulation of the place to
+which it is applied, and at the same time it irritates the superficial
+nerves, which in turn stimulate other more distant nerves. The latter
+nerves control the circulation in tissues not adjoining those to which
+the counter-irritant is applied, and thus it is possible for a mustard
+paste, for example, if applied at one point to bring about changes in
+the blood supply of another part of the body. The mechanism by which
+counter-irritation is brought about is an intricate nervous process
+called reflex action.
+
+
+HOT APPLICATIONS
+
+In applying either moist or dry heat the danger of burning or scalding a
+patient must be constantly kept in mind. This danger is always great,
+but it is especially great when the skin is tender like that of babies,
+children, and old people, or when the vitality is low as in cases of
+chronic or exhausting illness. Unfortunately accidents in applying heat
+are not uncommon; a moment's carelessness may cause serious injury and
+prolonged suffering.
+
+DRY HEAT.--Hot water bags are used to apply dry heat. They should be
+filled not more than two-thirds full of hot water, but the water must
+not be so hot that there is the slightest possibility of scalding the
+patient if the bag should leak. Boiling water should never be used.
+Before the stopper is screwed on, expel the air by squeezing the bag or
+by resting it upon a flat surface until the water reaches the top. After
+closing the bag make sure that both bag and stopper are in order, by
+noting whether leakage occurs when the bag is inverted and pressed
+moderately. Before it is placed near the patient the bag should be dried
+and entirely covered with a towel or canton flannel bag.
+
+Strong bottles, jugs, and jars, if they can be securely stoppered, may
+be used sometimes instead of hot water bags. The same precautions are
+necessary. Bricks, flat irons, or thick flannel bags containing salt or
+sand may be heated in the oven and used in the same way. Salt and sand
+retain heat for a long time, but are correspondingly slow to heat;
+therefore one bag should be heating in the oven while the other is in
+use. Their effect on the skin must be no less carefully watched than the
+effects of other hot applications.
+
+Hot dry flannel may be used without fear of burning a patient, and it
+sometimes yields sufficient warmth to relieve pain, particularly
+abdominal pain of babies. After it has been heated on a radiator or in
+an oven, it should be applied quickly and covered closely with another
+flannel to prevent escape of heat.
+
+Dry heat can be applied conveniently by an electric pad. The part to be
+heated may be wrapped in flannel or placed directly above or below the
+pad. The pad should be carefully watched to see that the switch is not
+accidentally turned, as it is possible for the pad to become hot enough
+to burn the patient or to set fire to the bed covers.
+
+MOIST HEAT.--To apply moist heat poultices or fomentations (stupes) are
+used.
+
+_Poultices_ may be made of various heat-retaining substances, but
+flaxseed meal is generally used. The poultices when ready should be
+applied without delay, therefore all preparations should be made in
+advance. To prepare a poultice, first provide a piece of gauze or thin
+old muslin about two inches wider than you wish the poultice to be when
+finished, and about two inches more than twice as long. In a shallow
+saucepan boil water, varying in amount according to the size of the
+poultice desired; about equal parts of water and meal will be needed.
+When the water is boiling briskly add the meal gradually, beating
+constantly with a spatula or knife. The poultice is done when the
+mixture coheres and is thick enough to drop from the spatula leaving it
+clean. Quickly spread a layer of the hot flaxseed from a quarter to half
+an inch thick on one-half of the muslin, leaving a margin on three sides
+of about an inch (Fig. 25). Fold in the margins of the cloth (Fig. 26)
+and then bring the other half of the cloth over the flaxseed so that the
+top of the poultice is covered. Tuck the free end of the upper half of
+the cloth under the turned in edges of the long sides.
+
+[Illustration: FIG. 25.--Turn the edges of the muslin over the flaxseed
+by folding first on the line _AA'_, and then on the lines _BB'_ and
+_CC'_.]
+
+[Illustration: FIG. 26.--Fold on the line _EE'_, bringing _FF'_ up over
+the flaxseed and tucking it under at _D_ and _D'_.]
+
+Carry the poultice on a hot plate, or rolled in a newspaper or hot
+towel. Test it carefully with the back of the hand, apply it to the skin
+gradually, cover it with cotton batting, oiled muslin, or several
+thicknesses of flannel, and keep it in place with a bandage or towel.
+Remove it as soon as it has become cold, and unless the skin is much
+reddened apply a fresh poultice. If the skin is much reddened, anoint it
+with vaseline or sweet oil, wrap it warmly, and apply the next poultice
+as soon as the appearance of the skin is normal.
+
+_Stupes_ or _hot fomentations_ are cloths, preferably of flannel or
+flannelette, wrung out of boiling water and applied to the skin. Each
+stupe should be three or four times as large as the area to be covered.
+Two are needed, so that one may be prepared before removing the other.
+To prevent escape of heat and moisture the stupe should be covered after
+it has been applied, first with a piece of rubber cloth or oiled silk or
+muslin, and next with several thicknesses of flannel, or cotton batting
+made into a pad. The whole should be kept in place with a bandage or
+towel used as a binder. The doctor will tell how often the stupes are to
+be applied, but if the skin becomes irritated they must be stopped until
+its appearance is again normal.
+
+[Illustration: FIG. 27.--WRINGING STUPE. (_From "Elementary Nursing
+Procedures," California State Board of Health._)]
+
+Great care must be taken in applying fomentations. They do little good
+unless very hot, but if applied too hot the patient is likely to be
+scalded. They must be wrung as dry as possible; but it is difficult to
+wring them without scalding the hands unless stupe wringers are used.
+Stupe wringers are heavy pieces of cloth, like roller towels or pieces
+of ticking, long enough to extend over opposite sides of the basin in
+which the stupe is to be boiled, and wide enough to hold the stupe
+easily. The wringer should be placed in the basin with the stupe
+arranged upon it. Boiling water should then be added, or the water,
+stupe, and wringer may be boiled together in the basin. After the stupe
+is ready, the wringer with the stupe upon it should be removed from the
+water by grasping the dry ends of the wringer. Then the ends should be
+twisted in opposite directions until the stupe inside is as dry as
+possible. Wringing is made easier if the wringer has wide hems into
+which sticks such as pieces of broom handles are inserted. By twisting
+the sticks in opposite directions the stupe may be wrung out easily.
+
+
+COLD APPLICATIONS
+
+DRY COLD.--Cold, like heat, may be used either dry or moist. Bags of
+rubber or of Japanese paper filled with small pieces of ice are used to
+apply dry cold. When weight is to be avoided, the bag should not be
+completely filled. After the bag has been filled and the air has been
+expelled, it should be stoppered securely and wrapped in a towel or
+piece of flannel, since it is possible for an uncovered ice bag to
+freeze the skin. Ice bags are easily punctured, and care should be taken
+not to bring pressure upon them especially when filled with sharp pieces
+of ice. An ice bag not in use should be thoroughly dry inside and out;
+it should be put away with enough absorbent cotton inside to keep the
+surfaces from adhering. Bags of Japanese paper are less costly than
+rubber, but less durable. To close them one should roll the top over and
+then tie it tightly with string.
+
+MOIST COLD.--Cold compresses for the head are often used for patients
+with fever or headache; they sometimes quiet a patient who is restless.
+An old handkerchief or piece of soft linen folded with the raw edges
+inside may be used as a compress. It should be large enough to cover the
+forehead. Two compresses at least should be provided, and a large piece
+of ice in a basin. One compress should be wrung so that it will not
+drip, and then applied to the head. The other meanwhile should be placed
+on the ice to cool. As soon as the first compress becomes warm, the
+second should be applied in its place.
+
+_Cold Compresses for the Eyes._--Soft material should be selected for
+eye compresses. Each one should be cut only a little larger than the eye
+and should fit neatly over it. Several compresses should be placed on a
+block of ice while one is applied to the eye, and every few minutes the
+compress should be changed. If there is discharge from the eye, each
+compress should be used but once; when used, they should be collected in
+a paper and afterward burned. Separate compresses should be used if both
+eyes are being treated. Definite directions in regard to changing
+compresses and the length of time the applications should be continued
+are generally given by the physician.
+
+
+COUNTER-IRRITANTS
+
+To some extent all hot applications are counter-irritants, but mustard
+pastes, mustard leaves, and the mustard foot-bath already described are
+the counter-irritants most commonly used.
+
+_Mustard Paste._--To make a mustard paste, mix dry mustard with flour,
+using for adults one part of mustard and six of flour to make a weak
+paste; increase the proportion of mustard up to equal parts of mustard
+and flour, according to the strength required. Use a smaller proportion
+of mustard for children; one part of mustard with from 6 to 10 parts of
+flour is generally enough. Add to the mustard and flour enough tepid
+water to make a paste, which must be absolutely free from lumps. Do not
+use hot water for this purpose, because it destroys some of the active
+properties of the mustard. Spread the paste on thin muslin, apply it to
+the skin, and remove it as soon as the skin is reddened so that its
+color resembles that of a strong sun-burn. If the skin is especially
+sensitive, mix a little sweet oil or vaseline with the paste.
+
+_Mustard leaves_ should be dipped in tepid water and may then be applied
+to the skin directly, but if specially sensitive, the skin should be
+protected by thin muslin or gauze. The leaf should remain until the skin
+is well reddened; a few minutes are generally sufficient.
+
+Care must be taken not to leave either a mustard leaf or a paste in
+place long enough to blister the skin. After the application has been
+removed; the part should be protected by a soft cloth until redness
+disappears. Vaseline or sweet oil should be applied to the skin if it is
+greatly irritated.
+
+Other counter-irritants in common use are iodine, turpentine, ammonia,
+kerosene, camphorated oil, capsicum vaseline, and various liniments.
+Tincture of iodine may be diluted with alcohol for especially sensitive
+skins; it sometimes causes blisters, and should not be applied more than
+once a day at most. Ammonia and turpentine cause blisters; they should
+not be used as counter-irritants except by a doctor's order, and then
+only after exact directions have been obtained. Turpentine and kerosene
+are inflammable and hence dangerous to use. It should be remembered that
+the action of all counter-irritants is physiologically the same, so that
+no advantage is obtained from the use of dangerous substances like
+kerosene and turpentine.
+
+
+EXERCISES
+
+1. What are the causes and symptoms of inflammation?
+
+2. Describe the process of inflammation.
+
+3. What is the effect of heat on an inflamed area? of cold?
+
+4. What are the dangers from hot applications, and how may they be
+guarded against?
+
+5. How should you fill a hot water bag? How should you cover it?
+
+6. Describe the method of preparing and applying a flaxseed poultice.
+
+7. Tell how to prepare and apply fomentations.
+
+8. How should you apply cold compresses to the head? to the eyes?
+
+9. How should you make a mustard paste for a baby six months old? for a
+grown person only slightly ill? for a feeble old person with a sensitive
+skin?
+
+
+FOR FURTHER READING
+
+Essentials of Medicine--Emerson, Chapter I.
+
+The Human Mechanism--Hough and Sedgwick, Chapter IX.
+
+
+
+
+CHAPTER XII
+
+CARE OF PATIENTS WITH COMMUNICABLE DISEASES
+
+
+The first chapter of this book described the ways in which communicable
+diseases are carried from person to person, and also some principles
+underlying methods of prevention. This chapter aims to show how these
+principles apply in the actual care of patients whose diseases are
+transmissible. In order to apply them intelligently, it is necessary to
+keep in mind certain facts in regard to the transmission of infections.
+A brief summary of these facts follows.
+
+Disease germs are present in the bodies of persons suffering from
+communicable disease, but they may also exist in the bodies of persons
+in good health; if present in the body, they may leave it in any bodily
+discharge. While every kind of germ does not leave the body by all the
+different routes, it is nevertheless true that most germs expelled from
+the body are carried in discharges from the nose, throat, bladder or
+bowels. Germ-laden discharges of an infected person may be distributed
+to other persons by water, milk and other foods, by certain insects, by
+unclean hands, by common drinking cups, towels, handkerchiefs, and
+similar articles, and directly by nose and throat spray. After they have
+been thus conveyed to other persons, the germs make their entrance into
+the body of their new victims through the digestive tract, through the
+nose, throat, and other mucous membranes, or through breaks in the skin.
+Prevention of communicable diseases, therefore, depends upon the measure
+of success attained in blocking the transit of germs from person to
+person; but methods of prevention, though easy to understand, are
+unfortunately sometimes difficult to carry out. In order to carry them
+out effectively one must devote to the problem great accuracy,
+unremitting care, considerable intelligence, and a highly developed
+conscience.
+
+Care of a patient suffering from transmissible disease is adequate only
+when it accomplishes two definite results. One result, which concerns
+the patient primarily, is to bring about his recovery as rapidly and as
+surely as possible; the other result, which concerns the community
+rather than the individual, is to make it impossible for the patient to
+infect others with his disease. In every case of communicable disease,
+from a slight cold in the head up to serious cases of pneumonia or
+typhoid fever, both the patient and the community must be constantly
+safe-guarded.
+
+INCUBATION PERIOD.--The interval between the moment when pathogenic
+germs enter the body, and the time when symptoms first appear and the
+patient begins to feel ill, is called the incubation period. Incubation
+periods vary according to the disease from a few hours to two or three
+weeks. The length of the period also varies somewhat in different cases
+of the same disease.
+
+CARE OF PATIENTS WITH COLDS OR OTHER SLIGHT INFECTIONS.--The usual
+symptoms of infectious diseases include fever, chill, sore throat, nasal
+discharge, cough, headache, vomiting and other digestive disturbances,
+and a general feeling of being sick all over. When one or more of these
+symptoms appear, unless they are very slight, a doctor should be sent
+for. The patient, whether child or grown person, should go to bed in a
+room alone and should stay in bed at least as long as the fever and
+symptoms of cold in the head continue, in order to protect others as
+well as himself. Persons in active life, it is true, are not always able
+to go to bed during colds; but there is no doubt that ultimately they
+would save time by doing so. It is especially necessary for children to
+remain in bed when suffering from colds, not only to insure their own
+well-being but also to protect others, since children are notably
+careless in regard to coughing, sneezing, and borrowing handkerchiefs.
+The patient needs mental rest as well as physical, and should not be
+allowed to work in bed.
+
+The patient's nose and throat discharges should be received only in
+material that can be burned, like old linen or muslin, gauze, or paper
+napkins. As soon as they are soiled these handkerchief substitutes
+should be placed in strong paper bags and afterward burned. Soiled
+handkerchiefs lurking under pillows or in other parts of the bed may
+infect other people or re-infect the patient. Handkerchiefs that may not
+be burned should be placed as soon as soiled in a covered receptacle
+filled with cold water containing a little washing soda; when several
+have been collected they should be boiled in the same covered receptacle
+for 20 minutes. After boiling they may go to the regular laundry.
+
+The patient's diet at first should be liquid or semi-solid. Large
+amounts of nourishment are not necessary during the first day or two,
+especially if the illness is likely to be short, but water should be
+taken as freely as possible. Cold drinks are generally acceptable during
+the feverish stage, but lemonade and other acids should be used with
+caution, since they sometimes irritate a sore throat. When the active
+symptoms have subsided the patient will need more food than usual, and a
+liberal, nourishing diet for a few days will do much to prevent the
+weakness and depressed vitality that often follow colds, tonsilitis, and
+other comparatively slight infections.
+
+The bowels should be carefully regulated, and a mild cathartic is often
+beneficial at the outset.
+
+Even during slight illness a patient should receive the daily care
+already described, and should be made as comfortable as possible. As in
+any illness, sponging and alcohol rubs are refreshing. An ice bag or
+cold compress may relieve headache, and hot applications or a cold
+compress on the throat are often soothing. The throat may be gargled
+with a solution of one teaspoonful of common salt dissolved in a pint of
+boiled water. If the patient perspires profusely he should be rubbed
+with a towel until dry, and provided with fresh warm, night clothes. An
+alcohol rub may well follow. It is most unwise for a patient who is
+perspiring freely to get up in a cold room and attend to himself.
+
+Common colds are far more serious than they are usually supposed to be.
+
+      "More people suffer from common colds than from any other
+      single ailment.... Could the sum total of suffering,
+      inconvenience, sequelæ, and economic loss resulting from
+      common colds be obtained, it would at once promote these
+      infections from the trivial into the rank of the serious
+      diseases.... Colds are contracted from other persons having
+      colds, just as diphtheria is contracted from diphtheria.
+      Arctic explorers exposed to all the conditions ordinarily
+      supposed to produce colds do not suffer from these ailments
+      until they return to civilization and become infected by
+      contact with their fellowmen.... While common colds are
+      never fatal, the complications and sequelæ are serious.
+      These are rheumatic fever, pneumonia, sinusitis, nephritis,
+      and a depressed vitality which favors other infections and
+      hastens the progress of organic diseases.
+
+      "Common colds are perhaps most contagious during the early
+      stages. If persons isolate themselves by remaining in bed
+      during the first three days of a cold, they would not only
+      benefit themselves, but would largely prevent the spread of
+      the infection. The contagiousness and severity of colds
+      differ in different epidemics and in different seasons of
+      the year, depending upon the particular micro-organism
+      involved and other factors not well understood.
+
+      "PREVENTION.--The prevention of colds consists, first in
+      avoiding the infection, and, secondly, in guarding against
+      the predisposing causes. Contact should be avoided with
+      persons who have colds, especially in street cars, offices,
+      and other poorly ventilated spaces where the risk of
+      persons coughing or sneezing directly in one's face is
+      imminent. Contact with the infection may further be guarded
+      against by a careful self-education in sanitary habits and
+      cleanliness, based upon the modern conception of contact
+      infection.
+
+      "Colds, like other diseases conveyed in the secretions from
+      the nose and mouth, are often conveyed by direct and
+      indirect contact through lack of hygienic cleanliness and a
+      disregard of sanitary habits. Kissing, the common drinking
+      cup, the roller towel, pipes, toys, pencils, fingers, food,
+      and other objects contaminated with the fresh secretions
+      will transmit the disease."--("Preventive Medicine and
+      Hygiene," Rosenau.)
+
+CARE DURING MORE SERIOUS INFECTIONS.--When a patient is suffering from
+serious transmissible disease, he needs the most skillful care
+available, and for the sake of others he must be strictly isolated or
+quarantined. By isolating or quarantining a patient is meant making such
+arrangements that germs expelled by the patient are necessarily
+destroyed before they can enter the body of another person. Isolation,
+therefore, includes disinfection, and while methods vary according to
+the nature of the particular disease, yet the principles given below are
+applicable in most cases.
+
+The first essential is that the patient should have a room to himself.
+No one except those caring for him should enter the sick-room for any
+purpose whatever; visitors should be rigidly excluded. At the outset all
+unnecessary articles should be removed from the sick-room, and it
+should be possible to boil, burn, scrub, or otherwise thoroughly clean
+everything allowed to remain. The windows should be screened in summer,
+and flies must be excluded. Fresh air is especially needed by patients
+with communicable diseases, and ventilation of the room must be adequate
+both day and night. Foul odors plainly indicate that the patient or
+something in the room is not clean. The remedy is obvious and deodorants
+are quite unnecessary if the patient and the room are properly cared
+for. It is highly desirable to reserve a bath room for the exclusive use
+of the patient and his attendant and also to reserve a room adjoining
+the patient's room for the exclusive use of the attendant. When it is
+impossible, as it often is, to give up so much space, each family must
+make the best arrangement it can to separate the patient and his
+attendant from the rest of the family.
+
+The attendant must remember that her ten fingers are the ten most active
+agents in distributing the communicable diseases. After handling the
+patient or anything that the patient has touched, and whenever she
+leaves the patient's room, she must scrub her hands thoroughly with warm
+water, soap, and a nail brush. She should not soil her hands
+unnecessarily, even though she intends to scrub them later. She must
+remember for her own protection to keep her hands away from her mouth
+and face, and to cleanse them with special care just before eating. If
+disinfection is needed in addition to the scrubbing, she must use
+conscientiously whatever solution the doctor orders.
+
+At the same time that she is caring for a patient with a communicable
+disease, the attendant ought not to care for children or other members
+of the family, she ought not to prepare food, and she ought not to
+handle dishes or utensils used by other persons. Every day, however,
+many women are doing just these things, and it is true that in many
+instances no bad results are observed. Yet if any arrangement to insure
+safety can possibly be made, it is inexcusable to run the risk of
+spreading diseases which kill thousands of persons every year and injure
+many more for life.
+
+When home conditions render adequate care and strict isolation of the
+patient impossible, hospital care should be seriously considered. No
+personal or sentimental objections should be allowed to influence the
+decision, if removing the patient to a hospital is necessary to
+safeguard his welfare or the welfare of the family. Hospital care should
+be considered especially for patients with typhoid fever, because
+untrained persons cannot safely care for patients so seriously ill.
+Since a patient with typhoid needs skilled care, and since he greatly
+endangers other persons, most authorities consider hospital care
+essential unless the patient can have the continuous services of a
+trained nurse and almost ideal home conditions. Many cases of typhoid,
+it is true, are successfully nursed at home in extremely adverse
+conditions by visiting nurses; yet in few kinds of sickness is
+continuous care by a graduate nurse more necessary to protect the
+community as well as to safeguard the patient himself.
+
+Members of a family in which there is typhoid should be immunized if the
+doctor advises it. This process, which is performed by the doctor, in
+the majority of cases renders a person immune to typhoid fever for three
+or four years.
+
+The question of home or institutional care for persons with tuberculosis
+must also be carefully considered. In some cases tuberculosis may be
+cared for at home with comparative safety, and in some other cases the
+risk is not very great if the patient is intelligent, careful, and well
+supervised. But everyone should face the fact that all cases of
+tuberculosis of the lungs involve some risk to others in the family, and
+most cases involve great risk. The danger to children is greater than to
+adults. Most tuberculosis infections, it is now believed, are acquired
+in childhood. The bad results of an infection acquired in childhood may
+not show themselves for years, since the germs may remain inactive until
+the person's resistance is lowered by some unfavorable condition.
+
+THE CHILDREN'S DISEASES.--The so-called children's diseases are probably
+the most familiar and the least regarded of all those belonging to the
+communicable group. Most persons, it is true, realize that scarlet fever
+is serious; everyone should also realize that measles and whooping-cough
+are serious. For example, in the State of New York during the year 1916,
+more children died from each of these diseases than from scarlet fever:
+in that year 745, or four times the number that died of scarlet fever,
+lost their lives from whooping-cough, while 913 died of measles. If
+diseases that kill hundreds of children every year are not serious, one
+is at a loss to know what a serious disease is.
+
+Some parents even expose children unnecessarily to these infections on
+the fatalistic theory that they must have the diseases sometime, and
+therefore the sooner the better. Nothing could be more mistaken; the
+diseases are not inevitable, and there is no advantage whatever in
+having them if escape is possible. Moreover, serious as the children's
+diseases are in themselves, their after-effects may be even more
+serious. At this very moment hundreds of people are going through
+life handicapped by weakened hearts or kidneys, by defective sight or
+hearing, merely because their parents considered the children's diseases
+necessary. The common belief that children should have these diseases as
+early as possible is also erroneous, since statistics show that the
+younger the child the more likely is the disease to prove fatal.
+
+Every mother should realize that the children's diseases are most
+infectious in the early stages. Early symptoms include fever, sore
+throat, and nasal discharge, and the trouble at first often resembles a
+severe cold. During this stage the diseases are most easily
+communicated. Measles in particular is generally not recognized until
+its most infectious stage has passed. The moral to be drawn is that sore
+throats, coughs, and colds should never be regarded lightly, and that
+their spread should be prevented by all possible means.
+
+The accompanying table taken from the regulations of the New York State
+Department of Health, gives symptoms of communicable diseases among
+children, and rules for isolation and exclusion from school.
+
+  NEW YORK STATE DEPARTMENT OF HEALTH
+  COMMUNICABLE DISEASES AMONG CHILDREN
+  RULES FOR ISOLATION AND EXCLUSION FROM SCHOOL
+
+  HERMAN M. BIGGS, M.D.
+  Commissioner
+
+  Issued by the
+  Division of Public Health Education
+
+  =======================================================================
+     DISEASE   |      PRINCIPAL SIGNS         |         METHOD OF       |
+               |       AND SYMPTOMS           |         INFECTION       |
+  -------------+------------------------------+-------------------------+
+  CHICKENPOX   | Rarely begins with fever.    | Contact with discharges |
+               | Rash appears on second day   | from nose and throat of |
+               | as small pimples, which in   | a patient.              |
+               | about a day become filled    |                         |
+               | with clear fluid. This fluid |                         |
+               | becomes yellow colored, a    |                         |
+               | crust forms and the scab     |                         |
+               | falls off in about 14 days.  |                         |
+               | Successive crops of papules  |                         |
+               | appear until tenth day.      |                         |
+  -------------+------------------------------+-------------------------+
+  DIPHTHERIA   | Onset may be rapid or        | Contact with discharges |
+               | gradual. The back of the     | from nose and throat,   |
+               | throat, tonsils, or palate   | occasionally by         |
+               | may show patches. The most   | drinking infected milk. |
+               | pronounced symptom is sore   |                         |
+               | throat. There may be hardly  |                         |
+               | any symptoms at all.         |                         |
+  -------------+------------------------------+-------------------------+
+  MEASLES      | Begins like cold in the      | Contact with discharges |
+               | head, with running nose,     | from nose and throat    |
+               | sneezing, inflamed and       | of a patient.           |
+               | watery eyes and fever.       |                         |
+               | Mulberry-tinted spots appear |                         |
+               | about the third day; rash    |                         |
+               | first seen behind the ears,  |                         |
+               | on forehead and face. The    |                         |
+               | rash varies with heat; may   |                         |
+               | almost disappear if the air  |                         |
+               | is cold, and come out again, |                         |
+               | with warmth.                 |                         |
+  -------------+------------------------------+-------------------------+
+  MEASLES      | Illness usually slight.      | Same as above.          |
+  (LIBERTY)    | Onset sudden. Lymph nodes in |                         |
+               | back of neck enlarged. Rash  |                         |
+               | often first thing noticed;   |                         |
+               | no cold in head. Usually     |                         |
+               | have fever, sore throat, and |                         |
+               | the eyes may be inflamed.    |                         |
+               | Rash sometimes resembles     |                         |
+               | measles and scarlet fever,   |                         |
+               | variable.                    |                         |
+  -------------+------------------------------+-------------------------+
+  MUMPS        | Onset may be sudden,         | Same as above.          |
+               | beginning with sickness and  |                         |
+               | fever, and pain about the    |                         |
+               | angle of the jaw. The        |                         |
+               | parotid glands become        |                         |
+               | swollen and tender. Opening  |                         |
+               | the mouth is accompanied by  |                         |
+               | pain.                        |                         |
+  -------------+------------------------------+-------------------------+
+  POLIOMYELITIS| Onset sudden, fever,         | Contact with discharge  |
+               | excitable, pain on bending   | from nose, throat or    |
+               | neck forward, pain on being  | bowels of a patient     |
+               | handled, headache, vomiting. | or carrier.             |
+               | Sometimes sudden development |                         |
+               | of weakness of one or more   |                         |
+               | muscle groups.               |                         |
+  -------------+------------------------------+-------------------------+
+  SCARLET      | The onset is usually sudden, | Discharges from nose    |
+  FEVER        | with headache, fever, sore   | and mouth, suppurating  |
+               | throat, and often vomiting.  | glands or ears of a     |
+               | Usually within twenty-four   | patient.                |
+               | hours the rash appears as    | Milk may convey         |
+               | fine, evenly diffused, and   | infection.              |
+               | bright red dots under skin.  |                         |
+               | The rash is seen first on    |                         |
+               | the neck and upper part of   |                         |
+               | chest, and lasts three to    |                         |
+               | ten days, when it fades and  |                         |
+               | the skin peels in scales,    |                         |
+               | flakes, or even large        |                         |
+               | pieces.                      |                         |
+  -------------+------------------------------+-------------------------+
+  SMALLPOX     | Onset sudden usually with    | All discharges of a     |
+               | fever and severe backache.   | patient and particles   |
+               | About third day upon         | of skin or scabs.       |
+               | subsidence of constitutional |                         |
+               | symptoms red shot-like       |                         |
+               | pimples, felt below the      |                         |
+               | skin, and seen first about   |                         |
+               | the face and wrists most on  |                         |
+               | exposed surfaces, develop.   |                         |
+               | They form little blisters    |                         |
+               | and after two days more      |                         |
+               | become filled with yellowish |                         |
+               | matter. Scabs form which     |                         |
+               | begin to fall off about the  |                         |
+               | fourteenth day.              |                         |
+  -------------+------------------------------+-------------------------+
+  SORE THROAT, | Begins with sore throat and  | Discharges from nose    |
+  ACUTE,       | weakness. Throat diffusely   | and mouth of a          |
+  SEPTIC       | reddened and may show        | patient.                |
+               | patches like diphtheria.     |                         |
+  -------------+------------------------------+-------------------------+
+  WHOOPING     | Begins with cough which is   | Discharges from nose    |
+  COUGH        | worse at night. Symptoms may | and mouth of a          |
+               | at first be very mild.       | patient.                |
+               | Characteristic "whooping"    |                         |
+               | cough develops in about 2    |                         |
+               | weeks, and the spasm of      |                         |
+               | coughing sometimes ends with |                         |
+               | vomiting.                    |                         |
+  =======================================================================
+  ===============================================================
+               |             EXCLUSION FROM SCHOOL              |
+               |-------+-------------------+--------------------+
+               |       | OTHER CHILDREN    |    OTHER SCHOOL    |
+               |       |    OF SAME        |     CHILDREN       |
+    DISEASE    |       |   HOUSEHOLD       | ESPECIALLY EXPOSED |
+               |       +--------+----------+--------+-----------+
+               |Patient|        |          |        |           |
+               |       | Non-   |          | Non-   |           |
+               |       | immunes|Immunes[3]| immunes| Immunes[3]|
+               |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  CHICKENPOX   |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  DIPHTHERIA   |  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  -------------+-------+--------+----------+--------+-----------+
+  MEASLES      |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  MEASLES      |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  (LIBERTY)    |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  MUMPS        |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  POLIOMYELITIS|  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  -------------+-------+--------+----------+--------+-----------+
+  SCARLET      |  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  FEVER        |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  SMALLPOX     |  Yes  |   Yes  |    Yes   |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  SORE THROAT, |  Yes  |   No   |    No    |   No   |    No     |
+  ACUTE,       |       |        |          |        |           |
+  SEPTIC       |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  WHOOPING     |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  COUGH        |       |        |          |        |           |
+  ===============================================================
+  ================================================================================
+              |               DURATION OF EXCLUSION FROM DATE OF ONSET           |
+              +--------------+------------+-------------------------+------------+
+              |              |  PATIENT   |      PATIENT REMAINS    |            |
+              |              |  GOES TO   |        ISOLATED AT      |            |
+              |              |  HOSPITAL  |           HOME          |            |
+    DISEASE   |              +------------+------------+------------+            |
+              |  PATIENT     | Other      | Other      | Children   |  Children  |
+              |              | children   | children   | who leave  |  exposed   |
+              |              | of         | who        | household  |  at        |
+              |              | the same   | remain at  | as soon as |  school    |
+              |              | household  | home       | disease is |            |
+              |              |            |            | discovered |            |
+  ------------+--------------+------------+------------+------------+------------+
+  CHICKENPOX  | Until all    | Exclude if non-immune until          |Exclude     |
+              | scabs are    | 21st day after child last            |from        |
+              | shed and     | saw patient.                         |school if   |
+              | disinfection |                                      |non-immune  |
+              | of person;   |                                      |during      |
+              | at least     |                                      |11th to 22d |
+              | 12 days.     |                                      |days after  |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  DIPHTHERIA  |Until         | Until two cultures at least 24       |            |
+              |patient is    | hours apart are reported             |            |
+              |recovered     | negative. Those showing              |            |
+              |and has two   | diphtheria bacilli should not        |            |
+              |cultures      | necessarily be immunized             |            |
+              |from throat   | unless symptoms appear.              |            |
+              |and nose which|                                      |            |
+              |contain no    |                                      |            |
+              |diphtheria    |                                      |            |
+              |bacilli;      |                                      |            |
+              |cultures not  |                                      |            |
+              |to be taken   |                                      |            |
+              |until 9 days  |                                      |            |
+              |from date of  |                                      |            |
+              |onset.        |                                      |            |
+              |Disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ------------+--------------+--------------------------------------+------------+
+  MEASLES     | Until        | Exclude non-immunes until            |If          |
+              | recovery and | 15th day after child last            |non-immune  |
+              | disinfection | saw patient.                         |exclude     |
+              | of person;   |                                      |from school |
+              | at least 7   |                                      |during 8th  |
+              | days from    |                                      |to 15th     |
+              | onset.       |                                      |day after   |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  MEASLES     | Until        | Exclude if non-immune until          |Exclude from|
+  (LIBERTY)   | recovery and | 22d day after child last             |school if   |
+              | disinfection | saw patient.                         |non-immune  |
+              | of person;   |                                      |during 11th |
+              | at least 8   |                                      |to 22d days |
+              | days.        |                                      |after       |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  MUMPS       |Two weeks     | Exclude 15th to 22d day after        |Exclude     |
+              |after onset   | child last saw patient.              |from 15th   |
+              |and one week  |                                      |to 22d day  |
+              |after         |                                      |after child |
+              |disappearance |                                      |last saw    |
+              |of swelling   |                                      |patient.    |
+              |and after     |                                      |            |
+              |disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ------------+--------------+------------+------------+------------+------------+
+  POLIO-      | Until        | 14 days    | Until 14   | 14 days    |            |
+  MYELITIS    | patient is   | from time  | days       | from time  |            |
+              | recovered.   | child      | after      | child      |            |
+              | Disinfection | last saw   | quarantine | last       |            |
+              | of person at | patient.   | raised.    | saw        |            |
+              | least 21     |            |            | patient.   |            |
+              | days.        |            |            |            |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SCARLET     |At least 30   | Seven days | Until      | Seven      |            |
+  FEVER       |days and until| from time  | seven days | days from  |            |
+              |discharges    | child      | after      | time       |            |
+              |have ceased   | last saw   | quarantine | child      |            |
+              |and           | patient.   | raised.    | last saw   |            |
+              |disinfection  |            |            | patient.   |            |
+              |of person.    |            |            |            |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SMALLPOX    |Recovery and  |Exclude if  |Exclude if  |Exclude if  |Exclude 20  |
+              |disinfection  |non-immune  |non-immune  |non-immune  |days unless |
+              |of person     |until 21st  |until 20    |until 21st  |they have   |
+              |at least 14   |day after   |days after  |day after   |been        |
+              |days.         |child last  |quarantine  |child last  |successfully|
+              |              |saw patient,|has been    |saw patient,|vaccinated  |
+              |              |or 7 days   |raised or   |or 7 days   |within 1    |
+              |              |after       |7 days after|after       |year in     |
+              |              |successful  |successful  |successful  |which       |
+              |              |vaccination |vaccination |vaccination |case they   |
+              |              |and         |and         |and         |may return  |
+              |              |disinfection|disinfection|disinfection|at once.    |
+              |              |of person.  |of person.  |of person.  |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SORE THROAT,|Until         |                                      |            |
+  ACUTE,      |recovery.     |                                      |            |
+  SEPTIC      |              |                                      |            |
+  ------------+--------------+--------------------------------------+------------+
+  WHOOPING    |Eight weeks   | Fourteen days provided no cough      |            |
+  COUGH       |or until 1    | develops.                            |            |
+              |week after    |                                      |            |
+              |last          |                                      |            |
+              |characteristic|                                      |            |
+              |cough and     |                                      |            |
+              |disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ================================================================================
+  =================================================================
+     DISEASE   |                  Remarks                         |
+               |                                                  |
+  -------------+--------------------------------------------------+
+  CHICKENPOX   | A mild disease and seldom any after effects.     |
+  -------------+--------------------------------------------------+
+  DIPHTHERIA   | Very dangerous, both during attack and from      |
+               | after effects. When diphtheria occurs in a       |
+               | school all children suffering from sore throat   |
+               | should be excluded and the health officer        |
+               | notified. The medical school inspector or        |
+               | health officer should take cultures from all     |
+               | inflamed throats and noses. There is great       |
+               | variation of type, and mild cases are often      |
+               | not recognized, but are as infectious as         |
+               | severe cases. There is frequently no immunity    |
+               | from further attacks.                            |
+  -------------+--------------------------------------------------+
+  MEASLES      | After effects often severe. Period of greatest   |
+               | risk of infection three days, before and after   |
+               | the rash appears. Great variation in type        |
+               | of disease. Dangerous in children under 2        |
+               | years of age. During an outbreak all children    |
+               | having a temperature over 99°F. should           |
+               | be sent home and the health officer notified.    |
+  -------------+--------------------------------------------------+
+  MEASLES      | After effects slight. Regulations strict,        |
+  (LIBERTY)    | because frequently confused with scarlet fever.  |
+  -------------+--------------------------------------------------+
+  MUMPS        | Seldom leaves after effects. Very infectious.    |
+               | Inflammation of genital organs of male or        |
+               | female may occur.                                |
+  -------------+--------------------------------------------------+
+  POLIOMYELITIS| Disease is most communicable in the early        |
+               | stages. After effect is paralysis of certain     |
+               | muscle groups, transitory or permanent.          |
+               | Death is due usually to paralysis of             |
+               | respiratory muscles.                             |
+  -------------+--------------------------------------------------+
+  SCARLET      | Dangerous both during attack and from after      |
+  FEVER        | effects. Great variation in type of disease.     |
+               | Slight attacks are as infectious as severe       |
+               | ones. Many mild cases not diagnosed and          |
+               | many concealed. A second attack is rare.         |
+               | When scarlet fever occurs in a school, all       |
+               | cases of sore throat should be sent home and     |
+               | health officer notified. Most fatal in           |
+               | children under ten years.                        |
+  -------------+--------------------------------------------------+
+  SMALLPOX     | Peculiarly infectious. When smallpox occurs      |
+               | in connection with a school or with any of       |
+               | the children's homes all persons exposed         |
+               | must be vaccinated or quarantined for a          |
+               | period of 20 days. Cases of modified smallpox    |
+               | in vaccinated persons, may be, and often         |
+               | are, so slight as to escape detection. Fact      |
+               | of existence of disease may be concealed.        |
+               | Mild or modified smallpox is as infectious as    |
+               | severe type.                                     |
+  -------------+--------------------------------------------------+
+  SORE THROAT, | Often leads to serious results, affections of    |
+  ACUTE,       | heart, kidneys, etc. Very apt to occur in        |
+  SEPTIC       | epidemics due to milk contaminated by a          |
+               | patient suffering from the disease.              |
+  -------------+--------------------------------------------------+
+  WHOOPING     | After effects often very severe and disease      |
+  COUGH        | causes great debility. Relapses are apt to       |
+               | occur. Second attack rare. Specially             |
+               | infectious for first week or two. If a child     |
+               | vomits after a paroxysm of coughing, it is       |
+               | probably suffering from whooping cough.          |
+               | Great variation in type of disease. Often        |
+               | fatal in young children.                         |
+  =================================================================
+
+  [3] Immunes are those who have had the diseases or in smallpox, who
+  have been successfully vaccinated within a year.
+
+  DISINFECTION: The cleansing and disinfection of the person includes
+  washing the entire body and the hair with soap and water; thorough
+  brushing of the teeth; rinsing the mouth; gargling the throat, and
+  douching and spraying the nose with an antiseptic solution; and
+  finally, a complete change of clothing (or a change of underwear and
+  a thorough shaking and brushing of the outer garments out of doors
+  before these are put on again). (_Facing p. 247_)
+
+It may be added that the ways by which poliomyelitis, or infantile
+paralysis, is spread are not definitely known at the time of writing.
+We are justified, however, in believing that investigation now in
+progress will make exact information available in the near future.
+
+      "The weight of present opinion inclines to the view that
+      poliomyelitis is exclusively a human disease, and is spread
+      by personal contact, whatever other causes may be found to
+      contribute to its spread. In personal contact we mean to
+      include all the usual opportunities, direct or indirect,
+      immediate or intermediate, for the transference of body
+      discharges from person to person, having in mind as a
+      possibility that the infection may occur through
+      contaminated food.
+
+      "The incubation period has not been definitely established
+      in human beings. The information at hand indicates that it
+      is less than two weeks, and probably in the great majority
+      of cases between 3 and 8 days."--(Report of Special
+      Committee on Infantile Paralysis, American Journal of
+      Public Health, November 1916.)
+
+
+DISINFECTION
+
+Specific directions for disinfecting in every kind of communicable
+disease would be too extended to be given here. In each case the
+attendant should learn from the doctor just how that particular disease
+is communicated, just what discharges, utensils, linen, etc., need to be
+disinfected, and just what disinfectants he prefers to have used. The
+following general methods are now in use, but it must be remembered that
+from time to time new methods are devised and new disinfectants are
+discovered.
+
+CARE OF NOSE AND THROAT DISCHARGES.--The care of handkerchiefs has
+already been described on page 239. Cloths or cotton used to wipe the
+eyes or to receive any other bodily discharge including vomitus, should
+be collected in the same way and burned. Everyone should be taught in
+early childhood to cover the nose and mouth with a handkerchief during
+coughing and sneezing; if the patient has not already learned to do so
+he must be taught now. If the amount of expectoration is great,
+waterproof receptacles should be provided, which should be burned with
+their contents.
+
+CARE OF DISCHARGES FROM THE BOWELS AND BLADDER.--At the present time the
+following preparations are commonly used to disinfect stools and urine:
+5% solution of carbolic acid; chloride of lime solution, made freshly
+whenever needed by mixing thoroughly ½ pound of chloride of lime with
+one gallon of water; and unslaked lime to which is added _hot_ water.
+The amount of carbolic solution used should be about equal in bulk to
+the amount of material to be disinfected; the chloride of lime solution
+should be at least twice, and the unslaked lime at least one-eighth the
+bulk. Fecal masses should be broken up so that the disinfectant may
+reach every part; they may be stirred with tightly twisted toilet paper,
+which should be left in the bedpan and disinfected with the stools. If
+these substances are used, disinfection is considered complete at the
+end of an hour, and the contents of the bedpan may then be emptied into
+the toilet with safety. It may be necessary to provide two bedpans so
+that one may be available for use while the contents of the other is
+being disinfected. Bedpans and urinals should be boiled daily and kept
+thoroughly clean at all times.
+
+In places having no sewerage system, disinfected discharges may be
+emptied into a trench situated at a distance from the well, and then
+covered with earth. As an extra precaution, the disinfected discharges
+may be mixed with sawdust or kerosene and burned in the trench.
+Directions for installing a sanitary privy may be found in Bulletin 68
+of the United States Public Health Service.
+
+BATH WATER and water that has been used for cleansing the teeth and
+mouth may be disinfected in the same way as urine, or it may be emptied
+into a suitable receptacle and boiled ten minutes.
+
+CARE OF THE HANDS.--Disinfectants for the hands should be used in
+addition to scrubbing with soap and water, not as a substitute. The
+hands may be disinfected after scrubbing by soaking them for three
+minutes in one of the following solutions: alcohol 70%, carbolic acid
+solution 2½%, or a solution made by adding one teaspoonful of lysol or
+of creolin to a pint of water. These disinfectants are poisons if taken
+internally; the bottles must be carefully labeled and kept in a safe
+place. It is a good plan to wear rubber gloves when handling infective
+material; the gloves should afterward be boiled for ten minutes.
+
+CARE OF UTENSILS.--A sufficient number of dishes, spoons, tumblers,
+basins, etc. must be reserved for the patient's exclusive use; these
+utensils must be washed separately and dried with towels not used for
+other dishes. Mistakes frequently occur by which other persons use the
+patient's dishes, and in consequence his dishes should not be kept in
+the cupboard with other dishes; if no other safe place can be found,
+they had better stay in the patient's room covered with a clean cloth or
+napkin. The dishes should be scalded daily and at the termination of the
+illness they must be boiled briskly for ten minutes before they are
+returned to general use. Food left on the patient's tray should be
+burned; it should not be eaten by any one else, nor placed in the pantry
+or refrigerator with other food.
+
+CARE OF LINEN.--A satisfactory way to disinfect towels, night gowns, bed
+linen, etc. is to place the articles immediately in a wash boiler filled
+with cold water to which a little washing soda has been added, and then
+to boil them in the same water for twenty minutes; they can afterward
+go safely into the regular laundry. The boiling may be done once a day;
+articles soiled in the meantime may be left to soak in the cold water
+and soda.
+
+DISINFECTION OF THE PERSON.--"The cleansing and disinfection of the
+person includes washing the entire body and the hair with soap and
+water; thorough brushing of the teeth; rinsing the mouth; gargling the
+throat, and douching and spraying the nose with an antiseptic solution;
+and finally, a complete change of clothing (or a change of underwear)
+and a thorough shaking and brushing of the outer garments out-of-doors
+before these are put on again."--(New York State Department of Health.)
+
+TERMINATION OF QUARANTINE.--After the patient has recovered, he and the
+attendant should, if the doctor thinks it necessary, disinfect
+themselves as directed above before they mingle again with other people.
+The exact time when it is safe for a person to come out of quarantine
+and resume ordinary life varies in different diseases. Moreover, opinion
+differs in regard to quarantine periods for the same diseases, so that
+the regulations of Boards of Health in different cities show wide
+variations. It is of course impossible to say at just what moment every
+patient, or even the majority of patients, will stop expelling germs.
+Quarantine periods are intended to protect the community as completely
+as possible without causing unnecessary hardship to individuals. In any
+given case, the local regulations should be strictly observed but
+release from quarantine is not a guarantee that the patient is not still
+discharging germs, and extreme care should still be taken to prevent the
+spread of saliva and other discharges.
+
+TERMINAL DISINFECTION.--A room that has been occupied by a patient with
+a communicable disease should be thoroughly cleaned at the termination
+of the illness. Dishes, utensils, bed linen, etc. should be cared for in
+the ways already described. The floor, bedstead, and other furniture
+should be washed with hot water, soap, and washing soda. The walls,
+windows, etc., should be wiped with a cloth wrung out of hot water, soap
+suds, and soda. The mattress, unless badly soiled with discharges,
+should be scrubbed with the same solution and a stiff brush, and left
+out-of-doors in the sunshine for a day or two, or until dry. If badly
+soiled, it is best to destroy the mattress unless the Board of Health
+has facilities for steam sterilization. Ordinary washing is all that is
+generally required for blankets, but if badly soiled they should be
+sterilized by steam or burned. The room should then be thoroughly
+sunned and aired for a day or two, with the windows wide open both day
+and night. Sunning and airing are among the most important measures in
+disinfecting a room, and should not be slighted. If there has been gross
+pollution, as when a careless consumptive persists in spitting on the
+floor and walls, it may be necessary to remove the old paint and paper
+and have the room done over. The room may safely be occupied after all
+these measures have been taken.
+
+FUMIGATION.--Many Boards of Health have abandoned fumigation after
+communicable diseases, except after those which like typhus and yellow
+fever, are carried by vermin or insects. Dry formaldehyde gas, which was
+formerly used for fumigation, has a violent effect on mucous membranes,
+but its power to kill bacteria, even on surfaces, appears to be weak,
+while its penetrating power is not sufficient to disinfect bedding,
+carpets, upholstered furniture, and other fabrics. Since fumigation is
+costly, troublesome, and ineffectual there seems to be no good reason
+for using it. Moreover, its use gives a false sense of security, so that
+really effective measures like sunning, airing, and scrubbing are likely
+to be neglected.
+
+Theory and practice of disinfection, it is clear, have radically
+changed in recent years. Modern knowledge requires concurrent
+disinfection, or the destruction of germs from the moment when symptoms
+are first noticed; all the time, day and night, this disinfection must
+go on with unremitting care. Today wet sheets are not hung in doorways
+nor are chemicals left about in open dishes to disinfect quite harmless
+air, but scrupulous cleanliness at all stages of disease is recognized
+as one of the most important measures, if not the most important
+measure, in disinfection.
+
+
+EXERCISES
+
+1. Summarize the ways in which infectious diseases are spread.
+
+2. What is meant by the incubation period? State the length of the
+incubation period in measles; Liberty measles; whooping-cough; scarlet
+fever; chicken-pox; diphtheria; mumps; typhoid fever.
+
+3. Name some of the early symptoms common to most infectious diseases.
+If such symptoms appear, what should be done while waiting for the
+doctor to come?
+
+4. Discuss the importance, prevention, and treatment of common colds.
+
+5. What measures should be taken to isolate a patient who is suffering
+from a communicable disease?
+
+6. What special care should the attendant of a patient with a
+communicable disease give to her own clothing and person?
+
+7. Why are the children's diseases more serious in reality than they are
+commonly supposed to be?
+
+8. Describe the symptoms of each of the following: Measles, scarlet
+fever, chicken-pox, mumps, whooping-cough, and diphtheria.
+
+9. How should bowel and bladder discharges be disinfected?
+
+10. How should dishes and other utensils be disinfected?
+
+11. How should linen be disinfected?
+
+12. Describe measures necessary for concurrent disinfection.
+
+13. Describe measures necessary for terminal disinfection.
+
+
+FOR FURTHER READING
+
+Preventive Medicine and Hygiene--Rosenau.
+
+The New Public Health--Hill, Chapters VII-XVII.
+
+Essentials of Medicine--Emerson, Chapters XII-XV.
+
+Health and Disease--Roger I. Lee, Chapter X-XIV.
+
+Disease and Its Causes--Councilman, Chapters V-IX.
+
+Publications of the New York State Department of Health, Albany,
+entitled: The Teacher and Communicable Disease; A Method for the Control
+of Communicable Diseases in Schools; Regulations and Instructions for
+Cleansing and Disinfection; The Conduct of an Isolation Period for
+Communicable Disease in a Home; Tuberculosis; Typhoid Fever; Scarlet
+Fever; Measles; Whooping-cough; Diphtheria; Poliomyelitis, Acute
+Anterior (Infantile Paralysis); Smallpox; Septic Sore Throat; Venereal
+Diseases. (Any of the above pamphlets will be sent upon receipt of a
+three cent stamp.)
+
+
+
+
+CHAPTER XIII
+
+COMMON AILMENTS AND EMERGENCIES
+
+
+This chapter describes a few home treatments for the relief of slight
+ailments and injuries, together with some measures that may be employed
+in emergencies. For more extended instructions in these subjects the
+student should consult the Red Cross Text-book on First Aid.
+
+
+CONDITIONS IN WHICH THE NERVOUS SYSTEM IS INVOLVED
+
+HEADACHE.--Headache is not a disease in itself, but a symptom common to
+many different disorders. Among the abnormal conditions often causing
+headaches are fatigue, eyestrain, indigestion, constipation, neuralgia,
+rheumatism, anæmia, acute infections, and other disorders. Treatment
+should consist in finding the cause and removing it if possible; clearly
+no one remedy can cure so many different causes. A physician should be
+consulted if headaches are of frequent occurrence, but in many cases
+rest and attention to other hygienic requirements are all that is
+needed. During an attack of headache a hot foot bath may give relief, or
+a mustard paste or cold applications on the back of the neck, or an ice
+bag or cold compress on the forehead.
+
+SLEEPLESSNESS, like headache, has many possible causes, and effective
+treatment consists in finding and removing them. Pain or discomfort of
+any kind, fatigue, overwork, and worry are common causes. Sleeplessness
+easily becomes a habit that may persist after its cause has been
+removed; hence a person who has formed the habit of sleeplessness should
+patiently strive to break the old habit and to substitute a better. A
+careful hygienic régime is essential for the patient, exercise in the
+open air, and cultivation of a hopeful and tranquil spirit. The diet
+should be liberal, but light and unstimulating; tea and coffee should be
+omitted, certainly during the latter part of the day. The patient should
+spend rather a dull evening, avoiding excitement and mental exertion
+that is difficult, even though pleasurable. He should retire early. A
+hot tub or foot bath, and a hot drink at bed time may help to produce
+sleep. The bedroom should be dark, cool, and well ventilated, the bed
+comfortable and the covers light but warm. The patient should be told
+that rest is the most important thing for him, and that he should not
+try too hard to sleep nor worry if unsuccessful. The patient should try
+to banish from his mind, at bed time, thoughts that are distressing, and
+even those that are especially interesting. By using patience and
+persistence most persons can regain the power of sleeping even when
+habits of sleeplessness have been long established.
+
+FAINTING is a partial or total loss of consciousness due to a diminished
+supply of blood in the brain. It may follow bleeding, exhaustion from
+heat, fatigue from prolonged standing and the like, or strong emotional
+disturbance, like fear or surprise. Fainting is less common than it
+formerly was; it now occurs most frequently among persons suffering from
+anæmia, heart weakness, or special susceptibility.
+
+Symptoms of fainting are pale face, cold perspiration, rapid, feeble
+pulse, and shallow, sighing respiration. Treatment consists in removing
+the patient into cool, fresh air, applying cold water to the face and
+keeping the head low. For a person who feels faint but has not lost
+consciousness, this treatment will probably prove sufficient; if,
+however, he becomes unconscious, place him so that the head is lower
+than the body, loosen the clothing, especially the clothing about the
+neck, apply cold water to the face and chest, and see that fresh air is
+plentiful. When the patient is sufficiently conscious to swallow, give a
+teaspoonful of aromatic spirits of ammonia in half a glass of water and
+keep him quiet until he has entirely recovered.
+
+A person who is unconscious from any cause always requires immediate
+attention. In emergency work elevate the patient's head if his face is
+flushed, and keep it low if his face is pale. Do not try to arouse an
+unconscious patient by shaking him and calling to him, in the first
+place because it is useless to do so, and in the second, because
+consciousness will return spontaneously if his condition improves.
+
+CONVULSIONS.--In every case of convulsions a doctor is needed at the
+earliest possible moment. Convulsions in adults are very serious; in
+babies and small children although serious they are less alarming, since
+they may follow comparatively slight disturbances, particularly
+disturbances of digestion.
+
+Treatment for babies and children with convulsions consists first in
+keeping the child as quiet as possible, and next in measures to draw
+blood from the brain toward the surface of the body. The child should
+first be undressed, moving him as little as possible, and put to bed
+between warm blankets. Cold should be applied to his head by a compress
+or ice bag, and hot water bag should be placed near his feet. An enema
+should then be given. A warm tub bath is sometimes used to apply heat,
+if the convulsion has not subsided by the time the child is undressed.
+If the bath is given the temperature of the water should not be above
+106°, and should be tested by a thermometer. If no thermometer is
+available, the water should be tested with the elbow rather than the
+hand, and cold water should be added if it feels uncomfortably warm.
+There is great danger of scalding a child during the excitement
+inevitably caused by a convulsion.
+
+Although haste is needed when a child has convulsions, yet quiet is
+essential, since the slightest movement tends to increase the
+convulsions or to start them again. As soon as the convulsions are over
+the child should be removed from the bath and put to bed between warm
+blankets. Even after the symptoms have completely subsided, the greatest
+care should be taken to keep the child quiet. He should be handled and
+disturbed as little as possible. The bath should be repeated if
+convulsions begin again. The doctor, when he comes, will probably order
+a dose of castor oil; and therefore, if it is impossible to obtain a
+doctor at once, the dose should be given.
+
+SHOCK (in the medical sense of the word) or _collapse_, is a serious
+condition in which a patient's vitality and all his bodily processes are
+profoundly depressed. Generally shock occurs only after a severe injury
+or a long exhausting illness. Since, however, some persons are
+peculiarly susceptible to it, the possibility of shock must be kept in
+mind in treating even slight injuries. The probability of shock is
+somewhat increased if patients are allowed to see their own wounds.
+Injured persons should always sit or lie down while wounds, however
+slight, are dressed.
+
+Symptoms of shock are pallor, pinched, anxious expression, dilated
+pupils, cold clammy skin, feeble breathing, and rapid, weak pulse. The
+patient may be mentally normal, or irrational, or unconscious, but more
+frequently he appears stupid, and though conscious, he pays no attention
+to what is going on. Unfortunately this condition is sometimes mistaken
+for sleepiness, and he is left alone to sleep just when active measures
+are most needed.
+
+If a patient shows any symptom of shock the doctor should be summoned
+immediately, but no time should be lost in beginning treatment, since
+the condition may be critical. It should be remembered, however, that
+panic and confusion may alarm a patient who is conscious, and thus
+increase the shock. The patient should be covered warmly, and undressed
+under blankets, without exposure or avoidable moving. His head should be
+low, and as quickly as possible hot water bags should be placed near but
+not upon him. If the patient is conscious and able to swallow he should
+be given hot coffee or aromatic spirits of ammonia, one teaspoonful in
+half a glass of water. The legs and arms should be rubbed from the
+extremities toward the heart, but care should be taken to avoid touching
+or moving injured parts. The patient should stay in bed, warmly covered
+and closely watched for some time after he has apparently recovered.
+
+Helping a patient into bed is not necessarily the first thing to be done
+in every case of sudden illness. Great harm may be done by the
+injudicious moving of injured persons, and often it is safer to make a
+person comfortable with pillows and blankets where he happens to be,
+certainly until a sufficient number of people can be found to lift him
+properly. Clothing should be removed carefully, and one should not
+hesitate to cut it away if undressing is painful or necessitates much
+moving.
+
+STIMULANTS, in emergency work, are frequently misused. They should not
+be given when the head has been injured, when bleeding is profuse, or
+when the face is red and the pulse strong. Neither should attempts be
+made to give fluids of any kind to patients not sufficiently conscious
+to swallow. Safe stimulants to use are black coffee, tea, or aromatic
+spirits of ammonia. Alcoholic liquors should not be given unless
+prescribed by a physician.
+
+SUNSTROKE AND HEAT EXHAUSTION are both caused by excessive heat either
+indoors or out, but they differ both in symptoms and in treatment.
+
+Sunstroke or heat stroke, usually begins with acute pain in the head,
+followed almost immediately by loss of consciousness. The skin is dry
+and very hot, the face is red or purple, the pupils are dilated, the
+breathing is difficult, the pulse is slow, and the temperature high.
+
+Treatment consists in sending for the doctor, removing the patient to a
+cool place, undressing him and applying cold, especially to the head and
+spine, or still better, placing him in a very cold bath. The body should
+be rubbed constantly in the direction of the heart. Stimulants should
+not be given.
+
+Symptoms of heat exhaustion, on the other hand, resemble those of shock.
+The doctor should be summoned, and the patient should be removed to a
+cool and quiet place, where he should stay warmly covered in a reclining
+position. Stimulants should be given, hot water bags applied, and the
+other measures for treating shock should be employed.
+
+
+CONDITIONS IN WHICH THE DIGESTIVE TRACT IS AFFECTED
+
+NAUSEA AND VOMITING are frequently caused by injudicious eating,
+especially when a person is worried or fatigued. A doctor should be
+consulted if either one occurs often, or if vomiting is accompanied by
+pain, prostration, diarrhoea, fever, or other acute symptoms. A person
+who is nauseated should lie down in a cool, quiet place. Hot
+fomentations may be applied to the abdomen, or a mustard paste over the
+stomach. Soda mints or a teaspoonful of baking soda may be given
+dissolved in hot water, and unless diarrhoea is present a Seidlitz
+powder or other saline cathartic may be given. A large quantity of warm
+water may be given to wash out the stomach; it is more effectual if salt
+or mustard is added, in the proportion of one teaspoonful to a glass of
+water.
+
+HICCOUGH, which is usually caused by digestive disturbances, is not
+serious in healthy people, and can generally be stopped by holding the
+breath, or by drinking water. If these measures are not effectual, salt
+or mustard in water as already described or a teaspoonful of the syrup
+of ipecac, may be given to produce vomiting. If the hiccough still
+continues, medical advice should be obtained.
+
+DIARRHOEA is ordinarily caused by an infection, or by an offending
+substance in the intestines. The offending substance should be removed
+before attempts are made to check the diarrhoea. When a baby has diarrhoea
+four things should be done--all food should be withheld; boiled water
+should be given freely; bowel movements should be saved for the doctor
+to see; and unless a doctor can be found immediately, castor oil should
+be given, from one-half to one teaspoonful according to the age of the
+child. Similar treatment should be given to older children. Adults
+should take one tablespoonful of castor oil and drink boiled water
+freely, but they should take no food until the doctor comes.
+
+CONSTIPATION has been discussed on pages 193 and 52.
+
+COLIC is a sharp, intermittent pain in the abdominal region; it is
+caused in many instances by indigestion or chilling. The following
+remedies may relieve it: a hot water bag, an emetic, as salt or mustard
+in luke-warm water, a Seidlitz powder or other saline cathartic, soda
+mints, or a teaspoonful of syrup of ginger in hot water. Unless it feels
+sore or tender, the abdomen may be rubbed up, on the right side, across,
+just below the waist, and down, on the left side. Babies may be given a
+few teaspoonfuls of warm water, or an enema of salt and water.
+
+Colic may be serious. The doctor should be summoned at once if the
+patient seems exhausted, if the pain is severe, if pain is increased
+rather than relieved by pressure, if the abdomen feels sore, especially
+on the right side, or if sharp abdominal pain is accompanied by fever,
+vomiting, and stubborn constipation. If the above-mentioned symptoms are
+present, no food, drink, or medicine should be given until the doctor
+comes.
+
+
+CONDITIONS IN WHICH THE EYES OR EARS ARE AFFECTED
+
+STYES generally accompany eyestrain or poor general health. The cause
+should be found and treated; and especial attention should be given to
+correcting eyestrain, indigestion, and constipation. Hot applications
+may be used, but if pus gathers, the stye should be treated by a
+physician.
+
+FOREIGN BODIES IN THE EYE may sometimes be removed by blowing the nose
+violently, by yawning several times, or by drawing the upper lid down
+over the lower. The eye should not be rubbed. If it proves impossible to
+dislodge the object by these methods or by others similar, the patient's
+eyelid should be turned back in the following way: Let the patient sit
+with his head back in a low chair placed in a good light, and stand
+behind him holding his head between your side and upper arm. In this
+position the patient's head is held firmly while both of the operator's
+hands are free. Next draw down the lower lid, and remove the object, if
+visible, on the corner of a clean handkerchief. To turn back the upper
+lid, grasp the eyelashes firmly, draw the lid down, out, and then up
+over a match or pencil placed across the middle line of the lid and held
+in your other hand. Then wipe the object carefully away if it is
+visible.
+
+Irritation that persists after the foreign body has been removed may be
+relieved by a cold compress continued for an hour or more, or by a drop
+or two of castor oil placed under the lid. If attempts to remove the
+foreign body prove unsuccessful, if the injury is severe, or if
+irritation continues after several hours, apply a cold compress, bandage
+it firmly so that the eyeball is kept at rest, and seek the aid of a
+physician.
+
+DISORDERS AFFECTING THE EARS.--Permanent deafness may result from
+neglecting disorders of the ears. Ear-ache, discharge from the ear,
+swelling in or about it, pain or tenderness behind it, all require
+medical attention and no time should be lost in securing it. To relieve
+pain the patient may lie with the ear on an ice bag, but nothing
+whatever should be put into the ear before the doctor comes, except when
+an insect has entered the ear, and causes acute distress by the noise of
+its beating wings. If such an accident has occurred, the patient should
+lie on the unaffected side, and warm sweet oil should be dropped very
+gently into the affected ear by means of a medicine dropper. The insect
+generally drowns in the oil and floats to the opening of the ear canal.
+After it has been removed, the patient should lie on the affected side
+so that the oil may drain out of the ear.
+
+No attempts should be made to remove foreign bodies from the ear or
+nose, unless they can be reached easily with the fingers. Hair pins,
+crochet hooks and similar instruments should never be used for this
+purpose. It is best for a doctor to remove foreign objects because
+unskillful attempts are likely to move them further in.
+
+
+CONDITIONS IN WHICH THE SKIN IS AFFECTED
+
+PRICKLY-HEAT, which affects babies and children more often than adults,
+is an eruption caused by heat and moisture, and aggravated by flannel
+underwear. It may be prevented by keeping the skin dry and cool, and it
+may be relieved by bathing the skin with alcohol and water, about one
+part of alcohol to three of water, and by using after the bath a powder
+made of two parts of starch to one of boracic acid, or any good talcum
+powder.
+
+INSECT BITES AND STINGS.--The sting, if still in the wound, should first
+be removed, and then ammonia should be applied, since the poison is
+generally acid. Applications of cold water, alcohol and water, or wet
+salt may relieve the subsequent burning and itching, but ammonia is
+generally most effective.
+
+IVY POISONING may be treated by applying cloths wet in a strong solution
+of baking soda or of boracic acid, or by applications of carbolized
+vaseline or ichthyol. Severe cases should have medical attention.
+Scratching and rubbing seem to spread the inflammation, and special care
+should be taken not to rub the face or eyes with infected hands.
+Susceptible people should avoid the plant if possible.
+
+
+OTHER EMERGENCIES
+
+CHILLS may be the result of infection or of exposure to cold. An early
+diagnosis of the trouble is so desirable that it is well to send for a
+doctor even when symptoms are not severe. If a person has a chill his
+temperature should be taken at once; fever and chill together probably
+indicate invasion by bacteria. When chills follow exposure to cold the
+patient should go to bed between warm blankets, his body should be
+briskly rubbed, and hot water bags and a hot drink should be given. If
+he prefers, he may take a hot bath before going to bed.
+
+CROUP is caused by a spasmodic closure of the larynx so that breathing
+is impeded. The child who develops croup may have a slight cold, but
+frequently shows no symptoms until he wakes in the night with a hoarse
+ringing cough and difficult breathing. True croup, though often
+distressing, is seldom serious, even when the symptoms are so severe
+that the child appears to be partly suffocated. An emetic should be
+given at once, preferably syrup of ipecac, one teaspoonful followed by
+warm water, or ten drops every 15 minutes until the child vomits freely.
+Hot fomentations may be applied to the throat and chest in order to
+hasten relaxation of the muscular spasm, and water should be kept
+boiling near the bed in a teakettle or uncovered saucepan. The child
+should stay in a warm room during the following day.
+
+Whenever a child develops a croupy cough his throat should be examined.
+A physician should be summoned if the throat is red and especially if
+the redness is associated with rise in temperature. Cases of diphtheria
+have been overlooked by neglecting such symptoms.
+
+
+BLEEDING
+
+In the vast majority of cases, bleeding can be stopped by elevating the
+injured part and applying pressure over the wound. One should, however,
+remember that loss of blood is not the only danger presented by an open
+wound, for pus-producing germs, if they make their entrance, may cause
+an infection which may be as serious as the bleeding itself. Hence in
+dealing with open wounds of any sort one should always keep in mind the
+danger of infection as well as the danger from loss of blood.
+
+TREATMENT OF SLIGHT WOUNDS.--Loss of blood from slight wounds is seldom
+so serious as the danger of infection; therefore small cuts, pin pricks,
+scratches, etc. should be encouraged to bleed by pressure near the wound
+in order to expel the germs that may have entered. After the wound has
+bled a little, tincture of iodine should be applied by means of a cotton
+swab both to the wound itself and also to the surrounding skin.
+
+After the wound has thus been disinfected it should be covered with a
+sterile dressing; a sterile or aseptic dressing is material in which all
+bacterial life has been destroyed. Gauze from a First Aid dressing or
+from a packet of sterile gauze should be used for this compress, or
+gauze may be cut from a sterile bandage. The compress serves two
+purposes: it protects the wound from infection, and if applied with
+pressure it checks further bleeding.
+
+The compress should be securely bandaged in place, or its edges may be
+fastened with adhesive plaster or collodion. Neither of the two latter
+should cover the wound itself. The outside bandage may be changed when
+soiled, but the compress itself should not be disturbed until the wound
+has healed. It is a mistake to dress wounds oftener than necessary,
+since handling them always increases the chance of introducing germs.
+Most children, like Tom Sawyer, delight in wounds, but they should be
+prevented if possible both from inspecting and from exhibiting them.
+
+If heat, swelling, redness, or pain develop in a wound after a day or
+two, a doctor should be consulted; and not a minute should be lost if
+the patient has a chill or if red streaks appear extending from the
+wound in the general direction of the heart. Until the doctor comes the
+wounded part should be elevated and covered with cold applications wet
+in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint
+of water.
+
+Several points should be remembered in dressing wounds. In the first
+place the mouth, which is full of germs, is not a good place for cut
+fingers. Moreover, wounds should not be touched by anything, especially
+the fingers, either washed or unwashed, nor should the scissors, fingers
+or other object be allowed to touch the surface of the dressing that is
+to be placed directly upon a wound. Unless they contain gross dirt
+wounds should not be washed with water, since washing introduces another
+chance of infection and accomplishes nothing except a tidy appearance,
+which is not essential. Furthermore, it should be remembered that
+exposure to the air will not infect a wound, and therefore time should
+be taken to find a suitable dressing. When a sterile dressing is quite
+impossible to obtain, the cleanest material available should be used;
+one of the best substitutes for a sterile dressing is the inner surface
+of a handkerchief or napkin that has not previously been unfolded since
+it was ironed. It is a common mistake to tie up a wound in the first
+article presented, which is usually a generous by-stander's soiled
+handkerchief. The same precautions in regard to cleanliness should be
+taken in dressing wounds that are known to be contaminated, since even
+into an infected wound it is possible to introduce more germs and more
+virulent ones.
+
+NOSEBLEED usually stops of itself, but if it is obstinate the patient
+should sit erect with the head back, and cold compresses should be
+placed on the nose and at the back of the neck. Pressure should be made
+on the upper lip by means of the fingers, or by a firm roll of paper or
+cotton placed under the upper lip. Salt or vinegar in water, a
+teaspoonful of either one to a cup of water, may be snuffed up the nose.
+The treatment should be continued for ten or fifteen minutes, or until
+bleeding stops; if the bleeding persists a doctor is needed.
+
+PROFUSE MENSTRUATION should be treated by keeping the patient quiet in
+bed with the head low and the feet slightly elevated. "Any marked
+increase, whether by amount, duration, or shortening of the interval
+between the periods ought to receive attention and be brought to the
+physician's notice" (Latimer). Painful menstruation may be relieved by
+rest in bed, mental as well as physical, by hot drinks and by the
+application of heat. Rest, and hygienic living persistently practised,
+will relieve most menstrual abnormalities. The common practice of using
+patent remedies and alcoholic liquors for disordered menstruation cannot
+be too strongly condemned.
+
+
+OTHER INJURIES
+
+SPRAINS.--A sprain is caused by twisting, stretching, or tearing the
+tissues about a joint. The first sharp pain comes from the injury to
+the tissues; subsequent pain is caused by the pressure of accumulated
+fluid. The other symptoms are those characteristic of inflammation.
+
+When a sprain is slight, the affected part should be elevated and kept
+at rest for the first twenty-four hours. Either heat or cold should be
+applied, or heat and cold alternately; a good treatment is to soak the
+part in hot water and afterward to allow cold water to run upon it from
+the tap. Gentle rubbing with a circular motion helps to reduce the
+swelling. If the joint must be used it should be bandaged tightly.
+
+Injuries to joints should never be neglected; and severe sprains always
+require medical attention, since in addition to the sprain a bone may be
+broken. A severely sprained joint should be elevated, treated with hot
+or cold applications, and kept at rest until it has been examined by a
+physician.
+
+BRUISES.--Bruises need no attention unless they are extensive or
+painful. The skin should be kept clean and if possible unbroken, since
+injured tissues are less resistant to infection than tissues in their
+normal state. Applications of cold water or of equal parts of cold water
+and alcohol may relieve the pain, but cold should not be used upon
+bruises that are extensive. A compress bandaged tightly in place may
+help to prevent swelling and discoloration.
+
+BURNS AND SCALDS.--Injuries from dry heat are called burns, and those
+from moist heat are called scalds. Both are painful, and both are
+dangerous if extensive or deep. Burns and scalds require medical
+attention if the injured area is extensive, if a large blister is
+formed, if the skin is destroyed or charred, and if symptoms of shock
+appear. Shock often follows burns or scalds even when the injury is
+comparatively slight.
+
+Treatment of slight burns, where the skin is reddened but not destroyed,
+has for its main object the exclusion of air. One of the following may
+be applied: dry baking soda, or baking soda made into a paste with
+water, picric acid gauze moistened in water, boracic acid ointment,
+vaseline, sweet oil, or castor oil; if none of these is obtainable,
+lard, cream, the white of an egg or unsalted butter may be used. Old
+muslin or linen bandaged lightly in place, should be used to cover the
+burn.
+
+The same treatment is used for sunburn, and also for small burns where
+blisters form. A blister, if it forms, should not be punctured; but if
+it is accidentally broken the skin of the blister should not be removed.
+It should be remembered that a broken blister is an open wound, and
+therefore liable to infection.
+
+BRUSH BURN is a name given to injuries where the surface of the skin
+has been removed. They include the scraped arms and legs which are
+common accidents in childhood. In order to dress a brush burn, particles
+of dirt should first be removed preferably by means of forceps that have
+been boiled, and the surrounding skin should then be cleansed with soap
+and water. The injured part should next be flushed with sterile salt
+solution, made by boiling water five minutes and adding to it salt in
+the proportion of one teaspoonful to a pint of water. If the dirt is
+difficult to remove a soap compress should be applied. To prepare the
+compress several thicknesses of gauze or muslin should be boiled in a
+strong solution of castile or green soap for ten minutes. The compress
+should remain in place several hours, and may be repeated if necessary.
+After the wound has been thoroughly cleansed, it should be dressed with
+old muslin that has been saturated in castor oil or spread with boracic
+ointment.
+
+
+EXERCISES
+
+1. Name some common causes of headache and of sleeplessness, and outline
+rational treatment for each of these disorders.
+
+2. Describe symptoms and treatment of shock; of fainting; of convulsions
+in children.
+
+3. Describe the treatment of all disturbances of the digestive tract
+mentioned in this book.
+
+4. What should be done if a foreign body has entered the eye? if one has
+entered the ear? What should be done for a person who has a stye? for a
+person with pain in or near the ear?
+
+5. How would you treat a sprain?
+
+6. Describe treatment for burns and scalds.
+
+7. Distinguish between heat stroke and heat prostration, and tell what
+treatment should be given in each case.
+
+8. What are the two principal dangers from slight wounds, and how should
+one guard against them? Show how you would dress a small cut.
+
+9. What should you do for a person with nose bleed?
+
+
+FOR FURTHER READING
+
+American National Red Cross Text Book on First Aid--Lynch.
+
+Immediate Care of the Injured--Morrow.
+
+Prompt Aid to the Injured--Doty.
+
+
+
+
+CHAPTER XIV
+
+SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS, CHRONICS, AND THE
+AGED
+
+
+In many cases of sickness institutional care has marked advantages. It
+may be the only solution when adequate provision for the sick is
+impossible at home; and it is often a necessity when a patient requires
+special equipment or apparatus, expert nursing, and medical attention
+within reach both day and night.
+
+On the other hand, it would not be desirable even if it were possible
+for all sick persons to be cared for in institutions. Care at home when
+it is adequate may be more successful than equally skillful care given
+elsewhere, since the sick quite as much as the well are injured by long
+separation from normal family life. Most children, because they need the
+attention of their own mothers, most convalescent and chronic patients,
+and most aged persons are cared for at home; and in the great majority
+of cases no better place for them could be found. Since patients of
+these four groups have needs peculiar to themselves, some special
+points in caring for them are considered in this chapter.
+
+
+CHILDREN
+
+Ability to observe quickly and accurately is seldom more needed than it
+is by a woman who cares for children. No one expects babies to explain
+their troubles, but people forget that small children are unable to
+describe their physical sensations with any degree of accuracy, although
+discomfort or sickness may show itself in all degrees of ill temper and
+bad conduct. For these exhibitions many a suffering child has been
+punished, where an older and more articulate person would have received
+considerate attention.
+
+Children, like babies, have a low resistance to disease. Moreover, they
+react quickly both to favorable and to unfavorable surroundings. Hence
+slight causes sometimes produce pronounced or even violent symptoms in
+children without giving cause for great anxiety, although the same
+symptoms if exhibited by adults, might indicate critical illness. On the
+other hand the recuperative power of children is high, and their
+recoveries are sometimes surprisingly rapid. It is a mistake, when a
+child has completely recovered from an acute but brief illness, to
+coddle him for weeks afterward merely because a grown person in similar
+circumstances would have failed to regain his strength.
+
+When a child is sick in bed, especial efforts should be made to insure
+adequate ventilation without chilling him. Children always lose heat
+rapidly because the body surface is proportionately large; when they are
+ill, therefore, it is especially necessary to keep them well covered, to
+see that their hands and feet are warm, and to avoid chilling them
+during their baths. But overheating must also be avoided, since all
+children, sick or well, who are too warmly dressed or who stay in rooms
+that are too warm, become weak and irritable and more susceptible than
+others to colds and other respiratory disorders. The child's skin should
+be kept clean and dry, but he should not be disturbed nor handled
+unnecessarily.
+
+Sick children require very simple food at short intervals. Variety is
+not so necessary for a child as for an adult, unless the child has been
+allowed to form bad habits of eating. Sick children should not be
+indulged unnecessarily, either in regard to their food or in other ways.
+However, attempts made during an illness to change the habits of a badly
+trained child are unwise because usually unsuccessful; parents who sow
+the wind by neglecting to train their children when they are in good
+health may as well make up their minds to reap a veritable whirlwind
+when the children are ill. Even when children are well trained it is
+difficult and sometimes impossible to prevent them from forming bad
+habits during sickness. Yet the labor of training a child reaps perhaps
+at no other time a richer reward than it does when the child is ill, and
+his recovery might be seriously impeded by unwillingness to accept
+necessary food, medicine, or treatment.
+
+PHYSICAL DEFECTS are faults in the structure of the body; adenoid
+growths, imperfect eyes, abnormally curved spines, and defective teeth
+are examples. Most physical defects can be cured in childhood by
+treatment or by slight operations. If untreated they frequently lead to
+sickness or to serious impairment of the body, and if neglected until
+adult life their injurious consequences are generally beyond remedy,
+even when the defects themselves can be repaired.
+
+Some indications of common physical defects are given below; they ought
+to be more generally known than they are. If a child exhibits one or
+more of the symptoms mentioned, he ought to be given a complete physical
+examination by a competent physician, and treatment, if needed, should
+begin without delay. The idea that children will outgrow these defects
+without treatment is erroneous. Better, however, than waiting until
+symptoms appear is the modern way of giving every child a physical
+examination at stated intervals, a practice already common in public
+schools where effective health work is carried on.
+
+EYESTRAIN frequently comes from imperfections in the shape of the eye;
+these imperfections can almost always be corrected by glasses. When a
+child is suffering from eyestrain, the eyes themselves may show
+indications of trouble; they may be blood-shot, the lids may itch or be
+crusted or inflamed, or styes may appear. In other cases the symptoms of
+eyestrain have no apparent connection with the eyes; such symptoms are
+headache, nausea, vomiting, indigestion, fatigue, irritability, poor
+scholarship, and nervous exhaustion. If a child shows any of these
+symptoms, or if he rubs his eyes, frowns, squints, wrinkles his
+forehead, sits bent over his book, or develops round shoulders, there is
+sufficient reason for having his eyes examined by an oculist.
+Examination by an optician should not be considered sufficient.
+
+ENLARGED TONSILS AND ADENOIDS.--The tonsils are masses of spongy tissue
+situated at the back of the mouth, on either side of the opening into
+the throat. If enlarged they may seriously interfere with breathing, and
+if diseased they frequently harbor the germs causing many acute
+infections, as well as germs of rheumatism and most of the heart
+disease originating in early life. Therefore the tonsils ought to be
+removed if they are diseased or greatly enlarged, but there is
+ordinarily no good reason for removing normal tonsils.
+
+Adenoids are situated at the back of the nose, and like the tonsils are
+composed of spongy tissue. Adenoids sometimes become so enlarged that
+they interfere with the passage of air through the nose, thus
+predisposing to catarrh, colds, and other respiratory diseases, to high
+palate with irregular teeth, to inflammation of the middle ear leading
+to deafness, to diminished mental activity, and to general poor health.
+
+If a child breathes through his mouth, if he snores at night, keeps his
+mouth open and has a dull, apathetic expression, his nose and throat
+should be examined, and if advisable his tonsils and adenoids should be
+removed.
+
+DEFECTIVE HEARING.--Permanent deafness among children in the great
+majority of cases comes from trouble in the throat or nose; hence the
+most effective measure to prevent deafness is to make sure that every
+child's nose, throat, and mouth are in a normal condition. Sensitive or
+timid children try to hide infirmities of any kind, but deaf children
+seem peculiarly unable to explain their difficulties. "No one," says
+Cornell, "has ever recorded that a small child complained of inability
+to hear." A child's ears should be examined if he breathes through his
+mouth, if he stoops habitually, if he is persistently inattentive, or if
+he is vague or stupid in carrying out directions. A child who appears
+normal at times and inattentive or stupid at other times should also be
+examined, since he may be deaf in one ear.
+
+Temporary deafness may come from accumulated wax in the ear. The wax
+should be removed by a doctor; inexpert attempts are likely to cause
+serious injury to the ear drum. Intermittent deafness may be caused by
+enlarged tonsils and adenoids. Children thus affected are not
+infrequently punished for seeming disobedience. Such children are
+especially liable to street accidents.
+
+DEFECTIVE TEETH have been considered on page 44.
+
+POSTURE.--In childhood the bones are soft and yield with comparative
+ease to continued strains; hence they often become deformed by bad
+positions assumed in sitting, standing, or in using the body in other
+ways. The postures habitually assumed by a child should be noticed and
+good postures should be insisted upon. But it is not enough to admonish
+him. The various causes tending to encourage bad positions should be
+corrected; among them are insufficient illumination of books and work,
+defective eyesight or hearing, obstructions in breathing, muscular
+weakness, and low general vitality. Children should have their chairs
+and tables suited to their size for their work both at home and in
+school.
+
+[Illustration: FIG. 28.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 29.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 30.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 31.--INCORRECT AND CORRECT STANDING POSTURES. (_From
+Cornell, "Health and Medical Inspection of School Children," F. A. Davis
+Co., Philadelphia._)]
+
+The adjustable chairs and desks now used in schools are a marked
+improvement upon the school furniture which has caused so many
+deformities in the past.
+
+[Illustration: FIG. 32.--ROUND SHOULDERS. (_Goldthwait, from Pyle's
+"Personal Hygiene."_)]
+
+One of the serious deformities caused by habitual faulty posture is
+curvature of the spine. A curvature not only injures a child's
+appearance and thus handicaps him in later life, but it brings strains
+and pressure upon the organs of the chest and abdomen which may
+seriously impair his health. As curvatures often pass unnoticed in their
+early stages, every child should be inspected occasionally when all his
+clothing has been removed, to see whether the weight is borne evenly on
+both feet, whether the development of the two sides is uniform, and
+whether the head and shoulders are properly carried. It should be
+noticed when the child stands, whether one shoulder is higher than the
+other, whether one shoulder blade projects more than the other, whether
+one hip is higher than the other, and whether one hand is lower than the
+other when the arms are hanging at the sides. The child should walk
+both toward and away from the observer, who should notice whether the
+child uses the two sides of his body in the same way, and whether he
+drags or shuffles his feet or has other abnormalities of gait.
+
+[Illustration: FIG. 33.--LATERAL CURVATURE. (_From Bancroft's "Posture
+of School Children." The Macmillan Co., New York._)]
+
+[Illustration: FIG. 34.--"WING SHOULDER BLADES IN FORWARD SHOULDERS.
+(_From Bancroft's "Posture of School Children." The Macmillan Co., New
+York._)]
+
+If abnormalities are found, a physician should be consulted. Often
+corrective exercises are all that is needed, and no one should put
+braces of any kind upon a child unless they have been prescribed by a
+physician. No attempt should be made to correct the common tendency of
+children to toe in or "walk pigeon-toed." Toeing-in is a natural manner
+of walking during the formative period and tends to strengthen the arch
+of the foot, while toeing-out tends to weaken the arch and to cause flat
+foot or broken arches.
+
+PREDISPOSITION TO NERVOUSNESS.--Heredity plays an important rôle in the
+predisposition to nervousness, so that children of nervous parents are
+particularly likely to show nervous instability. It is, however,
+difficult to say in a given case how much of his nervousness a child
+inherits and how much he acquires by imitating the irritability, the
+out-breaks of temper, and the other evidences of imperfect emotional
+control displayed by his nervously disposed parents. On the other hand,
+even children of nervous predisposition sometimes overcome their defects
+to some extent by imitating parents who have acquired self-control.
+
+Children predisposed to nervousness should be watched with special care,
+but they should not be allowed to realize that they are the objects of
+unusual solicitude. They need the most favorable surroundings that can
+be obtained, and their general health should be maintained at the
+highest possible level. Any condition that lowers vitality tends to
+increase their troubles; nervousness may be caused among children of
+good inheritance, and increased among others, by poor nutrition, lack of
+exercise and play out-of-doors, fatigue, loss of sleep, eyestrain,
+adenoid growths, and the poisons of infectious diseases.
+
+It is characteristic of many nervous children that they are too easily
+stimulated; they may be excitable, restless, unnaturally quick in
+moving, over-sensitive to pain and discomfort, easily fatigued,
+irritable in temper, and unable to control the emotions. They frequently
+make involuntary motions like grimacing and winking the eyes. Children
+of low nervous tone, however, are not necessarily excitable. A nervous
+child may be muscularly weak, awkward in gait, listless, dull, clumsy,
+forgetful, and inattentive. Such children often suffer from cold hands
+and feet and from profuse perspiration.
+
+Much can be done for these unfortunate children by removing the cause of
+their troubles if possible, by giving them simple and wholesome
+surroundings, by suiting their occupations to their strength, by
+eliminating mental strain, particularly during the adolescent period,
+and by training them to control their minds as well as their bodies.
+
+      "In addition to the hardening of the body, the education of
+      the child should include measures which increase the
+      resistance of the child against pain and discomforts of
+      various sorts. Every child, therefore, should undergo a
+      gradual process of 'psychic hardening' and be taught to
+      bear with equanimity the pain and discomfort to which
+      everyone sooner or later cannot help but be exposed. What I
+      have said about clothing, cold baths, walking in all
+      weather and at all temperatures, play and exercise in the
+      open air, has a bearing on this point, for a child who has
+      formed good habits in these various directions will have
+      learned many lessons in the steeling of his mind to bear
+      pain and to ignore small discomforts."--(Barker:
+      "Principles of Mental Hygiene Applied to the Management of
+      Children Predisposed to Nervousness.")
+
+
+CONVALESCENT PATIENTS
+
+After serious or prolonged illness the vitality is generally low and all
+bodily processes are likely to be depressed. During convalescence,
+therefore, the digestion is feeble, the muscles are weak so that fatigue
+follows slight exertion, and the sluggish condition of the circulation
+renders the patient especially sensitive to cold. Since the nervous
+system also becomes depressed and irritable, a convalescent patient is
+easily excited, easily discouraged, and quickly fatigued by mental
+effort. He finds the simplest decisions hard to make, and his emotions
+difficult to control; indeed, many a patient who has borne acute pain
+with unflinching courage becomes peevish at this stage, weeps easily,
+and expects more expression of sympathy than is good for him. Some
+persons naturally make quick recoveries, while others recuperate
+slowly. A long and tedious convalescence, it should be remembered, is
+the patient's misfortune rather than his fault.
+
+In restoring a convalescent patient to normal living it is imperative to
+proceed slowly. Food should be increased gradually both in variety and
+in amount; but the patient's appetite is not always a safe guide, and it
+may need to be encouraged or to be restrained. Both mental and physical
+exertion should begin only under careful supervision, and should
+increase by slow degrees. The patient should sleep as much as possible,
+should take long intervals of rest, and should continue no occupation to
+the point of fatigue. A patient who has been ill in a hospital or who
+has had at home the exclusive services of a nurse or an attendant, often
+finds the period following his return or following the nurse's departure
+an exceedingly difficult transition. The family should not expect or
+allow him to resume too many duties at a time when the mere acts of
+bathing and dressing may demand all the strength he has. Many
+convalescents are obliged, or think they are obliged, to take up regular
+work again before their strength is fully restored. There is generally
+no economy in so doing; indeed, time is saved in the end by waiting
+until recovery is complete before undertaking full work.
+
+Important as it is to build up the patient's physical strength, it is
+hardly less important to direct his thoughts away from himself and his
+sickness, and to help him renew his interest in normal living. During
+his illness he has of necessity relied upon the judgment and support of
+other persons, and his pain and discomfort have forced him to think
+constantly of himself and his many needs. The habit of sickness is
+readily broken by some persons, particularly by those whose nervous
+exhaustion has not been great and whose interests outside themselves are
+naturally keen. But the sick point of view has remarkable tenacity, and
+other patients, unless circumstances or deliberate efforts redirect
+their thoughts, will look upon themselves as invalids to the end of
+time.
+
+Hopefulness promotes health, while discouragement, apprehension, and
+unhappiness lower the tone of the whole system. Hence set backs,
+failures, delays, and relapses should not be dwelt upon, but signs of
+progress should be mentioned; judiciously however, since overdone
+attempts to cheer a patient seldom fail to have the opposite effect. If
+objects or situations that suggest undesirable thoughts are eliminated,
+the less often those thoughts tend to recur. Therefore, in order to
+break the habit of sickness, old thoughts must be gradually banished
+and new ones must be substituted. Sick-room appliances should be put out
+of sight as soon as they are no longer needed, and the patient may
+profit by moving into a different bed room. A few days spent away from
+home as soon as his strength permits often prove effective in breaking
+up sickness associations; the patient is generally encouraged when he
+finds that he can sleep in a different bed, endure some fatigue, and
+exist without daily visits from the doctor. Even a day spent at a
+different house in the same town sometimes directs the patient's
+thoughts into fresh channels. Gradually, but as quickly as safety
+allows, he should take his place in the normal family life and cease to
+be treated as an exception.
+
+Merely eliminating associations with sickness, however, is not enough;
+and exhorting a patient to forget himself and to become interested in
+something seldom accomplishes anything, especially if he is so depleted
+by illness that the thought of everyday activities suggests only
+weariness and pain. A person so weak that he is thoroughly fatigued by
+dressing himself should not be expected to view with enthusiasm the
+prospect of a full day's work. Much, however, may be accomplished by
+providing something that the patient really likes to do, and deliberate
+efforts must be made to stimulate his interest in some occupation,
+however simple it may be.
+
+Occupations for invalids are more than a means to pass away the time;
+they are also of distinct curative value. The patient's interest is not
+always easy to arouse, and some ingenuity may be needed in the
+beginning; sometimes interest is best aroused by working at some
+handicraft in his presence, and finally offering, as a favor, to teach
+him to do it also. His interest in any occupation is invariably
+increased if a well person not only directs but shares in the work.
+
+Care should be taken to select occupations suited to the patient's
+physical condition, to his age, tastes, and mental development. Two or
+three occupations are better than one, so that he may change from one to
+another before any one becomes tedious. Work requiring fine motions,
+close attention, or concentrated thought should be used for short
+periods, only, and no work should be continued to the point of fatigue.
+The patient should not be allowed to feel that he must finish a certain
+amount in a certain time. Even poor work is better than none, and a
+patient should always be encouraged by judicious praise.
+
+Games and puzzles are useful to some extent, but an aimless occupation
+is not so beneficial as one which has a tangible product, particularly
+a product that is useful as well as beautiful. Occupations frequently
+possible for invalids and convalescents include knitting, crocheting,
+many kinds of needle work, clay modeling, basketry, stenciling, weaving,
+book-binding, metal work, and photography. Manuals are now available
+giving directions for these and many other handicrafts. Sick children
+often enjoy collecting stamps, post marks, and other objects, making
+scrap books, sewing, weaving, knitting, paper folding, and various other
+kindergarten occupations.
+
+
+CHRONIC PATIENTS
+
+The whole field of caring for the sick offers nowhere greater
+opportunity for fine and finished work than it offers in the case of
+chronic invalids. It is an achievement of which an artist might be proud
+to make a chronic patient comfortable in body, happy in mind, and
+agreeable to others. Moreover, since success can never be attained by
+one who wearies in well doing, the care given to a chronic invalid tests
+not only the attendant's skill but also her moral and spiritual quality.
+
+Care of a chronic patient has for its aims maintaining the patient's
+health, rendering him as happy and comfortable in mind and body as it is
+possible for him to be, and providing whatever special treatment and
+attention his case requires. In order to maintain his health constant
+attention must be given to diet, to hygiene of the sick room, and indeed
+to all his surroundings. In many chronic illnesses, such as rheumatism
+and kidney disease, the diet is prescribed by the doctor; in every case
+care should be taken that the patient is not overfed or underfed, that
+the food is suited to his digestive powers, that foods causing
+flatulence are eliminated, particularly if the patient's trouble is
+heart disease, and not the least important requirement, that he derive
+as much pleasure from his food as possible.
+
+The regular daily care of the patient and of his room, already described
+in this book, should be scrupulously carried out, and no less
+scrupulously during the tenth year than it was during the tenth day.
+Cleanliness in every detail is absolutely essential to the patient's
+welfare; no one is more unpleasant either to himself or to others than a
+chronic patient who is neglected. Patients who are constantly in bed, it
+should be remembered, and paralyzed patients in particular, are
+peculiarly susceptible to pressure sores. If a patient is able, it is
+extremely important for him to sit up in a chair part of the day.
+Sitting up should never be omitted because it involves the expenditure
+of time and trouble for the attendant.
+
+It is often said that for most people some personal experience of
+sickness is beneficial; it can safely be said, however, that no one
+benefits from spending any considerable portion of his life in a state
+of helplessness and suffering. Behavior and character itself are
+determined by influences constantly coming into the mind from daily
+surroundings and associations with other people: one who recalls this
+fact needs only a moment's reflection to realize how ill adapted to
+healthy development of mind and character are the limited lives of the
+sick. Especially unfortunate is the situation of chronic invalids, shut
+off as they are from the objective interests and activities of normal
+life, deprived of all practice in making the salutary small adjustments
+and sacrifices required in every day living with other people, and
+self-centered as they necessarily tend to become from the inevitable
+focusing of attention upon their own discomforts and pain.
+
+On the whole, a surprisingly large number of invalids successfully
+resist the disintegrating effects of sickness upon character. But it is
+nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a
+few but debases many." A selfish invalid has more than once destroyed
+the happiness of an entire family, or spoiled the life of one member of
+it by monopolizing her whole time and attention. Families should
+remember that their injudicious sacrifices seldom bring enduring
+happiness or contentment to the patient himself; indeed, in the long run
+such sacrifices generally injure him even more than they injure his
+victims. Clearly much must and should be sacrificed by members of a
+family to the needs of an invalid; but in general it may be said that a
+sacrifice is injudicious if it relieves the patient of activity or
+responsibility that he can support without injury, if it makes him more
+dependent in mind or body, if it results in restricting his attention to
+himself and his affairs, or if it increases his tendency to make demands
+on others.
+
+Purposeful activity of some sort and the necessity for contributing to
+the welfare of others are essential parts of a wholesome life. If these
+essentials are entirely eliminated from the life of an invalid, the
+patient's greatest needs are probably left unsatisfied, even though the
+physical care he receives may be perfect in every detail. All that was
+said in regard to occupations for invalids applies with particular force
+to occupations for chronic patients, since however valuable manual
+occupations may be as a means to bring about recovery, they are still
+more valuable in furnishing interest and purpose in a life whose only
+prospect is a succession of weary, useless years. Handicapped patients
+sometimes learn occupations that yield a financial return, and ability
+to earn even a little stimulates self respect and mental health, whether
+the money is needed or not. The important point, however, is that the
+finished product should have a recognized use.
+
+In addition to enabling the patient to make things with his hands, a way
+should be found if possible by which he may contribute to the group of
+people with whom he lives. If a way can be discovered for him to do so,
+the opportunity should not be denied him nor should his service fail to
+be noted and appreciated, even if it is nothing more than telling a
+story to a restless child.
+
+
+CARE OF THE AGED
+
+At the end of life, as at its beginning, every individual especially
+needs the interest and protection of his own family. In ordinary
+circumstances neither a baby nor an aged person can be cared for so
+fittingly or so successfully in any other place as he can be in his own
+home.
+
+With advancing years is to be expected a general slowing down of all the
+powers. In old age both body and mind show characteristic changes, and
+particularly changes causing lowered resistance and diminished vigor. If
+the manner of living is adapted to these changes, both happiness and
+usefulness may be prolonged. But so gradually do the changes often come
+that they may escape notice for a long time, and the younger generation
+in looking back sometimes realizes with regret how much earlier measures
+might have been taken to prolong the usefulness and to mitigate the
+discomforts of aged parents and friends.
+
+Old people are keenly sensitive to cold, since the circulation gradually
+becomes less vigorous and they take little exercise. Keeping them warm
+both in bed and out adds more perhaps to their comfort than any other
+one measure. They should have warm underclothing and soft shawls and
+other extra wraps. A real service will be rendered by the person who
+invents a suitable and dignified wrap for old or feeble men, who dislike
+the informality of sweaters and feel disgraced by shawls. Old persons
+should and can be kept warm in bed, by providing them with hot water
+bags, with warm night clothes including stockings, by using woollen or
+outing flannel sheets if necessary, and by providing a sufficient number
+of light but warm bed covers. It is not always understood that many
+covers do not remedy the deficiencies of a thin mattress. If a thick
+mattress or two thin mattresses cannot be provided, a thick comforter or
+even many layers of newspaper should be placed between the mattress and
+the springs, and another thick comforter should be placed between the
+mattress and the lower sheet. Rubbing the body with warm olive oil often
+affords great comfort, by improving the circulation and thus increasing
+the sensation of warmth, and also by relieving the tendency of the skin
+to become dry and cracked. Poor circulation at night may cause cramps in
+the muscles of the legs; the cramps can usually be relieved by warmth
+and gentle rubbing.
+
+Old people frequently wish their rooms to be very hot, both by day and
+by night, even as hot as 80° or 85°, but if it is possible to keep them
+warm in any other way the temperature of the room should be kept at 70°.
+Well ventilated rooms are highly important for old people as for all
+others of low resistance, and it is entirely possible for their rooms to
+be warm and yet well ventilated. Aged persons should be carefully
+guarded from chill, exposure, crowds, and infected persons. Like little
+children they are peculiarly susceptible to the respiratory diseases,
+which cause many of the deaths commonly attributed to old age.
+
+Digestion usually becomes weaker than in earlier years, and less food is
+needed. It should be simple, hot, and divided into four or five meals
+rather than three. Old people often wake at an early hour, and hot
+nourishment will prevent them from growing weak and faint while waiting
+for the family breakfast. Both constipation and looseness of the bowels
+are common ailments in old age. So far as possible the bowels should be
+regulated by means of diet; but muscular weakness resulting in inability
+to control the bowels should not be mistaken for and treated as
+diarrhoea.
+
+It is unwise for old people to undertake unaccustomed or sudden muscular
+exertion, since the muscular system including the heart muscle grows
+weak and is generally unable to endure great strain. The bones,
+moreover, grow brittle and heal with difficulty if broken, so that
+persons of advanced years no matter how active should avoid walking on
+icy pavements, climbing on chairs to reach high shelves, and placing
+themselves in other insecure positions. Assistance must be tactfully
+given, however, as active old people are inclined to resent it. On the
+other hand, old people should be encouraged to continue moderate and
+safe activities, and to take regular exercises suited to their strength.
+Although increasing muscular weakness tends to make most old people
+indolent, it is far better for them both in mind and in body to remain
+as active as they can without danger of too great fatigue. At all
+events, they should be prevented if possible from becoming bedridden.
+
+Since in old age sight, hearing, and other special senses become less
+acute, one should remember that an old person may not notice the odor of
+escaping gas, the light of a smouldering match, or the sound of an
+approaching motor car, and that he must be specially guarded from such
+dangers of every day life. On account of their dulled perceptions old
+people are sometimes unjustly considered to be less intelligent than
+they really are. Young people moreover should be told, if an aged person
+is untidy and careless in personal habits, that the apparent negligence
+is caused by dulled perceptions and diminished muscular control for
+which old people are no more responsible than they are for failing
+eyesight or for inability to hear.
+
+Families should also realize that changes in mind and character are
+beyond an aged person's control and that they should not be made the
+cause for remonstrance or arguing. Just as the arteries harden with
+advancing years, as the bones become brittle and as other tissues become
+less flexible, so changes are likely to occur in the nervous system. It
+is not surprising when the brain substance like other tissues is
+becoming less flexible, that the powers of attention should weaken,
+that memory for recent events should diminish, or that other mental
+powers should fail. Changes in disposition are not uncommon: previously
+controlled persons sometimes become querulous and exacting, while
+excitable and irritable persons become more placid. With most old people
+emotions become less intense; feeble old people hardly realize great joy
+or great sorrow, and seldom look forward to death with apprehension.
+
+Among the most important changes that occur in the nervous system is its
+gradual loss in power to respond to new demands. New habits are
+difficult or impossible to form, and old habits are hard to break.
+Attempts to break the habits of a life time are therefore dangerous, and
+radical changes in old people's ways of living are attended by risk as
+well as by unhappiness. Such loss of adaptability in the nervous system
+makes it increasingly difficult for old people to assimilate new ideas
+and to understand new points of view. The feeling that the world is
+strange and that the next generation has gone on without them accounts
+for the tragic loneliness of many old people. Clearly it is for those
+who are younger and more flexible to bridge the gulf between the
+generations by their understanding and their sympathy.
+
+Physical care to whatever extent it is needed should be given to all old
+people as soon as they are unable to care for themselves, and thought
+should be given to adapting their surroundings and ways of living to
+their strength and needs, just as they should be adapted to the strength
+and needs of chronic patients. But a warning should be given against
+managing old people too much. It is hard for people who have managed
+their own lives successfully for many years to be managed, even for
+their own good. Indeed, it is questionable kindness to deprive old
+people of all freedom of action, even if following their own
+inclinations occasionally has disastrous results. Few persons would wish
+to prolong their lives if long life involved being thwarted in every
+desire, and sometimes real kindness consists in allowing old people to
+do certain things that are not good for them. Keeping them warm and
+letting them do as they please will go far to make old people happy.
+
+Many of the changes in old age reverse the developing process of
+childhood. In youth and age extremes meet, and the care of the aged
+presents certain marked similarities to the care of little children.
+Both require simple food, occupations suited to their strength, and
+protection from infections, from fatigue, and from nervous strain; both
+are dependent, more or less helpless, and for their happiness both need
+the affectionate care of their own families. But in one respect their
+needs are fundamentally different. In childhood formation of proper
+habits is all important, and in caring for children the future effect of
+every word and act must be taken into consideration. Old people, on the
+other hand, since they live largely in the past and their habits are
+irrevocably formed, may be indulged without harm in ways that would
+demoralize a child; with a clear conscience one may make them happy in
+ways both great and small. This difference makes possible one of the
+greatest pleasures that come to one who cares for the helpless and the
+sick, for of all enduring satisfactions few are greater than the power
+to fill with comfort and happiness the closing days of life.
+
+
+EXERCISES
+
+1. What is meant by a physical defect? Name some of the most common
+defects.
+
+2. Name some permanent injuries to the body caused by defective teeth;
+by diseased or enlarged tonsils and adenoids; by faulty posture.
+
+3. Describe some common symptoms of eye strain in children; of enlarged
+tonsils and adenoids; of deafness.
+
+4. Name several possible causes of round shoulders, and explain why
+urging a round-shouldered child to hold himself erect is seldom enough
+to make him correct his posture.
+
+5. What measures should be taken to overcome nervousness in children?
+
+6. Describe in detail the health work carried on in the public schools
+of your city or town. Considering the important part played by
+uncorrected physical defects in causing permanent physical disability
+among adults, do you think in the long run it is cheaper or more
+expensive for a community to spend money in protecting the health of
+school children?
+
+7. Discuss the particular needs of convalescent and of chronic patients.
+
+8. Explain the effect of activity upon recovery, and explain why it is
+desirable for invalids to have occupation.
+
+9. What special needs should be provided for in caring for old people?
+
+
+FOR FURTHER READING
+
+Invalid Occupations--Tracy.
+
+Occupation Therapy--Dunton.
+
+Handicrafts for the Handicapped--Hall and Buck.
+
+When Mother Lets Us Make Toys--Rich.
+
+Amusements for Convalescent Children--New York State Department of
+Health, Albany.
+
+Essentials of Medicine--Emerson, Chapter IX.
+
+Civics and Health--Allen.
+
+How to Live--Fisher and Fisk, Chapter III, Section II; and Supplementary
+Notes, Section III.
+
+Health Work in the Schools--Hoag and Terman.
+
+Medical Inspection of Schools--Gulick and Ayres.
+
+The Hygiene of the Child--Terman.
+
+Posture of School Children--Bancroft.
+
+
+
+
+CHAPTER XV
+
+QUESTIONS FOR REVIEW
+
+
+I. Show how you would:
+
+    1. Make an unoccupied bed. (Notice the number of minutes it takes
+       you to do it well.)
+
+    2. Remove all the covers from an unoccupied bed and leave the bed to
+       air.
+
+    3. Open a bed to receive a patient.
+
+II. Show how you would:
+
+    1. Change all the linen and remake an occupied bed. (How long did
+       it take you?)
+
+    2. Turn a patient from his back to his side, and the reverse.
+
+    3. Remove, shake, and readjust a patient's pillows.
+
+    4. Move a patient from one bed to another.
+
+    5. Prepare a weak patient to sit up in a chair, and assist him from
+       the bed to the chair.
+
+    6. Assist a weak patient from the chair to the bed.
+
+    7. Arrange pillows and back rest for a patient to sit up in bed; and
+       also how you would remove the pillows and back rest.
+
+III. Show how you would:
+
+    1. Lift a patient who has slipped down toward the foot of the bed,
+       and show what you would do to prevent him from slipping down.
+
+    2. Prevent bed covers from resting upon a sensitive foot, leg,
+       abdomen, or arm.
+
+    3. Describe and demonstrate every device you would use and every
+       thing you would do to prevent pressure sores.
+
+    4. Arrange pillows to support the arms of a person sitting up in
+       bed.
+
+    5. Arrange a table or a substitute for a table to support the book
+       or work of a patient sitting up in bed.
+
+    6. Arrange the light for a patient who is allowed to read in bed.
+
+IV.
+
+    1. Assemble all the articles you would use in giving a bed bath.
+       (How long did it take you?)
+
+    2. Show how to give a complete bed bath. (How long did it take you?
+       Did you have to stop the bath to fetch anything you had
+       forgotten?)
+
+    3. What special care would you give to the mouth and teeth? to the
+       finger and toe nails? to the hair? to badly tangled hair? How
+       would you cleanse the mouth of a helpless patient?
+
+    4. Show how to shampoo the hair of a bed patient.
+
+    5. Show how you would give a bath to a baby.
+
+    6. Show everything that you would do to prepare a patient for the
+       night.
+
+V.
+
+    1. Show how to take the temperature, pulse, and respiration.
+
+    2. Show how to cleanse a clinical thermometer.
+
+    3. Show how to give a foot bath (_a_) to a patient out of bed, (_b_)
+       to a patient in bed.
+
+    4. Show how you would give a cool sponge bath to a feverish patient.
+
+    5. Show how to give, remove, and cleanse a bed-pan.
+
+    6. Show how to fill and apply a hot water bag; an ice bag.
+
+    7. Show how to prepare and apply a mustard paste; a mustard leaf; a
+       flaxseed poultice; hot fomentations; cold compresses.
+
+    8. Show how to measure and administer a fluid medicine; pills or
+       tablets.
+
+    9. Show how to prepare and administer a salt and water enema to a
+       grown person; to a baby.
+
+   10. Show how to prepare steam inhalations.
+
+   11. Show how to apply an ointment; a liniment.
+
+VI.
+
+    1. Show how you would feed a helpless patient who is lying down.
+
+    2. Show how you would feed a patient who is able to sit up but
+       unable to use his hands.
+
+    3. Prepare a liquid nourishment tray.
+
+    4. Set a tray for light diet; for full diet.
+
+    5. Show how to place a tray for a patient unable to sit up but able
+       to feed himself; for a patient sitting up in bed.
+
+    6. What personal care should be given a patient just before meals?
+       just after meals?
+
+    7. How would you modify the diet of a patient inclined to
+       constipation? to diarrhoea?
+
+VII.
+
+    1. Describe effective household methods for removing dust.
+
+    2. Demonstrate the cleaning of a refrigerator.
+
+    3. Show how to ventilate a sick room while protecting the patient
+       from direct draughts.
+
+    4. Show how to clean a sick room with a minimum of disturbance to
+       the patient.
+
+    5. Explain how a patient with communicable disease should be
+       isolated.
+
+    6. Demonstrate the daily care of a room occupied by a patient with
+       communicable disease.
+
+    7. Explain methods of concurrent disinfection.
+
+    8. Explain methods of terminal disinfection.
+
+    9. Tell how the following should be disinfected: discharges from the
+       nose, throat, eyes, ears, bowels, bladder, wounds, and sores; bed
+       and personal linen; blankets; mattresses; dishes; utensils,
+       especially bedpans and urinals; clothing and person of the
+       attendant, especially the hands; furniture, rugs, and woodwork.
+
+VIII.
+
+    1. Name some of the most obvious symptoms of sickness.
+
+    2. Name some symptoms that would lead you to take a patient to a
+       doctor; to send for a doctor; to send for a doctor in haste.
+
+    3. Name some symptoms that are dangerous to neglect even though the
+       patient feels fairly well.
+
+    4. What are some of the symptoms of physical defects in children?
+       Name some conditions that are frequently caused by unremedied
+       defects.
+
+    5. Name some diseases commonly ushered in by symptoms resembling
+       those of a cold in the head.
+
+    6. What symptoms would lead you to isolate a patient?
+
+    7. Give as many illustrations as you can of the part played by good
+       and bad habits in determining health and sickness.
+
+IX.
+
+    1. How would you dress a cut? a burn? a sprain?
+
+    2. What would you do for a person suffering from colic? nausea?
+       diarrhoea? chill?
+
+    3. What are the symptoms of shock? heat stroke? heat prostration?
+       What treatment would you give in each case?
+
+    4. What would you do for a fainting person? for a person suffering
+       from nose bleed? from earache? from a cinder in the eye?
+
+    5. What course of action would you advise for a person troubled with
+       sleeplessness? frequent headaches? excessive irritability?
+       unusual depression of spirits? unfounded suspicions of other
+       persons' motives? a tendency to have the feelings hurt easily?
+       inability to control the emotions?
+
+X.
+
+    1. Why is it better to prevent sickness than to cure it?
+
+    2. Name the essentials of good hygienic conditions for babies, for
+       children, for grown people, for the aged.
+
+    3. How much of the sickness in the United States is preventable?
+
+    4. If part of the sickness is preventable, why is it not prevented?
+
+    5. What constitutes adequate care of the sick?
+
+    6. What proportion of the young men in your community who were
+       drafted have been rejected for physical disability? How many were
+       rejected for disabilities that might have been prevented?
+
+XI. (Answers to the following questions can generally be obtained from
+local health officers.)
+
+    1. What are the duties and powers of your local board of health?
+
+    2. How much did your city or town spend per person last year on
+       health protection? How does this amount compare with the amount
+       spent per person for police protection? for fire protection?
+
+    3. Who inspects the water supply in your town? the milk supply? the
+       food supply?
+
+    4. In your city, what was the number of deaths per 100,000 of the
+       population from tuberculosis each year for the last five years?
+       from typhoid fever?
+
+    5. Is there a tuberculosis sanitarium in your city or county? Are
+       nurses employed to supervise tuberculosis patients who remain at
+       home?
+
+    6. What provision does your community make for patients suffering
+       from other communicable diseases?
+
+    7. What measures are taken in your community to instruct school
+       children in matters of health? to instruct grown persons?
+
+    8. How does your community provide medical and nursing care for
+       persons unable to pay part or all of the cost of such service?
+
+XII. Explain why the following common beliefs are erroneous or
+unfounded:
+
+    1. That a damp cellar causes diphtheria.
+
+    2. That night air is harmful.
+
+    3. That one should "stuff a cold" and "starve a fever."
+
+    4. That almost everyone needs a tonic in the spring.
+
+    5. That the health of one's family would be endangered if a
+       tuberculosis hospital were placed on the next block.
+
+    6. That clearing up the back yard will protect the children of a
+       family from infantile paralysis.
+
+    7. That odorless and tasteless water is necessarily free from
+       harmful germs.
+
+    8. That all children should have the children's diseases, and have
+       them as early as possible.
+
+    9. That boils are a benefit to the system by removing impurities
+       from the blood.
+
+   10. That tomatoes cause cancer.
+
+   11. That consumption is inherited.
+
+   12. That dirt breeds disease.
+
+   13. That diseases come up drains.
+
+   14. That if a teaspoonful of medicine does you good, a tablespoonful
+       will do you more good.
+
+   15. That instinct teaches a mother how to care for her baby.
+
+   16. That low heeled shoes, though suitable for boys and men, cause
+       broken arches in women and girls.
+
+   17. That in one's own case, the rule that everyone needs regular
+       meals, regular hours of sleep, and daily exercise out of doors,
+       may be safely violated.
+
+
+
+
+APPENDIX
+
+
+The New York City Department of Health has kindly permitted us to
+include the following circulars of information issued by the Division of
+Child Hygiene.
+
+
+DEPARTMENT OF HEALTH THE CITY OF NEW YORK
+
+INSTRUCTIONS TO PARENTS REGARDING THE CARE OF THE MOUTH AND TEETH.
+
+The physical examination of school children shows that in many instances
+the teeth are in a decayed and unhealthy condition.
+
+Decayed teeth cause an unclean mouth. Toothache and disease of the gums
+may result.
+
+Neglect of the first teeth is a frequent cause of decay of the second
+teeth.
+
+If a child has decayed teeth, it cannot properly chew its food.
+Improperly chewed food and an unclean mouth cause bad digestion, and
+consequently poor general health.
+
+If a child is not in good health, it cannot keep up with its studies in
+school. It is more likely to contract any contagious disease, and it has
+not the proper chance to grow into a robust, healthy adult.
+
+If the child's teeth are decayed, it should be taken to a dentist at
+once.
+
+The teeth should be brushed after each meal, using a tooth brush and
+tooth powder.
+
+The following tooth powder is recommended:
+
+  2 oz. powdered precipitated chalk.
+  ½ oz. powdered Castile soap,
+  1 dram powdered orris root.
+  Thoroughly mix.
+
+This prescription can be filled by any druggist at a cost not to exceed
+fifteen cents.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+Instructions to Parents Regarding the Care of the Nose
+
+The physical examination of school children shows that in many instances
+they breathe through the mouth because they cannot breathe properly or
+sufficiently through the nose.
+
+This may be due to bad habits in regard to keeping the nose clean, or,
+in a majority of instances, to a growth which is known as "adenoids" and
+which stops up the back of the nose. In either case, the air is not
+breathed through the nose, and the child becomes what is known as a
+"mouth breather."
+
+Constant breathing through the mouth causes the child to become pale,
+restless in its sleep and dull in its actions. The child often speaks as
+though it had a cold in the head. Frequently there is an almost constant
+discharge from the nose.
+
+Mouth breathing renders a child especially liable to contract
+tuberculosis and other infectious diseases; in fact, the child has very
+little resistance to disease of any kind.
+
+Every child should be given a handkerchief, and be taught to thoroughly
+blow the nose several times each day. If, after doing this regularly,
+the child is still unable to breathe properly through the nose, it is
+probable that an adenoid growth is present. Such children should be
+taken to the family physician or to a dispensary for further advice and
+treatment.
+
+Do not wait too long in the hope that the child will outgrow the
+condition, for the effect of adenoid growths persisting throughout
+childhood may injure the person for life.
+
+Have your child's throat and nose examined one month after measles,
+scarlet fever, or diphtheria.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+Instructions to Parents on the Care of Children's Hair and Scalp
+
+Children affected with vermin of the head are excluded from school. The
+following directions will cure the condition:
+
+Mix one-half pint of sweet oil and one-half pint of kerosene oil. Shake
+the mixture well and saturate the hair with the mixture. Then wrap the
+head in a large bath towel or rubber cap so that the head is entirely
+covered; the head must remain covered from six to eight hours.
+
+(Tincture of larkspur may be used instead of oil mixture. The directions
+for use are the same.)
+
+After removing the towel, the head should be shampooed as follows:
+
+To two quarts of warm water add one teaspoonful of sodium carbonate
+(washing soda). Wet the hair with this solution and then apply Castile
+soap and rub the head thoroughly about ten minutes. Wash the soap out of
+the hair with repeated washings of clear warm water. Dry the hair
+thoroughly.
+
+Nits: If the head is shampooed regularly each week as above described,
+it will cure and prevent the condition of "nits."
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+DIET FOR CHILD FROM 12TH TO 18TH MONTH
+
+FIRST MEAL--ON RISING.
+
+(1) 1 to 2 ounces juice of a sweet orange
+
+or
+
+Pulp of 6 stewed prunes
+
+or
+
+1 ounce pineapple juice.
+
+(2) 8 ounces milk with either zwieback, or toasted biscuits or stale
+toasted bread.
+
+Note: Fruit must be given either ½ hour before or ½ hour after milk.
+
+SECOND MEAL--DURING FORENOON.
+
+Milk alone or with zwieback.
+
+NOON MEAL.
+
+(1) 6 ounces soup
+
+or
+
+3 ounces beef juice.
+
+Note: Soup may be made of chicken, beef or mutton.
+
+(2) Stale bread may be added to the above.
+
+FOURTH MEAL--AFTERNOON.
+
+Milk or toasted bread and milk.
+
+EVENING MEAL.
+
+(1) 4 ounces thick gruel mixed with 4 ounces top half milk.
+
+Taken with zwieback.
+
+Note: Gruel may be made of oatmeal, farina, barley, hominy, wheatena, or
+rice.
+
+(2) Apple sauce
+
+or
+
+Prune jelly.
+
+Total milk in 24 hours, 1 to 1¼ quarts.
+
+Note: 8 ounces is equal to a half pint.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+DIET FOR CHILD FROM 18TH TO 24TH MONTH
+
+BREAKFAST.
+
+(1) Juice of one sweet orange
+
+or
+
+Pulp of six stewed prunes
+
+or
+
+Pineapple juice (fresh or bottled) 1 ounce.
+
+(2) A cereal such as cream of wheat, oatmeal, farina, or hominy
+preparations with top milk (top 16 ounces) sweetened or salted. A glass
+of milk, bread and butter.
+
+Note: If constipated give the fruit ½ hour before breakfast with water;
+if not, they may be given during the forenoon.
+
+Raw fruit juice must be given either ½ hour before or ½ hour after milk.
+
+FORENOON.
+
+A glass of milk with two toasted biscuits or zwieback or graham
+crackers.
+
+DINNER.
+
+(1) Broth or soup made of beef, mutton, or chicken, and thickened with
+peas, farina, sago or rice
+
+or
+
+Beef juice with stale bread crumbs; or clear vegetable soup with yolk of
+egg
+
+or
+
+Egg soft boiled, with bread crumbs, or the egg poached, with a glass of
+milk.
+
+(2) Dessert: apple sauce, prune pulp, with stale lady-fingers or graham
+wafers
+
+or
+
+Plain puddings: rice, bread, tapioca, blanc-mange, junket or baked
+custard.
+
+SUPPER.
+
+Glass of milk, warm or cold; zwieback and custard or stewed fruit.
+
+Total milk in 24 hours, 1½ quarts.
+
+
+DEPARTMENT OF HEALTH
+
+CITY OF NEW YORK
+
+DIET FOR CHILD FROM TWO TO THREE YEARS
+
+BREAKFAST.
+
+(1) Juice of 1 sweet orange
+
+or
+
+Pulp of 6 stewed prunes
+
+or
+
+1 ounce pineapple juice (fresh or bottled)
+
+or
+
+Apple sauce.
+
+(2) A cereal such as oatmeal, farina, cream of wheat, hominy or rice,
+slightly sweetened or salted as preferred, with the addition of top milk
+(top 16 ounces)
+
+or
+
+A soft boiled or poached egg with stale bread or toast.
+
+(3) A glass of milk.
+
+Note: If constipated give the fruit ½ hour before breakfast with water;
+if not, they may be given during the forenoon.
+
+Milk and raw fruit juice must not be given at same meal.
+
+DINNER.
+
+(1) Broth or soup made of chicken, mutton or beef, thickened with
+arrowroot, split peas, rice, or with addition of the yolk of an egg or
+toast squares.
+
+(2) Scraped beef or white meat of chicken, or broiled fish (small
+amount)
+
+or
+
+Mashed or baked potatoes with fresh peas or spinach or carrots.
+
+(3) Dessert: apple sauce, baked apple, rice pudding, junket or custard.
+
+SUPPER.
+
+(1) A cereal or egg (if egg is not taken with breakfast) with stale
+bread or toast
+
+or
+
+Bread and milk or bread and cocoa or bread and custard.
+
+(2) Stewed fruit.
+
+
+DEPARTMENT OF HEALTH
+
+CITY OF NEW YORK
+
+DIET FOR CHILD FROM THREE TO SIX YEARS
+
+BREAKFAST.
+
+(1) Fruits: an orange, apple, pear or stewed prunes.
+
+(2) Cereal: oatmeal, hominy, rice or wheat preparations, well cooked and
+salted, with thin cream and sugar
+
+or
+
+Egg: soft boiled, poached, omelet or scrambled.
+
+(3) Milk or cocoa.
+
+DINNER.
+
+(1) Soup: beef, chicken or mutton.
+
+(2) Meat: chicken or beefsteak or roast beef or lamb chops or fish.
+
+(3) Vegetables: spinach or carrots or string beans, peas, cauliflower
+tops, mashed or baked potatoes, beets or lettuce (without vinegar)
+
+Macaroni, spaghetti.
+
+Bread and butter--not fresh bread or rolls.
+
+(4) Dessert: custard, rice or bread or tapioca pudding, ice cream (once
+a week) cornstarch pudding (chocolate or other flavor) stewed prunes or
+baked apple.
+
+SUPPER.
+
+(1) Milk toast or graham crackers and milk
+
+or
+
+A thick soup, as pea, or cream of celery with bread and butter
+
+or
+
+A cereal and thin cream with bread and butter.
+
+(2) Stewed fruit; custard or plain pudding; jam or jelly.
+
+
+
+
+GLOSSARY
+
+(For complete definitions of the following words the student is referred
+to general and scientific dictionaries)
+
+
+A
+
+ANTISEPTIC.--A substance which prevents or hinders the growth of
+micro-organisms.
+
+ANTITOXIN.--A substance that neutralizes the action of a toxin.
+
+ASEPTIC.--Free from living germs.
+
+AXILLA.--The armpit.
+
+
+B
+
+BACILLUS (pl. bacilli).--A rod-shaped or elongated bacterium.
+
+BACTERIAL.--Relating to bacteria.
+
+BACTERICIDE.--An agent having the power to destroy bacteria.
+
+BACTERIOLOGICAL.--Relating to bacteriology.
+
+BACTERIOLOGY.--The science dealing with microorganisms.
+
+BACTERIUM (pl. bacteria).--A unicellular vegetable micro-organism.
+
+
+C
+
+CARRIER.--An apparently healthy person who harbors pathogenic germs in
+his body.
+
+COCCUS (pl. cocci).--A bacterium of spherical or nearly spherical shape.
+
+COUNTER-IRRITANT.--A substance or agent which if applied to the skin
+causes irritation and thereby relieves an abnormal condition in another
+part of the body.
+
+
+D
+
+DEGENERATION.--A deterioration in cells or tissues of the body so that
+they become less able to perform their proper functions.
+
+DEGENERATIVE.--Pertaining to degeneration.
+
+DEODORANT.--An agent that destroys odors.
+
+DIGESTIVE TRACT.--The entire alimentary canal, including the mouth,
+oesophagus, stomach, and the small and large intestines.
+
+DIPLOCOCCUS.--A form of coccus in which two individuals remain attached
+after cell division has taken place.
+
+DISINFECT.--To destroy the germs of disease.
+
+DISINFECTANT.--An agent that destroys the germs of disease.
+
+DISINFECTION.--The process of destroying the germs of disease.
+
+
+E
+
+EMETIC.--A substance used to induce vomiting.
+
+ENEMA.--An injection of fluid into the rectum.
+
+
+F
+
+FECAL.--Pertaining to feces.
+
+FECES.--Matter discharged from the bowels; bowel movement.
+
+FERMENTATION.--Decomposition produced in an organic substance by the
+action of certain living agents.
+
+FISSION.--The process by which a cell divides into two parts.
+
+FLAGELLUM (pl. flagella).--A long hair-like appendage, by the action of
+which certain micro-organisms are enabled to move.
+
+FLEX.--To bend at a joint.
+
+FOMENTATION.--See _Stupe_.
+
+
+G
+
+GASTRIC JUICE.--The fluid secreted by the glands of the stomach.
+
+GERM.--A minute unicellular organism, either animal or vegetable; a
+micro-organism; a microbe.
+
+GERMICIDE.--An agent having the power to kill germs.
+
+
+H
+
+HOST.--An animal or plant in or upon which another organism lives.
+
+
+I
+
+IMMUNE.--Not susceptible to a particular disease; also, a person who is
+not susceptible to a particular disease.
+
+IMMUNITY.--The state in which an individual is not susceptible to a
+particular disease.
+
+IMMUNIZE.--To render immune.
+
+INCUBATION.--The interval between exposure to an infectious disease and
+the first appearance of symptoms.
+
+INFECT.--To communicate disease germs.
+
+INFECTION.--An agent by which disease may be communicated from one
+individual to another; also, an infectious disease.
+
+INOCULATE.--To introduce any biological product directly into the
+tissues of the body.
+
+INOCULATION.--The process of inoculating.
+
+INTESTINAL TRACT.--The small and large intestines.
+
+
+M
+
+MICROBE.--See _Germ_.
+
+MICRO-ORGANISM.--See _Germ_.
+
+MUCUS.--The substance secreted by mucous membranes.
+
+MUCOUS MEMBRANES.--The membranes lining certain cavities of the body,
+especially the digestive and respiratory tracts.
+
+
+N
+
+NUTRIENT.--One of several chemical groups to which the essential
+constituents of food belong.
+
+
+O
+
+ORGANIC.--Derived from or relating to an organism.
+
+ORGANISM.--An individual that is or has been alive.
+
+
+P
+
+PARASITE.--An individual that lives in or upon another individual.
+
+PASTEURIZATION.--The process of pasteurizing.
+
+PASTEURIZE.--To subject milk to a temperature of 142°-145° Fahrenheit
+for thirty minutes.
+
+PATHOGENIC.--Disease-producing.
+
+PERTUSSIS.--Whooping-cough.
+
+PROTEID.--One of the complex nitrogenous substances constituting the
+essential parts of animal and vegetable tissues.
+
+PROTOZOÖN (pl. protozoa).--An animal organism composed of a single cell.
+
+PUS.--The fluid product of inflammation; matter.
+
+PUTREFACTION.--Decomposition of nitrogenous organic matter brought about
+by micro-organisms and accompanied by a foul odor.
+
+
+R
+
+RESISTANCE.--See _Immunity_.
+
+RESPIRATORY TRACT.--The air passages, including the nose, mouth, larynx,
+trachea, bronchial tubes, and lungs.
+
+
+S
+
+SAPROPHYTE.--A vegetable organism that lives on decaying organic matter.
+
+SARCINA.--Literally, a bundle. Applied to bacteria grouped in bundles or
+packets.
+
+SEPTIC.--Putrefying or decomposing; infected by pus-producing bacteria.
+
+SEQUELA.--A disease or unhealthy condition following another disease or
+unhealthy condition.
+
+SERUM.--The fluid which separates from the clot after blood has
+coagulated; especially, that containing an antitoxin.
+
+SEWAGE.--Any substance containing urine or fecal matter; also, the
+substance which passes through sewers.
+
+SPIRILLUM (pl. spirilla).--A variety of bacteria having spirally twisted
+cells.
+
+SPORE.--A resting stage, characterized by great resistance, into which
+certain germs enter when conditions become unfavorable for their growth.
+
+SPUTUM.--Spit; expectoration.
+
+STAPHYLOCOCCUS.--A variety of bacteria that group themselves in masses
+resembling bunches of grapes.
+
+STERILE.--Free from living germs; aseptic.
+
+STERILIZATION.--The process of rendering sterile.
+
+STERILIZE.--To render sterile.
+
+STREPTOCOCCUS.--A variety of bacteria that arrange themselves in chains.
+
+STUPE.--A cloth wrung out of hot water and applied to the surface of the
+body.
+
+SUSCEPTIBLE.--Lacking resistance to a disease.
+
+SUSCEPTIBILITY.--The condition in which resistance to a disease is low.
+
+
+T
+
+TETRAD.--A variety of bacteria that arrange themselves in groups of
+four.
+
+TISSUE.--A collection of cells having the same function.
+
+TOXIN.--A poison produced by the action of micro-organisms.
+
+
+U
+
+UNICELLULAR.--Composed of a single cell.
+
+UTERUS.--The womb.
+
+
+V
+
+VACCINATE.--To inoculate with a poison in order to bring about immunity
+to a disease.
+
+VACCINE.--Any substance which if introduced into the body causes the
+formation of protective substances.
+
+VOMITUS.--Vomited substances.
+
+
+
+
+INDEX
+
+
+A
+
+  Abdomen, 68
+
+  Abdominal binder, 68
+
+  Action of drugs, 200
+
+  Adenoids, 284
+
+  Aged, care of, 303
+
+  Ailments and emergencies, 257
+
+  Air, 72
+
+  Alcohol, 160
+
+  Appliances,
+    bed cradles, 173
+    bedpans, 176
+    rubber utensils, 138
+
+  Applications, local, 220
+    cold, dry, 231
+    cold, moist, 235
+    hot, dry, 225
+      bricks, 226
+      flannel, 226
+      salt or sand, 226
+      water bags, 225
+    hot, moist, 227
+      fomentations, 229
+      poultices, 227
+      stupes, 229
+
+  Attendant, 127
+
+
+B
+
+  Bacteria, 1, 4, 5
+    bacilli, 5
+    coccus, 4
+    effects produced by, 3
+    entrance into the body, 9
+    food of, 2
+    immunity, 13
+    in food, 19
+    in water, 19
+    methods of study, 1
+    motion, 5
+    origin of communicable diseases, 3
+    parasites, 3, 8
+    saprophytes, 2
+    shape, 4
+    spirillum, 4
+    spores, 7
+    structure and development, 4
+    where found, 8
+
+  Bacteriology, 1
+
+  Baths, 42, 154
+    bed, 156
+    cleansing, 171
+    cold tub, 97, 171
+    daily, 24
+    foot, 165
+      mustard, 165
+    hot, 97
+    infant's, 78
+    sitz, 176
+    tub, 154
+
+  Bed cradles, 173
+
+  Bedmaking, 132
+
+  Bedpan, 176
+
+  Bed-rooms, care of, 84
+
+  Beds, 132
+    care of, 134
+    dimensions, 133
+    rubber pillow cases, 138
+    rubber sheets, 138
+    selection of, 132
+    wooden, 132
+
+  Bed sores, 169
+
+  Birth registration, 63
+
+  Blankets, 140
+
+  Bleeding, 272
+
+  Blindness, 33
+
+  Breast feeding, 73
+
+  Bruises, 276
+
+  Brush burn, 278
+
+  Burns, 277, 278
+
+
+C
+
+  Cancer, 111
+
+  Carriers, 17
+
+  Charts, 10, 246
+
+  Chickenpox, 236
+
+  Childhood, see Infancy, 60
+
+  Children, care of, 280
+    with adenoids, 284
+    with defective hearing, 285
+    with defective teeth, 286
+    with enlarged tonsils, 284
+    with eyestrain, 284
+    with incorrect posture, 286
+    with physical defects, 283
+    with predisposition to nervousness, 292
+
+  Chills, 270
+
+  Chronic patients, care of, 299
+
+  Circulars of information, 318
+    Department of Health, City of New York, 318
+      care of hair and scalp, 321
+      care of mouth and teeth, 318
+      care of nose, 320
+      diet of child twelfth to eighteenth month, 322
+      diet of child eighteenth to twenty-fourth month, 323
+      diet of child two to three years, 324
+      diet of child three to six years, 325
+
+  Cleaning room, 126
+
+  Cleanliness, personal, 41
+
+  Clothing, 47
+    disinfection of, 95
+    of infants, 68
+
+  Coccus, 4
+
+  Cold applications, 220
+
+  Cold, prevention of common, 241
+
+  Colic, 266
+
+  Compresses, cold, 232
+
+  Constipation, 52, 193, 266
+
+  Convalescents, care of, 294
+
+  Convulsions, 260
+
+  Counter irritants, 233
+
+  Croup, 271
+
+
+D
+
+  Degenerative diseases, 20, 24
+
+  Development of child, 64
+
+  Diaper, 69
+
+  Diarrhoea, 266
+
+  Diphtheria, 245
+
+  Disinfectants, 251
+
+  Disinfection, 248
+
+  Drainage, 40
+
+  Draughts, 32
+
+  Dust, effect upon health, 36
+
+
+E
+
+  Ear, disorders affecting, 268
+
+  Emergencies, 257
+
+  Enemata, 210
+    directions for giving, 210
+    for baby, 212
+
+  Environment, 29
+
+  Eruptive diseases, 236
+
+  Excreta, disinfection of, 249
+
+  Excretions, 52
+
+  Expectoration, 249
+
+  Eye, ailments, 267
+    compresses for, 232
+    foreign bodies in, 267
+
+  Eyestrain, 284
+
+
+F
+
+  Fainting, 259
+
+  Fatigue, 53, 106, 181
+
+  Feeding of infants, 73
+
+  Filtration of water, 50
+
+  Flies, as carriers of disease germs, 38
+
+  Floors, 120
+
+  Fomentations, 229
+
+  Food, 35, 48, 188
+    classification of, 48
+    for children, 78
+    for infants, 72
+
+  Foot bath, 165
+
+  Fumigation, 254
+
+  Furniture, 120
+
+
+G
+
+  Garbage, 37
+
+  Glossary, 326-330
+
+  Growth of child, 64
+
+
+H
+
+  Habits, 82
+
+  Hair, care of, 163
+
+  Handkerchiefs, 239
+
+  Hands, 11, 12, 43, 250
+
+  Headache, 257
+
+  Heat, application of, 220
+    exhaustion, 264
+
+  Heating, 54
+
+  Heredity, 27
+
+  Hiccough, 265
+
+  House, cleanliness of, 33
+
+  Humidity, 31
+
+  Hygiene, oral, 44
+    personal, 19, 28
+
+
+I
+
+  Immunity, 13
+
+  Infancy (and childhood), hygiene of, 60
+    air, fresh, 72
+    baths, 78
+    care of eyes, 80
+      of mouth, 81
+      of nostrils, 81
+      of genital organs, 81
+    clothing, 68
+    cry, significance of, 82
+    diet, 74
+    mother's milk, danger of substitutes, 72
+      water, 75
+      weaning, 75
+    excretions, 67
+    exercise, 83
+    growth and development, 64, 65
+      length at birth, 64
+        increase, 65
+      muscular development, 64
+      special senses, 66
+      speech, 66
+      teeth, 66
+      weight at birth, 64
+        increase, 65
+    habits, 82
+    mortality, 61
+    nursing bottles, 75
+      nipples, 75
+    play, 84
+    pulse, 96
+    respiration, 99
+    sleep, 70
+    toys, 85
+
+  Infection, 1, 43
+
+  Inflammation, 220
+
+  Inhalation, 213
+
+  Insects, 38, 270
+
+  Insect bites and stings, 270
+
+  Inunction, 214
+
+  Isolation, duration of, 247
+
+  Ivy poisoning, 270
+
+
+K
+
+  Kitchens, 34
+
+
+L
+
+  Light, 33, 124
+
+  Linen, 251
+
+  Lysol, 251
+
+
+M
+
+  Malaise, 106
+
+  Mattress, 135
+    care of, 136
+
+  Measles, 246
+
+  Medicines and remedies, 200
+    action of drugs, 200
+    amateur dosing, 202
+    enemata, 210
+    inhalation, 213
+    inunction, 214
+    patent remedies, 205
+    sprays and gargles, 213
+    suppositories, 209
+
+  Medicines, administration of, 206
+
+  Menstruation, profuse, 275
+
+  Mental condition, 104-112
+
+  Microorganisms, 9
+
+  Milk, 51
+    pasteurization, 51
+
+  Mouth, care of, 160
+    wash, 182
+
+  Mustard paste, 233
+    leaves, 233
+
+
+N
+
+  Nausea, 265
+
+  Nipple, bottle, 77
+    care of, 77
+
+  Non-communicable diseases, 20
+
+  Nosebleed, 274
+
+
+P
+
+  Pain, 105
+
+  Parasites, 3, 4, 8
+
+  Patent remedies, 205
+
+  Patient, care of,
+      with communicable disease, 236
+      with colds and slight infections, 238
+      with more serious infections, 242
+    changing sheet, 147
+    changing, 146
+    lifting, 146
+    mouth, 160
+    moving, 152
+
+  Personal hygiene, 19
+
+  Pillows, 137
+    covers, 138, 140
+
+  Poisonous drugs, 215
+
+  Posture, 286
+
+  Poultices, 227, 228
+
+  Prenatal care, 62
+
+  Prickly heat, 269
+
+  Protozoa, 8
+
+  Public agencies, 107
+
+  Public sanitation, 19
+
+  Pulse, 96
+
+  Purification of water, 50
+
+
+Q
+
+  Quarantine, termination of, 252
+
+
+R
+
+  Records, 107
+
+  Recreation, 55
+
+  Rectum, 93
+
+  Respiration, 99
+
+  Rest, 53
+
+  Rooms, 27
+
+
+S
+
+  Saprophytes, 2
+
+  Scalds, 277
+
+  Scarlet fever, 246
+
+  Sewage, 39
+
+  Sheets, 137, 138, 142
+
+  Shock, 261
+
+  Sick-room, model, 118
+
+  Sleep, 55, 70
+
+  Sleeplessness, 258
+
+  Small-pox, 246
+
+  Special senses in sickness, 101
+
+  Spores, 7
+
+  Sprains, 275
+
+  Sprays and gargles, 213
+
+  Stimulants, in emergency work, 263
+
+  Stupes, 229
+
+  Styes, 267
+
+  Sunstroke, 264
+
+  Suppositories, 209
+
+  Symptoms, 88
+
+
+T
+
+  Teeth, 45, 160
+    defective, 286
+    treatment, 46
+
+  Temperature, 92
+    method of taking, 92
+    normal, 95
+
+  Temperature of baths, 79, 155
+    of house, 30, 124
+    sponging for, 177
+    variations, 114, 206
+
+  Thermometer, clinical, care of, 92
+
+  Tonsils, enlarged, 284
+
+  Tuberculosis, 27-107
+
+
+U
+
+  Urine, 103
+
+
+V
+
+  Vaccination, 13, 25
+
+  Ventilation, 29, 123
+
+  Vomiting, 265
+
+
+W
+
+  Water, 49
+    filtration, 50
+
+  Weaning, 75
+
+  Weight, 65
+    loss of, 64
+
+  Whooping cough, 246
+
+  Wounds, 272
+
+
+
+
+[Transcriber's Note:
+
+
+Punctuation errors (e.g. missing period at end of sentence, missing
+quotation marks, etc.) and letters printed upside down have been
+corrected without note. Except where noted, inconsistencies in
+hyphenation, capitalization, and spelling (e.g. travelling and
+traveling) have not been changed. The original index had numerous
+errors, such as references to terms that do not appear in the text.
+Except where noted below, it has been left as printed.
+
+The following corrections were made:
+
+p. viii: Records, 105. to Records, 107. (under Chapter IV)
+
+p. ix: Care of the Patients with Communicable Diseases to Care of
+Patients with Communicable Diseases (under Chapter XII)
+
+p. ix: Care of liver, 251. to Care of linen, 251. (under Chapter XII)
+
+p. 15: innoculation to inoculation (Vaccination and inoculation have
+saved thousands of lives.)
+
+p. 16: principle to principal (principal causes which diminish
+resistance), to match cited text
+
+p. 37: gerns to germs (through which disease germs)
+
+p. 40: From "_The Human Mechanism_." to _From "The Human Mechanism."_
+(to match format of other captions)
+
+p. 41: perferably to preferably (preferably, chloride of lime.)
+
+p. 77: runnnig to running (thoroughly cleansed under running water)
+
+p. 82: symptons to symptoms (other symptoms of distress)
+
+p. 96: thay to they (taken together they are)
+
+p. 108: 8:30 to 8:30 a.m.
+
+p. 111: develope to develop (may develop into cancer)
+
+p. 115: missing degree symbol added (At noon his temperature was 101°)
+
+p. 132: illnes to illness (unless his illness is slight)
+
+p. 136: servicable to serviceable (makes a serviceable cover)
+
+p. 150: paitent to patient (ready for the patient.)
+
+p. 150-151: removed duplication of text in captions for Fig. 14 and Fig.
+15 (CHANGING THE DRAW SHEET, and CHANGING A PATIENT FROM ONE BED TO
+ANOTHER)
+
+p. 161: erroneous italics removed from "patient" and "her" (even a
+patient unable to sit up can brush her teeth)
+
+p. 167: added missing "bath" (to give a cool sponge bath)
+
+p. 175: ahould to should (the protection of the abdomen should)
+
+p. 177: expecially to especially (if it is especially difficult or
+undesirable)
+
+p. 177: patients' to patient's (between the patient's back and the pan;)
+
+p. 178: deoderant to deodorant (a properly kept pan needs no deodorant)
+
+p. 183: invarably to invariably (casual visitors almost invariably
+offend)
+
+p. 189: nurtients to nutrients (pancreatic juice acts upon all three
+nutrients)
+
+p. 195: solied to soiled (is always superior to soiled linen.)
+
+p. 205: appy to apply (apply even more strongly to using patent
+medicines.)
+
+p. 211: 166 to 176 (the directions on page 176.)
+
+p. 216: selzer to seltzer (seltzer aperient)
+
+p. 226: slighest to slightest (there is the slightest possibility of
+scalding)
+
+p. 227: accidently to accidentally (see that the switch is not
+accidentally)
+
+p. 228: cohers to coheres (when the mixture coheres)
+
+p. 229: annoint to anoint (anoint it with vaseline)
+
+p. 233: dicharge to discharge (If there is discharge from the eye,)
+
+p. 242: chould to should (visitors should be rigidly)
+
+p. 245: himelf to himself (safeguard the patient himself.)
+
+Table between pp. 246-247: diappearance to disappearance (Two weeks
+after onset and one week after disappearance)
+
+Table between pp. 246-247: pa-patient to patient (after child last saw
+patient.)
+
+p. 250: If to It (It may be necessary to provide two bedpans)
+
+p. 266: 216 to 193 (discussed on pages 193 and 52.)
+
+p. 280: etter to better (no better place)
+
+p. 300: attenom, to attention (constant attention must be given)
+
+p. 300: rotion to room, (hygiene of the sick room,)
+
+p. 301: salutory to salutary (making the salutary small adjustments)
+
+p. 308: querelous to querulous (sometimes become querulous)
+
+p. 329: Putrifying to Putrefying (Putrefying or decomposing)
+
+p. 331: bed-cradles to bed cradles (Index sub-entry, under "Appliances")
+
+p. 331: Bed-cradles to Bed cradles (Index entry)
+
+p. 331: Bed-sores to Bed sores (Index entry)
+
+p. 331: Brushburn to Brush burn (Index entry)
+
+p. 332: Foot-bath to Foot bath (Index entry)
+
+p. 333: Microörganisms to Microorganisms (Index entry)
+
+p. 333: Pre-natal to Prenatal (Index entry)
+
+p. 334: oss to loss (Index entry for "Weight, loss of")
+
+A fold-out table was facing p. 247 in the original book. For the plain
+text versions, it has been split into several smaller tables, with the
+"DISEASE" column repeated in each section. In the third section,
+"POLIOMYELITIS" has been hyphenated (POLIO-MYELITIS) to save space.
+
+The footnote pertaining to the table is immediately after it, not at the
+end of the chapter as usual.
+
+For the Lat-1 and ASCII versions, the oz. symbol has been replaced with
+oz., and oe ligatures have been changed to oe/OE.]
+
+
+
+
+
+End of the Project Gutenberg EBook of American Red Cross Text-Book on Home
+Hygiene and Care of the Sick, by Jane A. Delano and Anne Hervey Strong and American Red Cross
+
+*** END OF THIS PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***
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+The Project Gutenberg EBook of American Red Cross Text-Book on Home
+Hygiene and Care of the Sick, by Jane A. Delano and Anne Hervey Strong and American Red Cross
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: American Red Cross Text-Book on Home Hygiene and Care of the Sick
+
+Author: Jane A. Delano
+        Anne Hervey Strong
+        American Red Cross
+
+Release Date: May 4, 2010 [EBook #32250]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK AMERICAN RED CROSS TEXT-BOOK ***
+
+
+
+
+Produced by Heiko Evermann, Fox in the Stars, S.D., and
+the Online Distributed Proofreading Team at
+https://www.pgdp.net
+
+
+
+
+
+
+
+
+
+AMERICAN RED CROSS TEXT-BOOK
+
+ON
+
+HOME CARE OF THE SICK
+
+***
+
+DELANO
+
+
+
+
+  AMERICAN RED CROSS
+
+  TEXT-BOOK
+
+  ON
+
+  HOME HYGIENE
+
+  AND
+
+  CARE OF THE SICK
+
+  BY
+
+  JANE A. DELANO, R. N.
+
+  Chairman of the National Committee, Red Cross Nursing Service; Director,
+  Department of Nursing, American Red Cross; Late Superintendent
+  of the Nurse Corps, U. S. A.; of the Training Schools
+  for Nurses, Bellevue Hospital, New York City; and of the
+  Training School for Nurses, Hospital of the University
+  of Pennsylvania, Philadelphia
+
+  REVISED AND REWRITTEN
+
+  BY
+
+  ANNE HERVEY STRONG, R. N.
+
+  Professor of Public Health Nursing, Simmons College, Boston
+
+  _This is the Second Edition of the American Red Cross
+  Text-book in Elementary Hygiene and Home Care of
+  the Sick by Jane A. Delano and Isabel McIsaac._
+
+  PREPARED FOR AND ENDORSED BY
+
+  THE AMERICAN RED CROSS
+
+  PHILADELPHIA
+  P. BLAKISTON'S SON & CO.
+
+  1012 WALNUT STREET
+
+
+COPYRIGHT, 1918, BY AMERICAN RED CROSS
+
+THE MAPLE PRESS YORK PA
+
+
+
+
+PREFACE
+
+
+To the woman who wishes to protect her family from preventable diseases
+and is anxious to fit herself in the absence of a trained nurse to give
+intelligent care to those who are sick, this revision of the Red Cross
+text-book on Elementary Hygiene and Home Care of the Sick is
+particularly directed. It should appeal to men and to women who are
+interested in maintaining the health of their neighborhoods and
+communities and in affording effective cooperation to the public health
+authorities. To teachers wishing to impart protective health information
+to high school pupils, the book also should be useful as a class text as
+well as a guide.
+
+The war, which has caused the withdrawal from private practice of
+thousands of physicians and graduate nurses, makes it peculiarly
+important to the nation for every adult to have sound knowledge as to
+how to prevent contagion and epidemics, especially by precautionary
+attention to home and local sanitation. With nurses becoming more
+difficult to secure, the safety of the family demands that some member
+in each household know enough about elementary nursing to make a patient
+comfortable and to carry out accurately the instructions of the
+physician.
+
+The work of revision, based upon the latest knowledge of hygiene,
+sanitation and methods of home-nursing has been done by Miss Anne Hervey
+Strong, Professor of Public Health Nursing, Simmons College, under the
+personal direction of the author and the National Committee on Red Cross
+Nursing Service. The material has been painstakingly read by Dr. H. W.
+Rucker and Dr. Taliaferro Clarke of the United States Public Health
+Service, and Lieutenant Colonel Clarence H. Connor, Medical Corps,
+United States Army. Indebtedness to Dr. H. M. McCracken, President of
+Vassar College and Director of the Red Cross Junior Membership, for his
+valuable suggestion as to adapting the book for high school use as well
+as for the assistance rendered by his Department, also is gladly
+acknowledged.
+
+J. A. D.
+
+
+ACKNOWLEDGMENT
+
+I wish to express my gratitude to those who have so kindly helped in the
+work of preparing the present edition. Thanks are especially due to
+Professor Isabel Stewart, Miss Anna C. Jamme, Professor Curtis M.
+Hilliard, Professor Maurice Bigelow, Miss Katharine Lord, Miss Josephine
+Goldmark, and Miss Evelyn Walker.
+
+A. H. S.
+
+
+
+
+CONTENTS
+
+
+  PREFACE                                                            v
+
+  INTRODUCTION                                                      xi
+
+  CHAPTER I
+
+                                                                  PAGE
+
+  CAUSES AND PREVENTION OF SICKNESS                                  1
+
+     Communicable diseases, 1. Micro-organisms and bacteria,
+     1. Parasites, 3. Structure and development of parasites,
+     4. Bacteria, 4. Shape, 4. Size, 5. Motion, 5.
+     Multiplication, 5. Spores, 7. Distribution, 8. Protozoa,
+     8. Visible parasites, 8. Transmission of pathogenic
+     organisms, 9. Defenses of the body, 12. Immunity, 13.
+     Vaccination and inoculation, 15. Carriers, 17.
+     Non-communicable diseases, 20. Physical examinations, 22.
+
+  CHAPTER II
+
+  HEALTH AND THE HOME                                               27
+
+     Heredity, 27. Hygiene of environment and person, 28.
+     Ventilation, 29. Lighting, 32. Cleanliness of houses, 33.
+     Garbage, 37. Insects, 38. Sewage, 39. Personal
+     cleanliness, 41. Oral hygiene, 44. Treatment of teeth,
+     46. Clothing, 47. Food, 48. Elimination, 52. Rest and
+     fatigue, 53. Sleep, 55. Recreation, 55.
+
+  CHAPTER III
+
+  BABIES AND THEIR CARE                                             60
+
+     Growth and development, 64. Average size, 64. Muscular
+     development, 65. Development of special senses, of
+     speech, of teeth, 66. Normal excretions, 67. Clothing,
+     68. Sleep, 70. Fresh air, 72. Diet, 72. Intervals of
+     feeding, 73. Water, 75. Weaning, 75. Nursing bottles and
+     nipples, 75. Tables of diet, 78. Bathing, 78. Eyes, 80.
+     Mouth, 81. Nostrils, 81. Genital organs, 81. Development
+     of habits, 82. Exercise, 83. Play and toys, 85.
+
+  CHAPTER IV
+
+  INDICATIONS OF SICKNESS                                           88
+
+     Objective symptoms, 92. Temperature, 92. Pulse, 96.
+     Respiration, 99. General appearance, 100. Special senses,
+     101. Voice, tongue, throat, gums, 102. Cough, 103.
+     Appetite, 103. Excretions, 103. Loss of weight, 104.
+     Sleep, 104. Mental conditions, 104. Subjective symptoms,
+     105. Pain, 105. Records, 107. Tuberculosis, cancer and
+     mental illness, 107. Tuberculosis, 109. Cancer, 111.
+     Mental illness, 112.
+
+  CHAPTER V
+
+  EQUIPMENT AND CARE OF THE SICK ROOM                              117
+
+     Choice of a sick room, 118. Furnishing, 120. Ventilation,
+     123. Heating, 124. Lighting, 124. Cleaning, 126. The
+     attendant, 127.
+
+  CHAPTER VI
+
+  BEDS AND BEDMAKING                                               132
+
+     Bedsteads, 133. Mattresses, 135. Care of the mattress,
+     136. Pillows, 136. Protection of the mattress and
+     pillows, 137. Rubber sheets and pillow-cases, 138.
+     Sheets, 139. Draw sheets, 139. Pillow covers, 140.
+     Blankets, 140. Comforters and quilts, 141. Counterpanes,
+     141. Bedmaking, 141. To make an unoccupied bed, 143. To
+     change a patient's pillows, 146. Lifting a patient in
+     bed, 146. To turn a patient in bed, 147. To change sheets
+     while patient is in bed, 147. To move patient from one
+     bed to another, 150.
+
+  CHAPTER VII
+
+  BATHS AND BATHING                                                154
+
+     Cleansing baths, 154. Bed bath, 156. Care of the mouth
+     and teeth, 160. Care of the hair, 163. To wash the hair
+     of a bed patient, 164. Hot foot-baths, 165. Cool sponge
+     bath, 166.
+
+  CHAPTER VIII
+
+  APPLIANCES AND METHODS FOR THE SICK-ROOM                         169
+
+     Devices to give support, 172. Bedpans, 176. Daily routine
+     in the sick-room, 179. Time for visitors, 182.
+
+  CHAPTER IX
+
+  FEEDING THE SICK                                                 187
+
+     The digestive process, 188. Feeding the sick, 191. Liquid
+     diet, 192. Semi-solid diet, 192. Light or convalescent
+     diet, 193. Full diet, 193. Serving food for the sick,
+     195. To feed a helpless patient, 197.
+
+  CHAPTER X
+
+  MEDICINES AND OTHER REMEDIES                                     200
+
+     Action of drugs, 200. Amateur dosing, 202. Patent
+     remedies, 205. Administration of medicine, 206.
+     Suppositories, 209. Enemata, 210. Sprays and gargles,
+     213. Inhalation, 213. Inunction, 214. Household medicine
+     cupboard, 215.
+
+  CHAPTER XI
+
+  APPLICATION OF HEAT, COLD AND COUNTER-IRRITANTS                  220
+
+     Inflammation, 220. Hot applications, 225. Dry heat, 225.
+     Moist heat, 227. Stupes or hot fomentations, 229. Cold
+     applications, 231. Dry cold, 231. Moist cold, 232. Cold
+     compresses for the eyes, 232. Counter-irritants, 233.
+     Mustard paste, 233. Mustard leaves, 234.
+
+  CHAPTER XII
+
+  CARE OF PATIENTS WITH COMMUNICABLE DISEASES                      236
+
+     Incubation period, 238. Care of patients with colds or
+     other slight infections, 238. Care during more serious
+     infections, 242. Children's diseases, 246. Rules for
+     isolation and exclusion from school, 247. Disinfection,
+     248. Care of nose and throat discharges, 249. Care of
+     discharges from the bowels and bladder, 249. Bath water,
+     250. Care of the hands, 250. Care of utensils, 251. Care
+     of linen, 251. Disinfection of the person, 252.
+     Termination of quarantine, 252. Terminal disinfection,
+     253. Fumigation, 254.
+
+  CHAPTER XIII
+
+  COMMON AILMENTS AND EMERGENCIES                                  257
+
+     Conditions in which the nervous system is involved, 257.
+     Headache, 257. Sleeplessness, 258. Fainting, 259.
+     Convulsions, 260. Shock, 261. Stimulants, 263. Sunstroke
+     and heat exhaustion, 264. Conditions in which the
+     digestive tract is affected, 265. Nausea and vomiting,
+     265. Hiccough, 265. Diarrhoea, 266. Constipation, 266.
+     Colic, 266. Conditions in which the eyes or ears are
+     affected, 267. Styes, 267. Foreign bodies in the eye,
+     267. Disorders affecting the ears, 268. Conditions in
+     which the skin is affected, 269. Prickly heat, 269.
+     Insect bites and stings, 270. Ivy poisoning, 270. Other
+     emergencies, 270. Chills, 270. Croup, 271. Bleeding, 272.
+     Treatment of slight wounds, 272. Nose bleed, 274. Profuse
+     menstruation, 275. Other injuries, 275. Sprains, 275.
+     Bruises, 276. Burns and scalds, 277. Brush burn, 278.
+
+  CHAPTER XIV
+
+  SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS,
+  CHRONICS, AND THE AGED                                           280
+
+     Children, 281. Physical defects, 283. Eye-strain, 284.
+     Enlarged tonsils and adenoids, 284. Defective hearing,
+     285. Defective teeth, 286. Posture, 286. Predisposition
+     to nervousness, 292. Convalescent patients, 294. Chronic
+     patients, 299. Care of the aged, 303.
+
+  CHAPTER XV
+
+  QUESTIONS FOR REVIEW                                             312
+
+  APPENDIX                                                         319
+
+     Circulars of information issued by Division of Child
+     Hygiene, New York Department of Health.
+
+  GLOSSARY                                                         326
+
+  INDEX                                                            331
+
+
+
+
+INTRODUCTION
+
+
+Health and sickness, at all times momentous factors in the welfare of
+our nation, now as never before are matters of vital importance. To win
+its victories both in peace and in war, the nation needs all its
+citizens with all their powers, and it is a matter of more than passing
+interest that, as conservative estimates show, at least three persons
+out of every hundred living in the United States are constantly
+incapacitated by serious sickness. In 1910 these seriously sick persons
+numbered more than 3,000,000. Even more significant, perhaps, is the
+fact that at least half of our national sickness could be prevented if
+knowledge and resources that we now possess were fully utilized.
+
+The problem of sickness is by no means peculiar to our own day and
+generation. It has been a medical, a religious, and a social problem in
+every age. From the time of Job its meaning has baffled philosophers;
+from his day to ours thoughtful men have devoted their lives to
+searching for causes and cures. Yet before the middle of the last
+century little progress was made, either in scientific treatment or in
+prevention of disease.
+
+The invention of the microscope first made possible a real
+understanding of sickness. Through the microscope a new world was
+revealed,--a world of the infinitely small, swarming with tiny forms of
+animal and vegetable life. No one, however, appreciated the significance
+of these hitherto invisible plants and animals until the latter part of
+the 19th century, when the great French savant, Pasteur, proved that
+little vegetable forms, now called bacteria, cause putrefaction and
+fermentation, and also certain diseases of animals and man. Pasteur's
+discoveries were carried still further by other scientists, with the
+result that bacteriology has revolutionized medicine, agriculture, and
+many industries, and has made possible the brilliant achievements of
+modern sanitary science. For the first time in history the prevention of
+epidemics has become possible, and sickness is no longer regarded as a
+punishment for sin.
+
+Actual care of the sick, both in homes and in hospitals, has always been
+one of the responsibilities of women. The first general public hospital
+was built in Rome in the 4th century after Christ by Fabiola, a
+patrician lady. There she nursed the sick with her own hands, and from
+her day to ours extends an unbroken line of devoted women, handing down
+through the centuries their tradition of compassionate nursing service.
+It remained for Florence Nightingale, however, to give to the training
+its technical and scientific foundation, and thus to found the
+profession of nursing. As a result of her work, effectiveness was added
+to the spirit of service, that spirit which inspires the modern nurse no
+less than in an earlier day it inspired the Sisters of Charity who died
+nursing the wounded on the battlefields of Poland.
+
+But different generations have different needs, and to meet them the
+spirit of service must manifest itself in widely varying ways. The sick
+need care today no less than they did when St. Elizabeth bathed the feet
+of the lepers; but such limited service, however beautiful, is no longer
+enough. Today we serve best by preventing sickness. Cure of sickness and
+alleviation of suffering must never be neglected; not in cure, however,
+but in prevention lies the hope of modern sanitary science, of modern
+medicine, and of modern nursing.
+
+Nearly every woman at some time in her life is called upon to assist in
+caring for the sick. Indeed, approximately 90% of all sick persons in
+the United States are cared for at home, even in cities where hospital
+facilities are good. Moreover, every woman is largely responsible for
+maintaining her own health, and few escape responsibility at some time
+for maintaining the health of others. For such responsibility most women
+are poorly prepared. Every year in our own country thousands of persons,
+many of them babies and children, die merely because someone, in many
+cases a woman, is fatally ignorant of the laws governing sickness and
+health.
+
+Only prolonged and careful training, such as good hospital
+training-schools afford, can furnish the skill and judgment required in
+nursing persons who are seriously ill. Upon the trained nurse the modern
+practice of medicine makes great and ever-increasing demands: a nurse
+must perform complicated duties, meet critical situations, and carry out
+a wide variety of measures based on scientific principles which she must
+understand. Good will and sympathy are no longer enough; amateur
+nursing, even when performed with the best intentions, may involve grave
+dangers for those who are seriously ill.
+
+On the other hand, although it is true that a little knowledge is a
+dangerous thing, it is no less true that total ignorance may be more
+dangerous still. For instance, in cases of incipient, slight, or chronic
+illness, and in certain emergencies a little knowledge may be safer far
+than no knowledge at all; and no one, surely, should be ignorant of the
+principles of hygiene.
+
+The American Red Cross, recognizing the part that women can and should
+play in preventing sickness and in building up the health and vigor of
+the nation, has added to its larger patriotic services this elementary
+course of instruction in hygiene and home care of the sick. The lessons
+are not intended to take the place of a nurse's training, and procedures
+requiring technical skill are necessarily omitted. The object of the
+book is to supply a little knowledge of sickness, which though limited
+may yet be safe. The book is also designed to set forth some general
+laws of health; to make possible earlier recognition of symptoms; to
+teach greater care in guarding against communicable disease; and to
+describe some elementary methods of caring for the sick, which, however
+simple, are essential to comfort, and sometimes indeed to ultimate
+recovery.
+
+
+FOR FURTHER READING
+
+A History of Nursing--Dock and Nutting, Volume I.
+
+The Life of Florence Nightingale--Cook.
+
+The Life of Pasteur--Vallery-Radot.
+
+The House on Henry Street--Wald.
+
+Public Health Nursing--Gardner, Part I, Chapters I-III.
+
+Origin and Growth of the Healing Art--Berdoe.
+
+Medical History from the Earliest Times--Withington.
+
+Under the Red Cross Flag--Boardman.
+
+Report on National Vitality--Fisher, (Bulletin 30 of the Committee of
+One Hundred on National Health. Government Printing Office, Washington).
+
+
+
+
+CHAPTER I
+
+CAUSES AND PREVENTION OF SICKNESS
+
+
+Diseases of two kinds have long been recognized: first, those
+transmitted directly or indirectly from person to person, like smallpox,
+measles, and typhoid fever; and second, diseases like heart disease and
+apoplexy, which are not so transmitted. These two classes are popularly
+called "catching" and "not catching;" the former are the infectious or
+communicable diseases, and the latter the non-infectious or
+non-communicable. The term contagious, formerly applied to diseases
+supposed to be spread only by direct contact, is no longer an accurate
+or useful term.
+
+
+THE COMMUNICABLE DISEASES
+
+The invention of the microscope, as we have seen, revealed the existence
+of innumerable little plants and animals, so small that even many
+millions crowded together are invisible to the naked eye. These tiny
+living creatures are called micro-organisms or germs. The plant forms
+are called bacteria (singular, bacterium), and the animal forms
+protozoa (singular, protozoon). The common belief that all or even most
+bacteria are harmful is quite unfounded. As a matter of fact, while not
+less than 1500 different kinds of micro-organisms or germs are known,
+only about 75 varieties are known to produce disease.
+
+Most bacteria belong to the class of micro-organisms called saprophytes,
+which find their food in dead organic matter, both animal and vegetable,
+and cannot flourish in living tissues. These saprophytes act upon the
+tissues of dead animals and vegetables, and resolve them into simpler
+substances, which are then ready to serve as nourishment for plants
+higher in the vegetable kingdom. Thus the processes which we know as
+fermentation and putrefaction are due to the action of saprophytes.
+Higher plants in turn furnish food for men and animals, and so the food
+supply is used over and over in different forms, making what is known as
+the _food cycle_. If it were not for bacterial activities vegetation
+would be robbed of its supply of nourishment, and plant life would
+speedily end; destruction of plant life would deprive the animal kingdom
+of food and thus all life would become extinct. The saprophytes are
+consequently essential to the existence of both animals and vegetables.
+
+There are, however, other organisms called _parasites_, which can exist
+in living tissues of animals or vegetables. The organisms at whose
+expense the parasites live are called their _hosts_. Parasites not only
+contribute nothing to their hosts, but generally harm them by producing
+poisonous substances or depriving them of food. Some parasites are able
+to lead a saprophytic existence also, but as a rule they live at the
+expense of animal or plant life. Pathogenic, or disease-producing, germs
+belong to the group of parasites. The pathogenic germs which find
+favorable soil in the body produce poisons called toxins. These poisons
+or toxins interfere with the bodily functions, and thus cause what we
+know as communicable disease. Communicable diseases are caused by
+specific germs only: that is, a certain disease cannot develop unless
+its particular germs are present; the germs of typhoid for instance, can
+cause typhoid fever only, and not tuberculosis or other disease.
+
+A number of diseases are caused by micro-organisms that are now well
+known. Chief among these diseases are colds, septicaemia (blood
+poisoning), influenza, pneumonia, diphtheria, typhoid fever,
+tuberculosis, whooping cough, Asiatic cholera, bubonic plague,
+meningitis, tetanus ("lock jaw"), leprosy, gonorrhoea, syphilis,
+relapsing fever, typhus fever, glanders, and anthrax. Micro-organisms
+not yet identified probably cause the communicable diseases whose origin
+is not known with certainty. These include infantile paralysis,
+smallpox, scarlet fever, measles, mumps, chicken-pox, Rocky Mountain
+spotted fever, yellow fever, hydrophobia (rabies), foot-and-mouth
+disease. We can hardly doubt that the intensive laboratory research now
+in progress will reveal in the near future the specific germs of these
+diseases also.
+
+
+STRUCTURE AND DEVELOPMENT OF PARASITES
+
+The group of parasites consists of two general classes, the vegetable,
+and the animal. In the former class belong the bacteria, and in the
+latter the protozoa. The two classes are not sharply differentiated, but
+in general the vegetable parasites are less highly organized than the
+animal.
+
+
+BACTERIA
+
+SHAPE.--Bacteria are composed of single cells and are consequently
+called unicellular organisms. Under the microscope individual cells are
+seen to differ in size, shape, and structure. In shape bacteria show
+three different types; the rod-shaped (bacillus), the spherical
+(coccus), and the spiral (spirillum). The organisms causing typhoid
+fever for example are a variety of bacilli, those causing pneumonia are
+cocci, while those causing Asiatic cholera are spirilla.
+
+[Illustration: FIG. 1.--BACILLI OF VARIOUS FORMS. (_Williams._)]
+
+SIZE.--Bacteria vary greatly in size. Average rod-shaped bacteria are
+about 1/25000 of an inch long, but there are undoubtedly organisms so
+small that they cannot be seen, even by means of the strongest
+microscopes we now possess.
+
+[Illustration: STAPHYLOCOCCI. STREPTOCOCCI. DIPLOCOCCI. TETRADS.
+SARCINAE. FIG. 2.--(_Williams._)]
+
+MOTION.--The power of motion in certain species of bacteria is due to
+hair-like appendages called flagella. These flagella by a lashing
+movement somewhat resembling the action of oars enable the organisms to
+move through fluids.
+
+MULTIPLICATION.--After bacteria have fully developed, each cell divides
+into two equal parts; the process of division is called fission. Each
+of these two parts rapidly grows into a full-sized organism. Then
+fission again takes place, so that four bacteria replace the original
+one. In each of the four, fission occurs again, and so the process of
+multiplication continues. As bacteria develop they group themselves in
+characteristic ways. Some, like the streptococci, arrange themselves in
+chains; the diplococci, in pairs; the tetrads, in groups of four; others
+in packets called sarcinae, and still others, the staphylococci, form
+masses supposed to resemble bunches of grapes.
+
+[Illustration: FIG. 3.--SPIRILLA OF VARIOUS FORMS. (_Williams._)]
+
+[Illustration: FIG. 4.--BACTERIA SHOWING FLAGELLA. (_Williams._)]
+
+Under favorable conditions fission occurs rapidly; in some types a new
+generation may appear as often as every 15 minutes. Enormous
+multiplication would result if nothing occurred to check the process.
+But in nature such increase never continues unhindered, and bacteria,
+acting upon their food substances, produce acids and other materials
+injurious to themselves. Furthermore, lack of proper food, moisture, or
+favorable temperature, and competition with other organisms tend to
+prevent their unrestricted growth and multiplication.
+
+[Illustration: FIG. 5.--BACTERIA WITH SPORES. (_Williams._)]
+
+SPORES.--Most bacteria die if conditions become unfavorable to their
+growth, but some enter into a resting stage. This stage is characterized
+by the development of round or oval glistening bodies called spores,
+which are of dense structure and possess an extraordinary power to
+withstand heat, chemicals, and unfavorable surroundings. Except in rare
+instances a single cell produces but one spore. As soon as favorable
+conditions of temperature, moisture, and food supply are restored, the
+spore develops into the active form of the germ; it may, however, remain
+dormant for months or years. Spore formation, however, occurs in only a
+very few varieties of pathogenic bacteria.
+
+DISTRIBUTION.--Bacteria are very widely distributed in nature; they are
+in fact found practically everywhere on the surface of the earth. They
+are present in plants and water and food; on fabrics and furniture,
+walls and floors; and they are found in great numbers on the skin, hair,
+many mucous surfaces, and other tissues of the body.
+
+
+PROTOZOA
+
+The protozoa are the lowest group of the animal kingdom. Like bacteria
+they are composed of single cells so small as to be visible only under
+the microscope. They play an important part in causing certain diseases
+of man, especially in the tropics. Among the well-known human diseases
+of protozoan origin are malaria, amoebic dysentery, and
+sleeping-sickness. Protozoa also cause several wide-spread and serious
+plagues of domestic animals.
+
+
+VISIBLE PARASITES
+
+A few diseases are caused by parasites large enough to be seen with the
+naked eye. One of the most important is hookworm disease. This disease
+is caused by a tiny worm which penetrates the victim's skin and
+ultimately finds its way into the intestine. Other diseases also are
+caused by parasitic worms, such as tapeworms, pinworms, and trichinae.
+The latter are acquired as a result of eating infected meat,
+particularly infected pork that has not been thoroughly cooked.
+
+
+TRANSMISSION OF PATHOGENIC ORGANISMS
+
+Pathogenic or disease producing organisms need for their development
+food, moisture, darkness, and warmth, conditions that exist within the
+human body. When one or more of these factors is unfavorable,
+development of germs is checked; if unfavorable conditions are extreme
+or long continued, the organisms begin to die. It is difficult to say at
+exactly what moment they will die if deprived of moisture or exposed to
+extremes of temperature or other unfavorable conditions, just as it
+would be impossible to state at exactly what moment a collection of
+house plants would all be dead if water were withheld, or if the room
+temperature were greatly reduced.
+
+Most pathogenic organisms, however, do not flourish long outside the
+body, and owe their continued existence to a fairly direct transfer
+from person to person. They gain access to the body through mucous
+surfaces such as the respiratory and digestive tracts, and through
+breaks in the skin, such as cuts, abrasions, and the bites of certain
+insects. They leave the body chiefly in the nasal and mouth discharges,
+as in coughing, sneezing, and spitting, in the urine and bowel
+discharges, and in pus or "matter."
+
+[Illustration: FIG. 6. (_L. H. Wilder._)]
+
+The problem of controlling communicable diseases, consequently, lies in
+preventing the bodily discharges of one person from travelling directly
+into the body of another. If a person is not expelling pathogenic germs,
+it is clear that he cannot pass diseases on to others. But both
+pathogenic and harmless germs follow the same routes from person to
+person, so that safety as well as decency lies in preventing so far as
+possible all exchanges of bodily discharges.
+
+There are five routes by which the bodily discharges most frequently
+travel from one person to another. Four of these routes of infection are
+called public, because in most cases efforts of individuals alone are
+not sufficient to control them. The public routes are water, milk, food,
+and insects. The fifth, or private route, includes all means by which
+fresh discharges of one person are passed to another, as when nose and
+mouth discharges are carried in coughing, sneezing, and kissing, or when
+bowel and bladder discharges are carried by the hands. These five routes
+in a given case differ greatly in relative importance, but the fifth, or
+direct route plays an immense part, although its importance in causing
+sickness has only lately been recognized. It cannot be too strongly
+emphasized that the chief agent in the spread of human diseases is man
+himself, and the human hand is the great carrier of disease germs both
+to and from the body. If unclean hands could be kept away from the
+orifices of the body, particularly the mouth, many diseases would soon
+cease to exist.
+
+
+Defenses of the Body
+
+In view of all the dangers from disease-producing germs it may seem
+surprising that the human race has not long ago succumbed to its
+invisible enemies. But the body has various defenses by means of which
+it may prevent invasion, or successfully combat its enemies in case they
+do gain access.
+
+The unbroken skin is usually impassable to bacteria. Virulent organisms
+are often found upon the skin of perfectly healthy persons, where they
+appear to be harmless unless an abrasion occurs which affords entrance
+into the deeper tissues. Most bacteria breathed in with the air cling to
+the moist surfaces of the air-passages and never reach the lungs.
+
+Mucous membranes lining the mouth and other cavities of the body would
+prove favorable sites for the growth of bacteria if the mucus secreted
+by them were not frequently removed. The mouth of a healthy person may
+contain bacteria of many kinds, but the saliva has a slight disinfectant
+power and serves as a constant wash to the membranes. The normal gastric
+(stomach) juice is decidedly unfavorable to the growth of bacteria,
+although it does not always kill them; they often pass through the
+stomach and are found in large numbers in the intestines. Other bodily
+secretions, such as the tears and perspiration, tend to discourage
+bacterial growth.
+
+Tissues of the body vary greatly in their power to resist invading
+germs, so that the route by which germs enter influences the severity of
+their effects. Typhoid bacilli and the spirilla of Asiatic cholera when
+taken with food or water produce far more serious disturbances than when
+injected under the skin; infections from pus germs through an abrasion
+of the skin may result in a slight local disturbance, while the same
+amount introduced into a deeper wound might cause a fatal infection.
+Certain germs nourish in certain tissues only; even tuberculosis, which
+attacks practically all tissues, has its favorite locations.
+
+IMMUNITY.--In addition to its mechanical defenses against disease, the
+body shows a varying degree of _immunity_, or the power possessed by
+living organisms to resist infections. Immunity or resistance is the
+opposite of susceptibility. It is exceedingly variable, being greater or
+less in different people and under different conditions, but the exact
+ways in which it is brought about are still in many cases far from
+clear.
+
+Immunity may be _natural_ or _acquired_. By natural immunity is meant
+an inherited characteristic by which all individuals of a species are
+immune to a certain disease. The natural immunity of certain species of
+animals to the diseases of other animals is well known. Man is immune to
+many diseases of lower animals, and they in turn are immune to many
+diseases of man. Cattle, for instance, are immune to typhoid and yellow
+fever, while man shows high resistance to rinderpest and Texas fever;
+both, however, are susceptible to tuberculosis, to which goats are
+immune. There are all gradations of immunity within the same species.
+Moreover, certain individuals have a personal immunity against diseases
+to which others of the same race or species are susceptible.
+
+Immunity may be _acquired_ in several ways. It is commonly known that
+one attack of certain communicable diseases renders the individual
+immune for a varying length of time, and sometimes for life. Among these
+diseases are smallpox, measles, whooping-cough, scarlet fever, infantile
+paralysis, typhoid fever, chicken-pox, and mumps; erysipelas and
+pneumonia on the other hand appear to diminish resistance and to leave a
+person more susceptible to later attacks.
+
+Again, in some cases immunity may be artificially acquired by
+introducing certain substances into the body to increase its
+resistance. Examples of this method include the use of antitoxin as a
+protection against diphtheria, of sera in pneumonia and other
+infections, and vaccination against smallpox and typhoid fever whereby a
+slight form of the disease is artificially induced. Laboratory research
+goes on constantly, and doubtless many more substances will eventually
+be discovered that will reduce human misery as vaccines and antitoxin
+have already reduced it.
+
+Vaccination and inoculation have saved thousands of lives. Smallpox,
+once more prevalent than measles, was the scourge of Europe until
+vaccination was introduced. During the 18th century it was estimated
+that 60,000,000 people died of it, and at the beginning of the 19th
+century one-fifth of all children born died of smallpox before they were
+10 years old. In countries where vaccination is not practised the
+disease is as serious as ever; in Russia during the five years from
+1893-97, 275,502 persons died of smallpox, while in Germany where
+vaccination is compulsory, only 8 people died of it during the year
+1897. Death rates from diphtheria and typhoid fever have been greatly
+reduced by the use of antitoxin and antityphoid vaccine. Thus in New
+York State in 1894, before antitoxin was generally used, 99 out of every
+100,000 of the population died of diphtheria, while only 20 out of
+100,000 died of it in 1914. In 1911 a United States Army Division of
+more than 12,000 men camped at San Antonio, Texas, for four months. All
+of these men were vaccinated against typhoid fever and only a single
+case occurred during the summer, although conditions of camp life always
+tend to spread the disease.
+
+While many and various factors tend to lower resistance rather than to
+increase it, the idea that these factors act equally in all kinds of
+infection is erroneous.
+
+      "The principal causes which diminish resistance to
+      infection are: wet and cold, fatigue, insufficient or
+      unsuitable food, vitiated atmosphere, insufficient sleep
+      and rest, worry, and excesses of all kinds. The mechanism
+      by which these varying conditions lower our immunity must
+      receive our attention, for they are of the greatest
+      importance in preventive medicine. It is a matter of common
+      observation that exposure to wet and cold or sudden changes
+      of temperature, overwork, worry, stale air, poor food,
+      etc., make us more liable to contract certain diseases. The
+      tuberculosis propaganda that has been spread broadcast with
+      such energy and good effect has taught the value of fresh
+      air and sunshine, good food, and rest in increasing our
+      resistance to this infection.
+
+      "There is, however, a wrong impression abroad that because
+      a lowering of the general vitality favors certain diseases,
+      such as tuberculosis, common colds, pneumonia, septic and
+      other infections, it plays a similar role in all
+      communicable diseases. Many infections, such as smallpox,
+      measles, yellow fever, tetanus, whooping-cough, typhoid
+      fever, cholera, plague, scarlet fever, and other diseases,
+      have no particular relation whatever to bodily vigor. These
+      diseases often strike down the young and vigorous in the
+      prime of life. The most robust will succumb quickly to
+      tuberculosis if he receives a sufficient dose of the
+      virulent micro-organisms. A good physical condition does
+      not always temper the virulence of the disease; on the
+      contrary, many infections run a particularly severe course
+      in strong and healthy subjects, and, contrariwise, may be
+      mild and benign in the feeble. Physical weakness,
+      therefore, is not necessarily synonymous with increased
+      susceptibility to all infections, although true for some of
+      them. In other words, 'general debility' lowers resistance
+      in a specific, rather than in a general, sense."--(Rosenau:
+      Preventive Medicine and Hygiene, pp. 403 and 404.)
+
+
+CARRIERS
+
+Well persons who carry in their bodies pathogenic germs but who
+themselves have no symptoms of disease are called carriers. Thus typhoid
+carriers have typhoid bacilli in the intestinal tract, while they
+themselves show no symptoms of typhoid fever; diphtheria carriers have
+bacilli of diphtheria in the throat or nose, but have themselves no
+symptoms of diphtheria, and so on. It has now been proved that many
+patients harbor bacteria for weeks, months, or even years following an
+infection, and are dangerous distributors of disease; also, some
+healthy individuals without a history of illness harbor living bacteria
+which may infect susceptible persons in the usual ways. Transmission by
+healthy carriers goes far to explain the occurrence of diseases among
+persons who have apparently not been exposed. This explanation has
+greatly clarified the whole problem of the spread of communicable
+diseases. Carriers, unfortunately, exist in large numbers, and render
+the ultimate control of disease exceedingly difficult. They can usually
+be identified by bacteriological tests. To some extent they can be
+supervised; food handlers at least should be legally obliged to submit
+to physical examinations, and should be licensed only when proved free
+from communicable disease.
+
+Diseases are also spread by persons suffering from them in a form so
+mild or so unusual that they pass unrecognized. These persons are known
+as "missed" cases. Carriers of disease and "missed" cases go freely
+about the community, handling food, using common drinking cups,
+travelling in crowded street cars, standing in crowded shops; in various
+ways coming into close contact with other people, coughing and sneezing
+and kissing their friends no less often than normal individuals. It is
+consequently clear that the bodily discharges of supposedly normal
+persons may be hardly less a menace than those of persons known to be
+infected.
+
+Diseases that depend for transmission upon milk, water, food, and
+insects may be controlled by public action, that is, by specific
+measures taken by a large group of people in order to protect the
+individual. Such action constitutes _public sanitation_. There is,
+however, a large group of diseases, chiefly sputum-borne, that cannot be
+controlled except by individual action. Such individual action
+constitutes a large part of _personal hygiene_.
+
+The whole problem of controlling infections sounds simple, depending as
+it does for the most part upon unpolluted water, milk, and food,
+extermination of certain insects, and cleanliness in personal behaviour.
+In practice the problem is not so easy. Public sanitation has performed
+miracles in the past, and will do much in the future; behaviour,
+however, will continue to be influenced by many factors, social and
+economic as well as personal. Ignorance of the laws of health is an
+obstacle to progress, but in modern conditions even the instructed may
+be unable to control their ways of living and working. Indeed, such
+control is at present limited to the privileged few. On the ignorant and
+the poor, those least able to bear it, society loads the heaviest burden
+of sickness. Only when ignorance and poverty are abolished, as one day
+they will be, can the final stage be reached in the fight for public
+health.
+
+
+THE NON-COMMUNICABLE DISEASES
+
+In this group is included a great variety of maladies. Of some the
+causes are known, while in the case of others, origin, prevention, and
+remedy are still obscure. Here belong defects in structure of the body,
+both hereditary and acquired; insanity and other nervous diseases; new
+growths, like tumors and cancer; disturbances of bodily processes, as
+malnutrition and gout; and the important class of degenerative diseases,
+like arteriosclerosis, in which tissues become hardened and fibrous and
+hence less able to perform their normal functions.
+
+The degenerative diseases are playing a menacing part in national
+health. The average length of life in the United States has shown a
+marked increase it is true, during the last 40 years. But this gain
+represents chiefly the saving of life through prevention of communicable
+diseases, especially among babies and children; among people who have
+passed the 30th year on the other hand, death rates are actually
+increasing. This increase is most marked after the age of 45, and is
+caused chiefly by the increase of cancer, and of degenerative diseases
+of the heart, blood vessels, and kidneys. Degeneration of tissues is
+normally a condition typical of old age, and in aged persons it may
+occur in any tissue. There is no elixir of youth, and for old age there
+is no cure. But the important facts in this connection are that
+degenerative changes now occur prematurely, and that among a vast number
+of people, in various classes of society and various occupations, the
+vital organs show a marked tendency to break down after the age of 45.
+
+This condition is not inevitable. Before the beginning of the present
+war, death rates at all ages were decreasing in England, Sweden, and
+other European countries. In America also degenerative diseases can be
+checked or prevented to a large extent, and it is highly important that
+their causes should be generally understood.
+
+The two groups following include some of the probable causes:
+
+1. Conditions of life which result in continued overwork, and mental
+overwork in particular; worry, excitement, insufficient recreation and
+exercise, and other kinds of nervous strain typical of modern life,
+especially in cities.
+
+2. Irritating substances in the body, including poisonous substances
+resulting from infectious diseases, and from syphilis in particular;
+poisons from chronic infections, alcohol, and industrial poisons such
+as lead and other metals; overeating and improper eating, especially of
+meat and other proteins, and rich or highly seasoned food; faulty
+digestion, constipation, and imperfect elimination through the
+kidneys.--(See Dr. A. E. Shipley, in bulletin of the N. Y. City Dept. of
+Health, Feb., 1915.)
+
+The importance of early recognition cannot be overemphasized. In many of
+these troubles the symptoms are not pronounced, and the victims have no
+knowledge of their condition until they happen to be examined for life
+insurance, or until the disease is far advanced. And even when they
+realize that trouble exists, as for example constipation or overwork,
+most people absolutely fail to realize how serious the consequences may
+be. The first step toward remedy is periodic complete physical
+examination by a competent physician, in order to learn in time how to
+prevent these degenerative diseases, if present, from growing worse. The
+custom of undergoing an annual physical examination is becoming more
+common, and "such a course, conservatively estimated, would add 5 years
+to the average life of persons between 45 and 50."--(Winslow.)
+
+      "Recently, we have been making examinations of the
+      employees of whole institutions, large banks and other
+      industrial concerns in New York City, and we find almost
+      the same conditions there. Out of 2000 such examinations
+      among young men and women of an average age of 33, just in
+      the early prime of life, men and women supposedly picked
+      because of their especial fitness for work, only 3.14% were
+      found free of impairment or of habits of living which are
+      obviously leading to impairment. Of the remaining persons,
+      96.69% were unaware of impairment; 5.38% of the total
+      number examined were affected with chronic heart trouble;
+      13.10% with arteriosclerosis; 25.81% with high or low blood
+      pressure; 35.65% with sugar, casts or albumen in the urine;
+      12.77% with combination of both heart and kidney disease;
+      22.22% with decayed teeth or infected gums; 16.03% with
+      faulty vision uncorrected.... The fact of greatest import,
+      however, was that impairment, sufficiently serious to
+      justify the examiner in referring the examinee to his
+      family physician for medical treatment, was found in 59% of
+      the total number of cases, while 37.86% were on the road to
+      impairment because of the use of "too much alcohol," or
+      "too much tobacco," constipation, eye-strain, overweight,
+      diseased mouths, errors of diet, and so forth....
+
+      "And what is the cause of this appalling increase, in the
+      United States, of these and other degenerative diseases? I
+      believe it can be shown to the satisfaction of any
+      reasonable person that the increase is largely due to the
+      neglect of individual hygiene in United States....
+
+      "If a man were suddenly afflicted with smallpox or typhoid
+      fever or any other acute malady, he would lose no time in
+      getting expert advice and applying every known means to
+      save his life. But his life may be threatened just as
+      seriously, though possibly not so imminently, by
+      arteriosclerosis, heart disease, or Bright's disease, and
+      he will do nothing to prevent the encroachment of these
+      diseases until it is too late, but will continue to eat as
+      he pleases, drink as he pleases, smoke as he pleases, or
+      overwork, and worry himself into a premature
+      grave."--("Conservation of Life at Middle Age," Prof.
+      Irving Fisher, Am. Journal of Public Health, July, 1915.)
+
+Periodic physical examinations are as necessary for children as for
+adults, in order to detect physical defects. These defects are known to
+have such an immense bearing upon health that routine examinations of
+all children have become an integral part of the work of enlightened
+public schools.
+
+Prevention of degenerative disease, then, as well as of the enormous
+numbers of preventable accidents and injuries, depends in large measure
+upon proper living conditions and proper personal habits. The infectious
+diseases, according to Dr. Hill, cost us annually at least 10 billion
+dollars in addition to the loss of life, and he adds: "The infectious
+diseases in general radiate from and are kept going by women."--(Hill--
+New Public Health, p. 30.) Women, it is true, can prevent many of the
+infections, but they can do still more, for hygienic habits to be
+effective must be acquired early, and mothers and teachers, because they
+have practically the entire control of children, have the power to
+prevent many cases of degenerative as well as of communicable disease.
+
+
+EXERCISES
+
+1. Distinguish between communicable and non-communicable disease.
+
+2. Describe the part played by micro-organisms in causing disease.
+
+3. Describe the structure of bacteria and their method of
+multiplication.
+
+4. In what ways are pathogenic germs transmitted from person to person?
+
+5. Upon what preventive measures does the control of communicable
+diseases depend?
+
+6. What is meant by immunity?
+
+7. Against what diseases may immunity be acquired artificially? How has
+the practice of immunizing affected death rates from communicable
+diseases?
+
+8. What factors tend to lower resistance? Do they act equally in the
+case of all diseases?
+
+9. Define a carrier, and explain the importance of carriers in the
+spread of disease.
+
+10. Name some of the characteristics and causes of degenerative
+diseases.
+
+11. Whom do the degenerative diseases most commonly affect?
+
+12. Describe methods that should be employed to prevent degenerative
+diseases.
+
+
+FOR FURTHER READING
+
+The New Public Health--Hill, Chapters I-IX.
+
+Health and Disease--Roger I. Lee, Chapters XV-XXIV.
+
+Principles of Sanitary Science and the Public Health--Sedgwick, Chapters
+I, II, III.
+
+Scientific Features of Modern Medicine--Frederic S. Lee, Chapters II,
+IV-VI.
+
+Disease and Its Causes--Councilman, Chapter I.
+
+Preventive Medicine and Hygiene--Rosenau.
+
+Publications of the Life Extension Institute--25 West 45th Street, New
+York City.
+
+
+
+
+CHAPTER II
+
+HEALTH AND THE HOME
+
+
+Of all the considerations that determine health, heredity is the one
+unalterable factor. Although certain characteristics are obviously
+hereditary,--complexion, height, and mental and physical traits in great
+variety,--yet in the past heredity has been little understood. In
+consequence it has served too often as a scape goat for faults and
+failings not beyond an individual's control. Our first clear
+understanding of the principles underlying heredity resulted from
+experiments made by Mendel, an Austrian monk, during the last century,
+and it is now possible to predict with a high degree of accuracy the
+inheritance of certain characteristics.
+
+Many diseases, formerly considered hereditary because their actual
+causes were unknown, are now known to be communicable. Thus, it is now
+understood that tuberculosis is not hereditary, although little children
+may be infected by tuberculous parents. No germ diseases are inherited
+in the strict sense of the word; but a baby may be infected with
+syphilis before birth if his father or his mother has the disease.
+
+It is true, however, that certain tissue weaknesses of the body seem to
+be hereditary, and in consequence one family is more susceptible to
+digestive disorders, another to diseases of the lungs, a third to
+deafness, and so on. Moreover, general low vitality may be inherited. It
+should be emphasized, however, that hereditary weakness does not
+inevitably lead to disease. Many persons have succeeded in preventing
+the development of active disease by guarding against strain in
+directions where they are weak by inheritance.
+
+Of all tissue weaknesses that may be inherited, defects of the nervous
+system are the most serious. Nervous disorders of every degree of
+severity, from slight nervous instability even to insanity, may result
+when these tissues are defective; but it is now a recognized fact that
+nervous disorders in many cases can be prevented from developing.
+Feeblemindedness, another condition due to defective tissue, is known to
+be inherited in the majority of cases, and in all cases it is incurable.
+
+
+HYGIENE OF ENVIRONMENT AND PERSON
+
+By environment is meant everything outside the body that affects it;
+taken in its complete meaning the word might include everything that is
+or ever was in the whole universe. It is possible to consider here a few
+only of the many environmental and personal factors affecting the health
+of individuals.
+
+The home constitutes the important part of environment for most persons,
+and for children in particular, since they spend the greater part of
+their time in or about it, and get there the foundation on which their
+health in later years depends. For persons employed away from home,
+industrial and occupational hygiene is hardly less important; but those
+subjects are too extensive to be considered here.
+
+Most people live where they must, and few have any part in planning the
+construction of their own houses. In choosing a house, however, one
+should remember that rooms where sunshine never enters are unfit for
+continued occupation. For children in particular fresh air and sunshine
+are essential, and it may be economy in the end to pay a comparatively
+high rent for an apartment having sunshine during at least a part of the
+day. Ignorance and carelessness, unfortunately, can spoil the best
+living conditions, and sometimes even in the country fresh air and
+sunshine are excluded from sleeping and living rooms.
+
+VENTILATION.--Ventilation has a direct bearing on health, although,
+contrary to former belief, the actual amount of oxygen in the air is not
+ordinarily the most important factor; even badly ventilated rooms
+contain more than enough oxygen to support life. The factors of prime
+importance in ventilation are temperature, humidity, air movement, and
+the number of persons in a given space since the greater the distance
+from one another the less is the probability that diseases will be
+spread.
+
+Room temperature should not be above 70 deg. F. and, except for the aged
+or sick, it is better to be between 60 deg. and 65 deg. Some moisture in
+the air is desirable; the amount needed is from 50% to 55% of the total
+moisture that the air can hold at a given temperature. We have no
+apparatus to decrease humidity in the air of houses, and in summer we
+are obliged to endure humidity, if excessive, no matter how
+uncomfortable we may be. But in winter the air in most houses is too
+dry, so that the mucous membranes of the nose and throat often become
+irritated and susceptible to infection. Most heating systems,
+particularly in small buildings, make no provision for supplying
+moisture. Keeping water in open dishes on or near radiators is often
+recommended, and would greatly improve the condition of the air, if
+people remembered to keep the dishes filled.
+
+The following is a simple but effective device to increase humidity:
+Roll an ordinary desk blotter into a cone about 8 inches in diameter at
+the base, and keep it constantly submerged for about one inch in a dish
+of water. The water rises to the top of the blotter and a large surface
+for evaporation is thus afforded.
+
+[Illustration: FIG. 7.]
+
+Stagnant air is harmful. Air should be in constant though not
+necessarily perceptible motion. Air about the body, if motionless, acts
+like a warm moist blanket, preventing the passage of heat from the body.
+
+The three factors, heating, humidity, and air motion, must be considered
+together. Every person requires each hour about 3000 cubic feet of air,
+and the problem of heating and ventilating is that of providing this
+amount in gentle motion, at a temperature of about 65 deg. F., and of
+humidity from 50-55%. Higher temperatures and stagnant air cause
+disinclination to work, headache, nausea, restlessness, or sleepiness,
+and if continued are likely to result in loss of appetite, and anemia.
+The tuberculosis movement has clearly shown the benefits both for the
+sick and the well of living in the open air, and has caused great and
+beneficial changes within a generation. The more time spent in the open
+air the better; since however most persons who work must spend the
+greater part of the day indoors, ventilation is a matter of great
+importance.
+
+Although fresh air enthusiasts are still too few, yet some go to the
+extreme and think that because cool air in motion is good, the colder
+the air and more violent the motion the better. On the contrary,
+chilling the whole body or a part of the body lowers resistance.
+Draughts of air have no bad effects upon persons in good health,
+particularly those accustomed to changes in temperature. But draughts
+are likely to be injurious to aged or sick persons and babies, by
+diminishing their resistance to such infections as common colds and
+pneumonia. It should be remembered that draughts or cold alone cannot
+cause colds; the specific germs must be present.
+
+LIGHTING.--Amount and direction of light are physiologically important.
+Defects of the eyes, too prolonged use, and insufficient light are the
+commonest causes of eye strain. Most eye defects can be relieved by
+glasses. Children's eyes should be examined upon entering school, and as
+often afterward as the oculist advises. Prolonged use causes fatigue of
+the eyes, especially when the illumination is poor; within limits, the
+amount of light needed depends on the nature of the work. Light should
+come from the left side of right handed people; never from the front.
+Light reflected from snow, sand, glazed white paper of books, or other
+bright surfaces is fatiguing from its intensity, and from the unusual
+angle at which it enters the eyes. Too much light is harmful, and
+probably causes some of the effects, such as nausea and headache,
+commonly attributed to poor ventilation.
+
+Almost all blindness is preventable, and blindness due to industrial
+accidents and processes is no exception to this rule. Surely no
+individual precautions or legal measures are too great in order to guard
+against this saddest of all physical defects.
+
+CLEANLINESS OF HOUSES.--A clean, well-cared for house is desirable from
+every point of view, but certain kinds of cleanliness affect health more
+than others.
+
+The most scrupulous care should be exercised wherever food is stored or
+prepared. The kitchen is in reality a laboratory; in it either
+intelligently or ignorantly are formed chemical compounds which have a
+far-reaching effect upon family health. From the standpoint of health no
+other room in the house is so important. It should be bright, airy, and
+easy to clean. In cleaning kitchen tables and woodwork water should not
+be allowed to soak into cracks and dark corners, carrying with it
+particles of food for the nourishment of bacteria and insects. Linoleum,
+if used to cover the floor, should be well fitted at the edges to
+prevent water from running underneath. There should be neither cracks
+nor crevices in wall or floor, and no dark corners or out-of-the-way
+cupboards in which dust, food particles, and moisture can accumulate.
+Such conditions not only attract mice and roaches, but furnish favorable
+soil for the development of moulds and fungi which by their growth
+affect food deleteriously. Waging a constant warfare against the
+development of bacteria constitutes a large part of good housekeeping.
+
+All cooking utensils should be thoroughly washed, scalded, and dried
+before they are put away; the use of carelessly washed dishes is bad.
+Enameled or agate ware which has begun to chip should be discarded.
+Dish-cloths and towels should be washed and boiled after using, and if
+possible dried in the sun.
+
+Every place in which food is kept should have constant care. The
+refrigerator is particularly important. Its linings should be
+water-tight, and the drain freely open at all times; otherwise the
+surrounding wood will become foul and saturated with drainings. At least
+once a week it should be entirely emptied and cleaned in the following
+way: The racks should be thoroughly washed in hot soapsuds to which a
+small amount of washing soda has been added, rinsed in boiling water,
+dried and placed in the sun and air. All parts of the refrigerator
+should be washed in the same manner, especially grooves and projections
+where food or dirt may lodge. The drainpipe should be flushed, the whole
+interior rinsed again with plain hot water, thoroughly dried with a
+clean cloth, and left to air for at least an hour. The drainage pan
+should be washed and scalded frequently. Food showing the slightest
+evidence of spoiling should be removed from the refrigerator at once.
+
+Even more attention should be paid to the hands of the cook. They should
+be washed always before handling food, and always after visiting the
+toilet, using the handkerchief, or otherwise coming in contact with
+nose, mouth, or other bodily secretions. Theoretically coughing and
+sneezing ought not to occur in the neighborhood of food, especially of
+food to be eaten raw; and persons with coughs, colds, or other
+communicable disease, however slight, ought not to handle food. If this
+rule were observed in practice, more persons would go hungry, but fewer
+would be sick.
+
+Thorough cleaning of rooms involves soap, water, sunshine, air, and
+elbow grease, just as it did before germs were discovered. Cleaning
+means actually removing dirt and dust, not merely stirring it up to
+settle again; consequently dry sweeping and dusting are ineffectual.
+Vacuum cleaning, and sweeping and dusting with damp or "dustless" mops
+and dusters are good. Deodorants and disinfectants do not take the place
+of ordinary cleanliness.
+
+Dust does not carry living disease germs to an appreciable extent; the
+fact is now well established that diseases formerly thought to be
+transmitted by dust or even supposed to travel directly through the air,
+are carried on tiny particles of moisture and mucus expelled in coughing
+and sneezing. This mode of transmission is called droplet or spray
+infection; it is one of the most active agents in spreading certain
+kinds of communicable diseases.
+
+Nevertheless dust in motion is harmful; it irritates the lining
+membranes of the nose, throat, bronchial tubes, and lungs, even causing
+tiny wounds through which disease germs enter. Thus tuberculosis is
+especially prevalent among stone cutters, felt workers, and others
+engaged in dusty trades. Metallic dust is especially harmful, because it
+is harder and sharper than dust from organic substances like wool and
+cotton. Furthermore, presence of dust indicates a low standard of
+cleanliness. People who tolerate it generally tolerate uncleanliness in
+other forms, more serious though less apparent.
+
+Cleaning would not be so great a problem if most houses were not
+littered with such dust catchers as carpets, so-called ornaments, carved
+and upholstered furniture, banners, draperies, and a vast collection of
+articles that can only be classified as Christmas presents. In actual
+practice things that are difficult or expensive to clean seldom are
+cleaned; carpets for example are considered unhygienic, not because they
+cannot be cleaned, but because they are not. William Morris' advice to
+exclude from houses all articles not known to be useful or believed to
+be beautiful would, if followed, add years to the lives of housekeepers.
+
+GARBAGE, has little bearing on health, except in so far as it affords a
+breeding place for flies. If it contains disease germs it may be
+dangerous, but statistics show that garbage handlers, although they can
+hardly be called especially careful, are not more subject to sickness
+than other men of their class. Garbage disposal is chiefly a question of
+preventing a public nuisance; it is a matter of cleanliness and public
+decency.
+
+INSECTS.--Flies, cockroaches, and other scavenging insects may carry
+disease germs on their feet and thus infect food on which they walk.
+Typhoid, cholera, dysentery, and other diseases have been carried by
+flies. Flies are always a menace, and should not be tolerated; moreover,
+the thought of their coming to food directly from manure piles and privy
+vaults is disgusting. Houses should be thoroughly screened in the fly
+season, but it is better to destroy the nuisance at its source. The
+chief breeding places of flies are garbage cans and manure piles. If
+the garbage can is water tight, closely covered, frequently emptied, and
+thoroughly cleaned, flies will not develop in it; about ten days must
+elapse from the time when the egg is laid until the insect is ready to
+fly. Fly traps to fit on the garbage can are useful. Manure should be
+screened and removed frequently, or it can be treated chemically.
+Methods for treating it are given in "Preventive Medicine and
+Hygiene."--Rosenau, p. 255, and in Bulletin No. 118, of the U. S. Dept.
+of Agriculture, July 14, 1914.
+
+[Illustration: FIG. 8.--A FLY WITH GERMS (GREATLY MAGNIFIED) ON ITS
+LEGS. (_U. S. Dept. Agri._)]
+
+Other diseases carried by insects are malaria and yellow fever, each by
+a special species of mosquito; typhus fever, by lice; and bubonic
+plague, by rat fleas. Various diseases less common in this country are
+carried by other insects. Even when mosquitoes are not carrying disease
+germs their bites may be harmful since they are often rubbed, especially
+by children, until the skin is broken, and various infections may enter
+through the wounds. Insects of every kind, rats, mice, and vermin should
+be excluded from houses.
+
+SEWAGE.--Discharges from the bowels and bladder contain various germs,
+and constitute one of the most important routes by which germs of
+typhoid fever, cholera and certain other diseases travel from person to
+person. Keeping sewage out of the water supply is consequently of great
+importance. Where a system of sewage disposal exists, the responsibility
+of making the system adequate and thus safeguarding public health rests
+upon the community as a whole. Communities ordinarily get just as much,
+or just as little typhoid fever as they are willing to endure.
+
+[Illustration: FIG. 9.--HOW A WELL MAY BE POLLUTED. (_From "The Human
+Mechanism."_ Copyright by Theodore Hough and William T. Sedgwick. Ginn
+and Company, publishers. Used by permission.)]
+
+In places having no system of drainage privies must be used. They can be
+made harmless, as army camps prove, but they require scrupulous care.
+Fecal matter must be prevented from draining into wells and other water
+supplies, and must be screened from flies. The privy should be located
+at a distance from the well. The minimum distance that is safe depends
+in each case upon the nature of the soil and the direction of the
+natural drainage. Even when the privy is situated below the well on
+sloping ground, drainage may still occur from the privy to the well;
+however, a well-made, properly located pit privy is safe unless it is
+near a limestone formation. The dry earth system is satisfactory in
+places having an efficient public scavenger system; in this system pails
+or cans are used to receive the discharges, which are then covered with
+sand, ashes, earth or, preferably, chloride of lime. The buckets are
+frequently emptied and the contents buried at least one foot below the
+surface of the ground. The objection to this method for more extended
+use is that proper care of the cans is a disagreeable duty of which most
+households soon tire.
+
+PERSONAL CLEANLINESS.--The main functions of the skin are three: to
+protect underlying tissues, to excrete waste matter, and to regulate
+bodily heat by checking or allowing the evaporation of perspiration.
+After perspiration has evaporated solid matter is left upon the skin,
+and oily matter also is deposited on it by the glands that keep the
+skin lubricated. Removing these and other materials at least once a day
+is desirable to improve the bodily tone and sense of well-being. Real
+cleanliness is impossible without frequent use of warm water and soap.
+
+Cold baths are stimulating, though not very efficacious for cleansing
+purposes. They are valuable tonics if properly used, but delicate or
+elderly persons should use them only by a physician's advice. Chilly
+feelings or depression following should be the signal for any person to
+discontinue cold bathing or swimming in cold water.
+
+Warm baths are soothing in their effects, and are appropriate at bed
+time, particularly for persons inclined to sleeplessness. Very hot
+baths, especially if prolonged, may be harmful, and should not be taken
+often.
+
+There is no clear connection between general cleanliness and disease.
+Frequent bathing does not protect a person from any particular disease,
+except in so far as bathing necessarily includes washing the hands. If
+typhoid germs for example have actually been swallowed, a clean bodily
+exterior is of no avail in preventing typhoid fever or in diminishing
+its severity. The same is true of other diseases.
+
+But it is impossible to emphasize unduly the importance of clean hands.
+Hands are prime offenders in distributing fresh bodily secretions, and
+germs both innocent and harmful. All health authorities agree on this
+point.
+
+      "Perhaps 90% of all infections are taken into the body
+      through the mouth. They reach the mouth in water, food,
+      fingers, dust, and upon the innumerable objects that are
+      sometimes placed in the mouth. The fact that the great
+      majority of infections are taken by way of the mouth gives
+      scientific direction to personal hygiene. Sanitary habits
+      demand that the hands should be washed after defecation and
+      again before eating, and fingers should be kept away from
+      the mouth and nose, and that no unnecessary objects should
+      be mouthed. All food and drink should be clean or
+      thoroughly cooked. These simple precautions alone would
+      prevent many a case of infection."--(Rosenau: Preventive
+      Medicine and Hygiene, p. 366.)
+
+As Dr. Chapin says:
+
+      "Probably the chief vehicle for the conveyance of nasal and
+      oral secretion from one to another is the fingers. If one
+      takes the trouble to watch for a short time his neighbors,
+      or even himself, unless he has been particularly trained in
+      such matters, he will be surprised to note the number of
+      times that the fingers go to the mouth and the nose. Not
+      only is the saliva made use of for a great variety of
+      purposes, and numberless articles are for one reason or
+      another placed in the mouth, but for no reason whatever,
+      and all unconsciously, the fingers are with great frequency
+      raised to the lips or the nose. Who can doubt that if the
+      salivary glands secreted indigo the fingers would
+      continually be stained a deep blue, and who can doubt that
+      if the nasal and oral secretions contain the germs of
+      disease these germs will be almost as constantly found upon
+      the fingers? All successful commerce is reciprocal, and in
+      this universal trade in human saliva the fingers not only
+      bring foreign secretions to the mouth of their owner, but
+      there exchanging them for his own, distribute the latter to
+      everything that the hand touches. This happens not once,
+      but scores and hundreds of times during the day's round of
+      the individual. The cook spreads his saliva on the muffins
+      and rolls, the waitress infects the glasses and spoons, the
+      moistened fingers of the peddler arrange his fruit, the
+      thumb of the milkman is in his measure, the reader moistens
+      the pages of his book, the conductor his transfer tickets,
+      the "lady" the fingers of her glove. Every one is busily
+      engaged in this distribution of saliva, so that the end of
+      each day finds this secretion freely distributed on the
+      doors, window sills, furniture and playthings in the home,
+      the straps of trolley cars, the rails and counter and desks
+      of shops and public buildings, and indeed upon everything
+      that the hands of man touch. What avails it if the
+      pathogens do die quickly? A fresh supply is furnished each
+      day."--(Chapin: The Sources and Modes of Infection, p.
+      188.)
+
+ORAL HYGIENE.--Cleanliness and proper care of the mouth and teeth can
+hardly be over emphasized. Their bearing upon health is direct. Long ago
+it was recognized that persons with decayed or missing teeth frequently
+suffered from dyspepsia, a natural result of inability to masticate
+properly, but only within recent years has it been realized that decayed
+teeth give rise to many other diseased conditions. Bacteria are
+constantly present in the mouth. If the mucus of the mouth is not
+removed, it forms a sticky coat upon the surfaces of the teeth and gums.
+In this bacteria collect, and pus or matter may also be formed, which,
+if carried by the blood to other parts of the body, may cause digestive
+troubles, rheumatism, and diseases of heart and kidneys. (See Dr. T. B.
+Hartzell, Health News, Oct., 1915, "The Importance of Mouth Hygiene and
+How to Practise it.")
+
+To keep the mouth and teeth healthy they must have:
+
+1. Proper use.
+
+2. Proper care.
+
+3. Proper treatment.
+
+1. Teeth, like other parts of the body, need exercise. Foods that
+require a considerable amount of chewing should be included in the diet.
+Such food is needed by children as soon as their first teeth have come,
+but care must be exercised to see that the food is actually chewed
+before it is swallowed.
+
+2. A good brush should be provided. The stiffness of the bristles should
+be regulated according to the individual. The brush should be
+thoroughly rinsed after using, and discarded as soon as it is worn.
+Dental floss is generally needed to remove particles that have lodged
+between the teeth.
+
+Brushing the teeth by passing the bristles across them is not
+efficacious. They should be brushed not across but with the cracks, as a
+good housewife sweeps a floor.
+
+      "In the light of recent investigation conducted by some of
+      the leading students of mouth hygiene, the most effective
+      way to use the toothbrush is to place the bristles of the
+      brush firmly against the teeth, applying firm pressure, as
+      though trying to force the bristles between the teeth,
+      using a slight rotary or scrubbing motion.... After a
+      little practice the user of this method will be surprised
+      at the results obtained. Care should be used to go over all
+      the surfaces of the teeth in this manner."--(See Dr. W. G.
+      Ebersole. "The Importance of Mouth Hygiene and How to
+      Practice it," Health News, Oct., 1915.)
+
+After brushing the teeth, the mouth should be rinsed by forcing lukewarm
+water about the teeth, using all the force that can be brought to bear
+by the cheeks, lips, and tongue.
+
+3. TREATMENT.--The teeth, including the first teeth of children, should
+be inspected by a competent dentist at least twice a year. Periodic
+cleansing by a dentist, and early attention to small cavities, may
+prevent serious ill health and impairment of the body, as well as the
+acute suffering generally accompanying treatment of advanced dental
+defects.
+
+CLOTHING.--Clothing was originally used for purposes of ornament. Desire
+for protection from cold and dampness came later. The amount of clothing
+required varies greatly according to individual needs and habits, but it
+is increasingly recognized that light clothing is best, provided that
+the wearer is really protected from cold. Clothing should be porous in
+order to allow ventilation of the body, supported so far as possible
+from the shoulders, and clean and well aired. Dampness favors the growth
+of germs which may cause irritation of the skin.
+
+Clothing should not constrict the body or hamper its movements. Perhaps
+the worst health menace for which clothing is to blame comes from the
+high heeled shoes on which many women prefer to limp through life. From
+the health standpoint shoes are of great importance. Bad shoes are
+responsible for many cases of flat feet, whose muscles have degenerated
+through non-use, and for much so-called "rheumatism," which is merely
+the protest of abused muscles. Bad shoes also, by distorting the feet,
+prevent comfortable walking, which is the only out-of-door exercise
+readily available for the vast majority of people; and still worse, the
+resulting unnatural position of the body sometimes has serious
+consequences by bringing injurious strains on other muscles and organs.
+
+FOOD.--Two distinct problems are encountered here: the problem of
+nutrition, and the problem of preventing sickness. Nutrition, or proper
+feeding, is a subject beyond the scope of this book; it is nevertheless
+one of the most important, if not the most important, factor in
+maintaining health. Food preparation and care of children, the two most
+important functions of the home, are unfortunately relegated to the
+least intelligent and least interested members of most households in
+which servants are employed.
+
+Most American families eat too much protein food, such as meat and eggs.
+Excess of protein probably leads to degeneration of tissues, and plays a
+part in causing the degenerative diseases already mentioned. Habit is
+important here as in other ways of living, but cereals and vegetables
+should in large measure make up the diet of sedentary persons and indeed
+of everyone in warm weather.
+
+The amount of food required in 24 hours depends on many factors: age,
+height, weight, occupation, season, and habit. Underweight and
+overweight are both abnormal conditions; probably the latter is the more
+easily remedied. Both require the advice of a physician. Rapid reduction
+of weight involves certain dangers, especially for persons with weak
+hearts.
+
+Food may cause sickness either because it is in itself harmful, or
+because it carries disease germs. Meat from diseased animals should be
+destroyed before it reaches the market, but bacterial activities in food
+originally wholesome may form in it poisonous substances.
+
+The chief diseases known to be carried by food, water, or milk are
+typhoid fever, paratyphoid, dysentery and other diarrhoeal diseases,
+scarlet fever, diphtheria, septic sore throat, and tuberculosis. The
+sole problem here is to keep human and animal excretions out of food,
+water, and milk. Since thorough cooking kills disease germs, danger
+arises chiefly from raw foods. All fruits and vegetables eaten raw
+should first be thoroughly washed.
+
+Water is essential to health. At least three pints should be taken
+daily, the amount varying somewhat according to diet, exercise,
+temperature, and so forth. Most persons drink too little water.
+
+Cities and towns should of course have public supplies of pure water.
+Contamination of water, when it occurs, is caused chiefly by sewage
+from cesspools, privies, and drains. All well or spring water must be
+constantly watched and Boards of Health are always ready to examine
+samples of water and to report whether it is safe to drink. At the
+present time a porcelain filter is the only satisfactory kind for a
+household, but many domestic filters are so badly cared for that in
+actual practice they are worse than none. Danger from a filter
+containing an accumulation of impurities is greater than the danger from
+most ordinary water supplies. Boiling water for ten minutes kills all
+pathogenic germs, but this method is inconvenient on a large scale and
+is not practical for continued family use.
+
+Every effort should be made to insure a regular supply of pure water in
+every house. It is not satisfactory to have two kinds, one for drinking
+and one for other purposes, since mistakes are sure to be made,
+especially by children. Some families who use only bottled or filtered
+water for drinking purposes habitually run the risk involved in using
+impure water from the tap for cleaning the teeth.
+
+Freezing destroys most germs, but ice is not necessarily free from
+bacterial life, and should be used in drinking water only when known to
+be free from impurities. Neither does freezing milk or cream
+necessarily kill germs that may be contained in it.
+
+Raw milk plays so important a part in the spread of disease that its
+fitness for human consumption is open to serious question. Certified
+milk, where obtainable, is safe but expensive. Boiled milk is safe, but
+changed in taste and to some extent in quality. If milk is heated to 142
+deg.-145 deg. F. and kept at that temperature for 30 minutes all disease
+germs in it are killed. This process, called pasteurization, renders
+milk safe. The objection is sometimes made that continued use of
+pasteurized milk for infants causes scurvy, but in New York City where
+over 90 per cent. of the milk is pasteurized no increase in scurvy has
+been noticed, while a large diminution in deaths of infants from
+diarrhoeal diseases has resulted, as in all cities where pasteurization
+is required.
+
+The following is a simple method for pasteurizing a quart bottle of
+milk. If the directions are exactly followed the milk will be
+pasteurized at the end of the process; no thermometer need be used. To
+prevent the bottle from breaking, it is first warmed by placing it for a
+few minutes in a pail of warm water.
+
+      "From the results of the experiments it was concluded that
+      any housewife can pasteurize a one quart bottle of milk by:
+
+      1. Boiling 2-1/2 quarts of water in a large agate
+      saucepan; or better
+
+      2. Boiling 2 quarts of water in a 10 pound tin lard pail,
+      placing the slightly warmed bottle from the ice chest in
+      it, covering with a cloth and setting in a warm place. At
+      the end of one hour the bottle of milk should be removed
+      and chilled promptly. The water must be boiled in the
+      container in which the pasteurization is to be
+      done."--(Ruth Vories, in "Health News," Sept., 1916.)
+
+ELIMINATION.--Careful attention should be paid to elimination through
+the bowels and kidneys. Constipation is responsible for many common
+ailments; among them are headache, disinclination to work, irritable
+temper, and lowered resistance. If long continued, constipation becomes
+serious both from congestion and displacement of pelvic organs, and from
+absorption over a considerable time of even small amounts of the
+poisonous substances resulting from decomposition of food in the large
+intestine. The bowels can best be regulated by diet, water, exercise,
+and habit. The habitual use of cathartic and laxative drugs is most
+unwise, because they tend to aggravate the trouble. Moreover the
+habitual and continued use of injections and "internal baths" is
+harmful, and would not be considered necessary if bran and coarse flour
+and vegetables were substituted for concentrated foods. Greed, laziness,
+and lack of intelligence lead most persons suffering with constipation
+to prefer pills to the restraints demanded by hygienic living. The habit
+of evacuating the bowels at a regular time, if established in early
+childhood and rigidly adhered to, will prevent constipation among most
+healthy people. Any person who thinks drugs necessary should consult a
+physician, and be prepared to follow the regime he advises over a
+considerable period of time and at the cost of some self-denial.
+
+For healthy people, voiding urine presents no difficulty if a sufficient
+amount of water is taken; but some persons reduce the amount of liquid
+taken in order to escape the inconvenience of urination. This practice
+is harmful, and may involve insufficient cleansing of the entire system.
+If frequent urination disturbs sleep, liquids may be withheld during the
+evening; but the total amount of water taken in 24 hours should not be
+diminished.
+
+REST AND FATIGUE.--A fatigued person is a poisoned person. Muscular
+exertion burns the fuel constituents of the body, as we recognize by the
+greater heat generated within us during muscular exertion. Waste
+products, resulting from this burning process, accumulate if not
+removed, and clog the body in somewhat the same way that ashes and
+cinders clog a furnace. The fatigued person remains fatigued,
+consequently, until the accumulations of waste matter are removed by the
+normal action of the lungs, skin, and kidneys.
+
+Fatigue is caused by both mental and physical work, and when excessive,
+affects the nervous system most disastrously. The body can and should
+respond to occasional extra drafts on strength and endurance; its
+flexibility and power of adjusting to varying conditions may even be
+stimulated thereby. But even slight fatigue, if continued and especially
+if associated with anxiety or worry, has caused many nervous and mental
+breakdowns.
+
+Work carried beyond the point of normal fatigue requires a
+proportionately longer time for recovery. For example, if the point of
+fatigue has been reached by a certain finger muscle after 15
+contractions, and if half an hour is required to rest it completely, one
+might suppose that one hour would rest it after 30 contractions. This is
+not so, however; after 30 contractions 2 hours are required, or 4 times
+as much rest for twice the amount of work, if continued beyond the point
+of fatigue. Laboratory experiments and experience alike show that this
+principle holds true in other forms of fatigue. Thus the output of
+factories has been shown in many instances to be greater, other things
+being equal, when operatives work 8 hours a day than when they work
+longer. Excessive hours in any kind of work are the poorest economy.
+
+Fatigue is increased in direct proportion not only to muscular exertion
+but also to the amount of speed, complexity, responsibility, monotony,
+noise, and confusion involved in an occupation. Ability to bear fatigue
+differs greatly with different people, as ability varies to bear other
+kinds of strain. Rest at night and on Sunday, and the annual vacation
+should be enough to keep a person in good condition. If not, there is
+probably something wrong with the worker's health, the nature of his
+work, or his adaptation to his particular kind of work. This statement
+is not only true of persons regularly employed, but of those living at
+home, including children in school, women in "society," and especially
+mothers of families.
+
+SLEEP.--A sufficient amount of sleep is essential to health, but
+individual requirements vary widely. Each person should know and regard
+his own need, and children and young people should be obliged to go to
+bed early. Ability to sleep is largely habit; good habits should be
+formed and continued. Sleep-producing drugs should never be taken,
+except by a doctor's prescription.
+
+RECREATION.--Owing to the speed, complexity, and worry of modern life
+among all classes, and to the monotony of work in industry, recreation
+has become a matter of vital importance for everyone. Some muscular
+activity, preferably in the open air, is needed by every healthy person.
+Recreation should be as unlike the regular occupation as possible: going
+to the theatre, for example, is not the best exercise for sedentary
+workers employed all day in artificially lighted offices. The element of
+pleasure is essential. Hoisting dumb-bells purely from conscientious
+motives is seldom beneficial, and is generally soon abandoned.
+
+The part played by habit in matters of health is often overlooked.
+Although the body adjusts itself to widely varying conditions and even
+to unfavorable ones, the importance of forming desirable habits cannot
+be overemphasized. Sudden or radical changes in living, however,
+particularly among people no longer young, may play havoc. New and
+violent systems of exercise, weight reduction, and food fads forced on
+families by enthusiastic discoverers involve considerable risk.
+
+Many elements enter into health; in no single one is found hygienic
+salvation. Temptation always exists to emphasize one element at the
+expense of others. For instance, people who insist upon overventilating
+rooms regardless of others' comfort may themselves be utterly careless
+in regard to necessary sleep, and more than one fastidiously clean
+person has disregarded the highly unclean condition of constipation. To
+maintain sound health only a rational program will suffice: properly
+balanced work and play, sleep and food and all other elements must be
+included in due proportion. And over-anxious health seekers might well
+remember that health is not so much an end in itself, as a means to a
+happy and productive life; even in concern over health, it is possible
+for him that saveth his life to lose it.
+
+
+EXERCISES
+
+1. Explain the difference between an hereditary disease and hereditary
+susceptibility to a disease. How may hereditary susceptibility to a
+disease be combatted?
+
+2. What are the essentials of good ventilation?
+
+3. What is the proper temperature for a living room? What are the
+effects of higher temperatures? Of lower temperatures?
+
+4. Describe methods for maintaining household cleanliness.
+
+5. Discuss the importance from the point of view of health, of dust; of
+insects; of garbage; of sewage.
+
+6. What principles should guide one in deciding whether a certain water
+supply is safe to use for drinking purposes? What are the dangers of
+impure water? How can impure water be rendered safe?
+
+7. What diseases may be carried by milk? How can milk be rendered safe?
+
+8. Explain the health aspects of personal cleanliness.
+
+9. What care should be given the teeth and mouth? Why?
+
+10. What bad results frequently follow constipation? How should
+constipation be remedied?
+
+11. Name seven factors that are important in causing fatigue. Why is it
+uneconomical to continue work, either physical or mental, beyond the
+point of fatigue?
+
+12. What facilities for recreation, especially in the open air, does
+your community provide for little children? For school children? For
+working boys and girls? For grown people?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Introduction and Chapters I, III-V,
+VII-IX.
+
+How to Live--Fisher and Fisk, Chapters I, III-V.
+
+The Human Mechanism--Hough and Sedgwick, Chapters V, XXII-XXIX.
+
+Disease and Its Causes--Councilman, Chapters X, XII.
+
+Fatigue and Efficiency--Goldmark, Chapters II, III.
+
+Preventive Medicine and Hygiene--Rosenau.
+
+A Manual of Personal Hygiene--6th Edition, Edited by Walter L. Pyle.
+
+Four Epochs of a Woman's Life--Galbraith.
+
+Hygiene and Physical Culture for Women--Galbraith.
+
+The Home and Its Management--Kittredge.
+
+Exercise and Health--F. C. Smith, Supplement 24 to the Public Health
+Reports, Government Printing Office, Washington.
+
+The Sanitary Privy--Farmers' Bulletin 463, United States Department of
+Agriculture, Government Printing Office, Washington.
+
+Safe Disposal of Human Excreta at Unsewered Homes--Lumsden, Stiles and
+Freeman, Bulletin 68, Public Health Reports, Government Printing Office,
+Washington.
+
+The Disposal of Human Excreta and Sewage of the Country Home--New York
+State Department of Health, Albany.
+
+Milk and Its Relation to Public Health--Bulletin 56, Hygienic
+Laboratory, Government Printing Office, Washington.
+
+Milk and Its Relation to Health--New York State Department of Health,
+Albany.
+
+Other Publications of the United States Public Health Service and of the
+Departments of Health of the different states and cities.
+
+
+
+
+CHAPTER III
+
+BABIES AND THEIR CARE
+
+
+The principles of hygiene are fundamentally the same for young and old.
+The applications, however, differ at different ages. From the time when
+physical growth and development are complete until changes due to old
+age appear, an individual commonly has greater resistance than at other
+ages, and is able in consequence to endure unfavorable conditions of
+life with more success.
+
+Babies, on the other hand, are exceedingly sensitive to their
+environment. Surroundings that are even slightly unfavorable are likely
+to make babies sick. In order to remain healthy, they must have exactly
+the right kind of food, in the right quantities and at the right times;
+their sleep, exercise, and clothing must be carefully regulated; they
+must be protected from careless handling, from nervous strain, and above
+all, from the many kinds of infection to which they are peculiarly
+susceptible. The life of a baby fortunately can be controlled almost
+completely; when properly regulated it offers, therefore, an unequalled
+opportunity to see how hygienic principles work out in actual practice.
+
+The primitive mother's instinct to nourish and protect and succor her
+helpless child was the original form of nursing. Instinct alone,
+unfortunately, has never accomplished much in preserving health. The
+human race has now had an experience in the care of infants that extends
+over thousands of years. Yet today we are still, on the whole, less
+successful in keeping babies alive than we are in raising domestic
+animals; we still allow society to continue, like a modern Herod, in its
+ruthless career of slaughtering the innocents.
+
+About 14 babies out of every 100 born in the registration area[1] of the
+United States die before reaching the age of one year, while in some of
+our industrial cities as many as 25 out of every 100 born die before
+they are a year old. Most of these deaths are preventable. Thus, in a
+few American cities, the death rates have been so reduced that fewer
+than 10 babies out of every 100 die before completing the first year;
+while in Dunedin, New Zealand, as a result of the work of the Society
+for the Health of Women and Children, the infant death rate has been so
+reduced that in 1912 only about 4 out of every 100 babies died before
+they were a year old.
+
+While ignorant mothers, who may or may not be uneducated women, and
+contaminated milk, are as a matter of fact, chiefly responsible for our
+high infant death rates, yet as we have already seen, every factor in
+the environment has its effect upon a baby. This fact has led Sir Arthur
+Newsholme, an eminent English authority, to say:
+
+      "Infant Mortality is the most sensitive index we possess of
+      social welfare. If babies were well born and well cared
+      for, their mortality would be negligible. The infant death
+      rate measures the intelligence, health, and right living of
+      fathers and mothers, the standards of morals and sanitation
+      of communities and governments, the efficiency of
+      physicians, nurses, health officers, and educators."
+
+Care of the child should begin at the earliest possible moment: that is,
+nearly nine months before he is born. Care before birth, for want of a
+better name, is called prenatal care of the mother. Every woman who
+thinks that she is pregnant should put herself at once under the care of
+a competent physician, so that he can make the necessary examinations as
+early as possible. If she follows his advice in regard to hygiene and
+proper regulation of her life, she may be free from anxiety, and may
+justly expect that her delivery will be a safe and normal process.
+
+A demonstration of the value of prenatal care was recently made by the
+Boston District Nursing Association. During the year 1915 prenatal care
+was given to 751 expectant mothers in 5 wards of the city; each woman
+attended a pregnancy clinic, where she was under the care of an
+experienced obstetrician, and was visited at intervals by a nurse who
+kept careful watch of her general condition and gave necessary advice
+and encouragement. In consequence the death rate among the babies whose
+mothers had prenatal care was only half as great, through the whole
+first year of life, as the death rate of babies in the same wards whose
+mothers had not had prenatal care. Moreover, the rate of still-births
+was only half as great as the rate among the general population of
+Boston. If prenatal care can save so many lives, surely it ought to be
+available for every pregnant woman in the land, including even that
+generally neglected class of people who are neither very rich nor very
+poor.
+
+Each baby's birth should be recorded by the registrar of births, and
+parents should make sure that registration has been attended to in the
+city or town where they live. In some states birth registration is
+already obligatory, but in any case it is required by the child's own
+interest. For instance, in later life it may be necessary for him to
+prove the date and place of birth in order to establish, among other
+things, his right to vote and to inherit property, and to settle the
+question of his liability to military service. Moreover, complete and
+accurate birth registration is needed by every community because it is
+essential to such reforms as reducing infant mortality and abolishing
+child labor.
+
+
+GROWTH AND DEVELOPMENT
+
+Statements in regard to growth and development are based on observations
+of many children. It should be remembered that the following figures
+represent averages only, and that healthy children may vary from them
+considerably without giving cause for alarm.
+
+AVERAGE SIZE.--The average weight of a baby at birth is from 7 to 7-1/2
+lbs. and the average length is about 20 inches, but it is not unusual
+for a child to weigh anywhere from 5 to 10 pounds at birth and to
+measure from 16 to 22 inches in length. During the first week of life a
+baby loses slightly in weight. After the first week a healthy baby
+should gain from 4 to 8 ounces a week until he is six months old; after
+that time the weekly gain is less. The weight at birth will usually
+double during the first five months, and treble during the first year.
+Consequently, a baby weighing 7 pounds at birth may be expected to weigh
+14 pounds when five months old, and 21 pounds when a year old. Weight is
+one of the most important indications of a baby's condition. He should
+be weighed every week during the first 6 months, once in two weeks
+during the second 6 months, and once a month throughout the 2nd year.
+
+MUSCULAR DEVELOPMENT.--A baby at birth is helpless, and during the first
+few months he has little muscular control. During the third month he
+ordinarily begins to lift his head, and he can usually hold it up
+without support by the time he is 3 months old; when 7 to 8 months old
+he sits erect and begins to play with toys. From this time a baby makes
+rapid progress; he attempts to stand on his feet, begins to creep, and
+by the time he is 14 months old he is usually able to stand alone, or
+even to walk a few steps. He is usually running about without difficulty
+when fifteen or sixteen months old.
+
+Babies should never be urged to walk or to bear their weight on their
+feet. If healthy they are generally eager to go about unaided, and like
+to investigate their surroundings without assistance. If walking is
+unusually delayed, a physician should be consulted.
+
+DEVELOPMENT OF SPECIAL SENSES.--A new-born baby is unable to
+distinguish objects, but the eyes are sensitive to light and need
+careful protection. Hearing, although undeveloped at birth, soon becomes
+acute; consequently the child should stay in a quiet room. When six or
+eight weeks old he notices objects, and at three months old he welcomes
+his mother when he is hungry. A month or two later he begins to
+distinguish between familiar and unfamiliar faces, and to show approval
+or disapproval.
+
+DEVELOPMENT OF SPEECH.--A baby six or seven months old begins
+consciously to utter sounds, and usually can say a few unconnected words
+by the time he is a year old. The average child, however, does not begin
+to form sentences of more than two or three words until he is about two
+years old.
+
+DEVELOPMENT OF TEETH.--The so-called milk teeth are twenty in number;
+they are followed by thirty-two permanent teeth. The two lower front
+teeth (central incisors) generally appear when a child is from five to
+nine months old, and in from one to three months later the four upper
+front teeth (upper incisors) appear. All the first or milk teeth should
+have come through by the time a child is two and a half years old, but
+wide variations occur both in the time and order of appearance and
+should occasion no uneasiness if the child seems well. Unusual
+conditions of any sort should be referred to the physician; it is a
+great mistake to attribute all illness at this time to teething.
+
+The first of the permanent teeth appear when a child is about six years
+old. Mothers sometimes mistake the first permanent molars for temporary
+teeth, a mistake that frequently leads to neglect and even extraction of
+highly important teeth. All but the last four molars, sometimes called
+wisdom teeth, should be through by the time a child is fifteen. The
+wisdom teeth may not appear before the 20th or even the 25th year.
+
+NORMAL EXCRETIONS.--A new-born baby should have one or two bowel
+movements during the first twenty-four hours; the first bowel movements
+are sticky and almost black in color. After the baby begins to nurse,
+three to four movements a day are not unusual, and throughout infancy
+and childhood as well as adult life there should be one or two
+evacuations of the bowels daily. The character of the stools is more
+important than the number. While the baby is taking milk only, the
+movements should be soft, yellow in color, and nearly odorless. Change
+in frequency of the movements, or appearance of undigested food or curds
+of milk in the stool, should be carefully noted and if continued,
+reported to a physician; they may be the first signs of serious
+digestive trouble.
+
+The urine of an infant should be odorless and colorless. It should be
+voided at least once during the first twenty-four hours, and much more
+frequently after the baby begins to nurse. Marked diminution in the
+amount of urine should be reported to a doctor.
+
+Efforts should be made early to develop habits of regularity in the
+evacuation of the bladder and bowels. If taken up regularly most
+children learn to use a chamber for bowel movements by the time they are
+three months old. Normal children, if properly trained, usually have no
+bladder discharge during the night after they are 18 months old, and
+they learn even earlier to indicate a desire to urinate during the day
+time.
+
+CLOTHING.--The amount and weight of a baby's clothing should depend upon
+the season; but garments worn next to the skin, except the diaper,
+should be wholly or partly of wool, the lightest weight in summer and
+heavier weight in winter. During the first few weeks a baby's abdomen
+should be supported by a flannel binder about six inches wide, applied
+snugly but not tightly enough to restrict either the abdomen or chest
+walls. It may be replaced later by a loosely fitting knitted band worn
+for warmth only. Such a band is especially necessary if there is
+tendency to diarrhoea, but in no case should it be discarded before
+the 18th month. All garments except the diaper and first flannel binder
+should hang from the shoulders, and should fit loosely but well.
+
+Clothing for babies should be of soft materials and should be simply
+made. Even the first clothes should not be very long. The weight of very
+long clothing is an unnecessary burden, and prevents free movements of
+the legs. At night an entire change of clothing should be made, and a
+nightgown of warmer material substituted for the petticoat and slip.
+Most children are dressed too warmly indoors, but in low temperatures
+they need to be well protected.
+
+Diapers should be soft and absorbent. It may be necessary to wash new
+diapers several times before using in order to make them soft enough.
+Care should be taken not to apply them too tightly, or in such a way as
+to cause pressure on the genitals. They should be changed during the day
+whenever wet or soiled, and at night when the baby is taken up to be
+fed. Proper care of diapers is highly important, however laborious. They
+should be well washed, boiled, and thoroughly dried before they are used
+a second time. Diapers that have been wet but not soiled should not be
+dried and used again before being washed. Much work can be saved if
+pads of loosely woven absorbent material are used inside the diaper to
+receive discharges. The pads can be burned, but even if washed the labor
+is less than washing full sized diapers. Like all other infant's
+garments, diapers should be washed with pure white soap and without
+starch. Waterproof material used to cover the diaper is almost sure to
+irritate the baby's skin, and is consequently harmful.
+
+SLEEP.--During his first few weeks a normal baby sleeps about
+nine-tenths of the time, and should be left undisturbed except for
+necessary care. He should sleep in a crib, bassinet or basket protected
+from light and drafts; in no circumstances should a baby sleep in the
+bed with his mother or any other person. Pillows are unnecessary for
+babies, and indeed for older children, but if used they should be thin
+and firm.
+
+The amount of sleep necessary gradually diminishes, but during all the
+years of growth a child needs more sleep than an adult. The amount of
+sleep required daily is approximately as follows:
+
+  First month                  18 to 20 hours
+  Second to sixth month        16 to 18 hours
+  Sixth month to one year      14 to 15 hours
+  One to two years             13 to 14 hours
+  Two to four years            11 to 12 hours
+
+After this time a child should sleep at least ten hours out of the
+twenty-four. During the first year a nap in the middle of the forenoon
+and another in the afternoon are desirable. A child who is inclined to
+sleep so long that his nap interferes with his night's sleep, should be
+waked from his nap, but at the same hour every day. When a child is a
+year old, one nap during the day is often sufficient, if he is doing
+well, but the habit of taking a nap at some time during the day should
+be continued through the fifth year if possible, or even later.
+
+Babies should not be rocked or otherwise coaxed to go to sleep; they
+should be made comfortable and then left alone. They learn to go to
+sleep by themselves as soon as they are convinced that sleep is expected
+of them, and that no unfounded objections on their part will be
+regarded. Continued inability to sleep normally usually indicates
+discomfort or poor general condition, and should be taken up with the
+doctor. Pacifiers and thumb-sucking should not be allowed, since they
+lead to changes in the shape of the jaw with resulting imperfect
+adjustment of the teeth. Soothing syrup and like medicines should never
+be given to a baby; death or permanent injury has resulted from their
+use. It is impossible to emphasize too strongly the danger of giving
+them even a single time.
+
+FRESH AIR.--All that has been said about the importance of fresh air
+for adults applies with even greater force to infants and children.
+During his first month especially a baby is susceptible to draughts;
+nevertheless, the room should be well ventilated and its temperature
+kept between 68 deg. and 70 deg. F. during the day, and at about 65 deg.
+F. at night. Even in cold weather the room should be well aired two or
+three times a day; the baby should be removed to another room while the
+windows are open. After the baby is three or four months old the windows
+may be left open at night provided the outside temperature does not fall
+below freezing. A healthy baby two or three weeks old may be taken
+out-of-doors for a short time in mild weather; when he is three months
+old he may be taken out-of-doors even in winter on bright sunny days.
+The time spent out-of-doors should be gradually increased until the baby
+stays out the greater part of the day; but he should not be exposed to
+storms, wind, flying dust, dampness, extremes of temperature, or
+insects. The eyes should not be covered by veils, but they should be
+shielded from the direct rays of the sun at all times.
+
+DIET.--A baby, in order to thrive, must have suitable food, given at
+regular intervals. During the first few months of life no other food
+can take the place of mother's milk. Breast-fed babies are more robust
+than bottle-fed babies; more than this, they are less likely to contract
+infectious diseases or to suffer from digestive disorders. The number of
+bottle-fed babies who die every year is three times as great as the
+number of breast-fed babies who die. Many mothers do not understand the
+risk involved in weaning small babies; and so every year many little
+lives are lost, and lost needlessly. When poverty forces nursing mothers
+to wean their babies and seek work outside their homes, one can only say
+that a society which tolerates such a waste of infant life is indeed
+regardless of its own welfare.
+
+Special conditions, of course, may make it undesirable for a mother to
+nurse her baby. No one but the physician is competent to decide this;
+not even neighbors, grandmothers, other members of the family, or the
+mother herself. Where artificial feeding must be used, it should be
+carefully adapted to the individual child, and in consequence it must be
+prescribed by the doctor. Patent foods, notwithstanding the claims on
+their printed labels, should be used only under his advice.
+
+INTERVALS OF FEEDING.--Little milk is secreted during the first two days
+after the birth of a child. The baby should, nevertheless, be put to
+the breast as soon as he has had his first bath, if the mother is
+sufficiently rested. Always before and after nursing the mother's
+nipples should be washed in water that has been boiled. Nursing should
+be repeated at intervals of six hours during the first two days.
+
+The following schedule for the feeding of healthy babies is given by
+Holt in "Care and Feeding of Infants." (1917.)
+
+
+SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR
+
+  ------------------+--------+----------+----------+-----------+--------
+                    |        |          |          |           |
+                    |Interval|   Night  | No. of   | Quantity  |Quantity
+       Age          |between | feedings,| feedings,|  for one  | for 24
+                    |meals by|  6 p.m.  | in 24    |  feeding  | hours
+                    |  day   |    to    | hours    |           |
+                    |        |  6 a.m.  |          |           |
+  ------------------+--------+----------+----------+-----------+--------
+                    |  Hours |          |          |   Ounces  | Ounces
+  2d to 7th day     |    3   |     2    |     7    |    1-2    |  1-14
+  2d and 3d weeks   |    3   |     2    |     7    |  2-3-1/2  | 14-24
+  4th to 6th week   |    3   |     2    |     7    |    3-4    | 21-28
+  7th week to 3 mos.|    3   |     2    |     7    |3-1/2-5    | 25-35
+  3 to 5 months     |    3   |     1    |     6    |4-1/2-6    | 27-36
+  5 to 7 months     |    3   |     1    |     6    |5-1/2-6-1/2| 33-39
+  7 to 12 months    |    4   |     1    |     5    |    7-8-1/2| 35-43
+  ------------------+--------+----------+----------+-----------+--------
+
+During the period when seven feedings are given in 24 hours the
+following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m.,
+6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when
+the number of feedings is reduced from seven to six. Food should be
+given on exact schedule time; the baby if asleep should be waked for
+any meal except the one due at 2 a.m.
+
+WATER.--Pure boiled water should be given regularly even to a young
+baby. He is often satisfied with a little warm water if he is fretful
+between the hours of nursing. Water may be given from a cup, a spoon, or
+a bottle; it is desirable, however, for the baby to learn to drink from
+a cup before the period of weaning begins.
+
+WEANING.--Ordinarily, a baby should be fed from the breast until he is
+seven months old, either exclusively or with the exception after the
+second month of one bottle-feeding in twenty-four hours. This exception
+will do the baby no harm and may be a great relief to his mother.
+Partial breast-feeding should continue if possible through the ninth
+month, but every baby should be entirely weaned by the time he is one
+year old. It may be necessary, if either the baby or the mother is not
+thriving, to change the food before the ninth month; but it is desirable
+not to make the change in hot weather. Healthy babies, it should be
+remembered, increase in weight constantly, and steady gain in weight is
+the best indication that a baby's food is suitable.
+
+NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy glass,
+cylindrical in shape, without angles or corners to make cleaning
+difficult. The number of bottles provided should be two or three more
+than the number of feedings given in 24 hours.
+
+Short black rubber nipples which slip over the neck of the bottles
+should be selected. They should be of such a shape that they can easily
+be turned inside out; a nipple turner costs little, and is well worth
+the price. Nipples should be discarded when they become soft or when the
+opening grows so large that the milk runs in a stream rather than drop
+by drop.
+
+As soon as the baby has finished his meal, the bottle should be removed
+from his mouth, rinsed in clear hot water, and left standing filled with
+cold water until a convenient time for boiling all the bottles to be
+used during the next 24 hours. Sufficient time must be allowed for the
+bottles to cool thoroughly between the time when they are boiled and the
+time when they are refilled. When it is time to boil the bottles they
+should be placed in an agate or other suitable kettle, covered with
+water, and boiled vigorously for three minutes. A cloth placed in the
+bottom of the kettle will help to prevent the bottles from breaking.
+After the bottles have been removed from the boiling water, they should
+be stoppered at once, either with rubber stoppers or plugs of sterile
+cotton. The stoppers, if used, should be boiled with the bottles;
+sterile cotton may be purchased by the package.
+
+An easy and satisfactory method to care for rubber nipples is the
+following: Provide as many nipples as the number of feedings given in 24
+hours, and another, if desired, to be used in case of accident; provide
+also two cups of ordinary white enamel, each one large enough to hold
+all the nipples at once. One cup should have a cover; the other should
+not. To avoid mistakes it is well to have the cups different in shape.
+As soon as each feeding is finished the nipple should be thoroughly
+cleansed under running water by scrubbing it inside and out with a
+nipple brush. The nipple thus cleansed is placed in the cup without a
+cover. When all the nipples have been used, cleansed, and collected in
+the uncovered cup, they are transferred into the other cup; water is
+added, the cup is covered and its contents are boiled for three minutes.
+The nipples remain covered in the boiled water until needed; they are
+removed one by one for the successive feedings. Care must be used in
+removing a nipple to take it by the rim, not to touch other nipples
+during the process and not to dip the fingers into the water. The best
+way is to remove them by means of a glass rod, which is boiled with the
+nipples and kept with them in the cup when not in use. There are
+several advantages of this method of caring for nipples: it is easy; it
+reduces to a minimum the necessary handling of the nipples after
+boiling; and it reduces the probability of using the wrong nipple, since
+boiled nipples are always in one kind of receptacle and used nipples in
+another. It also prevents the too common practice of continuing to keep
+nipples in a supposedly antiseptic solution long after the solution has
+become badly soiled.
+
+TABLES of diet for children over one year of age may be found in the
+Appendix, page 322.
+
+BATHING.--Usually the cord has separated and the navel has entirely
+healed by the time a baby is 10 days old. After this time a daily tub
+bath should be given; it should be given not less than one hour after
+feeding. The temperature of the room should be from 70-72 deg., measured
+by a thermometer placed in the part of the room where the bath is to
+take place. In order to avoid chilling or tiring the baby the bath
+should be given quickly, without confusion or interruption; success can
+be achieved by using even a moderate amount of foresight. Before
+undressing the baby everything to be used should be collected and placed
+within easy reach,--clean clothing, soft towels, 2 wash cloths, pure
+white soap, powder, absorbent cotton, etc. The bath tub should last of
+all be filled with water, and its temperature tested by means of a bath
+thermometer. The temperature of the water should be from 98 deg. to 100
+deg. After the baby is three months old slightly cooler water should be
+splashed over his chest, back, neck, and arms just after he is removed
+from the tub, and as he grows older the temperature of his cool splash
+can be reduced. Children who become accustomed to cool water in this way
+take kindly to their cold showers later.
+
+The baby's face should be washed first and dried carefully, while his
+body is still covered. Next the head should be washed; a little soap
+should be used, but it must on no account enter the eyes. Next the
+entire body should be soaped with the hand; and then the baby should be
+placed gently in the bath, his head and shoulders supported by the
+attendant's left hand and forearm. Care should be taken to rinse off all
+the soap. The baby should not stay in the tub more than 2 or 3 minutes;
+after he has been removed from the tub he should be wrapped at once in a
+soft bath towel. He should be dried gently but thoroughly by patting
+with soft, warm towels rather than by rubbing. Folds of the skin should
+be dried with special care. A little powder may be applied, but a baby
+who is kept both clean and dry will not need much powder, if any. The
+baby should next be quickly dressed, with as little turning and moving
+as possible. Clothing should be drawn on over the feet instead of over
+the head, and the petticoat should be placed inside the slip so that the
+two garments may go on simultaneously.
+
+EYES.--Secretion accumulating in the corners of a baby's eyes should be
+removed by means of a bit of absorbent cotton moistened in boiled water.
+The secretion should be wiped away gently; a different piece of cotton
+should be used for each eye, and a piece that has been used should not
+be put back into the water. Further than this, eyes in a normal
+condition do not need cleansing.
+
+Every person who handles a baby should be very sure that her hands are
+clean; she should be doubly sure before she touches his eyes, since a
+baby's eyes are peculiarly susceptible to infection from any source.
+More than a quarter of all totally blind persons in the United States
+became blind by infection of the eyes at birth. Blindness of the new
+born can be prevented in practically all cases if the doctor uses a
+preparation of silver in the baby's eyes immediately after birth. This
+treatment is effective and entirely safe.
+
+If at any time the eyelids look red or swollen, or if a drop of matter
+appears between the lids, the physician should be summoned at once.
+Total blindness may result if treatment is delayed even a few hours.
+
+MOUTH.--The mouth should be rinsed after feeding by giving the baby a
+teaspoonful of boiled water. Until the teeth come it does not require
+other cleansing, and attempts to clean it may injure the delicate
+membranes that line it. Indeed, except in an emergency, fingers should
+not be inserted into a baby's mouth. The teeth when they appear should
+be cleaned by means of a soft tooth-brush.
+
+NOSTRILS.--The nostrils need no cleaning other than removal of mucus
+that can easily be reached by means of a piece of cotton. If a little
+vaseline is placed in the nostrils on a small piece of absorbent cotton
+in the early morning, collections of mucus will usually be softened so
+that they can be removed easily at bath time.
+
+GENITAL ORGANS.--The genital organs of girl babies should be gently
+washed twice a day, using absorbent cotton, and tepid water. Treatment
+other than cleanliness is ordinarily unnecessary. Vaseline may be
+applied if the genitals are slightly reddened; any discharge or abnormal
+appearance should be reported to the doctor. In the case of boy babies
+the foreskin should be gently drawn back twice a week after immersion in
+the tub; after the parts have been gently washed with absorbent cotton,
+it should be drawn forward again. No force should be employed in
+retracting the foreskin; the physician should be consulted if it cannot
+be retracted easily.
+
+THE DEVELOPMENT OF HABITS.--During his first few months crying is a
+child's only means of expression, and he quickly learns to make
+effective use of his limited opportunities. It is important for the
+mother to distinguish between crying caused by pain, illness, or hunger,
+and crying caused by temper. These cries are more or less distinctive,
+but no one can be sure in every case just what a crying baby is
+attempting to express.
+
+A cry caused by hunger is fretful and often interrupted by sucking the
+thumb; it ceases when the child is fed. A cry caused by indigestion is
+similar; the child is relieved for a short time by feeding, but soon
+begins to cry again. If he has acute pain, such as earache, the cry is
+sharp, repeated at frequent intervals and accompanied by other symptoms
+of distress, such as restlessness, contraction of the features, and
+drawing up the legs. In serious illness the cry is usually feeble,
+fairly constant except when the child is asleep, and exaggerated by
+slight causes.
+
+A limited amount of crying is useful exercise for a baby, and should not
+distress his mother unduly. Moreover, crying may be merely the
+expression of a wish to be taken up, to be played with, carried about or
+otherwise amused, to be given a pacifier, or to be indulged in other bad
+habits. If not indulged in these ways he may cry from temper. The cry of
+temper is loud and violent, accompanied by vigorous kicking or by
+holding the body rigid. Proper treatment of the baby may prevent many
+months of discomfort, and spare him the formation of his first bad
+habit. All other possible causes for crying should be eliminated. If the
+child continues to cry when he is warm and dry and comfortable, "It
+should simply be allowed to cry it out. This often requires an hour and
+in extreme cases two or three hours. A second struggle will seldom last
+more than ten or fifteen minutes and a third will rarely be necessary"
+(Holt). Gas may form in the child's stomach during prolonged crying. It
+is consequently permissible to take him up after 15 minutes, and hold
+him erect; he generally expels gas at once, and immediately experiences
+relief. As soon as he is relieved, he should go back to his crib.
+
+EXERCISE.--Exercise is essential to the development of the body, but
+during the first few weeks warmth and quiet are so important that a baby
+should not be disturbed except for necessary care. His position,
+however, should be changed occasionally; if he lies on the same side
+constantly the soft bones of the head may become misshapen from
+pressure. As the baby grows older he needs more exercise, and he may be
+given an opportunity for it by removing his outer clothing and placing
+him on a bed in a warm room for a short time each day. Unnecessary
+handling is not good for a baby at any age.
+
+After he becomes more active, he may play on a mattress or thick blanket
+placed on the floor. The blanket should be covered with a washable pad
+or rubber cloth and clean sheet, and the whole should be surrounded by a
+fence at least two feet high. In such an enclosure a baby may safely be
+left to play if protected from draughts and cold. Elevated pens that can
+be folded when not in use are more convenient but more expensive than
+the home-made arrangement. As soon as a child begins to run about he
+takes ample exercise, and he may even need to be guarded from too great
+fatigue, especially toward bedtime. Games and play should be adapted to
+the age of the child and sufficiently varied to exercise all portions of
+the body; but they should not be too violent nor too prolonged. Some
+supervision of children's play is necessary, but they should be given as
+much freedom as possible and allowed to develop their own initiative.
+
+PLAY AND TOYS.--The desire for play does not develop until a child is
+about six months old. At this age toys that can be washed, such as those
+of hard or soft rubber, should be selected. A baby instinctively carries
+everything to his mouth,--first his thumb, then playthings, and later
+whatever he may find, no matter how unsuitable. For his safety and
+protection this habit should be overcome as soon as possible, and he
+must learn to put nothing in his mouth except food and drink. Relatives
+are nearly always tempted to give too many and too fragile toys; they
+merely teach a child to be destructive and constantly to expect
+something new. Toys are the first possessions of which a child is
+conscious, and through them many desirable qualities may be developed:
+neatness and order, gentleness and a feeling of protection toward the
+helpless doll or Teddy bear, and unselfishness in sharing special
+treasures with playmates. Later the child may be given pets and made
+responsible for their care; but animals should not be subjected to
+unintentional cruelties from small children.
+
+
+EXERCISES
+
+1. What two factors are chiefly responsible for the deaths of babies
+under a year old? What other factors contribute? In your city or town
+what is the number of deaths per 1000 births of babies under one year
+old?
+
+2. Why is birth registration important to an individual? to a
+community? Is it required by law in your city?
+
+3. What is the average weight of babies at birth? Describe the rate at
+which they should gain.
+
+4. At what age may a normal child be expected to sit erect? to stand? to
+walk? to speak? When should his first teeth appear? his permanent teeth?
+
+5. Describe normal bowel movements of a baby.
+
+6. How should a young baby be dressed?
+
+7. Describe a baby's bath and toilet.
+
+8. Describe the surroundings that are suitable for a baby.
+
+9. What is the best food for a healthy baby? Why?
+
+10. Describe in detail a good daily program for a healthy baby four
+months old.
+
+11. What habits are desirable for a baby to form, and how may he be
+trained so that he will form them?
+
+12. Name all the indications that would tell you when a baby was not
+thriving, and in each case tell what you would do about it.
+
+
+FOR FURTHER READING
+
+The Care and Feeding of Children--Holt.
+
+The Care and Feeding of the Baby--Truby King.
+
+The Baby's First Two Years--R. M. Smith.
+
+The Care and Feeding of Children--J. L. Morse.
+
+Preventive Medicine and Hygiene--Rosenau, Section III, Chapter II.
+
+Pamphlets:
+
+  Prenatal Care, Mrs. Max West.
+
+  Infant Care, Mrs. Max West.
+
+  Child Care, Mrs. Max West. Published by the Children's Bureau,
+  United States Department of Labor, Washington, D. C. (Free on
+  request.)
+
+The Care of the Baby--Supplement No. 10 to the Public Health Reports,
+1913, Government Printing Office, Washington, D. C.
+
+Your Baby: How to Keep It Well--New York State Department of Health,
+Albany.
+
+Publications of the American Association for the Study and Prevention of
+Infant Mortality--1211 Cathedral Street, Baltimore, Md. (Free on
+request.)
+
+Publications of the National Committee for the Prevention of
+Blindness--130 East 22d Street, New York City. (Free on request.)
+
+
+FOOTNOTES:
+
+[1] An area including about two-thirds of the population of the United
+States.
+
+
+
+
+CHAPTER IV
+
+INDICATIONS OF SICKNESS
+
+
+By indications of sickness we mean all evidences of deviation from a
+normal physical condition. They may be apparent only to the person in
+whom they occur, or to a second person only, or to both. These
+deviations, commonly called the symptoms of sickness, are always
+important to notice, whether the conditions they indicate are serious or
+not.
+
+Early symptoms of sickness are often slight; hence they easily pass
+unnoticed. Yet a slight trouble, easily checked in its early stages,
+may, if neglected, grow into a serious or even fatal disorder: just as a
+burning match, which anyone could extinguish instantly, may kindle a
+fire beyond the power of an entire city to control.
+
+It is important, then, to notice even slight symptoms of sickness,
+first, in order to determine the nature of the trouble, and second, in
+order to institute treatment as early as possible. It is, however,
+hardly less important to observe symptoms accurately during the entire
+course of an illness. A patient's progress can be determined only by
+careful comparison between present and past conditions.
+
+Many symptoms can be detected only by methods requiring scientific
+apparatus as well as the knowledge and skill of a physician, but very
+pronounced symptoms are generally evident to anyone. The neighbors do
+not need to be told when a person has advanced tuberculosis; neither is
+an expert required to see that something ails a man with a broken leg.
+Furthermore less pronounced symptoms may often be clearly seen by any
+observant person, even by those not specially trained. Accordingly it is
+important for every woman who has charge of others, sick or well, to
+form the habit of noticing unusual appearances of any kind. This habit
+is one that most people must take pains to acquire, because people
+generally see only the things that their own experience in life has
+taught them to see. An added difficulty is the fact that when illness
+begins it is not a trained observer, but the untrained sufferer or
+untrained member of his family who decides whether to send for the
+doctor and thus to set in motion the machinery for treatment and cure.
+
+All the training and experience of a physician are required in order to
+decide what symptoms indicate, and to prescribe proper remedies.
+Diagnosis, or the process of determining the nature of illness from the
+symptoms observed, is often exceedingly difficult; it must take into
+consideration not one symptom only but the presence or absence of a
+number of symptoms. Untrained persons who attempt to make diagnoses are
+frequently led astray by the fact that actual causes of trouble may be
+situated far from the places where symptoms are felt or observed. For
+instance, the real cause of headache may lie in a region far removed
+from the head; and so-called heart-burn, which is caused by disordered
+digestion, has nothing to do with the heart. Again, an early symptom of
+tuberculosis of the hip joint is pain under the knee; a mother is
+clearly not doing the best thing when she assumes that any pain in a
+joint means rheumatism, and therefore doses her suffering child with the
+medicine that "helped" his rheumatic grandfather. No untrained person is
+equipped to make a diagnosis, and still less to prescribe medicine or
+treatment.
+
+Symptoms, like all other forms of discomfort, tend to trouble a patient
+in proportion to the amount of attention that he gives them. Hence, in
+order to avoid calling his attention to them unnecessarily they should
+be observed so far as possible without his knowledge; when it is
+unavoidable for him to realize what is going on, observation should be
+made a matter of routine, so that his interest may not be especially
+excited. For instance, everyone who has seen the routine medical
+inspection of school children realizes how little attention the children
+themselves give to the process, apparently regarding it merely as one of
+the many inexplicable proceedings of grown people. On the other hand,
+children who know their symptoms are over-anxiously watched soon learn
+to watch themselves and to exaggerate every little ache and pain.
+
+Symptoms may be divided into two classes: first, objective symptoms, or
+those that can be noted by an observer, like cough, pulse rate, or color
+of the skin; and second, the subjective symptoms, which are apparent
+only to the person affected, like pain and fatigue. The success of any
+woman who cares for the sick depends to a large extent upon her
+quickness and accuracy in noticing and reporting these symptoms and
+their variations. It should be remembered that pronounced symptoms are
+not the only ones of importance: even slight symptoms that continue over
+an appreciable length of time may be of very great importance. A brief
+description of some important symptoms follows, in order to help persons
+without technical training to describe the symptoms as well as to
+observe them.
+
+
+OBJECTIVE SYMPTOMS
+
+TEMPERATURE.--Bodily heat is produced by slow burning of food materials,
+which goes on for the most part in actively working muscles and glands.
+Heat thus generated is distributed by the blood to all parts of the
+body, but the surface of the body is generally cooler than the interior.
+In health the body temperature varies only a few degrees, no matter how
+much the temperature of its surroundings varies; consequently a
+temperature is abnormal if it is higher or lower than the usual
+temperature of a healthy person.
+
+The temperature is taken by means of a clinical thermometer placed
+either in the mouth, the rectum, or the armpit (axilla).
+
+[Illustration: FIG. 10.--CLINICAL THERMOMETER.]
+
+To take the mouth temperature, first wash the thermometer, using cold
+water and absorbent cotton or clean soft cloth. Next shake it until the
+mercury thread registers 96 deg. or below. It is well before purchasing
+a thermometer to see whether it can be shaken down easily. Next place
+the thermometer in the patient's mouth, with its bulb under his tongue;
+he must then keep his lips closed until it is removed. Leave the
+thermometer in his mouth for two minutes. Then remove the thermometer,
+read the temperature and record the result. Clean the thermometer at
+once, using first cold water and soap, and then alcohol, 70%.
+
+The mouth temperature of a healthy person is about 98.6 deg. F. This
+statement holds true if the person has been sitting with his mouth shut
+for a little while before his temperature is taken; but a hot bath,
+breathing through the mouth, eating or drinking, and so forth may cause
+marked temporary changes.
+
+The temperature in the rectum generally varies less than the temperature
+in the mouth unless it is taken when the rectum contains fecal matter.
+The temperature should be taken by rectum in babies and young children,
+restless, drowsy, or delirious patients, patients who cannot be trusted
+to keep the thermometer under the tongue, mouth breathers, and in any
+patients who have difficulty in keeping the mouth shut. The temperature
+is normally about half a degree higher in the rectum than in the mouth.
+
+In order to take a temperature by rectum, adults generally find it more
+convenient to lie on the side and prefer, if they are able, to insert
+and hold the thermometer themselves; but the attendant should be
+certain that they can do so without breaking the thermometer. Rectal
+thermometers should be lubricated with oil or vaseline before using;
+they should be inserted about two inches, left in three minutes, and
+cleansed in the same way as the mouth thermometer. A thermometer used to
+take rectal temperatures should never be used in the mouth.
+
+In taking the temperature of a baby place him on his back, hold him
+firmly with his legs elevated, and carefully insert the bulb of the
+thermometer, well oiled, for about one inch. Keep the child quiet, and
+hold the thermometer in place three minutes. Great importance should not
+be attached to a slight fever of short duration. The temperature of a
+child is much more easily affected by slight causes than that of an
+adult, and rectal temperatures between 97.5 deg. and 100.5 deg. should
+not cause anxiety unless continued.
+
+Temperatures taken in the axilla are less accurate than those taken by
+mouth or rectum. Consequently the method is less often used. The axilla
+should first be wiped; then the thermometer should be inserted and held
+for 5 minutes by pressing the arm tightly against the chest wall. The
+temperature in the axilla is normally about half a degree lower than in
+the mouth.
+
+The temperature varies somewhat according to the time of day. It is not
+unusual for the mouth temperature of persons who are entirely healthy to
+be as low as 97 deg. in the early morning, or as high as 99 deg. in the
+late afternoon, and probably most people's temperatures vary as much as
+a degree during the twenty-four hours. Even greater variations that are
+not long continued have little if any significance in people who feel
+well.
+
+Decided variations either above or below normal are highly important
+symptoms. A temperature below 98 deg. is called subnormal, and one above
+99.5 deg. is called fever. The number of degrees of fever does not
+necessarily bear a direct relation to the severity of an illness. Thus,
+it does not follow that one person is twice as sick as another, because
+his temperature is twice as many degrees above normal. All symptoms,
+including variations in temperature, must be considered in connection
+with one another, and it is generally impossible to state the
+significance of any one symptom taken by itself.
+
+The temperature should be taken once or twice a day as a matter of
+routine in almost every form of illness, and oftener when the patient's
+condition requires it. Also it should be taken as a matter of routine
+whenever there is indication of beginning sickness; especially when
+there is headache, pain, sore throat, coated tongue, cough or cold,
+chill, vomiting, diarrhoea, or rash. It is not a good plan to take
+one's own temperature oftener than necessary, or indeed anyone's;
+certainly not a baby's, since frequent use of the thermometer may
+irritate the rectum.
+
+PULSE.--Each time the heart beats, blood is forced out from the heart
+into the arteries, thus causing an expansion of the arterial walls. This
+expansion, called the pulse, can be felt in some places where arteries
+lie close to the surface of the body. The character of the pulse beat
+and its rate, or the number of times the beat occurs each minute, give
+information about the heart and blood vessels; taken together they are
+perhaps more important than any other one symptom.
+
+[Illustration: FIG. 11.--TAKING THE PULSE AT THE WRIST. NOTE THE
+POSITION OF ARM. (_From "Elementary Nursing Procedures," California
+State Board of Health._)]
+
+The pulse rate varies much more than the temperature. It differs in
+different individuals and at different ages, and it often shows great
+temporary changes, especially during exercise or eating, or as a result
+of excitement, fear, or other emotion. Definite statements in regard to
+normal pulse rates are hard to make, because different individuals
+though in perfect health show marked variations; we generally say,
+however, that the pulse rate of a normal man at rest is about 72 a
+minute, and that of a normal woman is about 80 a minute. At birth the
+pulse is quickest; it may then be from 124 to 144. From the 6th to the
+12th month it may be from 105 to 115 a minute, and from 90 to 105
+between the 2d and 6th years. About the time of puberty it reaches the
+adult rate, and during old age it may be decidedly slower than the adult
+rate.
+
+What we chiefly want to know about the pulse is
+
+1. Its rate, or number of beats per minute,
+
+2. Its force,--whether weak or strong,
+
+3. Its rhythm,--whether regular or irregular.
+
+Much practice is necessary before the pulse rate can be counted with any
+degree of accuracy, and wide experience with both normal and abnormal
+pulses is required in order to judge its strength, rhythm, or other
+characteristics.
+
+The pulse may be felt most conveniently on the thumb side of the front
+of the wrist. The pulse should be counted while the patient is lying
+down, and the watch used must have a second hand. To count the pulse,
+one should place two or three fingers (not the thumb) on the patient's
+wrist, and after the pulse has been felt distinctly for a few beats, the
+exact time by the second hand of the watch should be noticed and the
+counting begun immediately. It is generally best to count for half a
+minute, multiply the result by two to get the rate for a whole minute,
+and then to repeat for another half minute. The two results should agree
+within two beats, if the patient is quiet. A greater variation than two
+beats may mean that the pulse rate is varying, but when it is counted
+by inexperienced persons the apparent difference is generally the result
+of inaccurate counting, and it may be necessary to count two or three
+times more. The force of the pulse varies also in different individuals;
+it is, however, important to notice when it grows stronger or weaker in
+the same person. Normally the pulse-beat is regular like the ticking of
+a clock; it is called irregular if a few rapid or slow beats are
+followed by others of a different rate. During sickness the pulse should
+be counted whenever the temperature is taken, or oftener; and the result
+should be written down at once. The pulse of a sick person often shows
+changes both in rate and character; these changes are generally
+important and should be noticed.
+
+RESPIRATION.--Variations in the rate and character of respiration or
+breathing should be noticed. The normal rate of respiration for an adult
+at rest is 16 to 20 each minute, but it may be much faster, especially
+during muscular exercise. In babies the rate is about 30 to 35 a minute,
+and 20 to 25 in little children. The respirations, especially of babies,
+can best be counted during sleep by placing the hand lightly on the
+chest or abdomen. Since the respiration rate is partly under a person's
+control, it is almost sure to alter if the patient knows it is being
+counted; hence when the patient is awake it is better to keep one's
+fingers on his wrist, to place his hand upon his chest, and then to
+count the rise and fall of the chest while apparently counting the
+pulse. Sometimes it is possible to count the respirations merely by
+watching the rise and fall of the nightgown or bed clothes. The
+respiration is usually counted for a full minute. A watch with a second
+hand must be used, and the result should be recorded immediately.
+
+In certain forms of sickness breathing may become rapid, especially if
+the lungs or air passages are affected. In addition to the rate anything
+unusual about the breathing should be noticed whether it seems difficult
+or painful; if noisy, whether the sound is like snoring, or wheezing, or
+sighing, and so on.
+
+GENERAL APPEARANCE.--Any unusual expression of the face should be noted;
+whether it is drawn, pinched, anxious, excited, or dull and stupid; and
+also, whether the face is thin, swollen, or puffy under the eyes. The
+condition and appearance of the skin are significant: the skin may be
+dry, moist and clammy, hot or cold; its color, and the color of the face
+especially, may be flushed or pale or slightly yellow or blue. A bluish
+tinge about the nose, tips of the fingers, or the feet should be
+specially noticed. Reddened or discolored areas on any part of the body
+may be important, and also eruptions, rashes, swellings, or sores. It
+should be noticed whether the abdomen is normal or whether it is
+distended and hard.
+
+Strength or weakness is indicated to some extent by the way the patient
+moves, and by his ability to walk, stand, sit, hold up his head, feed
+himself, or turn in bed without assistance. The position he habitually
+takes is sometimes significant; in heart affections, for instance, he
+may be unable to lie down, in pleurisy he ordinarily lies on the
+affected side, and during abdominal pain he generally draws the knees
+up.
+
+SPECIAL SENSES.--The special senses are frequently disturbed in
+sickness. The eyes may be blood-shot; the patient may be over-sensitive
+to light, or see spots floating before the eyes, or he may be unable to
+see at all. The pupils of the eyes may be unusually large or small, or
+one may be large while the other is small. Swelling, redness, or
+discharge from the eyes should be noticed. Hearing and touch and smell
+may be impaired; or they may be abnormally acute, and cause real
+suffering. Taste may be impaired, especially when the nose is affected
+or when the mouth is not clean. Discharge from the nose or ears should
+be reported. Not only discharge, but also trouble of any kind, such as
+pain, tenderness, or swelling, is important if situated in or near the
+ears.
+
+THE VOICE is often much altered in sickness. It may be weak, hoarse, or
+whispered. Speech may be clear or thick, or the ability to speak may be
+entirely lost; in extreme weakness speaking is generally difficult, and
+may be impossible. Moaning, groaning, and other unusual sounds should be
+noted. A loud, sharp cry at night with or without waking, if a repeated
+occurrence, may be an early symptom of some diseases of children.
+
+THE TONGUE in health is red and moist; when extended it is somewhat
+pointed and can be held steadily. In sickness it may be cracked, dry and
+parched, or if the patient is not properly cared for, it may be covered
+with white, yellow, or brown coating; in many exhausting illnesses it is
+flabby and trembling. In scarlet fever the tongue is often a vivid red
+color, and is then called strawberry tongue. The odor of the breath may
+be foul from decay or neglect of the teeth, from indigestion,
+constipation, nasal catarrh, or special diseases.
+
+THE THROAT and tonsils are sometimes red and swollen as in simple sore
+throat; or they may be covered by white patches.
+
+THE GUMS may be swollen, tender, or bleeding. A collection of sticky
+brownish material may appear on the teeth and gums of neglected
+patients.
+
+COUGH when present may be: dry, or accompanied by expectoration;
+painful, frequent, loud, or whooping; and worse by day or by night. The
+sputum may be yellow, white, gray, rusty, blood-streaked, dark, or
+frothy. The amount of sputum should be noticed as well as its
+appearance.
+
+APPETITE or absence of appetite should be noted, and also the amount of
+food actually eaten by a patient; the amount eaten is frequently not the
+same as the amount carried to him on a tray.
+
+If VOMITING occurs, the color, consistency, amount, and general
+appearance of the vomitus should be noted; if its appearance is unusual
+the vomitus should be saved for the doctor's inspection.
+
+EXCRETIONS.--The number of bowel movements is important, and also their
+character. The consistency of the feces may be hard, soft or fluid;
+their color may be any shade of brown, yellow or green, from black to
+clay color. They should be saved for the doctor to see if appearance or
+odor is unusual.
+
+THE URINE in health is clear, amber colored, and slightly acid. From 30
+to 50 ounces should be excreted in 24 hours; the amount varies, however,
+especially according to the amount of fluid taken. It is important to
+notice whether the urine is scanty or greatly increased in amount, dark
+or pale, clear or cloudy, and whether sediment is deposited after
+standing. It is essential that urine should be voided in sufficient
+amount; the necessity for watching its quantity is frequently overlooked
+in the home care of the sick. Frequency of urination should also be
+noted. Inability to urinate, particularly where the urine has previously
+been scanty, is serious if continued; it should be reported to the
+doctor without delay. Inability to control the bladder and bowels are
+also symptoms to be reported.
+
+LOSS OF WEIGHT is significant in both adults and children, and failure
+of babies and children to gain in weight is a danger signal.
+
+SLEEP.--The number of hours a patient sleeps should be noticed and
+recorded as accurately as possible. The word of the patient on this
+subject is not sufficient evidence. Character of sleep should also be
+noted, whether it is quiet or restless, and whether the patient sleeps
+lightly or is difficult to arouse.
+
+MENTAL CONDITIONS.--It is important to watch carefully the mental
+condition of a patient; whether, for example, he is normal, or
+depressed, irritable, restless, apathetic, dull, excited, wandering,
+delirious, or unconscious. Hasty judgment of mental conditions should
+be avoided, but close attention to them is necessary.
+
+
+SUBJECTIVE SYMPTOMS
+
+PAIN is the most important subjective symptom and should never be
+disregarded. Bodily pain does not occur in persons who are in all
+regards physically and mentally well; hence pain is a sign that
+something, small or great, is out of order.
+
+      "Of all symptoms pain is the one which interests patients
+      the most. We here emphasize the truth, too little
+      understood, that pain is an unpleasant sensation, nothing
+      more, and is _never_ imagined. Imagination may be its
+      cause, but the pain thus produced hurts just as truly as
+      pain produced by a real disease. Pain is only a phenomenon
+      of consciousness; it is always real, even that felt in a
+      dream. If the patient is too unconscious to feel it, there
+      simply is no pain, no matter how badly the person's body is
+      injured." (Emerson: Essentials of Medicine, p. 356.)
+
+One should remember that no possible method exists to measure the
+intensity of pain exactly, or to describe its quality accurately.
+Therefore in describing pain, it is best to use the patient's own
+language. Four points should especially be observed, (1) its location;
+(2) its character, which may be dull or sharp, stabbing, throbbing or
+continuous, slight or severe; (3) the time at which it is worst; certain
+diseases, for instance, are characterized by more severe pain at night;
+(4) it should be noticed whether the pain is relieved or increased by
+change of position, eating or drinking, heat or cold, or the like. Pain
+may be felt in a part far from the place where the trouble really lies;
+thus a dislocated shoulder causes pain in the elbow.
+
+Pain is always a danger signal, although the significance is not always
+so great as the sufferer thinks. The more attention a patient gives to
+his pain, the more severe it always becomes, therefore his attention
+should not be called to it unnecessarily. A good observer, however, can
+get much information by noticing the patient's expression, position,
+motions, etc., without constantly asking him how he feels. Although many
+persons overestimate pain, others persistently disregard it, either
+because they are unwilling to take the necessary measures to remedy it,
+or because they wish to appear heroic. Both courses of action are
+mistaken; everyone should realize the folly and danger of bearing pain
+if it is possible to remove the cause.
+
+Nausea, fatigue and malaise are other subjective symptoms; malaise is
+the name given to a general feeling of physical discomfort not
+restricted to any one part of the body. All three are abnormal when
+there is not apparent or sufficient cause.
+
+RECORDS.--An accurate record should be kept of the patient's symptoms,
+medicine, diet, treatment, etc., so that the doctor may have a
+continuous record, and so that another person taking charge temporarily
+may know just what has been done for the patient. The record must be
+written; otherwise details cannot be remembered exactly. It should be as
+simple and concise as possible; it is the place for facts, not for
+opinions, and if inaccurate it is worse than none. It is better not to
+keep the record in the patient's room, for the patient should not see
+his own record, nor hear its contents discussed. The doctor usually
+writes his orders on the record sheet itself, or on a separate sheet to
+be attached to the record for reference. Blank record forms can be
+purchased, but a form that is made at home is entirely satisfactory. An
+example of a daily record sheet follows.
+
+
+                                  RECORD
+
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+   Date |  Hour    |Tem.|Pulse|Resp.|   Diet and     |B.M.|Urine|Remarks
+        |          |    |     |     |   medicine     |    |     |
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+  1916  |          |    |     |     |                |    |     |
+  Jan. 1|4 p.m.    |100 | 76  | 24  |Medicine        |    |     |
+        |5 p.m.    |    |     |     |                | 1  |oz.  |
+        |          |    |     |     |                |    |vii  |
+        |6 p.m.    |    |     |     |Supper:         |    |     |
+        |          |    |     |     | Baked potato,  |    |     |
+        |          |    |     |     | toast, fruit,  |    |     |
+        |          |    |     |     | tea.           |    |     |
+        |8 p.m.    |    |     |     |Medicine        |    |     |Sponge
+        |          |    |     |     |                |    |     |bath.
+        |9:30 p.m. |    |     |     |                |    |     |Asleep.
+  Jan. 2|3 a.m.    |    |     |     |                |    |oz.  |
+        |          |    |     |     |                |    |ix   |
+        |8 a.m.    |99  | 74  | 22  |Medicine        |    |     |Patient
+        |          |    |     |     |                |    |     |slept
+        |          |    |     |     |                |    |     |most
+        |          |    |     |     |                |    |     |of the
+        |          |    |     |     |                |    |     |night.
+        |8:30 a.m. |    |     |     |Breakfast:      |    |     |
+        |          |    |     |     | Cereal, orange,|    |     |
+        |          |    |     |     | toast, coffee. |    |     |
+        |9:30 a.m. |    |     |     |Bath.           |    |     |
+        |11:30 a.m.|    |     |     |                |    |     |Sat up
+        |          |    |     |     |                |    |     |1 hour.
+  ------+----------+----+-----+-----+----------------+----+-----+-------
+
+TUBERCULOSIS, CANCER, AND MENTAL ILLNESS.--As we have seen, early
+symptoms of sickness are always important; yet it seems worth while to
+mention particularly the early symptoms of tuberculosis, cancer, and
+mental disorders, because each of these diseases, though curable in
+many cases when taken in the early stages, is serious and often fatal
+if neglected. Certain facts relating to their cause and prevention
+should be known to everyone. Tuberculosis, long our greatest cause of
+death, is gradually growing less; but cancer and mental disease are now
+on the increase.
+
+TUBERCULOSIS.--Every year tuberculosis causes the death of about 150,000
+people in the United States. It is caused by the bacillus tuberculosis,
+a germ which may attack any tissue of the body, although it most
+frequently affects the lungs of grown people, and the bones and glands
+of children. The disease is not inherited, but susceptibility to it
+appears to be; it is readily communicated from person to person. The
+germ of tuberculosis is so widely distributed that probably few persons
+over 30 years of age have not been infected with it at some time,
+although the infection may have been too slight to be noticed. Indeed,
+most people have probably been infected many times, though without
+serious results.
+
+Tuberculosis is spread chiefly in two ways: (1) through any bodily
+discharges from infected persons, especially through the nose and mouth
+discharges; (2) through milk from infected cows. The ways by which the
+disease is spread indicate methods of prevention. Milk, especially for
+children, should either be pasteurized or should come from cows that
+have been tested and proved to be free from the disease. Other methods
+of prevention include avoiding any and all bodily discharges of infected
+persons, and increasing bodily resistance as far as possible. Good food,
+sufficient rest and fresh air are not only important preventives, but
+also the most efficacious means of cure. Persons who suffer from
+insufficient food, exposure, bad housing, long hours, and bad conditions
+of work are especially susceptible to tuberculosis, and thus it is
+rightly called a disease of poverty.
+
+Early symptoms of tuberculosis include cough, hoarseness, loss of
+appetite, pain in the side, loss of weight, getting tired easily,
+feeling run down, rise in temperature in the afternoon, night sweats,
+expectoration, and spitting blood. No one, nor even several, of these
+symptoms necessarily indicates the presence of tuberculosis; on the
+other hand, even the cough is not necessarily present when tuberculosis
+actually exists. When one or more of these symptoms appears and
+continues, a thorough examination should be made by a doctor;
+examination can do no harm, certainly, if tuberculosis is not found, and
+if it is, immediate treatment is of the greatest importance. No known
+drug or medicine is a cure for tuberculosis. Successful treatment
+depends on taking the disease in time and in following the doctor's
+advice unremittingly.
+
+CANCER.--The cause of cancer is not known. All the evidence, however,
+goes to show that it is neither communicable nor hereditary. Cancer may
+occur on the skin, stomach, or other organs; in women it most commonly
+occurs in the breast or uterus (womb). In both sexes it occurs most
+frequently after 40 years of age. No known medicine will cure cancer;
+salves and ointments have no effect. Radium and _x_-ray should not be
+relied upon if the cancer can be removed by operation. Safety consists
+in removing the growth entirely, and complete removal is possible only
+in the early stages.
+
+Early diagnosis is consequently of the greatest possible importance, and
+an examination can do no harm in any case. Warts and moles on the skin
+may develop into cancer, and should be removed if they show signs of
+irritation. Loss of appetite and weight, any disturbance of the stomach
+or intestines, and sores that refuse to heal should lead a person to
+consult a physician; the same is true of any lump in the breast, and of
+irregular or persistent bleeding from the uterus in women over forty.
+The fact that pain is not present in cancer until the late stages leads
+many persons to neglect the trouble until it is too far advanced for
+operation. Time is all-important; hope depends on operation in the early
+stages when there is a very great probability of permanent cure.
+
+MENTAL ILLNESS.--Insanity, like cancer, is increasing. Like both cancer
+and tuberculosis, hope lies in prevention and early treatment; and like
+them both, in its early symptoms it is too often unrecognized or
+neglected.
+
+Many people are surprised to learn that known, avoidable causes are
+responsible for the condition of about 50% of the insane patients now
+under treatment. Chief among these known causes is a communicable germ
+disease called syphilis, to which is due the disease called paresis, or
+"softening of the brain." About 25% of patients admitted to hospitals
+for the insane are there from the effects of habitual use of alcohol,
+even in "moderate" quantities. Other cases of insanity result from
+diseases of the heart, arteries, and kidneys, and still others have been
+traced to the poisons of tuberculosis, typhoid, diphtheria, and other
+communicable diseases. Prevention of insanity caused by these diseases
+depends upon prevention or complete cure of the diseases themselves.
+
+Still other causes of insanity are known. Hereditary nervous weakness
+may predispose to insanity, and for such persons, those whose nervous
+resistance is naturally not very great, the stress of living may prove
+too much. Mental breakdowns are rarely caused by overwork unless
+accompanied by worry or bad hygienic conditions, but they result not
+infrequently from bad mental habits.
+
+      "The average person, little realizes the danger of brooding
+      over slights, injuries, disappointments, or misfortunes, or
+      of an unnatural attitude towards his fellowmen, shown by
+      unusual sensitiveness or marked suspicion. Yet all these
+      unwholesome and painful trains of thought, may if persisted
+      in and unrelieved by healthy interests and activities, tend
+      towards insanity. Wholesome work relieved by periods of
+      rest and simple pleasures and an interest in the affairs of
+      others, are important preventives of unwholesome ways of
+      thinking. We should train ourselves not to brood, but to
+      honestly face personal difficulties."--(Why Should Anyone
+      Go Insane?, by Folks and Ellwood.)
+
+Prevention of insanity consequently depends chiefly upon avoiding
+alcohol and communicable diseases, especially syphilis; upon good
+hygiene, self-control, and avoidance of bad mental habits; and upon
+adopting a program of living and working that will not overtax one's
+nervous strength. Sleeplessness, unusual nervous fatigue following
+slight exertion, and diminished power to control the emotions, are among
+the danger signals. And when a person becomes unusually depressed or
+morose, excited or irritable, suspicious, unreasonable, or "queer," it
+is probable that expert medical advice should be obtained as quickly as
+possible.
+
+
+EXERCISES
+
+1. What is a symptom? Why are early symptoms especially important?
+
+2. Distinguish between objective and subjective symptoms.
+
+3. Tell all you can about normal and abnormal variations in the body
+temperature. What symptoms would lead you to take a person's
+temperature?
+
+4. Describe the method of taking temperatures.
+
+5. How should you cleanse a clinical thermometer? What are the dangers
+of neglecting to cleanse it properly?
+
+6. Describe both normal and abnormal pulse and respiration.
+
+7. Discuss the significance and importance of pain.
+
+8. Describe early symptoms of tuberculosis, cancer, and mental illness.
+What is the first step to be taken when any one of these symptoms
+appears?
+
+9. What symptoms of all those mentioned in this chapter did you notice
+in the last sick person with whom you had anything to do?
+
+10. What are the essentials of a good daily record? The following is an
+account that a mother gave of the first twenty-four hours of a child's
+illness. Make a chart for the patient, and include in it all the
+information the mother gave. Which do you consider more useful, your
+chart or the narrative?
+
+"Yesterday, October 10th, Johnny came home from school about half past
+three, and said he was too cold to play outdoors. He lay down and slept
+till about five, when he vomited a large amount of undigested food. I
+took his temperature and found that it was 103.8 deg., pulse 126, and
+respiration 28. At 10 that night his temperature was 102.5 deg., pulse
+116, and respiration the same as before. The next morning at 8 he had a
+temperature of 100.6 deg., pulse 114, respiration 24. At noon his
+temperature was 101 deg., pulse 118, respiration 24; and at 4 o'clock
+his temperature was 100.6 deg., pulse 122, respiration 22. The doctor
+came at 6 o'clock yesterday afternoon; according to his orders I put
+Johnny to bed, gave him half a tablespoonful of castor oil at 6.30, and
+a special gargle. His throat was red and sore and he seemed to feel very
+miserable. The doctor took a culture from the child's throat. At 8.15
+and again at 8.50 he had fluid bowel movements. At 9.30 he had a glass
+of milk, after which he slept until 6 a.m. when his bowels moved again
+and urine was passed. He passed eight ounces of urine at noon and four
+ounces at 3.30. He drank a glass of water at 6 this morning, and at 6.30
+I gave him a cup of hot broth. At 8 he had a glass of milk, but at 10 he
+refused everything but a glass of water. At 1.30 he had a large dish of
+ice cream. He had a cool sponge bath last night at 9, and a cleansing
+bath this morning at 8.45. This morning his throat was still sore but
+not so red, and I saw that he gargled every half hour when he was awake.
+This afternoon he seems brighter and asked for his harmonica, so his
+throat is probably more comfortable."
+
+
+FOR FURTHER READING
+
+Essentials of Medicine--Emerson, Chapters XVI, XVII.
+
+The Human Mechanism--Hough and Sedgwick, Chapter XII.
+
+Notes on Nursing--Florence Nightingale, Pages 105-136.
+
+Why Worry?--Walton.
+
+Those Nerves--Walton.
+
+Tuberculosis: Its Cause, Cure, and Prevention--Otis.
+
+Publications of the National Association for the Study and Prevention of
+Tuberculosis--105 East 22d Street, New York City. (Pamphlets free on
+request.)
+
+Publications of the National Committee for Mental Hygiene--50 Union
+Square, New York City. (Pamphlets free on request.)
+
+Publications of the Mental Hygiene Committee of the State Charities Aid
+Association--105 East 22d Street, New York City. (Pamphlets free on
+request.)
+
+Publications of The American Society for the Control of Cancer--25 West
+45th Street, New York City. (Pamphlets free on request.)
+
+
+
+
+CHAPTER V
+
+EQUIPMENT AND CARE OF THE SICK ROOM
+
+
+Adequate care of the sick consists to a large extent in rendering their
+physical and mental surroundings as favorable as possible. Obviously, a
+sick person, since his strength is already depleted, needs not only to
+have his resistance increased in all possible ways, but also to have all
+his remaining strength conserved by eliminating every unnecessary tax
+upon it. In sickness even slight fatigue, chill, or nervous strain,
+insufficient ventilation, or improper feeding, may become factors of
+immense importance. Nothing is trivial if it affects the welfare and
+comfort of a patient.
+
+Even when perfect provision for the care of the sick is out of the
+question, every effort should be made to insure as satisfactory
+arrangements as possible. Ideal conditions are seldom found except in
+buildings originally planned for the sick; yet in many houses a few
+simple changes will produce excellent results. Of course, it is not
+necessary in every case to adopt all the following suggestions. Common
+sense must be the guide. For instance, in illness that is slight and
+likely to be of short duration, a patient may be more distressed than
+benefited by radical changes in his surroundings. Except when certain
+essentials are concerned, great consideration should be given to a
+patient's preferences; yet on the other hand it is not reasonable to
+make an entire family miserable in order to gratify some slight whim.
+
+CHOICE OF A SICK ROOM.--A south or east exposure is generally best for a
+sick room. A south room may be undesirable in very hot weather, but
+sunshine during a part of the day is essential. The room should be
+quiet, near the bath room, and well removed from odors from the kitchen.
+It should be situated so that good ventilation is possible. It is
+desirable though not necessary for it to have more than one window; in
+summer the windows must be thoroughly screened. It should be possible to
+open the window without exposing the patient to a direct current of air,
+and to open the door without placing him in full view of all who pass
+through the hall.
+
+It is essential for the patient to have a room to himself. Unless he
+needs care or help or watching at night, not even the person caring for
+him should sleep in the room. Neither should the rest of the family
+keep their possessions in the sick room. Closets opening into the room,
+bureaus, and chiffoniers should be emptied of the belongings of other
+members of the family, to prevent people from tiptoeing into the sick
+room at all hours to remove garments. The sick room should for the time
+belong exclusively to the patient, and resulting inconvenience should be
+borne by well members of the family.
+
+Every possible precaution should be taken to exclude from a sick room
+unnecessary noises of all kinds; flapping curtains, squeaky doors and
+rocking chairs, heels without rubber, creaking corsets, noisy
+petticoats, ticking clocks, refractory bureau drawers, and rustling
+newspapers are among the everyday sounds that irritate the nerves of
+sick and well alike. Ordinary out-of-door noises do not usually disturb
+the sick, except when the country patient is brought to the city, or the
+reverse; but nearby and generally avoidable noise is the kind that
+distracts and harasses nervous patients.
+
+Whispering is an annoying sound and should not be allowed, either in the
+patient's room or just outside the door. Whatever the subject of
+conversation may be, the patient thinks that he is under discussion.
+Anything undesirable for him to hear should be settled well out of his
+hearing, and in speaking to him there is no possible objection to an
+ordinary well modulated voice.
+
+Usually a person's own room is more restful and less disturbing than a
+strange place, but if it serves as a work room as well as a bed room, it
+may easily be the worst place during sickness. The sight of a desk piled
+high with papers or a basket overflowing with accumulations of family
+mending may actually delay recovery; even the room itself may constantly
+suggest work, and work necessarily left undone. The essential thing to
+remember is that mental rest is no less important than physical, and
+every effort should be made to secure them both.
+
+FURNISHING.--Superfluous articles add to the care of a sick room, and in
+consequence they should be removed at the outset. All the furnishings
+that remain should be easy to clean, but it is not necessary for a sick
+room to look bare and desolate.
+
+The woodwork as in any other room should have a hard finish, and angles
+and corners that harbor dust should be as few as possible. Hard wood
+floors without cracks are best from the point of view of cleanliness and
+convenience. A few light, washable rugs make the best floor covering,
+but very small rugs on highly polished floors slide easily and are
+decidedly dangerous. Carpets diminish noise, but are objectionable from
+every other point of view.
+
+In furnishing houses people ought to realize more frequently than they
+do how greatly nervous fatigue may be increased by ill chosen wall
+coverings. Plain papers or tinted walls are best for bed rooms and the
+color should not be harsh or striking; soft gray, green, or buff is
+good. The design is no less important than the color; a design that on
+casual inspection appears quite harmless may become an instrument of
+torture to a person unable to escape from it for a single hour. Weak or
+nervous patients sometimes become quite exhausted from attempting to
+follow an intricate pattern, or from counting over and over a design
+that is frequently repeated on the wall. If the patient sees grotesque
+faces and figures in the design the paper is more objectionable still.
+
+Necessary furniture includes the bed, which will be discussed in detail
+later, a small table to stand by the head of the bed, a dresser, two
+chairs, and a wall thermometer. If the patient is able to sit up three
+chairs are needed, of which one should be an armchair with a high back.
+No rocking chair should be allowed in the room unless the patient
+himself prefers to sit in one; no one else should be allowed to rock in
+the room, since the motion is almost always annoying to patients.
+Elaborate, carved, or upholstered furniture is unsuitable in a sick
+room, but if it must be used it should have washable covers.
+
+Other desirable articles of furniture are a couch, screen, foot-stool
+and a second, larger table. In few cases, if any, is anything further
+really necessary, although patients frequently desire special articles
+to which there can be no objection.
+
+Most ornaments add much work and little beauty, and have no place in a
+sick-room. No heavy unwashable curtains or hangings should be allowed,
+but simple washable curtains and clean white covers for the tables and
+dresser are desirable. Pictures, if suitable, give much pleasure, but
+must be used with discretion. It goes without saying that the subjects
+should be pleasant, but not everyone realizes that complicated subjects
+are undesirable and that pictures of people or things in motion should
+be avoided; patients are sometimes worried to see motion that is forever
+incomplete.
+
+Flowers give great pleasure to the sick by adding color and variety and
+interest to their surroundings. They should be carefully tended and
+given fresh water daily. Fading flowers and forlorn plants should be
+removed from the sick room, and those having strong, heavy odors should
+not even be admitted. They do not need to be very many or very
+expensive; indeed, a potted plant or a few cut flowers are often more
+acceptable than the great masses of costly flowers that are daily
+brought to the private wards of hospitals.
+
+VENTILATION.--A patient needs fresh air certainly as much as a well
+person, and probably even more. His room should be thoroughly ventilated
+night and day. A fireplace makes the problem easier, but in most cases
+an open window is the main dependence. It should be possible to open
+windows at the top as well as at the bottom, and the patient may be
+protected from a direct draught by a screen, or by a sheet stretched
+along the side of the bed and fastened at the head and foot by tying it
+around the posts.
+
+Ventilating a room without subjecting the patient to draughts is not
+always easy. One method is to insert a board three or four inches high
+under the lower sash so that air is admitted between the two sashes.
+Another way to ventilate without causing a draught is to remove one or
+two panes of glass and tack cheese cloth over the opening; or to tack
+cheese cloth to the lower edge of the upper window casing and to the
+upper edge of the upper sash, after the sash has been lowered about a
+foot. Once or twice a day the room should be thoroughly aired by opening
+windows and doors until the air has been completely changed. The
+patient, including his head, must be well-covered during the process.
+An electric fan is useful in summer, but it should not be close enough
+to the bed for the patient to feel air blowing upon him.
+
+HEATING.--Great care should be taken to maintain a suitable temperature
+in the sick-room, and for this purpose a thermometer in the room is a
+necessity. Between 65 deg. and 68 deg. is generally the best
+temperature, and hot water bags and extra covers may be given if the
+patient is chilly. During a bath or other treatment in which the patient
+is more or less exposed the temperature should be 70 deg.. The
+temperature at night may be lower; how low will depend largely on the
+patient's condition and on what must be done for him during the night.
+Hot water, steam heat, or electricity is best for the sick room. Gas or
+oil stoves should never be used except in emergencies, and then for a
+short time only.
+
+LIGHTING.--Sunlight is one of the most powerful disinfectants, and for
+this reason if for no other it is needed in every sick room. Sunless
+rooms, moreover, even if they were wholesome, are too depressing to a
+patient's spirits for use except perhaps in hot summer days. Ordinary
+well-regulated light is best in a sick room, and except in a few
+diseases, especially those in which the eyes are affected, it is
+undesirable to darken the room or to encourage in any way an appearance
+of gloom. The patient's eyes, however, should be protected from bright
+lights shining directly upon them; in this connection it is well to
+remember that lights and their reflections strike differently upon the
+eyes of a person lying down from the way in which they strike the eyes
+of persons sitting or standing, and a light that seems agreeable to the
+attendant may therefore be painful to the patient.
+
+Almost all persons sleep best in dark rooms, and in most cases it is
+undesirable for a sick room to be lighted at night. The attendant,
+however, must be able to see what she is doing and generally needs a
+shaded candle, small night light, or electric flash. It should be
+possible to see the patient clearly in case of need, otherwise serious
+changes in his condition occurring in the night may pass unnoticed.
+
+A reading lamp on the bedside table is desirable for patients allowed to
+read, but reading in bed even with a well-regulated light is fatiguing,
+and should not be continued for long uninterrupted periods. A pocket
+flash light is safer than matches and a candle for patients who wish to
+consult their watches in the night; indeed, matches in the hands of
+patients always involve risk. Some patients find twilight a time of
+great depression. In such a case it had best be shortened by drawing
+the shades early, turning on the lights, and remembering not to leave
+him alone.
+
+CLEANING.--The sick-room should be kept thoroughly clean at all times,
+and the less dust stirred up in doing so the better. Dry sweeping or
+dusting should not be allowed. Ordinary brooms should be dampened or
+covered with damp cloths, and dust cloths should be dampened also; but
+dustless mops and dusters are still better. Vacuum cleaning is very
+desirable; the noise, which is its only disadvantage, is not a serious
+objection in most cases. The cleaning of rooms after a communicable
+disease will be considered later.
+
+A sick room must be kept tidy as well as clean. The effect of order is
+quieting, but it should be maintained whether the effect upon the
+patient is apparent or not. Food and medicine should not be kept in the
+sick-room, and all used dishes, tumblers, soiled linen, etc., should be
+removed at once. Unnecessary articles should not be found in the room at
+any time; every necessary article should be kept in its place, and its
+place should be a good one.
+
+Maintaining order in the room does not mean that patients should be made
+uncomfortable. All patients, especially old people, want certain
+possessions within reach, and their wishes should be considered in spite
+of the fact that the aesthetic effect is generally far from good. For
+instance, a perfectly smooth bed is undesirable if in order to make it
+smooth the patient must be tucked in so tightly that he is
+uncomfortable. And it would be a mistake to remove an old man's
+newspapers before he has read them, even if he persists in strewing them
+all over the floor.
+
+THE ATTENDANT.--One person and one person only should carry the entire
+responsibility for the patient. She should plan for him as well as care
+for him, should see the doctor and take the doctor's orders. Confusion
+and innumerable mistakes result when several members of the family
+attempt to do the talking and directing.
+
+The attendant should wear washable dresses with sleeves that can be
+rolled up, washable aprons, and shoes with rubber heels. All her
+clothing should be comfortable. She should be neat in appearance,
+scrupulously clean in person, and should keep her finger nails short and
+smooth. Jewelry, especially rings and chains that rattle, and finery of
+any sort are all out of place in a sick-room.
+
+The attendant must learn that her own sleep, her diet, and her
+out-of-door exercise are essential to the patient's well-being hardly
+less than to her own. An amateur nurse often considers that going
+without food and sleep is a proof of her devotion. In a passion of
+self-sacrifice she neglects herself utterly for the first few days, and
+as a consequence is quite useless at a later period when her services
+may be most needed. An exhausted, sleepy nurse, trained or untrained, is
+wholly unfit to be trusted with medicines and doctor's orders, to note
+changes in the patient's condition, or to give him kindly attention.
+Efficiency and fatigue have never pulled together since the world began,
+and no one can do good work when suffering from lack of sleep and rest.
+
+The person, then, who genuinely wishes to give her patient the best
+possible care should not make a martyr of herself. She should go out of
+doors daily; both fresh air and occasional absence from the patient are
+essential to her physical and mental well-being. Moreover, she will be
+showing her patient the greatest kindness in the long run if during her
+recreation time she thinks of him as little as possible. Indeed, she
+need not consider herself inhuman if she has a thoroughly good time.
+
+On the other hand, a person who is responsible for the care of a patient
+must be made to realize that she and she only is ultimately responsible
+during the entire 24 hours of every day. Being responsible for a patient
+does not mean that she should be with him every minute, or do everything
+herself: it does mean that she should plan so effectively that
+everything necessary is done, either by herself or by another competent
+person. When she goes away for even half an hour, she should appoint
+someone else to be responsible in her place and to her when she comes
+back. She must consequently make very clear just what she wants done. If
+there is medicine, nourishment, or treatment to be given, she can easily
+make a list, with the time for each, and ask that each item be crossed
+off the list as soon as the work has been done. She should not forget to
+ask for the list when she returns.
+
+What is really needed is a little executive ability. As Florence
+Nightingale said:
+
+      "It is impossible in a book to teach a person in charge of
+      the sick how to _manage_, as it is to teach her how to
+      nurse. Circumstances must vary with each different case.
+      But it is possible to press upon her to think for herself.
+      Now what does happen during my absence? I am obliged to be
+      away on Tuesday. But fresh air, or punctuality is not less
+      important to my patient on Tuesday than it was on Monday.
+      Or: At 10 p.m. I am never with my patient; but quiet is of
+      no less consequence to him at 10 than it was at 5 minutes
+      to 10. Curious as it may seem, this very obvious
+      consideration occurs comparatively to few, or, if it does
+      occur, it is only to cause the devoted friend or nurse to
+      be absent fewer hours, or even fewer minutes from her
+      patient--not to arrange so as that no minute and no hour
+      shall be for her patient without the essentials of her
+      nursing."--(Notes on Nursing.)
+
+It is exceedingly difficult to care for members of one's own family or
+to be cared for by them. Too much or too little is almost invariably
+expected by one person or the other, and where great affection is
+involved not only is the strain increased on both sides, but often harm
+results from too great unselfishness on either side or both. But
+sometimes the reverse is true, and then one should remember that normal
+behavior may be impossible for the sick. During weakness and pain,
+irritability and unreasonableness are as characteristic as other
+symptoms, and it is as foolish to demand a normal mental state from a
+sick person as it would be to demand a normal temperature. For a
+cheerful, reasonable, and unselfish patient--and there are surprisingly
+many--one should be devoutly thankful, but patience and pity should be
+given no less to those whose tortured nerves cause suffering to others
+as well as to themselves.
+
+Every woman who cares for the sick should remember that she is the
+patient's chief if not his only link with the normal world, and that his
+plight is pitiful indeed if she is complaining or irritable or
+unwilling. Anyone who cares for the sick should remember also that she
+is necessarily in a most intimate relation with the patient, and that
+such enforced intimacy calls for extra consideration on her part, and
+for the most scrupulous respect for confidential matters. It is
+inexcusable even for members of the patient's family to discuss with one
+another the patient's private concerns, or his queer or unreasonable or
+annoying ways. During sickness the skeletons in most people's mental
+closets walk forth, and anyone who misuses special opportunities to know
+intimate affairs can only be classed with eavesdroppers and village
+gossips.
+
+
+EXERCISES
+
+1. What are the essentials of a good sick room as to:
+
+  (_a_) Situation and exposure.
+  (_b_) Lighting and heating.
+  (_c_) Furnishing.
+  (_d_) Ventilation.
+
+2. How may a sick room be ventilated without exposing the patient to
+draughts?
+
+3. How should the bed be placed in relation to doors, windows, and
+walls?
+
+4. How should a sick room be cleaned?
+
+5. What in general are the duties of the attendant?
+
+6. Make a plan of your own bedroom, and show what changes, if any, would
+be desirable if it were to be used as a sick room.
+
+
+FOR FURTHER READING
+
+Notes on Nursing--Florence Nightingale, Pages 1-63, 84-105.
+
+
+
+
+CHAPTER VI
+
+BEDS AND BEDMAKING
+
+
+The common saying that the best bed for an invalid is his own bed
+contains an element of truth. Taking from a patient his own accustomed
+bed, even when a better is substituted, sometimes disturbs him greatly
+and makes him feel that he is indeed very ill. Nevertheless, a suitable
+bed is essential to the proper care of a helpless person, and no patient
+should continue to use an unsuitable one, unless his illness is slight
+and also likely to be of very short duration.
+
+Besides being comfortable, a bed suitable for the sick must be clean and
+easy to keep in a sanitary condition. The springs should be firm, and
+the mattress should be elastic and should give an even support without
+lumps and hollows. The bed covers should be clean, light, and warm; the
+pillows should be sufficient in number not only to make the head and
+shoulders comfortable, but also any other part of the body in need of
+support. Moreover, the bed should be so placed and of such a kind that
+the work of caring for the patient may be rendered as easy for the
+attendant as possible. In every household at least one bed suitable for
+a sick person should be available in case of need.
+
+BEDSTEADS.--Beds of white enameled iron, brass, or brass and iron
+combined are most easily kept clean, and are the best in every way. The
+frame should be strong enough to stand firmly, yet not so heavy that it
+is hard to move. It should have as few angles as possible, and all its
+joints should be smooth and well finished. The springs should be made of
+wire stretched tightly on a metal frame that fits smoothly into the head
+and foot pieces. Large castors should be used; they may be removed from
+the foot if the bed moves too easily.
+
+A bed to be used in sickness should have the following
+dimensions--length, 6 ft. 6 in., height 24 to 26 inches, width, 36
+inches. If a bed is either too high or too low the labor of lifting and
+moving the patient is greatly increased. If the bed is too narrow the
+patient is insecure. If the bed is too wide, its center is difficult or
+impossible to reach without leaning or kneeling upon it; and if too
+short, it will prove uncomfortable for a tall person. A bed that is too
+low may be raised on four heavy boxes of the same height; or still
+better, upon heavy wooden blocks which any carpenter can easily make,
+and which are well worth a little trouble to obtain. In the top of each
+block a hollow should be made into which the leg of the bed will fit
+after the castor has been removed. A broad firm stool or a low chair may
+be provided for a patient who has difficulty in getting in and out of a
+high bed.
+
+Beds with complicated attachments for moving patients are not
+recommended for family use. They are expensive, likely to get out of
+order, seldom needed, and generally unsatisfactory. In some surgical
+cases a bed with a firm, flat surface is necessary. Such a surface may
+be secured by placing between the mattress and springs two boards
+slightly separated, or one wide board with holes bored in it to afford
+ventilation.
+
+Wooden beds are undesirable: they are difficult to keep clean, they
+readily absorb moisture and odors, they cannot well be disinfected, and
+their solid frames prevent a free circulation of air. Moreover, it is
+almost impossible to render fit for use again a wooden bed into which
+vermin have once made their way. Folding beds and lounges even of the
+best type are unhygienic, usually too low for the patient's comfort, and
+often insecure.
+
+A bedstead should be wiped frequently with a damp cloth; if it is of
+enameled iron it may be washed with soap and water. The springs may be
+cleansed with a stiff brush dipped in kerosene oil. Excessive use of
+water upon the springs is likely to make them rust.
+
+MATTRESSES.--Various substances are used in the manufacture of
+mattresses, but nothing has yet been found that is as satisfactory as
+curled hair. It is light and clean and elastic, it does not readily
+absorb odors, and it is easily renovated. Although hair is more costly
+than other materials, a hair mattress may be used almost indefinitely if
+it is occasionally made over.
+
+Felt or cotton mattresses are firm, but heavy, difficult to keep clean,
+and likely to absorb odors. A useful mattress made from straw is
+sometimes found in country districts. Such a bed is thoroughly hygienic,
+for the worn straw may be burned and the tick washed and refilled with
+clean straw; but straw beds are generally hard and lumpy. The least
+desirable of all mattresses is the old fashioned feather bed, and it
+should never be used if a better can by any possibility be obtained; but
+a feather bed should not be arbitrarily taken away from an old person
+accustomed to its use, unless his welfare is really at stake.
+
+A mattress made in two sections is unnecessary for a single bed; indeed,
+a mattress made in one piece is more easily kept in place if the
+patient is restless. A good quality of blue and white ticking makes a
+serviceable cover for both mattress and pillows since its color is not
+likely to run.
+
+CARE OF THE MATTRESS.--A mattress should be brushed frequently with a
+whisk broom, especially around the tufts and edges. If a patient is long
+confined to bed, a fresh one should occasionally be substituted so that
+the regular mattress may be removed, well brushed, beaten with a carpet
+beater, and left exposed to the sun and air for a day or two. A mattress
+that is badly soiled should be sent to a cleaner and made over; it
+cannot be cleaned properly at home. It is generally possible to remove
+blood stains, if they have not soaked through the ticking, by applying a
+thick cream made from raw starch and cold water. When the starch becomes
+dry it should be brushed away, and the application should be repeated
+until the stain has disappeared. For the best results the starch should
+be applied before the stain is dry.
+
+PILLOWS.--One patient can use an almost unlimited number of feather
+pillows. Some should be soft and others firm, some large and some small;
+but pillows that are very large and thick are less useful than a greater
+number of smaller ones. It is well to have several small pillows of
+varying size and thickness to support different parts of the body.
+
+Hair pillows are often acceptable in warm weather, and they are also
+desirable for patients with high fever or excessive perspiration. Rubber
+air pillows are a convenience in traveling and add much to the comfort
+of a patient when he first goes out in a carriage or motor car, but air
+pillows are not sufficiently durable for general use.
+
+If a pillow tick becomes soiled, the feathers may be transferred to a
+clean tick by making an opening about six inches long in the end of each
+pillow, sewing the ticks together, and then shaking the feathers from
+one tick to the other. The soiled tick can then be washed. If the
+feathers themselves have become soiled they should be renovated by a
+cleaner. Pillows, like mattresses, should be frequently brushed, sunned,
+and aired. They should not be held in the mouth while a clean
+pillow-case is adjusted.
+
+PROTECTION OF THE MATTRESS AND PILLOWS.--In all cases of sickness the
+mattress must be adequately protected. Neglect is inexcusable and may
+cause expense and trouble as well as discomfort to the patient.
+
+The following may be used to protect the mattress or pillows: large
+quilted pads, small pads of cotton batting covered with old muslin or
+cheese cloth, slip covers for the mattress, rubber sheets and
+pillow-cases, old blankets and quilts that may be washed easily. Heavy
+wrapping paper, builders' paper, and newspapers serve well in
+emergencies, or for a short time.
+
+RUBBER SHEETS AND PILLOW-CASES.--Soft rubber cloth, single or double
+faced, is most frequently used when it is necessary to protect the bed
+from discharges. It may be purchased by the yard. Rubber sheets should
+not be used unless they are really necessary. They are hot and
+uncomfortable, and increase the tendency to perspire. When used, a
+rubber sheet should be 1 yard wide or wide enough to reach from the
+lower edge of the pillows down to the patient's knees, and long enough
+so that it can be tucked in securely on both sides of the bed. Rubber
+sheets may be cleaned by laying them on a flat surface and washing on
+both sides with soap and water, using a small brush if necessary. After
+rinsing they should be wiped, and when thoroughly dry they should be
+rolled rather than folded, to prevent the rubber from breaking.
+
+Rubber pillow-cases are used for a patient who perspires profusely, or
+who has a discharge of any kind from the head or neck, and also when
+substances which may wet or stain the pillow are applied to the head.
+They should be put on next to the pillow, securely fastened with tapes,
+snap hooks, or buttons, and covered with the regular pillow slip.
+
+Rubber sheets and pillow-cases are not durable. They should be used
+carefully, and frequently examined for holes or worn places by holding
+them up to the light. Even a pin hole near the center may render a
+rubber sheet or pillow-case as useless as a sieve.
+
+SHEETS.--Sheets of ample proportions are necessary for comfort, and
+important for sanitary reasons as well. For a bed of the dimensions
+mentioned in this lesson sheets should be three yards long, and two
+yards wide. A safe rule for any bed is to have the sheets one yard
+longer and one yard wider than the mattress. A sheet of these dimensions
+is large enough to be tucked under the sides and foot of the mattress,
+while at least twelve inches are left to fold over the blankets at the
+top. Cotton sheets are as good as linen for general use, or even better,
+and are far less expensive.
+
+DRAW SHEETS are used to cover rubber sheets, and to protect beds when
+the rubbers are not used. In hospitals special draw sheets are usually
+provided, but an ordinary sheet folded answers every purpose. New and
+expensive sheets should not be used for draw sheets, since they are
+more likely than other sheets to become stained. Draw sheets should be
+wide enough to extend about four inches beyond the rubber sheet at the
+top and bottom.
+
+PILLOW COVERS.--Pillow covers are generally made of cotton, but persons
+who can afford the cost frequently prefer linen, especially in hot
+weather. Unless fastened with buttons or tapes, a pillow case should be
+several inches longer than its pillow. It should be wide enough to slip
+on easily, but not so wide that it wrinkles or allows the pillow to
+turn. If it is too small the pillow will become hard and uncomfortable.
+These small things, unimportant as they are to the well, may cause much
+discomfort to a restless or nervous patient.
+
+BLANKETS.--All wool blankets are both light and warm, and are
+consequently the most comfortable bed covering. But unless they can be
+dry cleaned frequently, it is better to select blankets made from one
+part wool and two parts cotton. Blankets containing equal parts of wool
+and cotton are warmer, but are more injured by washing. Very light
+blankets of wool or outing flannel are useful in summer. Double blankets
+should always be cut in two and bound at the ends, since single blankets
+are easier than double blankets to handle and wash. Patients are
+frequently too warmly covered by day. Too much warmth is enervating, it
+causes the patient to perspire, and makes him restless and more
+susceptible to draughts and to changes of temperature. Two light
+blankets are warmer and more comfortable than one heavy blanket.
+
+COMFORTERS AND QUILTS.--Heavy cotton comforters are burdensome without
+being correspondingly warm. Eiderdown quilts or those padded with wool
+are good for a patient who sleeps out of doors, or whose room is kept at
+a low temperature. Bed covers that cannot be laundered readily should be
+protected by basting on both sides of the top a wide piece of muslin or
+linen, which can be removed and washed.
+
+COUNTERPANES.--White dimity counterpanes are desirable, since they are
+light in weight, easily laundered, and inexpensive. A heavy counterpane
+is uncomfortable at any time, and still more uncomfortable in sickness.
+If a light spread is not available, a sheet makes a good substitute. A
+counterpane should be wide enough to cover the sheets and blankets at
+the sides when the bed is open, and long enough to protect the bedding
+at the top and bottom.
+
+
+BED MAKING
+
+All methods of making beds for the sick are based upon a few underlying
+principles. The aim in every case is to obtain the following results
+with the least expenditure of time and labor: first, to secure comfort
+for the patient, and to eliminate all causes of friction, irritation, or
+pressure upon his skin; next to keep the covers firmly in place, so
+that the bed will not easily become disarranged; then to protect the
+mattress, and last, to secure as good an appearance as possible.
+
+[Illustration: FIG. 12.--THE DRAW SHEET IN PLACE. (_From "Elementary
+Nursing Procedures," California State Board of Health._)]
+
+TO MAKE AN UNOCCUPIED BED, proceed as follows: remove the pillows and
+covers one at a time, and place them on chairs, near an open window if
+possible. Brush the mattress and then set it up on its ends to air, or
+turn it back over the foot board. Wipe the bedstead with a damp cloth.
+Replace the mattress after it has aired, turning it from side to side
+and from end to end on alternate days. Cover the mattress, unless it is
+enclosed in a slip cover, with a white quilted pad or an old blanket,
+and then spread the lower sheet over the mattress, so that the middle
+fold of the sheet lies upon the center of the mattress in a straight
+line from the head of the bed to the foot. Tuck the sheet under, first
+at the top and then at the bottom, drawing it so that it is firm and
+tight. If the sheet is of proper length tuck fourteen or sixteen inches
+under at the top, but take care to cover the mattress at the foot also.
+Next tuck the sheet under at the side, folding its corners to make a
+neat finish like an envelope. Place the rubber sheet, if it must be
+used, across the bed, with its upper edge where the lower edge of the
+pillows will come. A draw sheet somewhat wider than the rubber sheet is
+needed next; an ordinary sheet, folded once the long way of the sheet,
+may be used, with the fold toward the head of the bed. Tuck both rubber
+and draw sheet securely under the mattress at the side. In some cases
+the rubber sheet may be placed next to the mattress, and covered by the
+mattress pad and lower sheet. Place the draw sheet as directed, whether
+the rubber is used or not. After the lower, rubber, and draw sheets have
+been adjusted on one side of the bed, go to the opposite side, draw them
+over smoothly, and tuck them under the mattress as tightly as possible.
+
+Next spread the upper sheet over the bed so that its upper edge reaches
+to the upper edge of the mattress, and its middle crease lies over the
+middle line of the mattress, and place it right side down, so that the
+smooth side of the hem will be uppermost when the sheet is turned over
+the blankets. Place the blankets so that their upper edges lie a little
+higher than the place where the lower edge of the pillow will come, and
+tuck them in firmly at the bottom and sides. If the blankets are not
+long enough to tuck in at the foot, place the lower blanket as directed
+and the upper blanket five or six inches lower than the first. When
+tucked in, the upper blanket holds the lower one in place fairly well.
+Place the counterpane evenly and smoothly, tuck it under at the foot,
+turn its corners neatly, turn its upper edge under the upper edge of the
+blankets and fold the upper sheet down over the whole. Last of all,
+shake the pillows and place them neatly on the bed.
+
+[Illustration: FIG. 13.--THE CLOSED BED. (_From "Elementary Nursing
+Procedures," California State Board of Health._)]
+
+Practice is necessary before it is possible to make a bed quickly and
+well, and a certain amount of proficiency in making an unoccupied bed
+should be acquired before undertaking to make a bed with a patient in
+it. One should learn to work in an orderly way, without confusion,
+unnecessary motion, or jarring of the bed.
+
+TO CHANGE A PATIENT'S PILLOWS.--Stand preferably on the right side of
+the bed and slip the left arm under the patient's shoulders, supporting
+his head in the hollow of the arm. Raise him slightly and remove the
+pillows one at a time with the right hand, drawing them outward on the
+left side of the bed. Place a small pillow under his head. Shake the
+pillows, change the cases if necessary, and replace them on the left
+side of the bed, ready to be drawn back into position. Raise the patient
+as before, remove the small pillow and draw the others into place. It is
+sometimes better to hold the patient on the upper pillow while removing
+and replacing the under one.
+
+LIFTING A PATIENT IN BED.--Patients tend to slip down toward the foot of
+the bed, and they should be raised if unable to help themselves. To
+raise the patient, instruct him to flex his knees and to press his feet
+firmly upon the bed; place one arm under his shoulders, as when
+changing pillows, the other arm under the thighs, and lift him upward
+without jerking. The lifting can be done more easily by two people, and
+with less discomfort to the patient: if he is entirely helpless two
+people are necessary. Two people should proceed as follows: Let _A_
+place her left arm under the patient's head and shoulders as before, her
+right arm under the small of his back; let _B_ place her right arm also
+under the small of his back and her left arm under his thighs, and at a
+signal let them lift together. In this way the weight is so evenly
+distributed that a heavy person can be lifted without great difficulty.
+
+TO TURN A PATIENT IN BED.--A patient may be turned toward or away from
+you. In turning a patient toward you, place one hand over his farther
+shoulder and the other over his hip, and turn him toward you. Then flex
+his knees slightly. To turn a patient from you, pass one hand as far as
+possible under the shoulders, and the other as far as possible under the
+thighs. Then raising the patient slightly, draw him back toward you,
+turning him at the same time, and then flex the knees. Lastly place a
+pillow firmly against his back to support it.
+
+TO CHANGE THE SHEETS WHILE THE PATIENT IS IN BED proceed as follows:
+First collect the fresh linen and place it conveniently near the bed.
+Then draw the bedclothes from beneath the mattress, raising the mattress
+meanwhile with one hand to prevent jarring the bed. Remove first the
+spread and then the upper blanket if there are two, fold each once and
+place it on a chair. Hold the remaining blanket in place with one hand,
+while with the other you draw the upper sheet out from under it; then
+fold the edges of the blanket up over the patient to keep them out of
+the way. The upper sheet, unless soiled, may be folded once and used
+again as a draw sheet. Next remove all the pillows, unless the patient
+prefers to keep one. Then move the patient toward one side of the bed
+and turn him on his side so that he faces the edge nearest him. Roll the
+draw sheet and rubber sheet together if both are to be removed, or
+separately if the rubber sheet is to remain on the bed; then roll the
+bottom sheet throughout its entire length, and bring the three sheets,
+all rolled as flat and as tightly as possible, close to the patient's
+back. Pleat about half of the fresh lower sheet lengthwise and place the
+pleated portion as close as possible to the rolled soiled sheets. Tuck
+in the other half of the fresh sheet at the top, bottom and side, draw
+the rubber sheet if it is to be replaced back over the fresh lower
+sheet, arrange the fresh draw sheet in place, tuck it in at the side,
+and roll its free portion close to the patient's back. The fresh side of
+the bed is then ready for the patient. Lift his feet back over the
+rolled sheets keeping his knees flexed, then turn him back over the
+rolled sheets on to the fresh smooth part, remove the soiled sheets and
+arrange the fresh ones in place on the side where the patient has just
+been lying. Be careful to keep him well covered with the blanket. After
+the lower sheets are in place and firmly tucked in, spread above the
+blanket the fresh upper sheet, and over the sheet spread the second
+blanket. Hold the sheet and blanket in place with one hand while using
+the other hand to draw out the first blanket from beneath the sheet. In
+this way the patient is constantly covered by a blanket. Place the
+blanket just removed above the other and finish the bed according to the
+directions given for an unoccupied bed, using special care, however not
+to draw the covers too tightly over the patient's feet.
+
+[Illustration: FIG. 14.--CHANGING THE DRAW SHEET. (_From Pope "Home Care
+of the Sick," American School of Home Economics, Chicago._)]
+
+TO MOVE A PATIENT FROM ONE BED TO ANOTHER.--On the fresh bed have the
+lower sheets in place but not the upper covers. Place the two beds close
+together side by side, and draw one mattress a little over the place
+where the two sides meet. Loosen the draw sheet under the patient, roll
+it on both sides close to the body and draw him gently over by means of
+this sheet, moving his shoulders at the same time. If the beds are
+unequal in height, use firm pillows or folded blankets to make an
+inclined plane.
+
+[Illustration: FIG. 15.--CHANGING A PATIENT FROM ONE BED TO ANOTHER.
+(_From Pope "Home Care of the Sick," American School of Home Economics,
+Chicago._)]
+
+If the beds differ greatly in height and indeed in most cases, it is
+better to carry the patient from one bed to the other. At least two
+people are needed; one alone should never attempt to carry anyone
+heavier than a small child. One method for lifting is as follows: Let
+two bearers, _A_ and _B_ stand on the same side of the bed. If the
+patient is to be moved into the right side of the fresh bed let both
+bearers stand on the right side of the occupied bed; if he is to go into
+the left side of the fresh bed, let them both stand on the left side of
+the occupied bed. Let _A_ place one arm under the patient's shoulders
+and her other under the small of his back, while _B_ places one arm
+under his hips and the other just below his knees. Draw the patient to
+the edge of the bed, instruct him to place his arms about the shoulders
+of _A_ and to hold the body rigid, and then lift together at a given
+signal, keeping his weight well up on the chests of the bearers.
+
+Whenever a patient must be turned, lifted, carried, or moved in any way,
+let him know beforehand just what you intend to do so that he may not be
+startled, and also that he may cooperate if possible. Grasp him firmly
+but gently, avoid pinching the skin, and move him steadily and
+smoothly, avoiding jerks and false starts. Do not attempt alone more
+than your strength is amply sufficient to accomplish, and endeavor at
+all times to handle the sick with the utmost gentleness and
+consideration.
+
+
+EXERCISES
+
+1. Describe a bedstead and mattress suitable for a sick person's use,
+and tell why they are to be preferred.
+
+2. How should the bedstead be cared for? the mattress? the pillows?
+
+3. How should a mattress and pillows be protected?
+
+4. Describe in detail the bed covers that are desirable for use in
+sickness.
+
+5. Name the results that a good method of bedmaking aims to secure.
+
+6. Describe the method of making an unoccupied bed.
+
+7. How should one change the pillows of a helpless patient?
+
+8. Describe the way in which you would lift and turn a patient in bed.
+
+9. Describe the method of changing sheets and remaking a bed while the
+patient is in it.
+
+10. Why are beds and bedmaking considered so important in the care of
+the sick?
+
+
+FOR FURTHER READING
+
+Notes on Nursing--Florence Nightingale, Pages 79-84.
+
+
+
+
+CHAPTER VII
+
+BATHS AND BATHING
+
+
+Bathing is necessary in sickness no less than in health. It stimulates
+and equalizes the circulation, is soothing in feverish conditions, is
+refreshing to most people, and by affording a certain amount of exercise
+it lessens the fatigue of lying in bed. Moreover, without frequent
+bathing it is impossible to keep the skin in good condition, since
+scales of dead skin, oily matter, and solid substances left by
+perspiration collect on the surface of the body when a person is lying
+still in bed as well as when he is leading an active life. The common
+belief that sick people are likely to catch cold from bathing is quite
+unfounded; every patient, unless his condition is such that the doctor
+orders otherwise, should have one complete cleansing bath each day. In
+addition to the regular cleansing bath other kinds are often prescribed
+as medical treatment.
+
+
+CLEANSING BATHS
+
+A _tub bath_ if allowed by a patient's condition, is the most
+satisfactory kind, but special precautions must be taken to guard her
+from fatigue and chill. The bath room and everything to be used should
+be made ready before she leaves her bed. Necessary clothing and toilet
+articles should be collected and arranged conveniently, a chair covered
+with a blanket and also a bath mat should be placed beside the tub, and
+the temperature of the bath room should be regulated so that it is about
+70 deg. F., or a little lower if the room is likely to become overheated
+as the bath proceeds. The bath water should be drawn last. Its
+temperature, tested by a thermometer, should be between 96 deg. and 100
+deg. at the beginning, and may be increased if desirable.
+
+If the patient is weak, wash and dry her face, neck, and ears, and if
+necessary cut the finger and toe nails before she leaves the bed, in any
+case before she enters the tub. As soon as the patient has left the bed,
+strip it and leave it to air; then assist her into the bath room and
+help her carefully into the tub. Do not allow her to stay in the water
+more than ten minutes at most, and stop the bath at once if she shows
+the slightest sign of faintness, dizziness, exhaustion, difficult
+breathing, marked change of color, or other unusual symptom. Indeed, if
+the patient is weak or her reaction to the bath uncertain, as when she
+takes her first tub bath after an illness, someone should always be
+within call to help the attendant in case of need. A faint, heavy
+patient in a bath tub is an impossible load for one person to handle.
+
+While the patient is in the tub, soap her well, brush her finger and toe
+nails, rinse, and rub her to stimulate the circulation. Then help her
+from the tub, seat her in the chair, draw the blanket closely about her
+from neck to feet, dry her with warm towels, exposing the body as little
+as possible, and, if she is to return to bed, put on a fresh night gown,
+and wrapper and slippers. Next place the lower sheet, the draw sheet,
+and one pillow on the bed as quickly as possible, help the patient into
+bed, keeping her well covered with a blanket, and finish making the bed.
+If she seems chilly, give a hot water bag and hot drink and leave the
+blanket next her in place. After the patient has been made comfortable,
+clean the tub and put the bath room in order.
+
+Even patients supposedly able to take tub baths without assistance
+should not lock the bath room door nor be left alone a long time.
+
+BED BATH.--Practice is essential in order to give a bed bath skillfully.
+The aim is to make the patient thoroughly clean and thoroughly dry,
+without chilling, fatiguing, or exposing her, without making the bed
+damp, and without unnecessary haste or delay. One method of giving a
+bed bath follows, but any method that accomplishes these aims is likely
+to be satisfactory.
+
+First see that the room is about 70 deg. F. and likely to remain so, and
+exclude draughts. Collect everything to be used, including a blanket to
+cover the patient, an old blanket or large bath towel to protect the
+bed, at least two other towels, one a bath towel and the other a face
+towel, two wash cloths, soap, nail brush, powder, alcohol, comb and
+brush, nail file, scissors, etc.; fresh bed and personal linen; a large
+basin containing water at 105 deg., a jug of hotter water, and a slop
+jar. Remove the upper bed clothes except one blanket, which should cover
+the patient constantly during the bath, and spread them where they will
+air; remove all the pillows but one, and place the bath blanket under
+the patient as the under sheet is placed in bed making. If a bath
+blanket is not used, keep the bath towel under the part that is being
+bathed by moving the towel from place to place.
+
+Next remove the night gown in the following way: Let the patient lie on
+her back, with her knees flexed; draw the gown up as far as possible,
+then raise or get her to raise her hips so that the gown may be drawn up
+above the waist. Next raise her head and shoulders with one arm and draw
+the night gown up to the neck with the other; remove one sleeve, draw
+the gown over the head and then off the other arm.
+
+[Illustration: FIG. 16.--WASHING A PATIENT WITHOUT EXPOSURE. (_Sanders
+"Modern Methods in Nursing."_)]
+
+The patient is now ready for the bath. Wet the wash cloth thoroughly,
+but hold it gathered in the hand so that it will not drip. Wash the
+face, neck, and ears first, dry them thoroughly, and next, using the
+second wash cloth, wash the arms and hands, chest and abdomen, giving
+particular attention to the armpits and navel. Raise the blanket
+slightly with one hand to keep it from becoming damp, but expose the
+patient as little as possible; the arms and legs need not remain covered
+while being washed. Dry each part thoroughly before washing the next.
+Next turn the patient on her side and wash the back, the buttocks, and
+upper part of the thighs; give special attention to the fold between the
+buttocks. Then turn the patient on her back, and wash the thighs, legs,
+and feet. If it is important to move the patient as little as possible,
+leave the back until last so that the under sheet may be changed without
+turning her again. Cut the toe nails if necessary before washing, and
+clean them carefully afterward. Unless there is a reason to the
+contrary, wash the hands and the feet in the basin, first protecting the
+bed with a towel, newspaper, or clean wrapping paper. Be sure to clean
+well between the toes, and to dry the feet thoroughly; they may need
+some friction. Throughout the bath empty and refill the basin as
+necessary.
+
+Wash the genital region last. Let the patient lie upon her back with
+knees flexed and separated, or upon one side with the knees flexed and
+one slightly raised. Patients who are able may take this part of the
+bath themselves with whatever assistance may be necessary. The
+attendant, however, must either do it herself or make sure that the
+patient does it thoroughly. To neglect a helpless patient is always
+unkind, and no less unkind when the motive is a mistaken sense of
+modesty. If discharge from the genitals is present use absorbent cotton,
+or clean, soft old cloth to wash the parts, and burn it afterward. It is
+sometimes desirable to place the patient on a bedpan and rinse the parts
+by a gentle stream of warm water poured from a jug. After the attendant
+has completed this part of the bath she should wash her own hands
+thoroughly.
+
+After the bath rub the patient with alcohol. If a complete alcohol rub
+is impossible, at least rub the points where pressure comes, especially
+the back. After the rub apply a little toilet powder if the patient
+desires it. When the toilet is complete remove the bath blanket, remake
+the bed and put the room in order.
+
+CARE OF THE MOUTH AND TEETH.--In sickness the mouth and teeth require
+more than ordinary attention; indeed, the condition of a patient's mouth
+is a fair index to the quality of the care she is receiving. If the
+patient can brush her own teeth she should do so in the morning, at
+night, and after meals. At those times the attendant, without waiting to
+be asked, should bring her a towel, tooth-brush, cup of tepid water,
+tooth paste or powder, and a small basin or dish to receive the used
+water. The process is generally more thorough when the patient does it
+herself, and even a patient unable to sit up can brush her teeth
+successfully if the nurse holds the powder and cup of water, and
+provides a basin shallow enough for the patient to use by turning her
+head to one side.
+
+[Illustration: FIG. 17.--THE NURSE ASSISTING THE PATIENT IN BRUSHING THE
+TEETH. (_From "Elementary Nursing Procedures," California State Board of
+Health._)]
+
+The attendant must cleanse the mouth of a patient who is unable to do it
+herself. If this cleansing is neglected, a dark tenacious substance
+collects upon the teeth and gums, composed chiefly of food particles,
+bacteria, mouth secretions, and worn out cells of the mucous membrane.
+Once formed it is difficult to remove, hence the mouths of all patients
+and especially those who have fever, must receive proper care from the
+very beginning of illness. Cotton swabs are convenient for cleansing the
+mouth; they are made by winding a small piece of absorbent cotton upon a
+match or wooden tooth-pick.
+
+To cleanse the mouth of a helpless patient, take to the bedside the
+mouth wash prescribed by the doctor, a towel to protect the bedclothes,
+several swabs, and a receptacle for used swabs; the latter should be a
+strong paper bag or several thicknesses of newspaper. Clean the tongue,
+gums, teeth, and spaces between the teeth gently but thoroughly, using
+especial care if the gums are tender. Dip only clean swabs in the
+solution, discard each one after using it once, and burn it afterward.
+Let the patient rinse her mouth after cleansing it if she is strong
+enough. If the mouth is very dry, encourage her to drink more water.
+Notify the doctor if the gums and tongue crack or bleed since he may
+wish to order a special mouth wash. Cold cream or boracic ointment may
+be used if the lips are dry and cracked.
+
+False teeth should be thoroughly brushed and cleansed, and kept in cold
+water if taken out during the night.
+
+CARE OF THE HAIR.--Long hair, if neglected, becomes tangled and matted
+in a surprisingly short time. Unless the patient is actually in a dying
+condition she is not too sick to have it properly attended to at least
+once a day. Before combing the hair protect the pillow with a towel;
+then part the hair in the middle from the forehead to the nape of the
+neck, and draw it to either side. Begin to comb at the ends, holding the
+strand of hair firmly in one hand placed between the head and the comb;
+in this way tangles can be removed without hurting. After combing and
+brushing the hair, braid it in two braids, beginning near the ears; draw
+it as tightly or loosely near the head as the patient prefers, but
+remember that tight braids mean fewer tangles. If the hair is heavy or
+badly tangled the patient may be too much fatigued to have it all combed
+at one time; in this case braid the part that has been finished and
+complete the work later.
+
+TO WASH THE HAIR OF A BED PATIENT.--The hair of a patient can be
+successfully washed in bed if sufficient care is taken not to chill or
+tire the patient, or to wet the bed. The following articles are needed:
+one small jug of strong soap suds made by dissolving a pure soap in hot
+water, one large jug of hot water at about 112 deg. F., one jug of cold
+water, a slop jar or foot tub, one long rubber sheet or piece of enamel
+cloth, and several towels including at least one bath towel. Let the
+patient lie as near the edge of the bed as possible. Roll one small
+towel lengthwise, place it below the hair at the back of the neck, bring
+it up above the ears to the forehead and pin tightly, in order to catch
+water that might wet the face and neck. Next make a kind of trough of
+the large rubber by rolling its long edges inward for a few inches.
+Place this across the bed under the patient's head so that her neck
+rests on the lower roll. Raise by means of pillows the end of the rubber
+trough that lies toward the middle of the bed, in order to prevent water
+from running into the bed or collecting under the patient's head. Let
+the other end of the rubber extend over the edge of the bed down into
+the slop jar or foot tub, which may be placed on a chair or stool. Then
+wash the hair and scalp with the soap solution, and rinse them
+thoroughly with water from the large jug. Squeeze as much water as
+possible from the hair, remove the rubber and substitute a heavy bath
+towel, and rub and fan the hair until dry. A shampoo in bed is tiring.
+Do not attempt it unless the patient is strong enough to stand not only
+the shampoo itself, but also a complete change of bed clothing, which
+will almost certainly be necessary if the attendant has been careless or
+clumsy in the slightest degree.
+
+HOT FOOT BATHS properly speaking are medical treatment, but they are
+taken by many persons to relieve colds, headache, or insomnia. Let the
+patient sit, well wrapped, with her feet in water at about 105 deg., and
+then increase the temperature gradually by adding hotter water. Take
+care to add hot water slowly and not to pour it directly upon the
+patient's feet or ankles; otherwise she may be scalded. Mustard may be
+added to the bath water in the proportion of one tablespoonful of
+mustard to each gallon of water. If mustard is to be used make it into a
+smooth paste with cold water, thin the paste with warm water, and when
+thin enough to pour easily add it to the bath water and stir well. The
+bath may continue for 10 to 20 minutes, and the feet should be dried
+afterward without friction. The patient should go to bed at once; she
+should not wander about, clearing away her foot bath, doing forgotten
+things, getting herself chilled, and losing all the good effects.
+
+A foot bath may be given easily to a patient in bed. Bring to the
+bedside a blanket, a towel, the tub filled with water, and something
+with which to protect the bed; this may be a rubber sheet, bath towel,
+old blanket folded, or several thick clean newspapers. Loosen the upper
+covers at the foot of the bed, fold them back above the patient's knees,
+and cover her legs and feet with the extra blanket making it overlap the
+bed clothing so that it will not slip. Flex the patient's knees, put the
+bed protector under her feet, place the tub on the side of the bed,
+raise the legs and feet with one hand and arm, and slide the tub into
+place with the other, raising the elbow in such a way that it keeps the
+blanket out of the water. Lower the feet slowly into the water, fold the
+towel, and place it over the edge of the tub in order to protect the
+patient's knees from the cold rim; then tuck the blanket closely about
+the tub and legs and proceed as before. After the bath use the towel,
+unless it is wet, to receive the feet when they are withdrawn from the
+tub. Remove the tub, dry the feet thoroughly, cover them warmly, and
+remake the bed.
+
+COOL SPONGE BATH.--For feverish patients doctors often order cool sponge
+baths. In order to give a cool sponge bath, first protect the bed
+thoroughly, but leave the patient uncovered except for a towel laid over
+the hips. Use cool water, or cool water and alcohol, and have the wash
+cloth as wet as it can be without dripping. Bathe the body without
+friction, using long, light strokes, and leave each part wet until the
+bath has been completed. Do not use soap. Sponge in this way the arms,
+legs, chest, and back, but not the abdomen, for ten to twenty minutes,
+giving special attention to the neck and inner side of the arms and
+legs, because in those places large blood vessels lie nearer the surface
+of the body. After finishing the bath dry the body by patting it gently
+with towels.
+
+Take the patient's pulse occasionally during the bath, and stop the bath
+at once if the patient's pulse grows weaker, if she shivers violently,
+or if her face, fingers, or toes turn a bluish color. Babies react
+rapidly to cool sponging; for a baby use tepid water, sponge for five
+minutes only, and watch the child closely during the bath.
+
+
+EXERCISES
+
+1. What may a bath be expected to accomplish in addition to cleansing?
+
+2. In giving a tub bath, what precautions should be taken to avoid
+chilling the patient? to avoid tiring the patient?
+
+3. What symptoms would lead you to think that a tub bath was not
+agreeing with a patient? What should you do in such a case?
+
+4. Name six essentials of a skillfully given bed bath.
+
+5. What preparations should be made and what articles assembled before
+beginning a bed bath?
+
+6. Describe the method of bathing a patient in bed.
+
+7. What care should the mouth and teeth of every sick person receive?
+How should such care be given to a patient who is helpless?
+
+8. Describe the daily care of a patient's hair, and tell how a shampoo
+may be given to a patient in bed.
+
+9. How should you give a mustard foot bath to a patient in bed?
+
+10. When and how should you give a cool sponge bath?
+
+
+FOR FURTHER READING
+
+The Human Mechanism--Hough and Sedgwick, Chapter XI.
+
+
+
+
+CHAPTER VIII
+
+APPLIANCES AND METHODS FOR THE SICK-ROOM
+
+
+Patients who are confined to bed even for a few days often suffer
+acutely from muscular tension, from pressure, and from fatigue due to
+lack of exercise. Indeed, many a sick person is surprised to find that
+the bed which had seemed so infinitely desirable can change into a place
+of torment after a few short days of illness. "Bed-weariness" is hard to
+bear in any case of illness, but it is doubly hard for persons who are
+really helpless.
+
+Unless the patient is an experienced sufferer he often has no idea what
+should be done to make him comfortable; while an equally inexperienced
+helper, though full of good will, is often discouraged to find that the
+arrangement she had thought perfect soon fails to satisfy her restless
+patient. But if she is willing to devote thought and ingenuity to
+removing small annoyances, she can do many things to alleviate his
+misery.
+
+BED SORES, or pressure sores, are caused by continued pressure upon the
+skin. The weight of the body, or of a part of the body, if it comes for
+a long time upon one place finally interferes with the circulation in
+the tissues on which the part rests, and consequently interferes with
+the nutrition of the affected part. Any tissue to which the blood is not
+bringing all its necessary food supply tends to lose its tone, to become
+weak, and if the condition persists, to break down altogether.
+
+The direct cause of bed sores then is pressure, and pressure is
+aggravated by moisture, wrinkles in the bed clothes, crumbs or other
+hard particles, lack of cleanliness, friction of any kind, or by rough,
+careless handling. Bed sores occur most often over bony prominences,
+such as the end of the spine, elbows, heels, shoulders, hips, ankles,
+and knees, but they may form anywhere, even on the ears or back of the
+head. They are more likely to appear on thin, aged, or depleted
+patients. These painful and serious sores can be prevented almost always
+by faithful care. When they occur, they result in the great majority of
+cases purely from negligence, and a person who knows the danger and yet
+through carelessness allows one to develop upon a patient may justly
+feel herself disgraced.
+
+Prevention of bed sores depends upon keeping the skin dry and clean and
+upon relieving pressure by special devices and by turning the patient
+frequently. The parts where pressure comes should be washed at least
+twice daily with warm water and soap, rubbed frequently with alcohol to
+improve the circulation and to keep up the tone of the skin, and
+powdered with a little good toilet powder. Much powder is likely to do
+harm by collecting in hard, irritating particles. The bed should be kept
+constantly dry and smooth, and free from crumbs, lumps, wrinkles, or
+other inequalities. Prolonged pressure should be relieved by turning the
+patient often,--once every waking hour is not too often if the body is
+emaciated,--and by pillows, pads, and rings.
+
+Small pillows or thick pads of cotton should be placed under the
+patient's back and shoulders, between the knees and ankles when he lies
+on his side, and in other places where sores are likely to develop.
+Rubber rings are useful, but few patients like them for a long time.
+They should not be inflated more than necessary to raise the affected
+part from the bed; if much inflated, they are uncomfortable and may do
+harm. The ring may be covered with a muslin pillow case, or it may be
+wound smoothly with long strips of bandage or old muslin. Ordinary
+cotton batting wound with strips of muslin may be made into rings and
+used to remove pressure from heels, elbows, or other parts. These cotton
+rings are less heating than pads, and give better support.
+
+The first sign of a bed sore is either redness of the skin or a dark
+discoloration like a bruise. Every point where a bed sore may form
+should be inspected daily. If the slightest symptom of a sore appears,
+the patient must not lie on the affected part, and every effort should
+be made to keep the skin from breaking; vigorous rubbing at this stage
+is dangerous, and will by no means make up for previous neglect. The
+condition should be reported to the doctor at once. If in spite of all
+efforts the skin does break, a peculiarly difficult kind of open wound
+results which must be treated and dressed according to the doctor's
+directions.
+
+DEVICES TO GIVE SUPPORT.--The variety and number of pillows one patient
+can use is almost unlimited. A weak patient when lying on his side
+should have his back supported by a pillow. When he lies on his back a
+pillow should be placed under his knees to lessen muscular tension, and
+if he may be raised in bed, several pillows are needed to support him
+comfortably. A back rest is useful for a patient who can sit up in bed.
+Satisfactory back rests of several types can be purchased, or one may be
+improvised from a straight chair placed on the bed bottom side up, so
+that its legs lie against the head of the bed and its back forms an
+inclined plane. Back rest and chair alike should be covered by several
+pillows to make them comfortable, and other pillows should be used to
+support the patient's arms.
+
+A person who is sitting up in bed always tends to slip down toward the
+foot. This tendency may be corrected by using a foot rest, knee pad, or
+pillow. A hard pillow may be placed in the bed at the foot for the
+patient to brace his feet against; or a short board, well padded, may be
+arranged as follows for the feet to rest against: Fasten ropes to the
+board, as the ropes of a swing are fastened to the seat; set the padded
+board on edge at a convenient point below the patient's feet, and hold
+it in place by tying the ropes of the "swing" to the head of the bed. A
+pillow may be used in the same way, either at the feet or under the
+knees, by folding it over a long strip of muslin, the ends of which are
+then tied to the sides of the bed, brought up to the head, and there
+tied to prevent slipping. A cylindrical cushion six or eight inches in
+diameter and as long as an ordinary pillow, stuffed with firm material,
+may also be used for this purpose. It should be held in place by strips
+of strong muslin or ticking sewed to the ends of the cushion and tied to
+the head of the bed. The cushion should have a washable cover.
+
+[Illustration: FIG. 18.--SHOWING FOOT-SLING FOR SUPPORTING PATIENT IN
+THE UPRIGHT POSITION. (_Sanders "Modern Methods in Nursing."_)]
+
+Supports called _bed cradles_ are used to keep the weight of the bed
+covers from sensitive parts of the body, generally the feet or abdomen.
+They are semi-circular pieces of wood or iron fastened together so that
+they will stand up. A satisfactory cradle may be improvised as follows:
+Cut a barrel hoop in two, cross the halves at right angles and tie them
+together firmly; place the cradle over the affected part under the bed
+clothes. A smaller cradle may be made by taking sections that are less
+than half of the barrel hoop. If used for one foot only, the cradle
+should be small enough not to interfere with the motion of the other
+foot; if used for both feet, it should be large enough to allow some
+freedom of motion. Since the cradle leaves an air space, the feet should
+be wrapped in a piece of soft flannel. A cradle used for the protection
+of the abdomen should extend a little beyond the body on each side.
+
+[Illustration: FIG. 19.--ADJUSTABLE BED REST.]
+
+Adjustable tables are convenient for patients who are able to sit up in
+bed. These tables are supported on one side only so that they may extend
+over the bed. Another kind of bedside table has short legs and stands
+directly on the bed. Such a table can easily be made at home from a wide
+board with supports six or eight inches high nailed to each end. A lap
+board supported by heavy books may serve for temporary use. Indeed,
+home-made substitutes are often as good as expensive apparatus or even
+better. If sick-room appliances must be bought, it is well to remember
+that simple standard designs are best. Complicated apparatus is soon out
+of order, and is generally a trial both to the patient and to those who
+must adjust it. Persons taking care of chronic patients may often obtain
+valuable suggestions in regard to appliances by consulting a visiting
+nurse or the superintendent of the local hospital.
+
+[Illustration: FIG. 20.--ADJUSTABLE TABLE.]
+
+BEDPANS are utensils to receive bowel and bladder discharges of patients
+lying in bed. Enamel bedpans are better than porcelain, although more
+expensive. The shape known as the "Perfection" is best for general use.
+A "slipper" bedpan, although harder to clean and ordinarily less
+comfortable, may be preferable if it is especially difficult or
+undesirable to raise the patient. The square or douche pan is preferred
+by some people, and is especially useful when the quantity of discharge
+is large, as after an injection.
+
+When a patient asks for the bedpan it should be brought if possible
+without a moment's delay, not only because no other form of neglect
+makes a patient realize her helplessness more acutely, but also because
+the desire to use it often passes quickly and delay may encourage the
+habit of constipation. If the patient does not ask for the bedpan, the
+attendant should offer it at suitable times. Bedpans should be warmed
+before use. An easy way to warm one is to let hot water run over it; the
+outside should afterward be dried.
+
+To place the bedpan, first flex the patient's knees and push the night
+gown up; place one hand under the patient's hips, raise them slightly,
+and with the other hand slip the pan into place. If the patient is
+entirely helpless two persons are needed to lift her. Place a pad or
+folded cloth between the patient's back and the pan; then lower the
+patient gently. Before removing the pan, bring toilet paper, water and
+two pieces of soft old muslin or gauze. A patient, if able, prefers to
+use the toilet paper without assistance; her hands should afterward be
+thoroughly washed. If she is unable, the attendant must do everything
+needed. After the patient has been cleaned as thoroughly as possible
+with paper raise her hips with one hand and then remove the pan; it is
+important to raise her first because the skin often adheres and may be
+injured if the pan is suddenly pulled away; carelessness in managing the
+bedpan has caused more than one bed sore. Then remove the pan with one
+hand and cover at once. Turn the patient, if helpless, on her side, wash
+the parts with one piece of old muslin, thoroughly dry them with the
+other, and either burn or thoroughly wash both pieces afterward.
+
+Empty the bedpan and clean it at once; ordinarily one can clean it
+without wetting or soiling the hands. Use cold water first, removing all
+adhering solid particles with a tightly rolled piece of toilet paper. Do
+not use a brush for this purpose. After using cold water, rinse the pan
+thoroughly in hot water, and at least once a day wash it well in hot
+soapsuds. Directions for disinfecting the pan will be given later, but
+remember that a properly kept pan needs no deodorant solution. Glass
+urinals should be provided for men, and kept clean in the same way.
+Contents of both bedpan and urinal should always be carefully inspected;
+neither should be emptied in the dark.
+
+
+DAILY ROUTINE IN THE SICK-ROOM
+
+Obviously the routine of a patient's day must vary according to her
+condition, her preferences, and the amount of time the attendant has to
+give her. The temperature, pulse, and respiration must be taken and all
+medicine, nourishment, and treatment given at the exact times ordered,
+but the attendant should learn whether or not the doctor wishes her to
+wake the patient for food or treatment. Good management in the sick-room
+depends upon foresight and planning, and therefore it is well to keep in
+mind the following suggestions:
+
+Vitality is lowest in the early morning, hence baths and treatments,
+especially if they are fatiguing or painful, should if possible be left
+until after breakfast. Patients often wake early and wait, weak and
+miserable, for the day to begin. A hot drink at this time may give
+relief and enable the patient to sleep again. Even though breakfast time
+is near, nourishment should be given as soon as the patient wakes. She
+may not admit that she is hungry, but her nourishment should not be
+delayed until the family breakfast is ready, or still worse, finished.
+
+Before breakfast the bedpan should be offered, the patient's face and
+hands should be washed, her teeth brushed, her hair tidied, the bed
+straightened, and the room put in order. These services should require a
+few minutes only. The room if properly arranged at bed time needs only a
+little attention now unless untidy work has gone on during the night;
+disorder in a sick-room is as unnecessary in the early morning as at any
+other time.
+
+After the patient has finished her breakfast she may rest, or if
+allowed, read her mail or the newspaper while the attendant prepares for
+her day's work; about an hour after breakfast the patient should be
+bathed, unless she prefers her bath in the evening. After the bath some
+form of light nourishment should be given, even to a patient who has
+regular meals. If a patient is able to sit up in a chair, the best time
+for her to do so is generally just after the bath and toilet have been
+completed; but if she feels tired she had better wait until afternoon.
+The bed room can be better aired and cleaned if it is possible to take
+her into another room; and she herself generally profits by a change of
+scene.
+
+The doctor should definitely state when and for how long a patient may
+sit up for the first time after an illness, and an amateur who may be
+ignorant of the dangers involved should not assume the responsibility of
+deciding. When a patient is to sit up for the first time, put on her
+stockings, slippers, and wrapper before she leaves the bed. Arrange an
+arm chair with pillows in the seat and at the back, bring it close to
+the bedside and cover it with a large blanket unfolded. The chair may
+face either the head or the foot of the bed. Help the patient to a
+sitting position on the extreme edge of the bed, with her feet hanging
+down. Next, standing in front of her and supporting her well, let her
+slip down until she stands upon her feet, then let her turn, and gently
+lower her into the chair. See that the patient while sitting up is
+warmly covered, and that her foot-stool, pillows, etc., are adjusted
+comfortably. Move her chair so that the outlook may be as interesting as
+possible, and at least a little different from the view from the bed.
+Most patients like to look out of the window; children and old people
+enjoy it particularly.
+
+If the patient shows signs of fatigue, she should go back to bed even
+before the appointed time. To help her back to bed, reverse the process
+of helping her out. A footstool may be needed if the bed is high, or
+two people to lift her if she is weak or heavy. When a patient is in bed
+no one should ever sit on the bed, lean against it, use it as a table
+for folding linen, making pads, etc., take hold of the bed posts in
+passing, or touch the bed unnecessarily in any way.
+
+The best time for visitors is the last of the morning or the early
+afternoon. A judicious visitor may do an immense amount of good,
+especially to a chronic patient; indeed, she may be the only ray of
+light in a dark day. Subjects of conversation should be pleasant, but
+not too stimulating or exciting. The visitor should be prepared to carry
+the burden of the conversation, to drop topics skillfully that seem to
+involve fatigue or excitement, and either to go or to stop talking if
+the patient seems tired. Visitors should remember to talk naturally and
+cheerfully on ordinary topics, and to avoid excessive sympathy and
+labored attempts to cheer the patient. They should also remember that
+few patients bear well even the mildest forms of teasing. The patient's
+room is not the place to discuss personal or family troubles; yet it is
+only too often chosen for such purposes, probably because the complainer
+knows that in it an audience is always to be found.
+
+Visitors not belonging to the family should not be present in the
+sick-room during treatment of any kind, unless their help is required;
+neither, as a rule, should they stay during the patient's meals. A
+member of the family may stay with advantage if the patient tires of
+eating alone, but casual visitors almost invariably offend by undue
+urging if the patient's appetite is poor, or by facetious remarks if it
+is good.
+
+Ordinarily only one visitor should be admitted at a time, since a weak
+patient may be tired merely by looking from one to another. If it is
+desirable to limit the call, the attendant should tell the visitor
+beforehand how long to stay, or arrange a signal for the visit to end.
+To announce baldly in the sick-room that the patient is tired and the
+visitor must go, will only elicit aggrieved protests from both. In
+illness lasting only a day or two all visitors should be discouraged;
+during colds, because they are communicable; during general fatigue,
+headaches, digestive upsets, and painful menstruation, because rest and
+quiet are highly desirable. Visitors at such times too frequently give
+injudicious sympathy, and may actually delay the recovery of patients
+who enjoy playing the role of interesting invalid.
+
+The time when a trustworthy visitor is present may be the best time for
+the attendant to rest. The patient should be told when the attendant is
+going, and approximately when she will return. It is a mistake to slip
+away while the patient sleeps; she seldom fails to wake before the time
+scheduled and to resent the desertion. Surprises of any kind, pleasant
+or unpleasant, are seldom good for patients.
+
+Toward the end of the afternoon the patient is probably tired,
+especially if she has not slept during the day. When fever is present
+her headache and restlessness increase as the day goes on, but it should
+be remembered that uncomfortable beds and too heavy covers cause much of
+the restlessness attributed to fever. Rubbing the back and legs with
+alcohol, giving a tepid sponge bath, remaking the bed or changing her
+position may help to soothe her.
+
+The evening should be kept free from excitement, and every possible
+effort should be made to encourage sleep. It is a mistake to think that
+a better night results from keeping a sleepy patient awake all the
+evening; sick people should sleep when they can. Just before bedtime the
+attendant should prepare her own cot, and then make the following
+preparations for the patient to sleep: wash the patient's face and hands
+or give a sponge bath if it is desired, brush the hair, change the night
+gown, brush crumbs from the bed, tighten the sheets or remake the bed if
+necessary, rub the back and other pressure points with alcohol, shake
+the pillows, give liquid nourishment, preferably hot, cleanse the mouth,
+and give the bedpan. See that the patient's feet are warm, the bed
+covers right, the room ventilated properly and in good order, and the
+light extinguished or arranged for the night. If the patient is inclined
+to be wakeful a hot foot bath may help her, or sponging the entire
+length of the spine for fifteen minutes, using very hot water and long
+downward quiet strokes. No conversation should be encouraged during
+preparations for the night. Patients in bed all day often lose the habit
+of sleeping at the regular time, and lie awake far into the night from a
+vague feeling that someone else is coming or something further is to be
+done for them. Consequently last of all ask the patient if she wants
+anything more; if not, say good-night, go out and stay out, at least
+until she has had a chance to go to sleep. She is thus helped to realize
+that nothing further is likely to happen, and that it is time to go to
+sleep.
+
+Toward morning the patient grows weaker. More bed covers will probably
+be needed, and they may often be added without waking her. Night at the
+best is a dreary time for the sick. Pain and weariness and
+discouragement are less bearable in the darkness; nervous fears and
+morbid fancies defy control. Never is kindness more needed or more
+appreciated than it is by those who lie awake and watch for the morning.
+
+
+EXERCISES
+
+1. Name all the causes, direct and indirect, of pressure sores.
+
+2. Why are pressure sores generally more serious than injuries of equal
+extent to the skin of a well person?
+
+3. Where are pressure sores most likely to occur and what are their
+symptoms?
+
+4. What measures should be employed to prevent pressure sores?
+
+5. Describe ways to support a person lying down in bed.
+
+6. Describe ways to support a person sitting up in bed.
+
+7. How may the weight of the bedclothes be removed from any particular
+part of the body?
+
+8. How should a bedpan be cared for?
+
+9. Describe in detail a day's routine either of yourself the last time
+you were ill in bed, or of another patient personally known to you.
+Could the plan of the day have been improved, and if so, in what ways?
+
+
+
+
+CHAPTER IX
+
+FEEDING THE SICK
+
+
+Substances used for food are generally grouped into three classes,
+called the three nutrients. The nutrients are: first, the proteids or
+nitrogenous substances, which are found in meat, fish, eggs, milk,
+cheese, peas, beans, etc.; second, the carbohydrates, which include
+sugars and starch; and third, the fats, which are found in butter, oil,
+the fat of meat, etc. In addition to the nutrients, water and certain
+mineral salts are essential to life, while some indigestible material
+like the fibre of vegetables is needed to give bulk and to stimulate the
+action of the intestines.
+
+The nutrients furnish the body with materials for growth, and for repair
+of tissues worn out by use; they also furnish fuel substances from which
+the body obtains its heat and its energy. All three nutrients can serve
+as fuel, but the proteids alone can furnish materials for growth and
+repair of tissues. In order to be used by the body for any purpose,
+nutrients must first go through a series of complicated changes known as
+digestion, which renders them soluble so that they can soak through the
+walls of the intestine.
+
+
+THE DIGESTIVE PROCESS
+
+Digestion begins in the mouth. There the food is crushed and its fibres
+separated by the teeth, it is moistened by the saliva, and substances in
+the saliva begin a chemical action upon the starch. Chewing should be
+sufficient to reduce the food to a soft mass well moistened with saliva.
+Slow eating is desirable, but the emphasis should be placed on thorough
+chewing. For instance, long intervals between bites are of no special
+benefit if mouthfuls of food are washed down by swallows of water.
+
+After it has been swallowed, the food passes into the stomach and
+remains there for a variable length of time, while it undergoes further
+preparation for absorption. It is moved about by the contraction of the
+muscular walls of the stomach, so that it becomes mixed with the stomach
+juices and more thoroughly softened. Some digestion of proteids goes on
+in the stomach, and a little absorption through the walls.
+
+Little by little the food is discharged from the stomach into the small
+intestine, and the most important part of digestion then begins. It is
+acted upon chemically by a fluid flowing into the intestine from an
+organ called the pancreas; this pancreatic juice acts upon all three
+nutrients and is of great importance in the digestive process. The bile
+and other juices that flow into the intestine perform important
+functions also.
+
+The food masses are moved along by rhythmic contractions of the
+intestine, and absorption goes on when the food has been so changed that
+it can soak through the intestinal walls into the blood and lymph
+vessels. The small intestine is about 20 feet long, and consequently
+affords a large surface for absorption, as does also the large
+intestine, into which the small intestine opens. The blood and lymph
+carry the digested food substances to all parts of the body, and thus
+the different tissues are provided with the materials they need for
+growth, repair, and energy. Excess of food substances may be stored as
+fat or expelled from the body.
+
+As the blood and lymph go through the tissues they take from the tissues
+the refuse, or the part that remains after the fuel substances have been
+consumed. This refuse from the tissues may be likened to the ashes from
+a furnace; it is finally eliminated from the body through the kidneys
+and lungs, and to some extent through the skin and bowels. The part of
+the food that is not digested of course never soaks through the
+intestinal walls; it merely passes through the small and large
+intestines and is finally expelled as feces or bowel movements. The
+characteristic odor of fecal matter results from the action of bacteria
+upon it while in the large intestine.
+
+It must be remembered that the body is not nourished merely by
+swallowing food: in order to nourish the body food must also be
+digested, absorbed, and made use of by the tissues. Many factors may
+operate both in health and in sickness to render food indigestible. It
+may be originally unsuited to the human digestive apparatus, or spoiled,
+or poor in quality, or badly cooked. But even when wholesome in itself
+it may be ill-adapted to a particular person at a particular time; thus
+it may be too great in amount, or eaten at improper hours. Moreover a
+person's own idiosyncrasy or manner of living or fatigue or illness may
+render it especially indigestible for him.
+
+Experiments have shown that pain, fear, worry, and other unpleasant
+emotions actually stop the action of the digestive juices and check
+muscular contractions of the small intestine. Furthermore, even the
+absence of pleasant anticipation of food has been shown to delay
+digestion for hours. Thus scientific knowledge confirms our common
+experience that such mental states seriously interfere with digestion.
+The converse is also true. Agreeable taste and odor of food, or even
+pleasurable thought of it, start the secretion of digestive fluids. It
+is a common saying that the mouth waters at the prospect of inviting
+food, but it is less well known that appetizing food does actually start
+the stomach juices also. A person who understands the physiological
+effect that the emotions have upon digestion is in a far better frame of
+mind to cope successfully with the difficulties of feeding the sick than
+one who considers sick persons' likes and dislikes entirely irrational.
+
+
+FEEDING THE SICK
+
+Nourishing the sick is not always an easy problem, but its importance
+can hardly be overestimated. Indeed, proper feeding in many illnesses
+makes the difference between life and death. The actual amount of
+nourishment needed in sickness is often less than in health, but it may
+be just as great, or even greater if the illness causes increased tissue
+waste. Yet the digestive process of a sick person must be rendered as
+little laborious as possible, all foods ordinarily difficult to digest
+must be eliminated, certain others must be withheld or restricted
+according to the nature of the sickness, and in addition one may have to
+deal with an appetite that is capricious, diminished, or totally absent.
+
+Diet for the sick is often a part of medical treatment; in such cases
+the doctor will prescribe special diets and his orders must be carefully
+carried out. Except for special diets, food for the sick is generally
+divided into four classes: first, liquid or fluid diet; second,
+semi-solid diet; third, light or convalescent diet; and lastly, full
+diet. These diets are not very sharply distinguished.
+
+LIQUID DIET generally includes milk, eggnog, albumen water, broths,
+soup, beef juice, thin gruel, and beverages. Liquid diet makes least
+demand upon the digestive powers, because it consists of food already
+dissolved and therefore nearer the condition in which it can be
+absorbed. Moreover, it is less likely than other foods to contain excess
+of fat, improperly cooked starches, and other indigestible material.
+Liquids must be given at regular intervals and at shorter intervals than
+solid foods; 6 to 8 ounces every two or three hours is not too much if
+the patient can take it. The doctor usually specifies the amount and the
+interval. Some patients will take more nourishment at one time if the
+interval is slightly increased.
+
+SEMI-SOLID DIET includes all fluids and in addition soft milk toast,
+soft cooked eggs, well cooked cereal, custards, ice cream and ices,
+junket, and gelatine jellies. Liquid or semi-solid diet is commonly
+given in acute fevers because digestive juices and other fluids of the
+body are then diminished, and also because their digestion places a
+minimum of work upon a system already burdened with bacterial poisons.
+
+LIGHT OR CONVALESCENT DIET generally means a simple mixed diet. In
+addition to the articles in the two preceding diets it includes oysters,
+chicken, baked potatoes, most fruits except bananas, simple desserts,
+white fish, and other meats and vegetables added judiciously until full
+diet is reached. Fried foods should not be included.
+
+FULL DIET means an unrestricted menu, but even from full diets
+especially indigestible foods should be excluded. The principles of
+feeding sedentary persons as described in manuals of dietetics apply to
+patients who are obliged to be inactive although not really ill, as for
+example, a patient suffering from a broken leg. Ordinarily in such
+cases, as in other kinds of illness, the appetite is greatly diminished,
+but a word of warning should be given against overfeeding patients whose
+meals are their chief interest. Such patients are only too likely to
+interpret full diet as anything they desire in any quantity at any time
+of day or night, and then to attribute their discomfort and irritability
+to their illness rather than to overeating.
+
+Constipation is especially stubborn in sickness, since the patient is
+deprived of his usual exercise and variety of food. So far as possible
+the bowels should be regulated by diet. Laxative foods include most
+vegetables with a large amount of fibre, coarse cereals and flour, oils
+and fats, and most fruits and fruit juices. Unfortunately many laxative
+foods are difficult for sick persons to digest and must therefore be
+used with caution. A glass of hot or cold water or orange juice an hour
+before breakfast may be helpful, and at bed time hot lemonade, oranges,
+prunes, figs, or other fruit if allowed.
+
+It is essential for patients to drink water freely, and it should be
+given between meals and also between liquid nourishments. Persons
+inexperienced in the care of the sick frequently make the mistake of
+bringing water only when a patient asks for it.
+
+Many acute illnesses begin with fever, headache, sore throat, and
+especially among children with vomiting, diarrhoea, and other digestive
+disturbances. In such cases all food should be withheld until the doctor
+comes, but boiled water, hot or cold, should be given freely. Efforts to
+tempt the appetite are then mistaken; few people are injured and many
+are benefited by omitting food even for 24 hours at the beginning of an
+acute illness, and with few exceptions a doctor can be found in a
+shorter time.
+
+SERVING FOOD FOR THE SICK.--Food for the sick should always be most
+carefully prepared and of the best quality, and in addition it should be
+as inviting, as varied, and as well served as possible. Neglect in these
+respects is inexcusable. Even slight carelessness in preparing or
+serving food may arouse disgust and thus banish permanently some
+valuable article from the dietary.
+
+Trays, dishes, tray cloths, and napkins for the patient must be
+absolutely clean and as attractive as possible. Cracked or chipped
+dishes should not be used. Individual sets of dishes for the sick may be
+purchased, and their convenience makes them well worth their price.
+Paper napkins may be used in many cases to save laundry work; clean
+white paper is always superior to soiled linen.
+
+Before the tray is brought to the bedside, everything should be arranged
+so that the patient can eat in comfort. It is bad management to let the
+soup cool while the patient's pillows and table are being adjusted. In
+setting the tray great care should be devoted to placing the articles
+conveniently, and to the appearance and garnishing of the food. Careful
+serving requires more thought, but little if any more actual time than
+slovenly serving. Dishes should not be so full that food is spilled in
+transit; hot dishes should be covered; hot dishes should reach the
+patient hot, and cold dishes cold. Liquid nourishment in a glass or cup
+should be served on a small tray or plate covered with a doily. Neither
+glass nor cup should be held by the rim.
+
+It is not uncommon to overload trays and to serve everything at once in
+order to save steps, but a patient is ordinarily more interested in a
+meal that is served in courses unless very long intervals elapse
+between. Moreover, if the meal is served in courses he is not tempted to
+eat dessert first and then to refuse the rest of the meal. If food is
+given sufficiently often it is safer to err on the side of serving too
+little at a time rather than too much, since the sight of large amounts
+of food is often disgusting.
+
+The patient's likes and dislikes should be considered as far as
+possible, but most patients should not be consulted about their menus
+beforehand. Great variety in one meal is not necessary; it should be
+introduced by varying successive meals. An article that has been
+especially disliked should not be served a second time, unless it can be
+disguised beyond a possibility of detection. An article of food to which
+a patient objects should be removed at once; one may appear disappointed
+if it seems wise, but should never argue. When patients persistently
+refuse necessary nourishment a difficult situation is presented;
+persuasion and every form of ingenuity must be used, and the doctor's
+cooperation enlisted. When, for example, a strict milk diet is ordered
+for a patient who announces that he never takes milk in any
+circumstances the situation may seem hopeless but it is not necessarily
+so.
+
+TO FEED A HELPLESS PATIENT.--Helpless and weak patients must be assisted
+to eat or drink. A napkin should first be placed under the patient's
+chin. The attendant should place her hand under the pillow, raise the
+head slightly, and hold the glass to his lips with her other hand. An
+ordinary tumbler can be used by a patient lying down if it is not more
+than a quarter full, or a special feeding cup may be purchased. Bent
+glass tubes may be used for cool liquids; they should be washed
+immediately after use. A child who can sit up sometimes takes more
+nourishment if it is given through a soda water straw.
+
+If the patient must be fed with a spoon care should be taken that the
+liquid is not too hot, but the attendant should not blow upon it to cool
+it. It should be given from the point of a spoon placed at right angles
+to the lips, and plenty of time between mouthfuls should be allowed. A
+swallow should not be given at the moment when the patient is drawing
+the breath in. Great patience is required if a helpless person is to be
+fed acceptably. The attendant should sit by the bedside rather than
+stand, should present at least the appearance of having unlimited time,
+and should endeavor not to deprive the patient in any way of the
+satisfaction he may derive from his nourishment.
+
+
+EXERCISES
+
+1. What needs of the body do food substances supply?
+
+2. Give an outline of the digestive process.
+
+3. Describe the effect of different mental states upon digestion, and
+give examples of the ways by which a knowledge of these effects may be
+utilized in feeding patients.
+
+4. Why is the problem of nourishing the body of especial importance in
+sickness?
+
+5. Name the four ordinary classes of diet for the sick, and mention all
+the articles you can belonging to each class.
+
+6. Why is constipation a common ailment among patients confined to bed,
+and what attempts should be made to overcome it by the diet?
+
+7. Why is it necessary for sick persons to drink water freely, and what
+efforts should the attendant make to encourage them to do so?
+
+8. Describe the proper serving of a patient's tray.
+
+9. How should helpless patients be assisted to eat?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Chapter II.
+
+The Human Mechanism--Hough and Sedgwick, Chapters VIII, XIII, XIX.
+
+Notes on Nursing--Florence Nightingale, Pages 63-79.
+
+How to Live--Fisher and Fisk, Chapter II.
+
+Bodily Changes in Pain, Hunger, Fear and Rage--Cannon, Chapter I.
+
+Food for the Invalid and the Convalescent--Winifred S. Gibbs.
+
+Practical Dietetics--Pattee, Chapters IV, V.
+
+Feeding the Family--Rose.
+
+Diet in Health and Disease--Friedenwald and Ruhrah.
+
+Feeding Children from Two to Seven Years Old--New York City Department
+of Health.
+
+American Red Cross Text Book on Home Dietetics--Ada Z. Fish.
+
+Emergency Cooking--Pamphlet 708, American Red Cross.
+
+War Diet in the Home--Pamphlet 706, American Red Cross.
+
+Red Cross Conservation Food Course for Children and Special
+Classes--Pamphlet 705, American Red Cross.
+
+
+
+
+CHAPTER X
+
+MEDICINES AND OTHER REMEDIES
+
+
+ACTION OF DRUGS.--Modern medical practice increasingly emphasizes diet,
+baths, exercises, and other hygienic measures in the treatment of
+sickness. Drugs are given far less than they were a generation ago; yet
+medicines are still the most familiar of all remedies, and the most
+abused by those who persist in treating themselves. Misuse of medicine
+even by intelligent people is astonishingly common.
+
+Problems of sickness and health would be enormously clarified if the
+uses and limitations of drugs were more generally understood. Many
+people still believe that every disease can be cured by a drug if only
+the doctor is clever or lucky enough to think of the right one to give.
+Such beliefs result naturally enough from centuries of faith in charms
+and magic, and occasionally are confirmed by remarkable cures apparently
+brought about by drugs, but really pure coincidence or the result of
+suggestion.
+
+It is a fact that a few medicines are known which if rightly used
+actually do cure certain diseases. An example of their action is the
+curative effect of quinine in malaria. Such medicines, unfortunately,
+are few. In the great majority of cases medicines do not cure disease;
+their beneficial action is ordinarily indirect and is due to their power
+either to increase or to check certain processes within the body.
+
+It is here that the abuse of drugs comes in. Disordered bodily processes
+give rise to symptoms of disease; and it is the symptoms of disease, not
+the disease itself, that trouble the patient. A patient with typhoid,
+for example, is not conscious of the toxins in his blood, but of
+headache, weakness, and fever; the man with eyestrain is not aware of an
+imperfectly shaped lens, but of headache and indigestion. What the
+patient wants is to have his symptoms relieved; in some cases they can
+be controlled by drugs, and the sufferer then considers himself cured.
+But the original condition persists: it may in the meantime be
+improving, but it may on the other hand be growing worse.
+
+Not infrequently it is best to check symptoms, and to check them by
+means of drugs. When they should be checked, only a thoroughly trained
+physician is qualified to decide. The question is not one for amateurs,
+since the whole practice of medicine, including the prescription of
+drugs, constantly becomes more nearly an exact science. People should
+obtain and follow expert advice in regard to health as they would in
+regard to other affairs of life. The constant self-dosing practised by
+thousands of people is harmful and unintelligent; it is, however, no
+less irrational to go to the other extreme and refuse to take medicine
+prescribed by a competent doctor.
+
+AMATEUR DOSING.--Amateur dosing either of oneself or of others is
+dangerous in more ways than one. In the first place, time is lost.
+Moreover, symptoms are characteristic; checking or altering them
+increases the difficulty of finding the real trouble. The man with
+eyestrain who takes one drug to stop his headache and another to "cure"
+his stomach, is simply delaying the time when properly adjusted glasses
+will relieve both. In this case the result may not be serious; but such
+a loss of time in finding the trouble and beginning proper treatment
+might prove fatal in the case of tuberculosis.
+
+Another objection to amateur prescription of medicine is the fact that
+most drugs have more than one effect. In addition to their main action
+they have others, subordinate or ordinarily less marked. These minor
+effects may be serious in some cases. Many headache remedies, for
+example, affect the heart; a dose that is harmless for a normal person
+may be strong enough to injure seriously a person with a weak heart. A
+doctor, and a doctor only, is competent to decide when and in what
+quantity medicines will be beneficial, because he alone understands both
+the condition of the patient and all the possible effects of the drug.
+
+In no circumstances should medicine prescribed for one person be taken
+by another. This rule seems obvious enough; yet every day people pass on
+their pet remedies to friends. Some medicines deteriorate after
+standing, and others grow stronger; nevertheless, medicine supposed to
+have cured a cough or a tonic supposed to have strengthened some member
+of the family after an attack of grippe is cheerfully administered
+months later to another member of the family, who, to make matters
+worse, may differ in age, strength, and probably in the nature of his
+sickness. Drugs are expensive, and it is considered economical to use
+them up; measured by lost time and impaired health such practices may be
+anything but thrifty.
+
+Cathartics, tonics, and various drugs to relieve pain and sleeplessness
+are among the remedies most commonly taken without medical advice.
+Enough has already been said about constipation to indicate proper
+hygienic treatment, but another warning should be given against
+habitual use of cathartics. Many of these drugs are irritating; even
+when not irritating, they are harmful, since the body depends more and
+more upon the drug to do for it what it should be enabled to do for
+itself, by remedying the original cause of the trouble. Licorice powder,
+cascara, saline cathartics such as Seidlitz powders and Rochelle Salts
+and some others are harmless for occasional use, if occasional is not
+too liberally interpreted.
+
+Tonics are poor substitutes for proper diet, rest, and fresh air. Using
+them may be likened to beating a tired horse; the horse goes faster, but
+he is not really stronger. In some emergencies the horse must go faster
+and there is nothing to do but beat him, and in some cases the tonic
+should be given; these, however, are cases for a doctor to decide.
+People persist in taking tonics because they are unwilling or unable to
+rest, or otherwise to change their ways of living.
+
+Medicines to stop pain or to induce sleep are probably the most
+pernicious of all self-prescribed remedies, for they add to other
+dangers the possibility of forming drug habits. These habits are so
+insidious and so powerful that it is not safe to take habit-forming
+drugs even once except by a doctor's direction. In short periods of time
+strong people, apparently firm in will and character, have acquired
+habits from supposedly moderate use of drugs like morphine, cocaine, and
+alcohol. No one, no matter how sure of his own self-control, can afford
+to run so grave a risk.
+
+PATENT REMEDIES.--Objections to self dosing in general apply even more
+strongly to using patent medicines. The ingredients of patent medicines
+are ordinarily unknown, so that using them is unintelligent at best.
+Sometimes they contain habit-forming or other harmful drugs. In other
+cases the ingredients are innocent enough, but totally unable to bring
+about the results claimed for them. The old story about a powerful
+remedy discovered by accident and thus unknown to the medical profession
+deceives only the ignorant or credulous; with our present knowledge of
+chemistry and physiology powerful remedies are not discovered in that
+way.
+
+Even to these comparatively harmless patent preparations there are two
+serious objections. One is the loss of time, during which the patient
+may grow worse. The other is that money is obtained under false
+pretenses; fraud is a common element in the success of patent remedies.
+One of the least harmful, a substance called "Murine" may be taken as an
+example[2]. This substance was widely advertised at one time as a
+"positive cure for sore eyes." Analysis showed it to be a solution of
+borax, which cost about five cents a gallon to prepare. It sold for one
+dollar an ounce, or at the rate of $128.00 a gallon. Although it could
+not bring about the wonderful cures advertised, it was practically
+harmless, and buyers of "Murine" must have been injured chiefly in
+pocket. But with "cancer cures" and "consumption cures" it is a
+different story. Early treatment of these diseases is essential to
+recovery; delay in many cases means robbing the sufferer of his only
+chance of life. No drugs are now known that will cure these diseases,
+and it seems incredible that anyone should be willing to practise such
+cruel deception upon ignorant people merely for the sake of making
+money.
+
+ADMINISTRATION OF MEDICINE.--Medicines may be introduced into the body
+in a number of ways. In the majority of cases they are swallowed and
+finally carried to the tissues by the blood just as digested food is
+carried.
+
+Except in rare emergencies no medicine should be given to a sick person
+without the doctor's order. The prescribed dose should be accurately
+measured in a medicine glass having a scale to show the number of
+teaspoonfuls. When measuring medicine, think only of what you are doing;
+neither talk nor listen to conversation. First read the label on the
+bottle. Next, shake the bottle, if the medicine is liquid, in order to
+mix the contents thoroughly. Then remove the cork with the second and
+third fingers, and hold it between them while pouring, thus keeping the
+cork clean and protecting the contents of the bottle. Hold the medicine
+glass on a level with the eyes, and in the other hand hold the bottle,
+with the side bearing the label uppermost to avoid soiling it; pour out
+the dose, measuring exactly, wipe the bottle, replace the cork, and
+again read the label on the bottle.
+
+Most medicines should be diluted with a little water. Pills and capsules
+should not be presented to patients in the attendant's fingers, but on a
+saucer or teaspoon. Acids and medicines containing iron should be taken
+through a glass tube kept for medicine exclusively. Tubes and glasses
+should be washed at once after use, and neither they nor the bottles
+should stay in the patient's room. If a dose is omitted for any reason,
+do not increase the next dose; give the regular dose at the next regular
+time.
+
+Serious mistakes in giving or taking drugs are far too common, and no
+precautions are too great to guard against them. Never use medicine from
+a box or bottle that has no label. Never take or give another person a
+medicine selected in the dark, even though you have positive knowledge
+that there is no other bottle or box of medicine in the whole house; in
+just such circumstances the fatal mistakes occur.
+
+A few things can be done to make medicines more palatable. The water
+used to dilute the dose and to be taken after it should be very cold.
+Holding the nose is helpful. A piece of cracker, a peppermint, or a
+slice of lemon or orange, if allowed, may be taken afterward. Giving
+disagreeable medicine in ordinary food, as lemon juice, orange juice, or
+milk, and giving bitter powders in jam or jelly, is unwise because it
+sometimes results in life long dislike for a useful article of diet.
+Where food is given directly after the dose to take away its taste, the
+association of dislike seems to be formed less frequently.
+
+The taste of castor oil is so disgusting that it often causes vomiting,
+but if skillfully given the oil need not be tasted by a patient who is
+willing to cooperate. Its way of sticking to the tongue and teeth
+constitutes the chief difficulty; the object therefore is to prevent it
+from sticking by swallowing the dose all at once. To administer the oil,
+wet the inside of a medicine glass or large spoon with very cold water,
+and leave a little water in the bottom. Pour the required dose in slowly
+and cover it with more cold water. Let the patient hold in his hand
+something to take away the taste,--cracker, bread, peppermint, or
+whatever is allowed; for castor oil water is not very effectual. Then
+direct him to hold his nose, open his mouth, and hold his breath;
+caution him to let the oil run down without swallowing until all has
+been taken, and afterward to chew the cracker, continuing to hold his
+nose until he has swallowed the cracker. When the patient understands
+and is ready, pour the dose in quickly as far back as possible, taking
+care not to spill the last drop on the lips. This process may seem
+unduly troublesome, but when castor oil is needed it is badly needed and
+efforts to make it stay down are worth while. The following method also
+effectually disguises the taste of castor oil: place in a glass a
+teaspoonful of baking soda, add the prescribed dose of oil and then the
+juice of half a lemon. Mix all together thoroughly and let the patient
+take the mixture while it is effervescing. This method may be used
+unless the patient is not allowed soda and lemon juice. Castor oil may
+be bought in capsules, but on account of their size many people find the
+capsules impossible to swallow.
+
+SUPPOSITORIES.--Sometimes medicines are given through the rectum. For
+this purpose they are combined with cocoa butter or other material, and
+made into small cones called suppositories. They melt at a low
+temperature and should be kept on ice until needed. A suppository
+should be lubricated with vaseline, and inserted very gently as far as
+the finger can be introduced, while the patient is lying on the back or
+left side.
+
+ENEMATA.--An injection of a fluid into the rectum is called an enema.
+(Plural, enemas, or enemata.) Enemas are generally used to cause
+evacuation of the bowels.
+
+For a simple purgative enema one of the following is generally used:
+plain water; or a solution of common salt in the proportion of one
+teaspoonful of salt to one pint of water; or soap suds made with a white
+soap such as castile or ivory. Unless otherwise ordered the temperature
+of the enema should be between 105 deg. and 110 deg. F.
+
+To give an enema, one should proceed as follows: First protect the bed
+by placing under the patient's hips a rubber sheet, covered by a draw
+sheet or large towel. Let the patient lie on the back, with the knees
+flexed and head low. Bring to the bedside a commode or bedpan, and
+lastly the solution contained in a fountain syringe having a long rubber
+tube, stopcock and short hard rubber nozzle. The bag of the syringe may
+be hung on the bed post or elsewhere, but it should not be more than
+three feet at most above the patient's head. Lubricate the nozzle with
+vaseline either from a tube, or removed from a jar by means of a piece
+of toilet paper; never dip the nozzle itself into a vaseline jar. Let
+the solution flow into the bedpan until it runs warm and smoothly; a
+jerky flow means presence of air bubbles which cause pain if injected
+into the bowels. Unless the patient is able to do it herself, gently
+insert the nozzle, and at the same time start the flow. Force must not
+be used in inserting the nozzle, and the flow should be gentle; if the
+solution goes in rapidly the patient may be unable to retain it. If
+there is a desire to expel the enema as soon as the injection has begun,
+shut off the current and wait a minute, meanwhile making gentle pressure
+upon the patient's abdomen with one hand; then lower the bag a little
+and begin again. A grown person should take from two to four pints, and
+a child from one to two pints. After the enema is finished give the
+bedpan immediately; the enema will, however, be more effective if
+retained a few minutes. The bedpan should be given and removed according
+to the directions on page 176. Sometimes an enema is expelled with such
+violence that it soils the upper sheet; to protect the covers a rubber
+sheet may be spread over the patient's knees and legs. Since an enema
+sometimes causes nausea or faintness, a patient should be watched
+constantly during the process.
+
+To give an enema to a baby one may use a small syringe having a soft
+rubber bulb with a nozzle directly attached, or the ordinary fountain
+syringe with the small, hard rubber tip designed for infants. The enema
+should be given in a warm room free from draughts, and the baby must be
+warmly covered throughout the process. First cover the lap with a pad or
+folded blanket. Upon the blanket place a warmed rubber sheet, and over
+the rubber a warm diaper. Hold the baby on your lap, so that he lies on
+his back with his knees drawn up. Hold his feet or legs firmly in your
+left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that
+all the air is expelled from the syringe, and then proceed as already
+directed. A baby will take from two or three ounces up to half a pint or
+even more, according to the size of the child. After the injection is
+finished place a small vessel under the baby's hips, and hold it until
+the fluid has been expelled, keeping the child well covered all the
+time.
+
+After being used, the nozzle of a fountain syringe should be washed with
+soap and water, boiled, dried and put away in a clean place. Inserting
+the nozzle into the bag of the syringe immediately after withdrawing it
+from the rectum is a filthy but not uncommon practice. The syringe
+should be kept clean inside and out; it should be washed in hot
+soapsuds, rinsed in clean hot water, drained, and when thoroughly dry
+wrapped in a clean towel or tissue paper. The ordinary fountain syringe
+hanging for months by a dirty string on a hook in the bath room is an
+unpleasant and generally an unclean object.
+
+SPRAYS AND GARGLES.--Several other methods of administering medicines
+are occasionally employed. Some remedies may be applied directly to the
+throat by gargles, and to the nose and throat by sprays. The throat may
+be cleansed by gargling with a solution of a teaspoonful of baking soda
+or common salt in a glass of warm water. Nose sprays should not be used
+except under medical advice, and it is well to remember that if the
+mouth washes, gargles, and sprays advertised to be disinfectants were
+really strong enough to kill germs, they would be too harsh for common
+or continued use. The nozzles of nose and throat sprays should be boiled
+immediately after use. A surprising number of families who have
+progressed far beyond common drinking cups and towels, continue to use a
+common nose spray without even washing the nozzle. Children while they
+are well should be taught to gargle the throat; a child with a sore
+throat and an aching head is in a poor condition to learn anything.
+
+INHALATION or breathing in, is another method used to introduce drugs
+into the membranes of the nose, throat, and lungs. Smelling salts are an
+example of substances used for inhalation; they are used to stimulate
+persons who are faint. They should not be placed close to the nostrils,
+nor used at all when the patient is totally unconscious.
+
+Inhalations of steam are often used in asthma, croup, and bronchitis.
+Special croup kettles are made for the purpose, but an ordinary pitcher
+half full of boiling water may be used instead. The patient's head
+should be held closely over the pitcher, and a towel should be adjusted
+around the top covering the patient's nose and mouth, but admitting just
+enough air to make it possible for him to breathe. If a drug is ordered
+it should be added to the water.
+
+INUNCTION, or rubbing a substance into the skin, is sometimes ordered
+for delicate babies and children. After the skin of the abdomen has been
+washed with warm soapy water and thoroughly dried, the substance
+ordered, generally olive oil or cod liver oil, should be applied by
+means of a circular movement of the palm of the hand. The oil should be
+warm and the rubbing continued until it is absorbed.
+
+Ointments are also applied by inunction. A small quantity at a time
+should be rubbed in, using a circular motion. If an ointment is ordered
+to be applied where the skin is broken, the ointment should be spread
+upon gauze and applied without friction. Liniments are rubbed in in the
+same way as ointments. In many cases rubbing accomplishes more than the
+ointment or liniment itself, so that this part of the treatment must not
+be slighted.
+
+HOUSEHOLD MEDICINE CUPBOARD.--In every household a small cupboard is
+needed for medical and surgical supplies. Glass shelves are desirable,
+because they show when dirty and are easily cleaned, but a wooden
+cupboard can easily be lined with clean paper or white enamel cloth held
+in place with thumb tacks. Dirty, stained shelves should not be
+tolerated. The cupboard should be kept locked and the key put well out
+of the reach of children. In the cupboard should be kept medicines in
+daily use; they should not be paraded on family dinner tables.
+
+Poisonous drugs should have rough glass bottles and conspicuous labels.
+All medicine bottles should be kept well corked, since evaporation may
+take place and the remaining solution, by becoming stronger, may be
+dangerous to use in the ordinary amount. Pills and tablets sometimes
+deteriorate by standing, and may become so hard that they pass through
+the stomach and intestines without dissolving. It is best to buy drugs
+and surgical supplies in small quantities; when it is cheaper to buy
+more at a time the druggist should be asked whether they will
+deteriorate or not.
+
+Almost every family needs to keep on hand some cathartics, some
+disinfectants, some material for first aid, and a few simple appliances.
+Most families have certain other needs peculiar to themselves, and for
+those who live at a distance from drug stores a greater quantity and
+variety may be required. Elaborate equipment and extensive supplies of
+medicines are neither economical nor necessary for household use.
+
+Castor oil, Rochelle or other laxative salts, and two grain cascara
+tablets ordinarily constitute a sufficient supply of cathartics. The
+dose of castor oil is one or two teaspoonfuls for a baby up to a
+tablespoonful for an adult. Rochelle salts and seltzer aperient are
+given dissolved in water; the ordinary dose is from one to four
+teaspoonfuls. Seidlitz powders come in two packets, one white and one
+blue. The contents of the packets should first be dissolved in separate
+glasses each filled about a quarter full of water. One solution should
+then be poured into the other and the mixture taken while it is
+effervescing. Cascara tablets are generally given in one to ten grain
+doses.
+
+A small bottle of tincture of iodine and one of 70% alcohol should be
+kept for disinfecting. Neither one is for internal use. The iodine is
+used to disinfect small wounds and abrasions of the skin. It is applied
+with cotton swabs and several swabs should be made and kept on hand in a
+box or envelope. Alcohol is used to disinfect thermometers and other
+instruments that cannot be boiled, for rubbing, and may also be used for
+disinfecting the skin. A 90% solution is sometimes used for rubbing; it
+need not be bought until needed. Denatured and wood alcohol are poisons
+and should be used in households only in spirit lamps; they are not safe
+for other purposes.
+
+First aid materials may include two gauze bandages two and one-half
+inches wide and two bandages one inch wide, one American Red Cross First
+Aid Outfit, a small package of absorbent cotton, a roll of old muslin, a
+package of adhesive plaster one inch wide, boracic ointment, picric acid
+gauze or other application for burns, safety pins, and a pair of
+scissors.
+
+For use in cases of fainting or exhaustion it is well to keep aromatic
+spirits of ammonia on hand. Its bottle should have a rubber stopper. The
+dose is one-half to one teaspoonful, in a quarter to half a glass of
+water. Hot coffee and tea are also good stimulants, but the time
+necessary to prepare them makes it desirable to have aromatic ammonia
+on hand. Household or ordinary ammonia must not be used as a substitute.
+
+Olive oil, mustard, and baking soda may be brought from the kitchen when
+needed. It is assumed that vaseline, cold cream, hand lotion, talcum
+powder, and other toilet preparations will also be available.
+
+Only a few appliances are necessary. Among them are a medicine glass, a
+teaspoon, clinical thermometer, hot water bag, fountain syringe, and an
+alcohol lamp in houses without gas or electric stoves. It is better not
+to buy other appliances until they are needed, particularly rubber goods
+since they deteriorate rapidly.
+
+
+EXERCISES
+
+1. Why is it dangerous for persons without medical training to prescribe
+medicines? What is the especial danger of dosing oneself?
+
+2. What is meant by a habit-forming drug? Name all you can, and tell why
+they are peculiarly dangerous.
+
+3. What are the special objections to patent medicines?
+
+4. What precautions should be taken in order to administer medicine
+accurately? What precautions to avoid giving wrong medicines?
+
+5. How may some disagreeable medicines be made more palatable?
+
+6. Tell how to prepare and give a soapsuds enema.
+
+7. How should a fountain syringe be cared for? a throat spray?
+
+8. Describe methods for giving steam inhalations.
+
+9. Describe the equipment and care of a household medicine cupboard.
+
+10. What drugs is it well for a family to keep on hand? What appliances?
+What materials for first aid?
+
+11. How many drugs in addition to those prescribed by a physician have
+you or your family on hand at the present time? How many do you consider
+really necessary? Are any of these medicines used to remedy troubles
+that might be cured by sufficient attention to rest, exercise, diet, and
+fresh air?
+
+
+FOR FURTHER READING
+
+Health and Disease--Roger I. Lee, Chapter VI.
+
+How to Live--Fisher and Fisk, Supplementary Notes, Sections IV, V.
+
+Scientific Features of Modern Medicine--Frederic S. Lee, Chapters III,
+VIII.
+
+The Human Mechanism--Hough and Sedgwick, Chapter XX.
+
+The Conquest of Nerves--Courtney.
+
+Primitive Psychotherapy and Quackery--Lawrence, Chapters I-V.
+
+Nostrums and Quackery--American Medical Association. (See especially
+"Cancer Cures" and "Consumption Cures.")
+
+
+FOOTNOTES:
+
+[2] See "Nostrums and Quackery," p. 445.
+
+
+
+
+CHAPTER XI
+
+APPLICATION OF HEAT, COLD, AND COUNTER-IRRITANTS
+
+
+INFLAMMATION.--A process called inflammation sometimes occurs in tissues
+that have been injured or invaded by bacteria. Although painful, it is
+nevertheless one of the reparative processes of the body, and therefore
+beneficial. Common examples of inflammation are boils, sore throat, and
+the swollen, painful condition resulting from sprains and fractures.
+Characteristic symptoms of inflammation are heat, redness, swelling, and
+pain.
+
+When a tissue has been invaded by bacteria, nearby blood vessels dilate,
+thus bringing an increased supply of blood to the affected part. This
+extra supply serves to wash away the offending substance, and at the
+same time it brings more white blood corpuscles, one function of which
+is to destroy bacteria. From the increased supply of blood the affected
+part becomes red and hot, and so much blood may come that the vessels
+further on are unable to carry it away fast enough. Some of the fluid
+part of the blood is then forced out into the tissues, and the part
+becomes swollen. Distension of the tissues and pressure on the nerve
+endings cause pain, and the injured part now exhibits the characteristic
+symptoms of inflammation.
+
+[Illustration: FIG. 21.--"THE HISTORY OF A BOIL." This figure represents
+a cross-section of normal skin. Note the surface layer, or cuticle, and
+the "true skin," or cutis. In the cutis one sees that the blood
+capillaries are just wide enough for the blood-cells to pass through "in
+single file." The skin has just been pricked by a dirty pin. On the
+point of this pin were several poisonous germs which were deposited at
+_a_. (_From Emerson's "Essentials of Medicine."_)]
+
+[Illustration: FIG. 22.--"THE HISTORY OF A BOIL" (continued). The poison
+from these germs diffuses through the cutis. The capillaries dilate. The
+leucocytes force their way through the walls of the capillaries and
+travel towards these germs. Note the dumb-bell shape of the leucocytes
+as they pass through the minute holes in the capillary walls, and their
+pseudopods as they travel towards their common destination, attracted by
+the poison from the germs. The skin in this region is now swollen, red,
+hot, and painful. (_From Emerson's "Essentials of Medicine."_)]
+
+At this point, if the injury begins to heal or the bacterial infection
+to yield, the extra blood supply is gradually carried off, the blood
+vessels resume their normal size, and the tissues return to their usual
+condition. If, however, the infection does not yield so quickly, more
+and more white blood corpuscles assemble and pass through the walls of
+the tiny blood vessels into the tissues. Here the struggle continues.
+Some bacteria and some white blood corpuscles are killed, and substances
+are formed which liquify these dead cells and also some cells of the
+surrounding tissues. The resulting fluid is called pus or matter, and in
+the case of a boil we then say it has come to a head. If the infection
+occurs near a cavity or near the surface of the body, the pus may escape
+by breaking through at the point of least resistance, and may carry most
+of the poisons along with it. If the pus finds no outlet it may be
+gradually absorbed by the blood stream, and healing may result without
+discharging. On the other hand, the germs may make their way into the
+circulation, thus causing the serious condition known as blood
+poisoning.
+
+[Illustration: FIG. 23.--"THE HISTORY OF A BOIL" (continued). The
+migration of leucocytes has continued until now they form a dense mass
+surrounding the germs. The poison of the germs has killed all the
+leucocytes and also all the cutis immediately around them, and now
+digestive fluids from the dead leucocytes is turning the whole dead mass
+into liquid pus. The boil has "come to a head." There is a little lump
+on the skin and through its thin covering of cuticle can be seen the
+yellow pus. (_From Emerson's "Essentials of Medicine."_)]
+
+Inflammation may be treated by means of hot applications, cold
+applications, or counter-irritants. The effect of heat is to dilate the
+vessels and hence to increase the flow of blood to the injured part.
+This increased blood supply makes the reparative process go on more
+vigorously, and also makes it possible for the accumulated fluid to be
+more rapidly carried away. Moist heat softens the tissues so that pus,
+if formed, can escape more easily.
+
+[Illustration: FIG. 24.--"THE HISTORY OF A BOIL" (concluded). The boil
+has finally ruptured. The liquid pus has escaped carrying with it the
+germs and most of their poisons; the migration of leucocytes has
+stopped; the capillaries are returning to normal size and now new tissue
+will grow and fill up this hole. (_From Emerson's "Essentials of
+Medicine."_)]
+
+Cold acts in just the opposite way. It decreases the size of the blood
+vessels so that less blood comes to cause pain and swelling; at the same
+time it diminishes the number of white blood corpuscles and the
+nutritive substance brought by the blood. The nature and location of the
+infection determine whether heat or cold is to be preferred.
+
+Counter-irritants, of which mustard is an example, have a complicated
+action. A counter-irritant affects the blood circulation of the place to
+which it is applied, and at the same time it irritates the superficial
+nerves, which in turn stimulate other more distant nerves. The latter
+nerves control the circulation in tissues not adjoining those to which
+the counter-irritant is applied, and thus it is possible for a mustard
+paste, for example, if applied at one point to bring about changes in
+the blood supply of another part of the body. The mechanism by which
+counter-irritation is brought about is an intricate nervous process
+called reflex action.
+
+
+HOT APPLICATIONS
+
+In applying either moist or dry heat the danger of burning or scalding a
+patient must be constantly kept in mind. This danger is always great,
+but it is especially great when the skin is tender like that of babies,
+children, and old people, or when the vitality is low as in cases of
+chronic or exhausting illness. Unfortunately accidents in applying heat
+are not uncommon; a moment's carelessness may cause serious injury and
+prolonged suffering.
+
+DRY HEAT.--Hot water bags are used to apply dry heat. They should be
+filled not more than two-thirds full of hot water, but the water must
+not be so hot that there is the slightest possibility of scalding the
+patient if the bag should leak. Boiling water should never be used.
+Before the stopper is screwed on, expel the air by squeezing the bag or
+by resting it upon a flat surface until the water reaches the top. After
+closing the bag make sure that both bag and stopper are in order, by
+noting whether leakage occurs when the bag is inverted and pressed
+moderately. Before it is placed near the patient the bag should be dried
+and entirely covered with a towel or canton flannel bag.
+
+Strong bottles, jugs, and jars, if they can be securely stoppered, may
+be used sometimes instead of hot water bags. The same precautions are
+necessary. Bricks, flat irons, or thick flannel bags containing salt or
+sand may be heated in the oven and used in the same way. Salt and sand
+retain heat for a long time, but are correspondingly slow to heat;
+therefore one bag should be heating in the oven while the other is in
+use. Their effect on the skin must be no less carefully watched than the
+effects of other hot applications.
+
+Hot dry flannel may be used without fear of burning a patient, and it
+sometimes yields sufficient warmth to relieve pain, particularly
+abdominal pain of babies. After it has been heated on a radiator or in
+an oven, it should be applied quickly and covered closely with another
+flannel to prevent escape of heat.
+
+Dry heat can be applied conveniently by an electric pad. The part to be
+heated may be wrapped in flannel or placed directly above or below the
+pad. The pad should be carefully watched to see that the switch is not
+accidentally turned, as it is possible for the pad to become hot enough
+to burn the patient or to set fire to the bed covers.
+
+MOIST HEAT.--To apply moist heat poultices or fomentations (stupes) are
+used.
+
+_Poultices_ may be made of various heat-retaining substances, but
+flaxseed meal is generally used. The poultices when ready should be
+applied without delay, therefore all preparations should be made in
+advance. To prepare a poultice, first provide a piece of gauze or thin
+old muslin about two inches wider than you wish the poultice to be when
+finished, and about two inches more than twice as long. In a shallow
+saucepan boil water, varying in amount according to the size of the
+poultice desired; about equal parts of water and meal will be needed.
+When the water is boiling briskly add the meal gradually, beating
+constantly with a spatula or knife. The poultice is done when the
+mixture coheres and is thick enough to drop from the spatula leaving it
+clean. Quickly spread a layer of the hot flaxseed from a quarter to half
+an inch thick on one-half of the muslin, leaving a margin on three sides
+of about an inch (Fig. 25). Fold in the margins of the cloth (Fig. 26)
+and then bring the other half of the cloth over the flaxseed so that the
+top of the poultice is covered. Tuck the free end of the upper half of
+the cloth under the turned in edges of the long sides.
+
+[Illustration: FIG. 25.--Turn the edges of the muslin over the flaxseed
+by folding first on the line _AA'_, and then on the lines _BB'_ and
+_CC'_.]
+
+[Illustration: FIG. 26.--Fold on the line _EE'_, bringing _FF'_ up over
+the flaxseed and tucking it under at _D_ and _D'_.]
+
+Carry the poultice on a hot plate, or rolled in a newspaper or hot
+towel. Test it carefully with the back of the hand, apply it to the skin
+gradually, cover it with cotton batting, oiled muslin, or several
+thicknesses of flannel, and keep it in place with a bandage or towel.
+Remove it as soon as it has become cold, and unless the skin is much
+reddened apply a fresh poultice. If the skin is much reddened, anoint it
+with vaseline or sweet oil, wrap it warmly, and apply the next poultice
+as soon as the appearance of the skin is normal.
+
+_Stupes_ or _hot fomentations_ are cloths, preferably of flannel or
+flannelette, wrung out of boiling water and applied to the skin. Each
+stupe should be three or four times as large as the area to be covered.
+Two are needed, so that one may be prepared before removing the other.
+To prevent escape of heat and moisture the stupe should be covered after
+it has been applied, first with a piece of rubber cloth or oiled silk or
+muslin, and next with several thicknesses of flannel, or cotton batting
+made into a pad. The whole should be kept in place with a bandage or
+towel used as a binder. The doctor will tell how often the stupes are to
+be applied, but if the skin becomes irritated they must be stopped until
+its appearance is again normal.
+
+[Illustration: FIG. 27.--WRINGING STUPE. (_From "Elementary Nursing
+Procedures," California State Board of Health._)]
+
+Great care must be taken in applying fomentations. They do little good
+unless very hot, but if applied too hot the patient is likely to be
+scalded. They must be wrung as dry as possible; but it is difficult to
+wring them without scalding the hands unless stupe wringers are used.
+Stupe wringers are heavy pieces of cloth, like roller towels or pieces
+of ticking, long enough to extend over opposite sides of the basin in
+which the stupe is to be boiled, and wide enough to hold the stupe
+easily. The wringer should be placed in the basin with the stupe
+arranged upon it. Boiling water should then be added, or the water,
+stupe, and wringer may be boiled together in the basin. After the stupe
+is ready, the wringer with the stupe upon it should be removed from the
+water by grasping the dry ends of the wringer. Then the ends should be
+twisted in opposite directions until the stupe inside is as dry as
+possible. Wringing is made easier if the wringer has wide hems into
+which sticks such as pieces of broom handles are inserted. By twisting
+the sticks in opposite directions the stupe may be wrung out easily.
+
+
+COLD APPLICATIONS
+
+DRY COLD.--Cold, like heat, may be used either dry or moist. Bags of
+rubber or of Japanese paper filled with small pieces of ice are used to
+apply dry cold. When weight is to be avoided, the bag should not be
+completely filled. After the bag has been filled and the air has been
+expelled, it should be stoppered securely and wrapped in a towel or
+piece of flannel, since it is possible for an uncovered ice bag to
+freeze the skin. Ice bags are easily punctured, and care should be taken
+not to bring pressure upon them especially when filled with sharp pieces
+of ice. An ice bag not in use should be thoroughly dry inside and out;
+it should be put away with enough absorbent cotton inside to keep the
+surfaces from adhering. Bags of Japanese paper are less costly than
+rubber, but less durable. To close them one should roll the top over and
+then tie it tightly with string.
+
+MOIST COLD.--Cold compresses for the head are often used for patients
+with fever or headache; they sometimes quiet a patient who is restless.
+An old handkerchief or piece of soft linen folded with the raw edges
+inside may be used as a compress. It should be large enough to cover the
+forehead. Two compresses at least should be provided, and a large piece
+of ice in a basin. One compress should be wrung so that it will not
+drip, and then applied to the head. The other meanwhile should be placed
+on the ice to cool. As soon as the first compress becomes warm, the
+second should be applied in its place.
+
+_Cold Compresses for the Eyes._--Soft material should be selected for
+eye compresses. Each one should be cut only a little larger than the eye
+and should fit neatly over it. Several compresses should be placed on a
+block of ice while one is applied to the eye, and every few minutes the
+compress should be changed. If there is discharge from the eye, each
+compress should be used but once; when used, they should be collected in
+a paper and afterward burned. Separate compresses should be used if both
+eyes are being treated. Definite directions in regard to changing
+compresses and the length of time the applications should be continued
+are generally given by the physician.
+
+
+COUNTER-IRRITANTS
+
+To some extent all hot applications are counter-irritants, but mustard
+pastes, mustard leaves, and the mustard foot-bath already described are
+the counter-irritants most commonly used.
+
+_Mustard Paste._--To make a mustard paste, mix dry mustard with flour,
+using for adults one part of mustard and six of flour to make a weak
+paste; increase the proportion of mustard up to equal parts of mustard
+and flour, according to the strength required. Use a smaller proportion
+of mustard for children; one part of mustard with from 6 to 10 parts of
+flour is generally enough. Add to the mustard and flour enough tepid
+water to make a paste, which must be absolutely free from lumps. Do not
+use hot water for this purpose, because it destroys some of the active
+properties of the mustard. Spread the paste on thin muslin, apply it to
+the skin, and remove it as soon as the skin is reddened so that its
+color resembles that of a strong sun-burn. If the skin is especially
+sensitive, mix a little sweet oil or vaseline with the paste.
+
+_Mustard leaves_ should be dipped in tepid water and may then be applied
+to the skin directly, but if specially sensitive, the skin should be
+protected by thin muslin or gauze. The leaf should remain until the skin
+is well reddened; a few minutes are generally sufficient.
+
+Care must be taken not to leave either a mustard leaf or a paste in
+place long enough to blister the skin. After the application has been
+removed; the part should be protected by a soft cloth until redness
+disappears. Vaseline or sweet oil should be applied to the skin if it is
+greatly irritated.
+
+Other counter-irritants in common use are iodine, turpentine, ammonia,
+kerosene, camphorated oil, capsicum vaseline, and various liniments.
+Tincture of iodine may be diluted with alcohol for especially sensitive
+skins; it sometimes causes blisters, and should not be applied more than
+once a day at most. Ammonia and turpentine cause blisters; they should
+not be used as counter-irritants except by a doctor's order, and then
+only after exact directions have been obtained. Turpentine and kerosene
+are inflammable and hence dangerous to use. It should be remembered that
+the action of all counter-irritants is physiologically the same, so that
+no advantage is obtained from the use of dangerous substances like
+kerosene and turpentine.
+
+
+EXERCISES
+
+1. What are the causes and symptoms of inflammation?
+
+2. Describe the process of inflammation.
+
+3. What is the effect of heat on an inflamed area? of cold?
+
+4. What are the dangers from hot applications, and how may they be
+guarded against?
+
+5. How should you fill a hot water bag? How should you cover it?
+
+6. Describe the method of preparing and applying a flaxseed poultice.
+
+7. Tell how to prepare and apply fomentations.
+
+8. How should you apply cold compresses to the head? to the eyes?
+
+9. How should you make a mustard paste for a baby six months old? for a
+grown person only slightly ill? for a feeble old person with a sensitive
+skin?
+
+
+FOR FURTHER READING
+
+Essentials of Medicine--Emerson, Chapter I.
+
+The Human Mechanism--Hough and Sedgwick, Chapter IX.
+
+
+
+
+CHAPTER XII
+
+CARE OF PATIENTS WITH COMMUNICABLE DISEASES
+
+
+The first chapter of this book described the ways in which communicable
+diseases are carried from person to person, and also some principles
+underlying methods of prevention. This chapter aims to show how these
+principles apply in the actual care of patients whose diseases are
+transmissible. In order to apply them intelligently, it is necessary to
+keep in mind certain facts in regard to the transmission of infections.
+A brief summary of these facts follows.
+
+Disease germs are present in the bodies of persons suffering from
+communicable disease, but they may also exist in the bodies of persons
+in good health; if present in the body, they may leave it in any bodily
+discharge. While every kind of germ does not leave the body by all the
+different routes, it is nevertheless true that most germs expelled from
+the body are carried in discharges from the nose, throat, bladder or
+bowels. Germ-laden discharges of an infected person may be distributed
+to other persons by water, milk and other foods, by certain insects, by
+unclean hands, by common drinking cups, towels, handkerchiefs, and
+similar articles, and directly by nose and throat spray. After they have
+been thus conveyed to other persons, the germs make their entrance into
+the body of their new victims through the digestive tract, through the
+nose, throat, and other mucous membranes, or through breaks in the skin.
+Prevention of communicable diseases, therefore, depends upon the measure
+of success attained in blocking the transit of germs from person to
+person; but methods of prevention, though easy to understand, are
+unfortunately sometimes difficult to carry out. In order to carry them
+out effectively one must devote to the problem great accuracy,
+unremitting care, considerable intelligence, and a highly developed
+conscience.
+
+Care of a patient suffering from transmissible disease is adequate only
+when it accomplishes two definite results. One result, which concerns
+the patient primarily, is to bring about his recovery as rapidly and as
+surely as possible; the other result, which concerns the community
+rather than the individual, is to make it impossible for the patient to
+infect others with his disease. In every case of communicable disease,
+from a slight cold in the head up to serious cases of pneumonia or
+typhoid fever, both the patient and the community must be constantly
+safe-guarded.
+
+INCUBATION PERIOD.--The interval between the moment when pathogenic
+germs enter the body, and the time when symptoms first appear and the
+patient begins to feel ill, is called the incubation period. Incubation
+periods vary according to the disease from a few hours to two or three
+weeks. The length of the period also varies somewhat in different cases
+of the same disease.
+
+CARE OF PATIENTS WITH COLDS OR OTHER SLIGHT INFECTIONS.--The usual
+symptoms of infectious diseases include fever, chill, sore throat, nasal
+discharge, cough, headache, vomiting and other digestive disturbances,
+and a general feeling of being sick all over. When one or more of these
+symptoms appear, unless they are very slight, a doctor should be sent
+for. The patient, whether child or grown person, should go to bed in a
+room alone and should stay in bed at least as long as the fever and
+symptoms of cold in the head continue, in order to protect others as
+well as himself. Persons in active life, it is true, are not always able
+to go to bed during colds; but there is no doubt that ultimately they
+would save time by doing so. It is especially necessary for children to
+remain in bed when suffering from colds, not only to insure their own
+well-being but also to protect others, since children are notably
+careless in regard to coughing, sneezing, and borrowing handkerchiefs.
+The patient needs mental rest as well as physical, and should not be
+allowed to work in bed.
+
+The patient's nose and throat discharges should be received only in
+material that can be burned, like old linen or muslin, gauze, or paper
+napkins. As soon as they are soiled these handkerchief substitutes
+should be placed in strong paper bags and afterward burned. Soiled
+handkerchiefs lurking under pillows or in other parts of the bed may
+infect other people or re-infect the patient. Handkerchiefs that may not
+be burned should be placed as soon as soiled in a covered receptacle
+filled with cold water containing a little washing soda; when several
+have been collected they should be boiled in the same covered receptacle
+for 20 minutes. After boiling they may go to the regular laundry.
+
+The patient's diet at first should be liquid or semi-solid. Large
+amounts of nourishment are not necessary during the first day or two,
+especially if the illness is likely to be short, but water should be
+taken as freely as possible. Cold drinks are generally acceptable during
+the feverish stage, but lemonade and other acids should be used with
+caution, since they sometimes irritate a sore throat. When the active
+symptoms have subsided the patient will need more food than usual, and a
+liberal, nourishing diet for a few days will do much to prevent the
+weakness and depressed vitality that often follow colds, tonsilitis, and
+other comparatively slight infections.
+
+The bowels should be carefully regulated, and a mild cathartic is often
+beneficial at the outset.
+
+Even during slight illness a patient should receive the daily care
+already described, and should be made as comfortable as possible. As in
+any illness, sponging and alcohol rubs are refreshing. An ice bag or
+cold compress may relieve headache, and hot applications or a cold
+compress on the throat are often soothing. The throat may be gargled
+with a solution of one teaspoonful of common salt dissolved in a pint of
+boiled water. If the patient perspires profusely he should be rubbed
+with a towel until dry, and provided with fresh warm, night clothes. An
+alcohol rub may well follow. It is most unwise for a patient who is
+perspiring freely to get up in a cold room and attend to himself.
+
+Common colds are far more serious than they are usually supposed to be.
+
+      "More people suffer from common colds than from any other
+      single ailment.... Could the sum total of suffering,
+      inconvenience, sequelae, and economic loss resulting from
+      common colds be obtained, it would at once promote these
+      infections from the trivial into the rank of the serious
+      diseases.... Colds are contracted from other persons having
+      colds, just as diphtheria is contracted from diphtheria.
+      Arctic explorers exposed to all the conditions ordinarily
+      supposed to produce colds do not suffer from these ailments
+      until they return to civilization and become infected by
+      contact with their fellowmen.... While common colds are
+      never fatal, the complications and sequelae are serious.
+      These are rheumatic fever, pneumonia, sinusitis, nephritis,
+      and a depressed vitality which favors other infections and
+      hastens the progress of organic diseases.
+
+      "Common colds are perhaps most contagious during the early
+      stages. If persons isolate themselves by remaining in bed
+      during the first three days of a cold, they would not only
+      benefit themselves, but would largely prevent the spread of
+      the infection. The contagiousness and severity of colds
+      differ in different epidemics and in different seasons of
+      the year, depending upon the particular micro-organism
+      involved and other factors not well understood.
+
+      "PREVENTION.--The prevention of colds consists, first in
+      avoiding the infection, and, secondly, in guarding against
+      the predisposing causes. Contact should be avoided with
+      persons who have colds, especially in street cars, offices,
+      and other poorly ventilated spaces where the risk of
+      persons coughing or sneezing directly in one's face is
+      imminent. Contact with the infection may further be guarded
+      against by a careful self-education in sanitary habits and
+      cleanliness, based upon the modern conception of contact
+      infection.
+
+      "Colds, like other diseases conveyed in the secretions from
+      the nose and mouth, are often conveyed by direct and
+      indirect contact through lack of hygienic cleanliness and a
+      disregard of sanitary habits. Kissing, the common drinking
+      cup, the roller towel, pipes, toys, pencils, fingers, food,
+      and other objects contaminated with the fresh secretions
+      will transmit the disease."--("Preventive Medicine and
+      Hygiene," Rosenau.)
+
+CARE DURING MORE SERIOUS INFECTIONS.--When a patient is suffering from
+serious transmissible disease, he needs the most skillful care
+available, and for the sake of others he must be strictly isolated or
+quarantined. By isolating or quarantining a patient is meant making such
+arrangements that germs expelled by the patient are necessarily
+destroyed before they can enter the body of another person. Isolation,
+therefore, includes disinfection, and while methods vary according to
+the nature of the particular disease, yet the principles given below are
+applicable in most cases.
+
+The first essential is that the patient should have a room to himself.
+No one except those caring for him should enter the sick-room for any
+purpose whatever; visitors should be rigidly excluded. At the outset all
+unnecessary articles should be removed from the sick-room, and it
+should be possible to boil, burn, scrub, or otherwise thoroughly clean
+everything allowed to remain. The windows should be screened in summer,
+and flies must be excluded. Fresh air is especially needed by patients
+with communicable diseases, and ventilation of the room must be adequate
+both day and night. Foul odors plainly indicate that the patient or
+something in the room is not clean. The remedy is obvious and deodorants
+are quite unnecessary if the patient and the room are properly cared
+for. It is highly desirable to reserve a bath room for the exclusive use
+of the patient and his attendant and also to reserve a room adjoining
+the patient's room for the exclusive use of the attendant. When it is
+impossible, as it often is, to give up so much space, each family must
+make the best arrangement it can to separate the patient and his
+attendant from the rest of the family.
+
+The attendant must remember that her ten fingers are the ten most active
+agents in distributing the communicable diseases. After handling the
+patient or anything that the patient has touched, and whenever she
+leaves the patient's room, she must scrub her hands thoroughly with warm
+water, soap, and a nail brush. She should not soil her hands
+unnecessarily, even though she intends to scrub them later. She must
+remember for her own protection to keep her hands away from her mouth
+and face, and to cleanse them with special care just before eating. If
+disinfection is needed in addition to the scrubbing, she must use
+conscientiously whatever solution the doctor orders.
+
+At the same time that she is caring for a patient with a communicable
+disease, the attendant ought not to care for children or other members
+of the family, she ought not to prepare food, and she ought not to
+handle dishes or utensils used by other persons. Every day, however,
+many women are doing just these things, and it is true that in many
+instances no bad results are observed. Yet if any arrangement to insure
+safety can possibly be made, it is inexcusable to run the risk of
+spreading diseases which kill thousands of persons every year and injure
+many more for life.
+
+When home conditions render adequate care and strict isolation of the
+patient impossible, hospital care should be seriously considered. No
+personal or sentimental objections should be allowed to influence the
+decision, if removing the patient to a hospital is necessary to
+safeguard his welfare or the welfare of the family. Hospital care should
+be considered especially for patients with typhoid fever, because
+untrained persons cannot safely care for patients so seriously ill.
+Since a patient with typhoid needs skilled care, and since he greatly
+endangers other persons, most authorities consider hospital care
+essential unless the patient can have the continuous services of a
+trained nurse and almost ideal home conditions. Many cases of typhoid,
+it is true, are successfully nursed at home in extremely adverse
+conditions by visiting nurses; yet in few kinds of sickness is
+continuous care by a graduate nurse more necessary to protect the
+community as well as to safeguard the patient himself.
+
+Members of a family in which there is typhoid should be immunized if the
+doctor advises it. This process, which is performed by the doctor, in
+the majority of cases renders a person immune to typhoid fever for three
+or four years.
+
+The question of home or institutional care for persons with tuberculosis
+must also be carefully considered. In some cases tuberculosis may be
+cared for at home with comparative safety, and in some other cases the
+risk is not very great if the patient is intelligent, careful, and well
+supervised. But everyone should face the fact that all cases of
+tuberculosis of the lungs involve some risk to others in the family, and
+most cases involve great risk. The danger to children is greater than to
+adults. Most tuberculosis infections, it is now believed, are acquired
+in childhood. The bad results of an infection acquired in childhood may
+not show themselves for years, since the germs may remain inactive until
+the person's resistance is lowered by some unfavorable condition.
+
+THE CHILDREN'S DISEASES.--The so-called children's diseases are probably
+the most familiar and the least regarded of all those belonging to the
+communicable group. Most persons, it is true, realize that scarlet fever
+is serious; everyone should also realize that measles and whooping-cough
+are serious. For example, in the State of New York during the year 1916,
+more children died from each of these diseases than from scarlet fever:
+in that year 745, or four times the number that died of scarlet fever,
+lost their lives from whooping-cough, while 913 died of measles. If
+diseases that kill hundreds of children every year are not serious, one
+is at a loss to know what a serious disease is.
+
+Some parents even expose children unnecessarily to these infections on
+the fatalistic theory that they must have the diseases sometime, and
+therefore the sooner the better. Nothing could be more mistaken; the
+diseases are not inevitable, and there is no advantage whatever in
+having them if escape is possible. Moreover, serious as the children's
+diseases are in themselves, their after-effects may be even more
+serious. At this very moment hundreds of people are going through
+life handicapped by weakened hearts or kidneys, by defective sight or
+hearing, merely because their parents considered the children's diseases
+necessary. The common belief that children should have these diseases as
+early as possible is also erroneous, since statistics show that the
+younger the child the more likely is the disease to prove fatal.
+
+Every mother should realize that the children's diseases are most
+infectious in the early stages. Early symptoms include fever, sore
+throat, and nasal discharge, and the trouble at first often resembles a
+severe cold. During this stage the diseases are most easily
+communicated. Measles in particular is generally not recognized until
+its most infectious stage has passed. The moral to be drawn is that sore
+throats, coughs, and colds should never be regarded lightly, and that
+their spread should be prevented by all possible means.
+
+The accompanying table taken from the regulations of the New York State
+Department of Health, gives symptoms of communicable diseases among
+children, and rules for isolation and exclusion from school.
+
+  NEW YORK STATE DEPARTMENT OF HEALTH
+  COMMUNICABLE DISEASES AMONG CHILDREN
+  RULES FOR ISOLATION AND EXCLUSION FROM SCHOOL
+
+  HERMAN M. BIGGS, M.D.
+  Commissioner
+
+  Issued by the
+  Division of Public Health Education
+
+  =======================================================================
+     DISEASE   |      PRINCIPAL SIGNS         |         METHOD OF       |
+               |       AND SYMPTOMS           |         INFECTION       |
+  -------------+------------------------------+-------------------------+
+  CHICKENPOX   | Rarely begins with fever.    | Contact with discharges |
+               | Rash appears on second day   | from nose and throat of |
+               | as small pimples, which in   | a patient.              |
+               | about a day become filled    |                         |
+               | with clear fluid. This fluid |                         |
+               | becomes yellow colored, a    |                         |
+               | crust forms and the scab     |                         |
+               | falls off in about 14 days.  |                         |
+               | Successive crops of papules  |                         |
+               | appear until tenth day.      |                         |
+  -------------+------------------------------+-------------------------+
+  DIPHTHERIA   | Onset may be rapid or        | Contact with discharges |
+               | gradual. The back of the     | from nose and throat,   |
+               | throat, tonsils, or palate   | occasionally by         |
+               | may show patches. The most   | drinking infected milk. |
+               | pronounced symptom is sore   |                         |
+               | throat. There may be hardly  |                         |
+               | any symptoms at all.         |                         |
+  -------------+------------------------------+-------------------------+
+  MEASLES      | Begins like cold in the      | Contact with discharges |
+               | head, with running nose,     | from nose and throat    |
+               | sneezing, inflamed and       | of a patient.           |
+               | watery eyes and fever.       |                         |
+               | Mulberry-tinted spots appear |                         |
+               | about the third day; rash    |                         |
+               | first seen behind the ears,  |                         |
+               | on forehead and face. The    |                         |
+               | rash varies with heat; may   |                         |
+               | almost disappear if the air  |                         |
+               | is cold, and come out again, |                         |
+               | with warmth.                 |                         |
+  -------------+------------------------------+-------------------------+
+  MEASLES      | Illness usually slight.      | Same as above.          |
+  (LIBERTY)    | Onset sudden. Lymph nodes in |                         |
+               | back of neck enlarged. Rash  |                         |
+               | often first thing noticed;   |                         |
+               | no cold in head. Usually     |                         |
+               | have fever, sore throat, and |                         |
+               | the eyes may be inflamed.    |                         |
+               | Rash sometimes resembles     |                         |
+               | measles and scarlet fever,   |                         |
+               | variable.                    |                         |
+  -------------+------------------------------+-------------------------+
+  MUMPS        | Onset may be sudden,         | Same as above.          |
+               | beginning with sickness and  |                         |
+               | fever, and pain about the    |                         |
+               | angle of the jaw. The        |                         |
+               | parotid glands become        |                         |
+               | swollen and tender. Opening  |                         |
+               | the mouth is accompanied by  |                         |
+               | pain.                        |                         |
+  -------------+------------------------------+-------------------------+
+  POLIOMYELITIS| Onset sudden, fever,         | Contact with discharge  |
+               | excitable, pain on bending   | from nose, throat or    |
+               | neck forward, pain on being  | bowels of a patient     |
+               | handled, headache, vomiting. | or carrier.             |
+               | Sometimes sudden development |                         |
+               | of weakness of one or more   |                         |
+               | muscle groups.               |                         |
+  -------------+------------------------------+-------------------------+
+  SCARLET      | The onset is usually sudden, | Discharges from nose    |
+  FEVER        | with headache, fever, sore   | and mouth, suppurating  |
+               | throat, and often vomiting.  | glands or ears of a     |
+               | Usually within twenty-four   | patient.                |
+               | hours the rash appears as    | Milk may convey         |
+               | fine, evenly diffused, and   | infection.              |
+               | bright red dots under skin.  |                         |
+               | The rash is seen first on    |                         |
+               | the neck and upper part of   |                         |
+               | chest, and lasts three to    |                         |
+               | ten days, when it fades and  |                         |
+               | the skin peels in scales,    |                         |
+               | flakes, or even large        |                         |
+               | pieces.                      |                         |
+  -------------+------------------------------+-------------------------+
+  SMALLPOX     | Onset sudden usually with    | All discharges of a     |
+               | fever and severe backache.   | patient and particles   |
+               | About third day upon         | of skin or scabs.       |
+               | subsidence of constitutional |                         |
+               | symptoms red shot-like       |                         |
+               | pimples, felt below the      |                         |
+               | skin, and seen first about   |                         |
+               | the face and wrists most on  |                         |
+               | exposed surfaces, develop.   |                         |
+               | They form little blisters    |                         |
+               | and after two days more      |                         |
+               | become filled with yellowish |                         |
+               | matter. Scabs form which     |                         |
+               | begin to fall off about the  |                         |
+               | fourteenth day.              |                         |
+  -------------+------------------------------+-------------------------+
+  SORE THROAT, | Begins with sore throat and  | Discharges from nose    |
+  ACUTE,       | weakness. Throat diffusely   | and mouth of a          |
+  SEPTIC       | reddened and may show        | patient.                |
+               | patches like diphtheria.     |                         |
+  -------------+------------------------------+-------------------------+
+  WHOOPING     | Begins with cough which is   | Discharges from nose    |
+  COUGH        | worse at night. Symptoms may | and mouth of a          |
+               | at first be very mild.       | patient.                |
+               | Characteristic "whooping"    |                         |
+               | cough develops in about 2    |                         |
+               | weeks, and the spasm of      |                         |
+               | coughing sometimes ends with |                         |
+               | vomiting.                    |                         |
+  =======================================================================
+  ===============================================================
+               |             EXCLUSION FROM SCHOOL              |
+               |-------+-------------------+--------------------+
+               |       | OTHER CHILDREN    |    OTHER SCHOOL    |
+               |       |    OF SAME        |     CHILDREN       |
+    DISEASE    |       |   HOUSEHOLD       | ESPECIALLY EXPOSED |
+               |       +--------+----------+--------+-----------+
+               |Patient|        |          |        |           |
+               |       | Non-   |          | Non-   |           |
+               |       | immunes|Immunes[3]| immunes| Immunes[3]|
+               |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  CHICKENPOX   |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  DIPHTHERIA   |  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  -------------+-------+--------+----------+--------+-----------+
+  MEASLES      |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  MEASLES      |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  (LIBERTY)    |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  MUMPS        |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  POLIOMYELITIS|  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  -------------+-------+--------+----------+--------+-----------+
+  SCARLET      |  Yes  |   Yes  |    Yes   |   Yes  |    Yes    |
+  FEVER        |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  SMALLPOX     |  Yes  |   Yes  |    Yes   |   Yes  |    No     |
+  -------------+-------+--------+----------+--------+-----------+
+  SORE THROAT, |  Yes  |   No   |    No    |   No   |    No     |
+  ACUTE,       |       |        |          |        |           |
+  SEPTIC       |       |        |          |        |           |
+  -------------+-------+--------+----------+--------+-----------+
+  WHOOPING     |  Yes  |   Yes  |    No    |   Yes  |    No     |
+  COUGH        |       |        |          |        |           |
+  ===============================================================
+  ================================================================================
+              |               DURATION OF EXCLUSION FROM DATE OF ONSET           |
+              +--------------+------------+-------------------------+------------+
+              |              |  PATIENT   |      PATIENT REMAINS    |            |
+              |              |  GOES TO   |        ISOLATED AT      |            |
+              |              |  HOSPITAL  |           HOME          |            |
+    DISEASE   |              +------------+------------+------------+            |
+              |  PATIENT     | Other      | Other      | Children   |  Children  |
+              |              | children   | children   | who leave  |  exposed   |
+              |              | of         | who        | household  |  at        |
+              |              | the same   | remain at  | as soon as |  school    |
+              |              | household  | home       | disease is |            |
+              |              |            |            | discovered |            |
+  ------------+--------------+------------+------------+------------+------------+
+  CHICKENPOX  | Until all    | Exclude if non-immune until          |Exclude     |
+              | scabs are    | 21st day after child last            |from        |
+              | shed and     | saw patient.                         |school if   |
+              | disinfection |                                      |non-immune  |
+              | of person;   |                                      |during      |
+              | at least     |                                      |11th to 22d |
+              | 12 days.     |                                      |days after  |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  DIPHTHERIA  |Until         | Until two cultures at least 24       |            |
+              |patient is    | hours apart are reported             |            |
+              |recovered     | negative. Those showing              |            |
+              |and has two   | diphtheria bacilli should not        |            |
+              |cultures      | necessarily be immunized             |            |
+              |from throat   | unless symptoms appear.              |            |
+              |and nose which|                                      |            |
+              |contain no    |                                      |            |
+              |diphtheria    |                                      |            |
+              |bacilli;      |                                      |            |
+              |cultures not  |                                      |            |
+              |to be taken   |                                      |            |
+              |until 9 days  |                                      |            |
+              |from date of  |                                      |            |
+              |onset.        |                                      |            |
+              |Disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ------------+--------------+--------------------------------------+------------+
+  MEASLES     | Until        | Exclude non-immunes until            |If          |
+              | recovery and | 15th day after child last            |non-immune  |
+              | disinfection | saw patient.                         |exclude     |
+              | of person;   |                                      |from school |
+              | at least 7   |                                      |during 8th  |
+              | days from    |                                      |to 15th     |
+              | onset.       |                                      |day after   |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  MEASLES     | Until        | Exclude if non-immune until          |Exclude from|
+  (LIBERTY)   | recovery and | 22d day after child last             |school if   |
+              | disinfection | saw patient.                         |non-immune  |
+              | of person;   |                                      |during 11th |
+              | at least 8   |                                      |to 22d days |
+              | days.        |                                      |after       |
+              |              |                                      |child last  |
+              |              |                                      |saw patient.|
+  ------------+--------------+--------------------------------------+------------+
+  MUMPS       |Two weeks     | Exclude 15th to 22d day after        |Exclude     |
+              |after onset   | child last saw patient.              |from 15th   |
+              |and one week  |                                      |to 22d day  |
+              |after         |                                      |after child |
+              |disappearance |                                      |last saw    |
+              |of swelling   |                                      |patient.    |
+              |and after     |                                      |            |
+              |disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ------------+--------------+------------+------------+------------+------------+
+  POLIO-      | Until        | 14 days    | Until 14   | 14 days    |            |
+  MYELITIS    | patient is   | from time  | days       | from time  |            |
+              | recovered.   | child      | after      | child      |            |
+              | Disinfection | last saw   | quarantine | last       |            |
+              | of person at | patient.   | raised.    | saw        |            |
+              | least 21     |            |            | patient.   |            |
+              | days.        |            |            |            |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SCARLET     |At least 30   | Seven days | Until      | Seven      |            |
+  FEVER       |days and until| from time  | seven days | days from  |            |
+              |discharges    | child      | after      | time       |            |
+              |have ceased   | last saw   | quarantine | child      |            |
+              |and           | patient.   | raised.    | last saw   |            |
+              |disinfection  |            |            | patient.   |            |
+              |of person.    |            |            |            |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SMALLPOX    |Recovery and  |Exclude if  |Exclude if  |Exclude if  |Exclude 20  |
+              |disinfection  |non-immune  |non-immune  |non-immune  |days unless |
+              |of person     |until 21st  |until 20    |until 21st  |they have   |
+              |at least 14   |day after   |days after  |day after   |been        |
+              |days.         |child last  |quarantine  |child last  |successfully|
+              |              |saw patient,|has been    |saw patient,|vaccinated  |
+              |              |or 7 days   |raised or   |or 7 days   |within 1    |
+              |              |after       |7 days after|after       |year in     |
+              |              |successful  |successful  |successful  |which       |
+              |              |vaccination |vaccination |vaccination |case they   |
+              |              |and         |and         |and         |may return  |
+              |              |disinfection|disinfection|disinfection|at once.    |
+              |              |of person.  |of person.  |of person.  |            |
+  ------------+--------------+------------+------------+------------+------------+
+  SORE THROAT,|Until         |                                      |            |
+  ACUTE,      |recovery.     |                                      |            |
+  SEPTIC      |              |                                      |            |
+  ------------+--------------+--------------------------------------+------------+
+  WHOOPING    |Eight weeks   | Fourteen days provided no cough      |            |
+  COUGH       |or until 1    | develops.                            |            |
+              |week after    |                                      |            |
+              |last          |                                      |            |
+              |characteristic|                                      |            |
+              |cough and     |                                      |            |
+              |disinfection  |                                      |            |
+              |of person.    |                                      |            |
+  ================================================================================
+  =================================================================
+     DISEASE   |                  Remarks                         |
+               |                                                  |
+  -------------+--------------------------------------------------+
+  CHICKENPOX   | A mild disease and seldom any after effects.     |
+  -------------+--------------------------------------------------+
+  DIPHTHERIA   | Very dangerous, both during attack and from      |
+               | after effects. When diphtheria occurs in a       |
+               | school all children suffering from sore throat   |
+               | should be excluded and the health officer        |
+               | notified. The medical school inspector or        |
+               | health officer should take cultures from all     |
+               | inflamed throats and noses. There is great       |
+               | variation of type, and mild cases are often      |
+               | not recognized, but are as infectious as         |
+               | severe cases. There is frequently no immunity    |
+               | from further attacks.                            |
+  -------------+--------------------------------------------------+
+  MEASLES      | After effects often severe. Period of greatest   |
+               | risk of infection three days, before and after   |
+               | the rash appears. Great variation in type        |
+               | of disease. Dangerous in children under 2        |
+               | years of age. During an outbreak all children    |
+               | having a temperature over 99 F. should           |
+               | be sent home and the health officer notified.    |
+  -------------+--------------------------------------------------+
+  MEASLES      | After effects slight. Regulations strict,        |
+  (LIBERTY)    | because frequently confused with scarlet fever.  |
+  -------------+--------------------------------------------------+
+  MUMPS        | Seldom leaves after effects. Very infectious.    |
+               | Inflammation of genital organs of male or        |
+               | female may occur.                                |
+  -------------+--------------------------------------------------+
+  POLIOMYELITIS| Disease is most communicable in the early        |
+               | stages. After effect is paralysis of certain     |
+               | muscle groups, transitory or permanent.          |
+               | Death is due usually to paralysis of             |
+               | respiratory muscles.                             |
+  -------------+--------------------------------------------------+
+  SCARLET      | Dangerous both during attack and from after      |
+  FEVER        | effects. Great variation in type of disease.     |
+               | Slight attacks are as infectious as severe       |
+               | ones. Many mild cases not diagnosed and          |
+               | many concealed. A second attack is rare.         |
+               | When scarlet fever occurs in a school, all       |
+               | cases of sore throat should be sent home and     |
+               | health officer notified. Most fatal in           |
+               | children under ten years.                        |
+  -------------+--------------------------------------------------+
+  SMALLPOX     | Peculiarly infectious. When smallpox occurs      |
+               | in connection with a school or with any of       |
+               | the children's homes all persons exposed         |
+               | must be vaccinated or quarantined for a          |
+               | period of 20 days. Cases of modified smallpox    |
+               | in vaccinated persons, may be, and often         |
+               | are, so slight as to escape detection. Fact      |
+               | of existence of disease may be concealed.        |
+               | Mild or modified smallpox is as infectious as    |
+               | severe type.                                     |
+  -------------+--------------------------------------------------+
+  SORE THROAT, | Often leads to serious results, affections of    |
+  ACUTE,       | heart, kidneys, etc. Very apt to occur in        |
+  SEPTIC       | epidemics due to milk contaminated by a          |
+               | patient suffering from the disease.              |
+  -------------+--------------------------------------------------+
+  WHOOPING     | After effects often very severe and disease      |
+  COUGH        | causes great debility. Relapses are apt to       |
+               | occur. Second attack rare. Specially             |
+               | infectious for first week or two. If a child     |
+               | vomits after a paroxysm of coughing, it is       |
+               | probably suffering from whooping cough.          |
+               | Great variation in type of disease. Often        |
+               | fatal in young children.                         |
+  =================================================================
+
+  [3] Immunes are those who have had the diseases or in smallpox, who
+  have been successfully vaccinated within a year.
+
+  DISINFECTION: The cleansing and disinfection of the person includes
+  washing the entire body and the hair with soap and water; thorough
+  brushing of the teeth; rinsing the mouth; gargling the throat, and
+  douching and spraying the nose with an antiseptic solution; and
+  finally, a complete change of clothing (or a change of underwear and
+  a thorough shaking and brushing of the outer garments out of doors
+  before these are put on again). (_Facing p. 247_)
+
+It may be added that the ways by which poliomyelitis, or infantile
+paralysis, is spread are not definitely known at the time of writing.
+We are justified, however, in believing that investigation now in
+progress will make exact information available in the near future.
+
+      "The weight of present opinion inclines to the view that
+      poliomyelitis is exclusively a human disease, and is spread
+      by personal contact, whatever other causes may be found to
+      contribute to its spread. In personal contact we mean to
+      include all the usual opportunities, direct or indirect,
+      immediate or intermediate, for the transference of body
+      discharges from person to person, having in mind as a
+      possibility that the infection may occur through
+      contaminated food.
+
+      "The incubation period has not been definitely established
+      in human beings. The information at hand indicates that it
+      is less than two weeks, and probably in the great majority
+      of cases between 3 and 8 days."--(Report of Special
+      Committee on Infantile Paralysis, American Journal of
+      Public Health, November 1916.)
+
+
+DISINFECTION
+
+Specific directions for disinfecting in every kind of communicable
+disease would be too extended to be given here. In each case the
+attendant should learn from the doctor just how that particular disease
+is communicated, just what discharges, utensils, linen, etc., need to be
+disinfected, and just what disinfectants he prefers to have used. The
+following general methods are now in use, but it must be remembered that
+from time to time new methods are devised and new disinfectants are
+discovered.
+
+CARE OF NOSE AND THROAT DISCHARGES.--The care of handkerchiefs has
+already been described on page 239. Cloths or cotton used to wipe the
+eyes or to receive any other bodily discharge including vomitus, should
+be collected in the same way and burned. Everyone should be taught in
+early childhood to cover the nose and mouth with a handkerchief during
+coughing and sneezing; if the patient has not already learned to do so
+he must be taught now. If the amount of expectoration is great,
+waterproof receptacles should be provided, which should be burned with
+their contents.
+
+CARE OF DISCHARGES FROM THE BOWELS AND BLADDER.--At the present time the
+following preparations are commonly used to disinfect stools and urine:
+5% solution of carbolic acid; chloride of lime solution, made freshly
+whenever needed by mixing thoroughly 1/2 pound of chloride of lime with
+one gallon of water; and unslaked lime to which is added _hot_ water.
+The amount of carbolic solution used should be about equal in bulk to
+the amount of material to be disinfected; the chloride of lime solution
+should be at least twice, and the unslaked lime at least one-eighth the
+bulk. Fecal masses should be broken up so that the disinfectant may
+reach every part; they may be stirred with tightly twisted toilet paper,
+which should be left in the bedpan and disinfected with the stools. If
+these substances are used, disinfection is considered complete at the
+end of an hour, and the contents of the bedpan may then be emptied into
+the toilet with safety. It may be necessary to provide two bedpans so
+that one may be available for use while the contents of the other is
+being disinfected. Bedpans and urinals should be boiled daily and kept
+thoroughly clean at all times.
+
+In places having no sewerage system, disinfected discharges may be
+emptied into a trench situated at a distance from the well, and then
+covered with earth. As an extra precaution, the disinfected discharges
+may be mixed with sawdust or kerosene and burned in the trench.
+Directions for installing a sanitary privy may be found in Bulletin 68
+of the United States Public Health Service.
+
+BATH WATER and water that has been used for cleansing the teeth and
+mouth may be disinfected in the same way as urine, or it may be emptied
+into a suitable receptacle and boiled ten minutes.
+
+CARE OF THE HANDS.--Disinfectants for the hands should be used in
+addition to scrubbing with soap and water, not as a substitute. The
+hands may be disinfected after scrubbing by soaking them for three
+minutes in one of the following solutions: alcohol 70%, carbolic acid
+solution 2-1/2%, or a solution made by adding one teaspoonful of lysol
+or of creolin to a pint of water. These disinfectants are poisons if
+taken internally; the bottles must be carefully labeled and kept in a
+safe place. It is a good plan to wear rubber gloves when handling
+infective material; the gloves should afterward be boiled for ten
+minutes.
+
+CARE OF UTENSILS.--A sufficient number of dishes, spoons, tumblers,
+basins, etc. must be reserved for the patient's exclusive use; these
+utensils must be washed separately and dried with towels not used for
+other dishes. Mistakes frequently occur by which other persons use the
+patient's dishes, and in consequence his dishes should not be kept in
+the cupboard with other dishes; if no other safe place can be found,
+they had better stay in the patient's room covered with a clean cloth or
+napkin. The dishes should be scalded daily and at the termination of the
+illness they must be boiled briskly for ten minutes before they are
+returned to general use. Food left on the patient's tray should be
+burned; it should not be eaten by any one else, nor placed in the pantry
+or refrigerator with other food.
+
+CARE OF LINEN.--A satisfactory way to disinfect towels, night gowns, bed
+linen, etc. is to place the articles immediately in a wash boiler filled
+with cold water to which a little washing soda has been added, and then
+to boil them in the same water for twenty minutes; they can afterward
+go safely into the regular laundry. The boiling may be done once a day;
+articles soiled in the meantime may be left to soak in the cold water
+and soda.
+
+DISINFECTION OF THE PERSON.--"The cleansing and disinfection of the
+person includes washing the entire body and the hair with soap and
+water; thorough brushing of the teeth; rinsing the mouth; gargling the
+throat, and douching and spraying the nose with an antiseptic solution;
+and finally, a complete change of clothing (or a change of underwear)
+and a thorough shaking and brushing of the outer garments out-of-doors
+before these are put on again."--(New York State Department of Health.)
+
+TERMINATION OF QUARANTINE.--After the patient has recovered, he and the
+attendant should, if the doctor thinks it necessary, disinfect
+themselves as directed above before they mingle again with other people.
+The exact time when it is safe for a person to come out of quarantine
+and resume ordinary life varies in different diseases. Moreover, opinion
+differs in regard to quarantine periods for the same diseases, so that
+the regulations of Boards of Health in different cities show wide
+variations. It is of course impossible to say at just what moment every
+patient, or even the majority of patients, will stop expelling germs.
+Quarantine periods are intended to protect the community as completely
+as possible without causing unnecessary hardship to individuals. In any
+given case, the local regulations should be strictly observed but
+release from quarantine is not a guarantee that the patient is not still
+discharging germs, and extreme care should still be taken to prevent the
+spread of saliva and other discharges.
+
+TERMINAL DISINFECTION.--A room that has been occupied by a patient with
+a communicable disease should be thoroughly cleaned at the termination
+of the illness. Dishes, utensils, bed linen, etc. should be cared for in
+the ways already described. The floor, bedstead, and other furniture
+should be washed with hot water, soap, and washing soda. The walls,
+windows, etc., should be wiped with a cloth wrung out of hot water, soap
+suds, and soda. The mattress, unless badly soiled with discharges,
+should be scrubbed with the same solution and a stiff brush, and left
+out-of-doors in the sunshine for a day or two, or until dry. If badly
+soiled, it is best to destroy the mattress unless the Board of Health
+has facilities for steam sterilization. Ordinary washing is all that is
+generally required for blankets, but if badly soiled they should be
+sterilized by steam or burned. The room should then be thoroughly
+sunned and aired for a day or two, with the windows wide open both day
+and night. Sunning and airing are among the most important measures in
+disinfecting a room, and should not be slighted. If there has been gross
+pollution, as when a careless consumptive persists in spitting on the
+floor and walls, it may be necessary to remove the old paint and paper
+and have the room done over. The room may safely be occupied after all
+these measures have been taken.
+
+FUMIGATION.--Many Boards of Health have abandoned fumigation after
+communicable diseases, except after those which like typhus and yellow
+fever, are carried by vermin or insects. Dry formaldehyde gas, which was
+formerly used for fumigation, has a violent effect on mucous membranes,
+but its power to kill bacteria, even on surfaces, appears to be weak,
+while its penetrating power is not sufficient to disinfect bedding,
+carpets, upholstered furniture, and other fabrics. Since fumigation is
+costly, troublesome, and ineffectual there seems to be no good reason
+for using it. Moreover, its use gives a false sense of security, so that
+really effective measures like sunning, airing, and scrubbing are likely
+to be neglected.
+
+Theory and practice of disinfection, it is clear, have radically
+changed in recent years. Modern knowledge requires concurrent
+disinfection, or the destruction of germs from the moment when symptoms
+are first noticed; all the time, day and night, this disinfection must
+go on with unremitting care. Today wet sheets are not hung in doorways
+nor are chemicals left about in open dishes to disinfect quite harmless
+air, but scrupulous cleanliness at all stages of disease is recognized
+as one of the most important measures, if not the most important
+measure, in disinfection.
+
+
+EXERCISES
+
+1. Summarize the ways in which infectious diseases are spread.
+
+2. What is meant by the incubation period? State the length of the
+incubation period in measles; Liberty measles; whooping-cough; scarlet
+fever; chicken-pox; diphtheria; mumps; typhoid fever.
+
+3. Name some of the early symptoms common to most infectious diseases.
+If such symptoms appear, what should be done while waiting for the
+doctor to come?
+
+4. Discuss the importance, prevention, and treatment of common colds.
+
+5. What measures should be taken to isolate a patient who is suffering
+from a communicable disease?
+
+6. What special care should the attendant of a patient with a
+communicable disease give to her own clothing and person?
+
+7. Why are the children's diseases more serious in reality than they are
+commonly supposed to be?
+
+8. Describe the symptoms of each of the following: Measles, scarlet
+fever, chicken-pox, mumps, whooping-cough, and diphtheria.
+
+9. How should bowel and bladder discharges be disinfected?
+
+10. How should dishes and other utensils be disinfected?
+
+11. How should linen be disinfected?
+
+12. Describe measures necessary for concurrent disinfection.
+
+13. Describe measures necessary for terminal disinfection.
+
+
+FOR FURTHER READING
+
+Preventive Medicine and Hygiene--Rosenau.
+
+The New Public Health--Hill, Chapters VII-XVII.
+
+Essentials of Medicine--Emerson, Chapters XII-XV.
+
+Health and Disease--Roger I. Lee, Chapter X-XIV.
+
+Disease and Its Causes--Councilman, Chapters V-IX.
+
+Publications of the New York State Department of Health, Albany,
+entitled: The Teacher and Communicable Disease; A Method for the Control
+of Communicable Diseases in Schools; Regulations and Instructions for
+Cleansing and Disinfection; The Conduct of an Isolation Period for
+Communicable Disease in a Home; Tuberculosis; Typhoid Fever; Scarlet
+Fever; Measles; Whooping-cough; Diphtheria; Poliomyelitis, Acute
+Anterior (Infantile Paralysis); Smallpox; Septic Sore Throat; Venereal
+Diseases. (Any of the above pamphlets will be sent upon receipt of a
+three cent stamp.)
+
+
+
+
+CHAPTER XIII
+
+COMMON AILMENTS AND EMERGENCIES
+
+
+This chapter describes a few home treatments for the relief of slight
+ailments and injuries, together with some measures that may be employed
+in emergencies. For more extended instructions in these subjects the
+student should consult the Red Cross Text-book on First Aid.
+
+
+CONDITIONS IN WHICH THE NERVOUS SYSTEM IS INVOLVED
+
+HEADACHE.--Headache is not a disease in itself, but a symptom common to
+many different disorders. Among the abnormal conditions often causing
+headaches are fatigue, eyestrain, indigestion, constipation, neuralgia,
+rheumatism, anaemia, acute infections, and other disorders. Treatment
+should consist in finding the cause and removing it if possible; clearly
+no one remedy can cure so many different causes. A physician should be
+consulted if headaches are of frequent occurrence, but in many cases
+rest and attention to other hygienic requirements are all that is
+needed. During an attack of headache a hot foot bath may give relief, or
+a mustard paste or cold applications on the back of the neck, or an ice
+bag or cold compress on the forehead.
+
+SLEEPLESSNESS, like headache, has many possible causes, and effective
+treatment consists in finding and removing them. Pain or discomfort of
+any kind, fatigue, overwork, and worry are common causes. Sleeplessness
+easily becomes a habit that may persist after its cause has been
+removed; hence a person who has formed the habit of sleeplessness should
+patiently strive to break the old habit and to substitute a better. A
+careful hygienic regime is essential for the patient, exercise in the
+open air, and cultivation of a hopeful and tranquil spirit. The diet
+should be liberal, but light and unstimulating; tea and coffee should be
+omitted, certainly during the latter part of the day. The patient should
+spend rather a dull evening, avoiding excitement and mental exertion
+that is difficult, even though pleasurable. He should retire early. A
+hot tub or foot bath, and a hot drink at bed time may help to produce
+sleep. The bedroom should be dark, cool, and well ventilated, the bed
+comfortable and the covers light but warm. The patient should be told
+that rest is the most important thing for him, and that he should not
+try too hard to sleep nor worry if unsuccessful. The patient should try
+to banish from his mind, at bed time, thoughts that are distressing, and
+even those that are especially interesting. By using patience and
+persistence most persons can regain the power of sleeping even when
+habits of sleeplessness have been long established.
+
+FAINTING is a partial or total loss of consciousness due to a diminished
+supply of blood in the brain. It may follow bleeding, exhaustion from
+heat, fatigue from prolonged standing and the like, or strong emotional
+disturbance, like fear or surprise. Fainting is less common than it
+formerly was; it now occurs most frequently among persons suffering from
+anaemia, heart weakness, or special susceptibility.
+
+Symptoms of fainting are pale face, cold perspiration, rapid, feeble
+pulse, and shallow, sighing respiration. Treatment consists in removing
+the patient into cool, fresh air, applying cold water to the face and
+keeping the head low. For a person who feels faint but has not lost
+consciousness, this treatment will probably prove sufficient; if,
+however, he becomes unconscious, place him so that the head is lower
+than the body, loosen the clothing, especially the clothing about the
+neck, apply cold water to the face and chest, and see that fresh air is
+plentiful. When the patient is sufficiently conscious to swallow, give a
+teaspoonful of aromatic spirits of ammonia in half a glass of water and
+keep him quiet until he has entirely recovered.
+
+A person who is unconscious from any cause always requires immediate
+attention. In emergency work elevate the patient's head if his face is
+flushed, and keep it low if his face is pale. Do not try to arouse an
+unconscious patient by shaking him and calling to him, in the first
+place because it is useless to do so, and in the second, because
+consciousness will return spontaneously if his condition improves.
+
+CONVULSIONS.--In every case of convulsions a doctor is needed at the
+earliest possible moment. Convulsions in adults are very serious; in
+babies and small children although serious they are less alarming, since
+they may follow comparatively slight disturbances, particularly
+disturbances of digestion.
+
+Treatment for babies and children with convulsions consists first in
+keeping the child as quiet as possible, and next in measures to draw
+blood from the brain toward the surface of the body. The child should
+first be undressed, moving him as little as possible, and put to bed
+between warm blankets. Cold should be applied to his head by a compress
+or ice bag, and hot water bag should be placed near his feet. An enema
+should then be given. A warm tub bath is sometimes used to apply heat,
+if the convulsion has not subsided by the time the child is undressed.
+If the bath is given the temperature of the water should not be above
+106 deg., and should be tested by a thermometer. If no thermometer is
+available, the water should be tested with the elbow rather than the
+hand, and cold water should be added if it feels uncomfortably warm.
+There is great danger of scalding a child during the excitement
+inevitably caused by a convulsion.
+
+Although haste is needed when a child has convulsions, yet quiet is
+essential, since the slightest movement tends to increase the
+convulsions or to start them again. As soon as the convulsions are over
+the child should be removed from the bath and put to bed between warm
+blankets. Even after the symptoms have completely subsided, the greatest
+care should be taken to keep the child quiet. He should be handled and
+disturbed as little as possible. The bath should be repeated if
+convulsions begin again. The doctor, when he comes, will probably order
+a dose of castor oil; and therefore, if it is impossible to obtain a
+doctor at once, the dose should be given.
+
+SHOCK (in the medical sense of the word) or _collapse_, is a serious
+condition in which a patient's vitality and all his bodily processes are
+profoundly depressed. Generally shock occurs only after a severe injury
+or a long exhausting illness. Since, however, some persons are
+peculiarly susceptible to it, the possibility of shock must be kept in
+mind in treating even slight injuries. The probability of shock is
+somewhat increased if patients are allowed to see their own wounds.
+Injured persons should always sit or lie down while wounds, however
+slight, are dressed.
+
+Symptoms of shock are pallor, pinched, anxious expression, dilated
+pupils, cold clammy skin, feeble breathing, and rapid, weak pulse. The
+patient may be mentally normal, or irrational, or unconscious, but more
+frequently he appears stupid, and though conscious, he pays no attention
+to what is going on. Unfortunately this condition is sometimes mistaken
+for sleepiness, and he is left alone to sleep just when active measures
+are most needed.
+
+If a patient shows any symptom of shock the doctor should be summoned
+immediately, but no time should be lost in beginning treatment, since
+the condition may be critical. It should be remembered, however, that
+panic and confusion may alarm a patient who is conscious, and thus
+increase the shock. The patient should be covered warmly, and undressed
+under blankets, without exposure or avoidable moving. His head should be
+low, and as quickly as possible hot water bags should be placed near but
+not upon him. If the patient is conscious and able to swallow he should
+be given hot coffee or aromatic spirits of ammonia, one teaspoonful in
+half a glass of water. The legs and arms should be rubbed from the
+extremities toward the heart, but care should be taken to avoid touching
+or moving injured parts. The patient should stay in bed, warmly covered
+and closely watched for some time after he has apparently recovered.
+
+Helping a patient into bed is not necessarily the first thing to be done
+in every case of sudden illness. Great harm may be done by the
+injudicious moving of injured persons, and often it is safer to make a
+person comfortable with pillows and blankets where he happens to be,
+certainly until a sufficient number of people can be found to lift him
+properly. Clothing should be removed carefully, and one should not
+hesitate to cut it away if undressing is painful or necessitates much
+moving.
+
+STIMULANTS, in emergency work, are frequently misused. They should not
+be given when the head has been injured, when bleeding is profuse, or
+when the face is red and the pulse strong. Neither should attempts be
+made to give fluids of any kind to patients not sufficiently conscious
+to swallow. Safe stimulants to use are black coffee, tea, or aromatic
+spirits of ammonia. Alcoholic liquors should not be given unless
+prescribed by a physician.
+
+SUNSTROKE AND HEAT EXHAUSTION are both caused by excessive heat either
+indoors or out, but they differ both in symptoms and in treatment.
+
+Sunstroke or heat stroke, usually begins with acute pain in the head,
+followed almost immediately by loss of consciousness. The skin is dry
+and very hot, the face is red or purple, the pupils are dilated, the
+breathing is difficult, the pulse is slow, and the temperature high.
+
+Treatment consists in sending for the doctor, removing the patient to a
+cool place, undressing him and applying cold, especially to the head and
+spine, or still better, placing him in a very cold bath. The body should
+be rubbed constantly in the direction of the heart. Stimulants should
+not be given.
+
+Symptoms of heat exhaustion, on the other hand, resemble those of shock.
+The doctor should be summoned, and the patient should be removed to a
+cool and quiet place, where he should stay warmly covered in a reclining
+position. Stimulants should be given, hot water bags applied, and the
+other measures for treating shock should be employed.
+
+
+CONDITIONS IN WHICH THE DIGESTIVE TRACT IS AFFECTED
+
+NAUSEA AND VOMITING are frequently caused by injudicious eating,
+especially when a person is worried or fatigued. A doctor should be
+consulted if either one occurs often, or if vomiting is accompanied by
+pain, prostration, diarrhoea, fever, or other acute symptoms. A person
+who is nauseated should lie down in a cool, quiet place. Hot
+fomentations may be applied to the abdomen, or a mustard paste over the
+stomach. Soda mints or a teaspoonful of baking soda may be given
+dissolved in hot water, and unless diarrhoea is present a Seidlitz
+powder or other saline cathartic may be given. A large quantity of warm
+water may be given to wash out the stomach; it is more effectual if salt
+or mustard is added, in the proportion of one teaspoonful to a glass of
+water.
+
+HICCOUGH, which is usually caused by digestive disturbances, is not
+serious in healthy people, and can generally be stopped by holding the
+breath, or by drinking water. If these measures are not effectual, salt
+or mustard in water as already described or a teaspoonful of the syrup
+of ipecac, may be given to produce vomiting. If the hiccough still
+continues, medical advice should be obtained.
+
+DIARRHOEA is ordinarily caused by an infection, or by an offending
+substance in the intestines. The offending substance should be removed
+before attempts are made to check the diarrhoea. When a baby has diarrhoea
+four things should be done--all food should be withheld; boiled water
+should be given freely; bowel movements should be saved for the doctor
+to see; and unless a doctor can be found immediately, castor oil should
+be given, from one-half to one teaspoonful according to the age of the
+child. Similar treatment should be given to older children. Adults
+should take one tablespoonful of castor oil and drink boiled water
+freely, but they should take no food until the doctor comes.
+
+CONSTIPATION has been discussed on pages 193 and 52.
+
+COLIC is a sharp, intermittent pain in the abdominal region; it is
+caused in many instances by indigestion or chilling. The following
+remedies may relieve it: a hot water bag, an emetic, as salt or mustard
+in luke-warm water, a Seidlitz powder or other saline cathartic, soda
+mints, or a teaspoonful of syrup of ginger in hot water. Unless it feels
+sore or tender, the abdomen may be rubbed up, on the right side, across,
+just below the waist, and down, on the left side. Babies may be given a
+few teaspoonfuls of warm water, or an enema of salt and water.
+
+Colic may be serious. The doctor should be summoned at once if the
+patient seems exhausted, if the pain is severe, if pain is increased
+rather than relieved by pressure, if the abdomen feels sore, especially
+on the right side, or if sharp abdominal pain is accompanied by fever,
+vomiting, and stubborn constipation. If the above-mentioned symptoms are
+present, no food, drink, or medicine should be given until the doctor
+comes.
+
+
+CONDITIONS IN WHICH THE EYES OR EARS ARE AFFECTED
+
+STYES generally accompany eyestrain or poor general health. The cause
+should be found and treated; and especial attention should be given to
+correcting eyestrain, indigestion, and constipation. Hot applications
+may be used, but if pus gathers, the stye should be treated by a
+physician.
+
+FOREIGN BODIES IN THE EYE may sometimes be removed by blowing the nose
+violently, by yawning several times, or by drawing the upper lid down
+over the lower. The eye should not be rubbed. If it proves impossible to
+dislodge the object by these methods or by others similar, the patient's
+eyelid should be turned back in the following way: Let the patient sit
+with his head back in a low chair placed in a good light, and stand
+behind him holding his head between your side and upper arm. In this
+position the patient's head is held firmly while both of the operator's
+hands are free. Next draw down the lower lid, and remove the object, if
+visible, on the corner of a clean handkerchief. To turn back the upper
+lid, grasp the eyelashes firmly, draw the lid down, out, and then up
+over a match or pencil placed across the middle line of the lid and held
+in your other hand. Then wipe the object carefully away if it is
+visible.
+
+Irritation that persists after the foreign body has been removed may be
+relieved by a cold compress continued for an hour or more, or by a drop
+or two of castor oil placed under the lid. If attempts to remove the
+foreign body prove unsuccessful, if the injury is severe, or if
+irritation continues after several hours, apply a cold compress, bandage
+it firmly so that the eyeball is kept at rest, and seek the aid of a
+physician.
+
+DISORDERS AFFECTING THE EARS.--Permanent deafness may result from
+neglecting disorders of the ears. Ear-ache, discharge from the ear,
+swelling in or about it, pain or tenderness behind it, all require
+medical attention and no time should be lost in securing it. To relieve
+pain the patient may lie with the ear on an ice bag, but nothing
+whatever should be put into the ear before the doctor comes, except when
+an insect has entered the ear, and causes acute distress by the noise of
+its beating wings. If such an accident has occurred, the patient should
+lie on the unaffected side, and warm sweet oil should be dropped very
+gently into the affected ear by means of a medicine dropper. The insect
+generally drowns in the oil and floats to the opening of the ear canal.
+After it has been removed, the patient should lie on the affected side
+so that the oil may drain out of the ear.
+
+No attempts should be made to remove foreign bodies from the ear or
+nose, unless they can be reached easily with the fingers. Hair pins,
+crochet hooks and similar instruments should never be used for this
+purpose. It is best for a doctor to remove foreign objects because
+unskillful attempts are likely to move them further in.
+
+
+CONDITIONS IN WHICH THE SKIN IS AFFECTED
+
+PRICKLY-HEAT, which affects babies and children more often than adults,
+is an eruption caused by heat and moisture, and aggravated by flannel
+underwear. It may be prevented by keeping the skin dry and cool, and it
+may be relieved by bathing the skin with alcohol and water, about one
+part of alcohol to three of water, and by using after the bath a powder
+made of two parts of starch to one of boracic acid, or any good talcum
+powder.
+
+INSECT BITES AND STINGS.--The sting, if still in the wound, should first
+be removed, and then ammonia should be applied, since the poison is
+generally acid. Applications of cold water, alcohol and water, or wet
+salt may relieve the subsequent burning and itching, but ammonia is
+generally most effective.
+
+IVY POISONING may be treated by applying cloths wet in a strong solution
+of baking soda or of boracic acid, or by applications of carbolized
+vaseline or ichthyol. Severe cases should have medical attention.
+Scratching and rubbing seem to spread the inflammation, and special care
+should be taken not to rub the face or eyes with infected hands.
+Susceptible people should avoid the plant if possible.
+
+
+OTHER EMERGENCIES
+
+CHILLS may be the result of infection or of exposure to cold. An early
+diagnosis of the trouble is so desirable that it is well to send for a
+doctor even when symptoms are not severe. If a person has a chill his
+temperature should be taken at once; fever and chill together probably
+indicate invasion by bacteria. When chills follow exposure to cold the
+patient should go to bed between warm blankets, his body should be
+briskly rubbed, and hot water bags and a hot drink should be given. If
+he prefers, he may take a hot bath before going to bed.
+
+CROUP is caused by a spasmodic closure of the larynx so that breathing
+is impeded. The child who develops croup may have a slight cold, but
+frequently shows no symptoms until he wakes in the night with a hoarse
+ringing cough and difficult breathing. True croup, though often
+distressing, is seldom serious, even when the symptoms are so severe
+that the child appears to be partly suffocated. An emetic should be
+given at once, preferably syrup of ipecac, one teaspoonful followed by
+warm water, or ten drops every 15 minutes until the child vomits freely.
+Hot fomentations may be applied to the throat and chest in order to
+hasten relaxation of the muscular spasm, and water should be kept
+boiling near the bed in a teakettle or uncovered saucepan. The child
+should stay in a warm room during the following day.
+
+Whenever a child develops a croupy cough his throat should be examined.
+A physician should be summoned if the throat is red and especially if
+the redness is associated with rise in temperature. Cases of diphtheria
+have been overlooked by neglecting such symptoms.
+
+
+BLEEDING
+
+In the vast majority of cases, bleeding can be stopped by elevating the
+injured part and applying pressure over the wound. One should, however,
+remember that loss of blood is not the only danger presented by an open
+wound, for pus-producing germs, if they make their entrance, may cause
+an infection which may be as serious as the bleeding itself. Hence in
+dealing with open wounds of any sort one should always keep in mind the
+danger of infection as well as the danger from loss of blood.
+
+TREATMENT OF SLIGHT WOUNDS.--Loss of blood from slight wounds is seldom
+so serious as the danger of infection; therefore small cuts, pin pricks,
+scratches, etc. should be encouraged to bleed by pressure near the wound
+in order to expel the germs that may have entered. After the wound has
+bled a little, tincture of iodine should be applied by means of a cotton
+swab both to the wound itself and also to the surrounding skin.
+
+After the wound has thus been disinfected it should be covered with a
+sterile dressing; a sterile or aseptic dressing is material in which all
+bacterial life has been destroyed. Gauze from a First Aid dressing or
+from a packet of sterile gauze should be used for this compress, or
+gauze may be cut from a sterile bandage. The compress serves two
+purposes: it protects the wound from infection, and if applied with
+pressure it checks further bleeding.
+
+The compress should be securely bandaged in place, or its edges may be
+fastened with adhesive plaster or collodion. Neither of the two latter
+should cover the wound itself. The outside bandage may be changed when
+soiled, but the compress itself should not be disturbed until the wound
+has healed. It is a mistake to dress wounds oftener than necessary,
+since handling them always increases the chance of introducing germs.
+Most children, like Tom Sawyer, delight in wounds, but they should be
+prevented if possible both from inspecting and from exhibiting them.
+
+If heat, swelling, redness, or pain develop in a wound after a day or
+two, a doctor should be consulted; and not a minute should be lost if
+the patient has a chill or if red streaks appear extending from the
+wound in the general direction of the heart. Until the doctor comes the
+wounded part should be elevated and covered with cold applications wet
+in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint
+of water.
+
+Several points should be remembered in dressing wounds. In the first
+place the mouth, which is full of germs, is not a good place for cut
+fingers. Moreover, wounds should not be touched by anything, especially
+the fingers, either washed or unwashed, nor should the scissors, fingers
+or other object be allowed to touch the surface of the dressing that is
+to be placed directly upon a wound. Unless they contain gross dirt
+wounds should not be washed with water, since washing introduces another
+chance of infection and accomplishes nothing except a tidy appearance,
+which is not essential. Furthermore, it should be remembered that
+exposure to the air will not infect a wound, and therefore time should
+be taken to find a suitable dressing. When a sterile dressing is quite
+impossible to obtain, the cleanest material available should be used;
+one of the best substitutes for a sterile dressing is the inner surface
+of a handkerchief or napkin that has not previously been unfolded since
+it was ironed. It is a common mistake to tie up a wound in the first
+article presented, which is usually a generous by-stander's soiled
+handkerchief. The same precautions in regard to cleanliness should be
+taken in dressing wounds that are known to be contaminated, since even
+into an infected wound it is possible to introduce more germs and more
+virulent ones.
+
+NOSEBLEED usually stops of itself, but if it is obstinate the patient
+should sit erect with the head back, and cold compresses should be
+placed on the nose and at the back of the neck. Pressure should be made
+on the upper lip by means of the fingers, or by a firm roll of paper or
+cotton placed under the upper lip. Salt or vinegar in water, a
+teaspoonful of either one to a cup of water, may be snuffed up the nose.
+The treatment should be continued for ten or fifteen minutes, or until
+bleeding stops; if the bleeding persists a doctor is needed.
+
+PROFUSE MENSTRUATION should be treated by keeping the patient quiet in
+bed with the head low and the feet slightly elevated. "Any marked
+increase, whether by amount, duration, or shortening of the interval
+between the periods ought to receive attention and be brought to the
+physician's notice" (Latimer). Painful menstruation may be relieved by
+rest in bed, mental as well as physical, by hot drinks and by the
+application of heat. Rest, and hygienic living persistently practised,
+will relieve most menstrual abnormalities. The common practice of using
+patent remedies and alcoholic liquors for disordered menstruation cannot
+be too strongly condemned.
+
+
+OTHER INJURIES
+
+SPRAINS.--A sprain is caused by twisting, stretching, or tearing the
+tissues about a joint. The first sharp pain comes from the injury to
+the tissues; subsequent pain is caused by the pressure of accumulated
+fluid. The other symptoms are those characteristic of inflammation.
+
+When a sprain is slight, the affected part should be elevated and kept
+at rest for the first twenty-four hours. Either heat or cold should be
+applied, or heat and cold alternately; a good treatment is to soak the
+part in hot water and afterward to allow cold water to run upon it from
+the tap. Gentle rubbing with a circular motion helps to reduce the
+swelling. If the joint must be used it should be bandaged tightly.
+
+Injuries to joints should never be neglected; and severe sprains always
+require medical attention, since in addition to the sprain a bone may be
+broken. A severely sprained joint should be elevated, treated with hot
+or cold applications, and kept at rest until it has been examined by a
+physician.
+
+BRUISES.--Bruises need no attention unless they are extensive or
+painful. The skin should be kept clean and if possible unbroken, since
+injured tissues are less resistant to infection than tissues in their
+normal state. Applications of cold water or of equal parts of cold water
+and alcohol may relieve the pain, but cold should not be used upon
+bruises that are extensive. A compress bandaged tightly in place may
+help to prevent swelling and discoloration.
+
+BURNS AND SCALDS.--Injuries from dry heat are called burns, and those
+from moist heat are called scalds. Both are painful, and both are
+dangerous if extensive or deep. Burns and scalds require medical
+attention if the injured area is extensive, if a large blister is
+formed, if the skin is destroyed or charred, and if symptoms of shock
+appear. Shock often follows burns or scalds even when the injury is
+comparatively slight.
+
+Treatment of slight burns, where the skin is reddened but not destroyed,
+has for its main object the exclusion of air. One of the following may
+be applied: dry baking soda, or baking soda made into a paste with
+water, picric acid gauze moistened in water, boracic acid ointment,
+vaseline, sweet oil, or castor oil; if none of these is obtainable,
+lard, cream, the white of an egg or unsalted butter may be used. Old
+muslin or linen bandaged lightly in place, should be used to cover the
+burn.
+
+The same treatment is used for sunburn, and also for small burns where
+blisters form. A blister, if it forms, should not be punctured; but if
+it is accidentally broken the skin of the blister should not be removed.
+It should be remembered that a broken blister is an open wound, and
+therefore liable to infection.
+
+BRUSH BURN is a name given to injuries where the surface of the skin
+has been removed. They include the scraped arms and legs which are
+common accidents in childhood. In order to dress a brush burn, particles
+of dirt should first be removed preferably by means of forceps that have
+been boiled, and the surrounding skin should then be cleansed with soap
+and water. The injured part should next be flushed with sterile salt
+solution, made by boiling water five minutes and adding to it salt in
+the proportion of one teaspoonful to a pint of water. If the dirt is
+difficult to remove a soap compress should be applied. To prepare the
+compress several thicknesses of gauze or muslin should be boiled in a
+strong solution of castile or green soap for ten minutes. The compress
+should remain in place several hours, and may be repeated if necessary.
+After the wound has been thoroughly cleansed, it should be dressed with
+old muslin that has been saturated in castor oil or spread with boracic
+ointment.
+
+
+EXERCISES
+
+1. Name some common causes of headache and of sleeplessness, and outline
+rational treatment for each of these disorders.
+
+2. Describe symptoms and treatment of shock; of fainting; of convulsions
+in children.
+
+3. Describe the treatment of all disturbances of the digestive tract
+mentioned in this book.
+
+4. What should be done if a foreign body has entered the eye? if one has
+entered the ear? What should be done for a person who has a stye? for a
+person with pain in or near the ear?
+
+5. How would you treat a sprain?
+
+6. Describe treatment for burns and scalds.
+
+7. Distinguish between heat stroke and heat prostration, and tell what
+treatment should be given in each case.
+
+8. What are the two principal dangers from slight wounds, and how should
+one guard against them? Show how you would dress a small cut.
+
+9. What should you do for a person with nose bleed?
+
+
+FOR FURTHER READING
+
+American National Red Cross Text Book on First Aid--Lynch.
+
+Immediate Care of the Injured--Morrow.
+
+Prompt Aid to the Injured--Doty.
+
+
+
+
+CHAPTER XIV
+
+SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS, CHRONICS, AND THE
+AGED
+
+
+In many cases of sickness institutional care has marked advantages. It
+may be the only solution when adequate provision for the sick is
+impossible at home; and it is often a necessity when a patient requires
+special equipment or apparatus, expert nursing, and medical attention
+within reach both day and night.
+
+On the other hand, it would not be desirable even if it were possible
+for all sick persons to be cared for in institutions. Care at home when
+it is adequate may be more successful than equally skillful care given
+elsewhere, since the sick quite as much as the well are injured by long
+separation from normal family life. Most children, because they need the
+attention of their own mothers, most convalescent and chronic patients,
+and most aged persons are cared for at home; and in the great majority
+of cases no better place for them could be found. Since patients of
+these four groups have needs peculiar to themselves, some special
+points in caring for them are considered in this chapter.
+
+
+CHILDREN
+
+Ability to observe quickly and accurately is seldom more needed than it
+is by a woman who cares for children. No one expects babies to explain
+their troubles, but people forget that small children are unable to
+describe their physical sensations with any degree of accuracy, although
+discomfort or sickness may show itself in all degrees of ill temper and
+bad conduct. For these exhibitions many a suffering child has been
+punished, where an older and more articulate person would have received
+considerate attention.
+
+Children, like babies, have a low resistance to disease. Moreover, they
+react quickly both to favorable and to unfavorable surroundings. Hence
+slight causes sometimes produce pronounced or even violent symptoms in
+children without giving cause for great anxiety, although the same
+symptoms if exhibited by adults, might indicate critical illness. On the
+other hand the recuperative power of children is high, and their
+recoveries are sometimes surprisingly rapid. It is a mistake, when a
+child has completely recovered from an acute but brief illness, to
+coddle him for weeks afterward merely because a grown person in similar
+circumstances would have failed to regain his strength.
+
+When a child is sick in bed, especial efforts should be made to insure
+adequate ventilation without chilling him. Children always lose heat
+rapidly because the body surface is proportionately large; when they are
+ill, therefore, it is especially necessary to keep them well covered, to
+see that their hands and feet are warm, and to avoid chilling them
+during their baths. But overheating must also be avoided, since all
+children, sick or well, who are too warmly dressed or who stay in rooms
+that are too warm, become weak and irritable and more susceptible than
+others to colds and other respiratory disorders. The child's skin should
+be kept clean and dry, but he should not be disturbed nor handled
+unnecessarily.
+
+Sick children require very simple food at short intervals. Variety is
+not so necessary for a child as for an adult, unless the child has been
+allowed to form bad habits of eating. Sick children should not be
+indulged unnecessarily, either in regard to their food or in other ways.
+However, attempts made during an illness to change the habits of a badly
+trained child are unwise because usually unsuccessful; parents who sow
+the wind by neglecting to train their children when they are in good
+health may as well make up their minds to reap a veritable whirlwind
+when the children are ill. Even when children are well trained it is
+difficult and sometimes impossible to prevent them from forming bad
+habits during sickness. Yet the labor of training a child reaps perhaps
+at no other time a richer reward than it does when the child is ill, and
+his recovery might be seriously impeded by unwillingness to accept
+necessary food, medicine, or treatment.
+
+PHYSICAL DEFECTS are faults in the structure of the body; adenoid
+growths, imperfect eyes, abnormally curved spines, and defective teeth
+are examples. Most physical defects can be cured in childhood by
+treatment or by slight operations. If untreated they frequently lead to
+sickness or to serious impairment of the body, and if neglected until
+adult life their injurious consequences are generally beyond remedy,
+even when the defects themselves can be repaired.
+
+Some indications of common physical defects are given below; they ought
+to be more generally known than they are. If a child exhibits one or
+more of the symptoms mentioned, he ought to be given a complete physical
+examination by a competent physician, and treatment, if needed, should
+begin without delay. The idea that children will outgrow these defects
+without treatment is erroneous. Better, however, than waiting until
+symptoms appear is the modern way of giving every child a physical
+examination at stated intervals, a practice already common in public
+schools where effective health work is carried on.
+
+EYESTRAIN frequently comes from imperfections in the shape of the eye;
+these imperfections can almost always be corrected by glasses. When a
+child is suffering from eyestrain, the eyes themselves may show
+indications of trouble; they may be blood-shot, the lids may itch or be
+crusted or inflamed, or styes may appear. In other cases the symptoms of
+eyestrain have no apparent connection with the eyes; such symptoms are
+headache, nausea, vomiting, indigestion, fatigue, irritability, poor
+scholarship, and nervous exhaustion. If a child shows any of these
+symptoms, or if he rubs his eyes, frowns, squints, wrinkles his
+forehead, sits bent over his book, or develops round shoulders, there is
+sufficient reason for having his eyes examined by an oculist.
+Examination by an optician should not be considered sufficient.
+
+ENLARGED TONSILS AND ADENOIDS.--The tonsils are masses of spongy tissue
+situated at the back of the mouth, on either side of the opening into
+the throat. If enlarged they may seriously interfere with breathing, and
+if diseased they frequently harbor the germs causing many acute
+infections, as well as germs of rheumatism and most of the heart
+disease originating in early life. Therefore the tonsils ought to be
+removed if they are diseased or greatly enlarged, but there is
+ordinarily no good reason for removing normal tonsils.
+
+Adenoids are situated at the back of the nose, and like the tonsils are
+composed of spongy tissue. Adenoids sometimes become so enlarged that
+they interfere with the passage of air through the nose, thus
+predisposing to catarrh, colds, and other respiratory diseases, to high
+palate with irregular teeth, to inflammation of the middle ear leading
+to deafness, to diminished mental activity, and to general poor health.
+
+If a child breathes through his mouth, if he snores at night, keeps his
+mouth open and has a dull, apathetic expression, his nose and throat
+should be examined, and if advisable his tonsils and adenoids should be
+removed.
+
+DEFECTIVE HEARING.--Permanent deafness among children in the great
+majority of cases comes from trouble in the throat or nose; hence the
+most effective measure to prevent deafness is to make sure that every
+child's nose, throat, and mouth are in a normal condition. Sensitive or
+timid children try to hide infirmities of any kind, but deaf children
+seem peculiarly unable to explain their difficulties. "No one," says
+Cornell, "has ever recorded that a small child complained of inability
+to hear." A child's ears should be examined if he breathes through his
+mouth, if he stoops habitually, if he is persistently inattentive, or if
+he is vague or stupid in carrying out directions. A child who appears
+normal at times and inattentive or stupid at other times should also be
+examined, since he may be deaf in one ear.
+
+Temporary deafness may come from accumulated wax in the ear. The wax
+should be removed by a doctor; inexpert attempts are likely to cause
+serious injury to the ear drum. Intermittent deafness may be caused by
+enlarged tonsils and adenoids. Children thus affected are not
+infrequently punished for seeming disobedience. Such children are
+especially liable to street accidents.
+
+DEFECTIVE TEETH have been considered on page 44.
+
+POSTURE.--In childhood the bones are soft and yield with comparative
+ease to continued strains; hence they often become deformed by bad
+positions assumed in sitting, standing, or in using the body in other
+ways. The postures habitually assumed by a child should be noticed and
+good postures should be insisted upon. But it is not enough to admonish
+him. The various causes tending to encourage bad positions should be
+corrected; among them are insufficient illumination of books and work,
+defective eyesight or hearing, obstructions in breathing, muscular
+weakness, and low general vitality. Children should have their chairs
+and tables suited to their size for their work both at home and in
+school.
+
+[Illustration: FIG. 28.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 29.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 30.--INCORRECT SITTING POSTURES. (_From Cornell,
+"Health and Medical Inspection of School Children." F. A. Davis Co.,
+Philadelphia._)]
+
+[Illustration: FIG. 31.--INCORRECT AND CORRECT STANDING POSTURES. (_From
+Cornell, "Health and Medical Inspection of School Children," F. A. Davis
+Co., Philadelphia._)]
+
+The adjustable chairs and desks now used in schools are a marked
+improvement upon the school furniture which has caused so many
+deformities in the past.
+
+[Illustration: FIG. 32.--ROUND SHOULDERS. (_Goldthwait, from Pyle's
+"Personal Hygiene."_)]
+
+One of the serious deformities caused by habitual faulty posture is
+curvature of the spine. A curvature not only injures a child's
+appearance and thus handicaps him in later life, but it brings strains
+and pressure upon the organs of the chest and abdomen which may
+seriously impair his health. As curvatures often pass unnoticed in their
+early stages, every child should be inspected occasionally when all his
+clothing has been removed, to see whether the weight is borne evenly on
+both feet, whether the development of the two sides is uniform, and
+whether the head and shoulders are properly carried. It should be
+noticed when the child stands, whether one shoulder is higher than the
+other, whether one shoulder blade projects more than the other, whether
+one hip is higher than the other, and whether one hand is lower than the
+other when the arms are hanging at the sides. The child should walk
+both toward and away from the observer, who should notice whether the
+child uses the two sides of his body in the same way, and whether he
+drags or shuffles his feet or has other abnormalities of gait.
+
+[Illustration: FIG. 33.--LATERAL CURVATURE. (_From Bancroft's "Posture
+of School Children." The Macmillan Co., New York._)]
+
+[Illustration: FIG. 34.--"WING SHOULDER BLADES IN FORWARD SHOULDERS.
+(_From Bancroft's "Posture of School Children." The Macmillan Co., New
+York._)]
+
+If abnormalities are found, a physician should be consulted. Often
+corrective exercises are all that is needed, and no one should put
+braces of any kind upon a child unless they have been prescribed by a
+physician. No attempt should be made to correct the common tendency of
+children to toe in or "walk pigeon-toed." Toeing-in is a natural manner
+of walking during the formative period and tends to strengthen the arch
+of the foot, while toeing-out tends to weaken the arch and to cause flat
+foot or broken arches.
+
+PREDISPOSITION TO NERVOUSNESS.--Heredity plays an important role in the
+predisposition to nervousness, so that children of nervous parents are
+particularly likely to show nervous instability. It is, however,
+difficult to say in a given case how much of his nervousness a child
+inherits and how much he acquires by imitating the irritability, the
+out-breaks of temper, and the other evidences of imperfect emotional
+control displayed by his nervously disposed parents. On the other hand,
+even children of nervous predisposition sometimes overcome their defects
+to some extent by imitating parents who have acquired self-control.
+
+Children predisposed to nervousness should be watched with special care,
+but they should not be allowed to realize that they are the objects of
+unusual solicitude. They need the most favorable surroundings that can
+be obtained, and their general health should be maintained at the
+highest possible level. Any condition that lowers vitality tends to
+increase their troubles; nervousness may be caused among children of
+good inheritance, and increased among others, by poor nutrition, lack of
+exercise and play out-of-doors, fatigue, loss of sleep, eyestrain,
+adenoid growths, and the poisons of infectious diseases.
+
+It is characteristic of many nervous children that they are too easily
+stimulated; they may be excitable, restless, unnaturally quick in
+moving, over-sensitive to pain and discomfort, easily fatigued,
+irritable in temper, and unable to control the emotions. They frequently
+make involuntary motions like grimacing and winking the eyes. Children
+of low nervous tone, however, are not necessarily excitable. A nervous
+child may be muscularly weak, awkward in gait, listless, dull, clumsy,
+forgetful, and inattentive. Such children often suffer from cold hands
+and feet and from profuse perspiration.
+
+Much can be done for these unfortunate children by removing the cause of
+their troubles if possible, by giving them simple and wholesome
+surroundings, by suiting their occupations to their strength, by
+eliminating mental strain, particularly during the adolescent period,
+and by training them to control their minds as well as their bodies.
+
+      "In addition to the hardening of the body, the education of
+      the child should include measures which increase the
+      resistance of the child against pain and discomforts of
+      various sorts. Every child, therefore, should undergo a
+      gradual process of 'psychic hardening' and be taught to
+      bear with equanimity the pain and discomfort to which
+      everyone sooner or later cannot help but be exposed. What I
+      have said about clothing, cold baths, walking in all
+      weather and at all temperatures, play and exercise in the
+      open air, has a bearing on this point, for a child who has
+      formed good habits in these various directions will have
+      learned many lessons in the steeling of his mind to bear
+      pain and to ignore small discomforts."--(Barker:
+      "Principles of Mental Hygiene Applied to the Management of
+      Children Predisposed to Nervousness.")
+
+
+CONVALESCENT PATIENTS
+
+After serious or prolonged illness the vitality is generally low and all
+bodily processes are likely to be depressed. During convalescence,
+therefore, the digestion is feeble, the muscles are weak so that fatigue
+follows slight exertion, and the sluggish condition of the circulation
+renders the patient especially sensitive to cold. Since the nervous
+system also becomes depressed and irritable, a convalescent patient is
+easily excited, easily discouraged, and quickly fatigued by mental
+effort. He finds the simplest decisions hard to make, and his emotions
+difficult to control; indeed, many a patient who has borne acute pain
+with unflinching courage becomes peevish at this stage, weeps easily,
+and expects more expression of sympathy than is good for him. Some
+persons naturally make quick recoveries, while others recuperate
+slowly. A long and tedious convalescence, it should be remembered, is
+the patient's misfortune rather than his fault.
+
+In restoring a convalescent patient to normal living it is imperative to
+proceed slowly. Food should be increased gradually both in variety and
+in amount; but the patient's appetite is not always a safe guide, and it
+may need to be encouraged or to be restrained. Both mental and physical
+exertion should begin only under careful supervision, and should
+increase by slow degrees. The patient should sleep as much as possible,
+should take long intervals of rest, and should continue no occupation to
+the point of fatigue. A patient who has been ill in a hospital or who
+has had at home the exclusive services of a nurse or an attendant, often
+finds the period following his return or following the nurse's departure
+an exceedingly difficult transition. The family should not expect or
+allow him to resume too many duties at a time when the mere acts of
+bathing and dressing may demand all the strength he has. Many
+convalescents are obliged, or think they are obliged, to take up regular
+work again before their strength is fully restored. There is generally
+no economy in so doing; indeed, time is saved in the end by waiting
+until recovery is complete before undertaking full work.
+
+Important as it is to build up the patient's physical strength, it is
+hardly less important to direct his thoughts away from himself and his
+sickness, and to help him renew his interest in normal living. During
+his illness he has of necessity relied upon the judgment and support of
+other persons, and his pain and discomfort have forced him to think
+constantly of himself and his many needs. The habit of sickness is
+readily broken by some persons, particularly by those whose nervous
+exhaustion has not been great and whose interests outside themselves are
+naturally keen. But the sick point of view has remarkable tenacity, and
+other patients, unless circumstances or deliberate efforts redirect
+their thoughts, will look upon themselves as invalids to the end of
+time.
+
+Hopefulness promotes health, while discouragement, apprehension, and
+unhappiness lower the tone of the whole system. Hence set backs,
+failures, delays, and relapses should not be dwelt upon, but signs of
+progress should be mentioned; judiciously however, since overdone
+attempts to cheer a patient seldom fail to have the opposite effect. If
+objects or situations that suggest undesirable thoughts are eliminated,
+the less often those thoughts tend to recur. Therefore, in order to
+break the habit of sickness, old thoughts must be gradually banished
+and new ones must be substituted. Sick-room appliances should be put out
+of sight as soon as they are no longer needed, and the patient may
+profit by moving into a different bed room. A few days spent away from
+home as soon as his strength permits often prove effective in breaking
+up sickness associations; the patient is generally encouraged when he
+finds that he can sleep in a different bed, endure some fatigue, and
+exist without daily visits from the doctor. Even a day spent at a
+different house in the same town sometimes directs the patient's
+thoughts into fresh channels. Gradually, but as quickly as safety
+allows, he should take his place in the normal family life and cease to
+be treated as an exception.
+
+Merely eliminating associations with sickness, however, is not enough;
+and exhorting a patient to forget himself and to become interested in
+something seldom accomplishes anything, especially if he is so depleted
+by illness that the thought of everyday activities suggests only
+weariness and pain. A person so weak that he is thoroughly fatigued by
+dressing himself should not be expected to view with enthusiasm the
+prospect of a full day's work. Much, however, may be accomplished by
+providing something that the patient really likes to do, and deliberate
+efforts must be made to stimulate his interest in some occupation,
+however simple it may be.
+
+Occupations for invalids are more than a means to pass away the time;
+they are also of distinct curative value. The patient's interest is not
+always easy to arouse, and some ingenuity may be needed in the
+beginning; sometimes interest is best aroused by working at some
+handicraft in his presence, and finally offering, as a favor, to teach
+him to do it also. His interest in any occupation is invariably
+increased if a well person not only directs but shares in the work.
+
+Care should be taken to select occupations suited to the patient's
+physical condition, to his age, tastes, and mental development. Two or
+three occupations are better than one, so that he may change from one to
+another before any one becomes tedious. Work requiring fine motions,
+close attention, or concentrated thought should be used for short
+periods, only, and no work should be continued to the point of fatigue.
+The patient should not be allowed to feel that he must finish a certain
+amount in a certain time. Even poor work is better than none, and a
+patient should always be encouraged by judicious praise.
+
+Games and puzzles are useful to some extent, but an aimless occupation
+is not so beneficial as one which has a tangible product, particularly
+a product that is useful as well as beautiful. Occupations frequently
+possible for invalids and convalescents include knitting, crocheting,
+many kinds of needle work, clay modeling, basketry, stenciling, weaving,
+book-binding, metal work, and photography. Manuals are now available
+giving directions for these and many other handicrafts. Sick children
+often enjoy collecting stamps, post marks, and other objects, making
+scrap books, sewing, weaving, knitting, paper folding, and various other
+kindergarten occupations.
+
+
+CHRONIC PATIENTS
+
+The whole field of caring for the sick offers nowhere greater
+opportunity for fine and finished work than it offers in the case of
+chronic invalids. It is an achievement of which an artist might be proud
+to make a chronic patient comfortable in body, happy in mind, and
+agreeable to others. Moreover, since success can never be attained by
+one who wearies in well doing, the care given to a chronic invalid tests
+not only the attendant's skill but also her moral and spiritual quality.
+
+Care of a chronic patient has for its aims maintaining the patient's
+health, rendering him as happy and comfortable in mind and body as it is
+possible for him to be, and providing whatever special treatment and
+attention his case requires. In order to maintain his health constant
+attention must be given to diet, to hygiene of the sick room, and indeed
+to all his surroundings. In many chronic illnesses, such as rheumatism
+and kidney disease, the diet is prescribed by the doctor; in every case
+care should be taken that the patient is not overfed or underfed, that
+the food is suited to his digestive powers, that foods causing
+flatulence are eliminated, particularly if the patient's trouble is
+heart disease, and not the least important requirement, that he derive
+as much pleasure from his food as possible.
+
+The regular daily care of the patient and of his room, already described
+in this book, should be scrupulously carried out, and no less
+scrupulously during the tenth year than it was during the tenth day.
+Cleanliness in every detail is absolutely essential to the patient's
+welfare; no one is more unpleasant either to himself or to others than a
+chronic patient who is neglected. Patients who are constantly in bed, it
+should be remembered, and paralyzed patients in particular, are
+peculiarly susceptible to pressure sores. If a patient is able, it is
+extremely important for him to sit up in a chair part of the day.
+Sitting up should never be omitted because it involves the expenditure
+of time and trouble for the attendant.
+
+It is often said that for most people some personal experience of
+sickness is beneficial; it can safely be said, however, that no one
+benefits from spending any considerable portion of his life in a state
+of helplessness and suffering. Behavior and character itself are
+determined by influences constantly coming into the mind from daily
+surroundings and associations with other people: one who recalls this
+fact needs only a moment's reflection to realize how ill adapted to
+healthy development of mind and character are the limited lives of the
+sick. Especially unfortunate is the situation of chronic invalids, shut
+off as they are from the objective interests and activities of normal
+life, deprived of all practice in making the salutary small adjustments
+and sacrifices required in every day living with other people, and
+self-centered as they necessarily tend to become from the inevitable
+focusing of attention upon their own discomforts and pain.
+
+On the whole, a surprisingly large number of invalids successfully
+resist the disintegrating effects of sickness upon character. But it is
+nevertheless true, as Dr. Weir Mitchell says, that "Sickness ennobles a
+few but debases many." A selfish invalid has more than once destroyed
+the happiness of an entire family, or spoiled the life of one member of
+it by monopolizing her whole time and attention. Families should
+remember that their injudicious sacrifices seldom bring enduring
+happiness or contentment to the patient himself; indeed, in the long run
+such sacrifices generally injure him even more than they injure his
+victims. Clearly much must and should be sacrificed by members of a
+family to the needs of an invalid; but in general it may be said that a
+sacrifice is injudicious if it relieves the patient of activity or
+responsibility that he can support without injury, if it makes him more
+dependent in mind or body, if it results in restricting his attention to
+himself and his affairs, or if it increases his tendency to make demands
+on others.
+
+Purposeful activity of some sort and the necessity for contributing to
+the welfare of others are essential parts of a wholesome life. If these
+essentials are entirely eliminated from the life of an invalid, the
+patient's greatest needs are probably left unsatisfied, even though the
+physical care he receives may be perfect in every detail. All that was
+said in regard to occupations for invalids applies with particular force
+to occupations for chronic patients, since however valuable manual
+occupations may be as a means to bring about recovery, they are still
+more valuable in furnishing interest and purpose in a life whose only
+prospect is a succession of weary, useless years. Handicapped patients
+sometimes learn occupations that yield a financial return, and ability
+to earn even a little stimulates self respect and mental health, whether
+the money is needed or not. The important point, however, is that the
+finished product should have a recognized use.
+
+In addition to enabling the patient to make things with his hands, a way
+should be found if possible by which he may contribute to the group of
+people with whom he lives. If a way can be discovered for him to do so,
+the opportunity should not be denied him nor should his service fail to
+be noted and appreciated, even if it is nothing more than telling a
+story to a restless child.
+
+
+CARE OF THE AGED
+
+At the end of life, as at its beginning, every individual especially
+needs the interest and protection of his own family. In ordinary
+circumstances neither a baby nor an aged person can be cared for so
+fittingly or so successfully in any other place as he can be in his own
+home.
+
+With advancing years is to be expected a general slowing down of all the
+powers. In old age both body and mind show characteristic changes, and
+particularly changes causing lowered resistance and diminished vigor. If
+the manner of living is adapted to these changes, both happiness and
+usefulness may be prolonged. But so gradually do the changes often come
+that they may escape notice for a long time, and the younger generation
+in looking back sometimes realizes with regret how much earlier measures
+might have been taken to prolong the usefulness and to mitigate the
+discomforts of aged parents and friends.
+
+Old people are keenly sensitive to cold, since the circulation gradually
+becomes less vigorous and they take little exercise. Keeping them warm
+both in bed and out adds more perhaps to their comfort than any other
+one measure. They should have warm underclothing and soft shawls and
+other extra wraps. A real service will be rendered by the person who
+invents a suitable and dignified wrap for old or feeble men, who dislike
+the informality of sweaters and feel disgraced by shawls. Old persons
+should and can be kept warm in bed, by providing them with hot water
+bags, with warm night clothes including stockings, by using woollen or
+outing flannel sheets if necessary, and by providing a sufficient number
+of light but warm bed covers. It is not always understood that many
+covers do not remedy the deficiencies of a thin mattress. If a thick
+mattress or two thin mattresses cannot be provided, a thick comforter or
+even many layers of newspaper should be placed between the mattress and
+the springs, and another thick comforter should be placed between the
+mattress and the lower sheet. Rubbing the body with warm olive oil often
+affords great comfort, by improving the circulation and thus increasing
+the sensation of warmth, and also by relieving the tendency of the skin
+to become dry and cracked. Poor circulation at night may cause cramps in
+the muscles of the legs; the cramps can usually be relieved by warmth
+and gentle rubbing.
+
+Old people frequently wish their rooms to be very hot, both by day and
+by night, even as hot as 80 deg. or 85 deg., but if it is possible to
+keep them warm in any other way the temperature of the room should be
+kept at 70 deg. Well ventilated rooms are highly important for old
+people as for all others of low resistance, and it is entirely possible
+for their rooms to be warm and yet well ventilated. Aged persons should
+be carefully guarded from chill, exposure, crowds, and infected persons.
+Like little children they are peculiarly susceptible to the respiratory
+diseases, which cause many of the deaths commonly attributed to old age.
+
+Digestion usually becomes weaker than in earlier years, and less food is
+needed. It should be simple, hot, and divided into four or five meals
+rather than three. Old people often wake at an early hour, and hot
+nourishment will prevent them from growing weak and faint while waiting
+for the family breakfast. Both constipation and looseness of the bowels
+are common ailments in old age. So far as possible the bowels should be
+regulated by means of diet; but muscular weakness resulting in inability
+to control the bowels should not be mistaken for and treated as
+diarrhoea.
+
+It is unwise for old people to undertake unaccustomed or sudden muscular
+exertion, since the muscular system including the heart muscle grows
+weak and is generally unable to endure great strain. The bones,
+moreover, grow brittle and heal with difficulty if broken, so that
+persons of advanced years no matter how active should avoid walking on
+icy pavements, climbing on chairs to reach high shelves, and placing
+themselves in other insecure positions. Assistance must be tactfully
+given, however, as active old people are inclined to resent it. On the
+other hand, old people should be encouraged to continue moderate and
+safe activities, and to take regular exercises suited to their strength.
+Although increasing muscular weakness tends to make most old people
+indolent, it is far better for them both in mind and in body to remain
+as active as they can without danger of too great fatigue. At all
+events, they should be prevented if possible from becoming bedridden.
+
+Since in old age sight, hearing, and other special senses become less
+acute, one should remember that an old person may not notice the odor of
+escaping gas, the light of a smouldering match, or the sound of an
+approaching motor car, and that he must be specially guarded from such
+dangers of every day life. On account of their dulled perceptions old
+people are sometimes unjustly considered to be less intelligent than
+they really are. Young people moreover should be told, if an aged person
+is untidy and careless in personal habits, that the apparent negligence
+is caused by dulled perceptions and diminished muscular control for
+which old people are no more responsible than they are for failing
+eyesight or for inability to hear.
+
+Families should also realize that changes in mind and character are
+beyond an aged person's control and that they should not be made the
+cause for remonstrance or arguing. Just as the arteries harden with
+advancing years, as the bones become brittle and as other tissues become
+less flexible, so changes are likely to occur in the nervous system. It
+is not surprising when the brain substance like other tissues is
+becoming less flexible, that the powers of attention should weaken,
+that memory for recent events should diminish, or that other mental
+powers should fail. Changes in disposition are not uncommon: previously
+controlled persons sometimes become querulous and exacting, while
+excitable and irritable persons become more placid. With most old people
+emotions become less intense; feeble old people hardly realize great joy
+or great sorrow, and seldom look forward to death with apprehension.
+
+Among the most important changes that occur in the nervous system is its
+gradual loss in power to respond to new demands. New habits are
+difficult or impossible to form, and old habits are hard to break.
+Attempts to break the habits of a life time are therefore dangerous, and
+radical changes in old people's ways of living are attended by risk as
+well as by unhappiness. Such loss of adaptability in the nervous system
+makes it increasingly difficult for old people to assimilate new ideas
+and to understand new points of view. The feeling that the world is
+strange and that the next generation has gone on without them accounts
+for the tragic loneliness of many old people. Clearly it is for those
+who are younger and more flexible to bridge the gulf between the
+generations by their understanding and their sympathy.
+
+Physical care to whatever extent it is needed should be given to all old
+people as soon as they are unable to care for themselves, and thought
+should be given to adapting their surroundings and ways of living to
+their strength and needs, just as they should be adapted to the strength
+and needs of chronic patients. But a warning should be given against
+managing old people too much. It is hard for people who have managed
+their own lives successfully for many years to be managed, even for
+their own good. Indeed, it is questionable kindness to deprive old
+people of all freedom of action, even if following their own
+inclinations occasionally has disastrous results. Few persons would wish
+to prolong their lives if long life involved being thwarted in every
+desire, and sometimes real kindness consists in allowing old people to
+do certain things that are not good for them. Keeping them warm and
+letting them do as they please will go far to make old people happy.
+
+Many of the changes in old age reverse the developing process of
+childhood. In youth and age extremes meet, and the care of the aged
+presents certain marked similarities to the care of little children.
+Both require simple food, occupations suited to their strength, and
+protection from infections, from fatigue, and from nervous strain; both
+are dependent, more or less helpless, and for their happiness both need
+the affectionate care of their own families. But in one respect their
+needs are fundamentally different. In childhood formation of proper
+habits is all important, and in caring for children the future effect of
+every word and act must be taken into consideration. Old people, on the
+other hand, since they live largely in the past and their habits are
+irrevocably formed, may be indulged without harm in ways that would
+demoralize a child; with a clear conscience one may make them happy in
+ways both great and small. This difference makes possible one of the
+greatest pleasures that come to one who cares for the helpless and the
+sick, for of all enduring satisfactions few are greater than the power
+to fill with comfort and happiness the closing days of life.
+
+
+EXERCISES
+
+1. What is meant by a physical defect? Name some of the most common
+defects.
+
+2. Name some permanent injuries to the body caused by defective teeth;
+by diseased or enlarged tonsils and adenoids; by faulty posture.
+
+3. Describe some common symptoms of eye strain in children; of enlarged
+tonsils and adenoids; of deafness.
+
+4. Name several possible causes of round shoulders, and explain why
+urging a round-shouldered child to hold himself erect is seldom enough
+to make him correct his posture.
+
+5. What measures should be taken to overcome nervousness in children?
+
+6. Describe in detail the health work carried on in the public schools
+of your city or town. Considering the important part played by
+uncorrected physical defects in causing permanent physical disability
+among adults, do you think in the long run it is cheaper or more
+expensive for a community to spend money in protecting the health of
+school children?
+
+7. Discuss the particular needs of convalescent and of chronic patients.
+
+8. Explain the effect of activity upon recovery, and explain why it is
+desirable for invalids to have occupation.
+
+9. What special needs should be provided for in caring for old people?
+
+
+FOR FURTHER READING
+
+Invalid Occupations--Tracy.
+
+Occupation Therapy--Dunton.
+
+Handicrafts for the Handicapped--Hall and Buck.
+
+When Mother Lets Us Make Toys--Rich.
+
+Amusements for Convalescent Children--New York State Department of
+Health, Albany.
+
+Essentials of Medicine--Emerson, Chapter IX.
+
+Civics and Health--Allen.
+
+How to Live--Fisher and Fisk, Chapter III, Section II; and Supplementary
+Notes, Section III.
+
+Health Work in the Schools--Hoag and Terman.
+
+Medical Inspection of Schools--Gulick and Ayres.
+
+The Hygiene of the Child--Terman.
+
+Posture of School Children--Bancroft.
+
+
+
+
+CHAPTER XV
+
+QUESTIONS FOR REVIEW
+
+
+I. Show how you would:
+
+    1. Make an unoccupied bed. (Notice the number of minutes it takes
+       you to do it well.)
+
+    2. Remove all the covers from an unoccupied bed and leave the bed to
+       air.
+
+    3. Open a bed to receive a patient.
+
+II. Show how you would:
+
+    1. Change all the linen and remake an occupied bed. (How long did
+       it take you?)
+
+    2. Turn a patient from his back to his side, and the reverse.
+
+    3. Remove, shake, and readjust a patient's pillows.
+
+    4. Move a patient from one bed to another.
+
+    5. Prepare a weak patient to sit up in a chair, and assist him from
+       the bed to the chair.
+
+    6. Assist a weak patient from the chair to the bed.
+
+    7. Arrange pillows and back rest for a patient to sit up in bed; and
+       also how you would remove the pillows and back rest.
+
+III. Show how you would:
+
+    1. Lift a patient who has slipped down toward the foot of the bed,
+       and show what you would do to prevent him from slipping down.
+
+    2. Prevent bed covers from resting upon a sensitive foot, leg,
+       abdomen, or arm.
+
+    3. Describe and demonstrate every device you would use and every
+       thing you would do to prevent pressure sores.
+
+    4. Arrange pillows to support the arms of a person sitting up in
+       bed.
+
+    5. Arrange a table or a substitute for a table to support the book
+       or work of a patient sitting up in bed.
+
+    6. Arrange the light for a patient who is allowed to read in bed.
+
+IV.
+
+    1. Assemble all the articles you would use in giving a bed bath.
+       (How long did it take you?)
+
+    2. Show how to give a complete bed bath. (How long did it take you?
+       Did you have to stop the bath to fetch anything you had
+       forgotten?)
+
+    3. What special care would you give to the mouth and teeth? to the
+       finger and toe nails? to the hair? to badly tangled hair? How
+       would you cleanse the mouth of a helpless patient?
+
+    4. Show how to shampoo the hair of a bed patient.
+
+    5. Show how you would give a bath to a baby.
+
+    6. Show everything that you would do to prepare a patient for the
+       night.
+
+V.
+
+    1. Show how to take the temperature, pulse, and respiration.
+
+    2. Show how to cleanse a clinical thermometer.
+
+    3. Show how to give a foot bath (_a_) to a patient out of bed, (_b_)
+       to a patient in bed.
+
+    4. Show how you would give a cool sponge bath to a feverish patient.
+
+    5. Show how to give, remove, and cleanse a bed-pan.
+
+    6. Show how to fill and apply a hot water bag; an ice bag.
+
+    7. Show how to prepare and apply a mustard paste; a mustard leaf; a
+       flaxseed poultice; hot fomentations; cold compresses.
+
+    8. Show how to measure and administer a fluid medicine; pills or
+       tablets.
+
+    9. Show how to prepare and administer a salt and water enema to a
+       grown person; to a baby.
+
+   10. Show how to prepare steam inhalations.
+
+   11. Show how to apply an ointment; a liniment.
+
+VI.
+
+    1. Show how you would feed a helpless patient who is lying down.
+
+    2. Show how you would feed a patient who is able to sit up but
+       unable to use his hands.
+
+    3. Prepare a liquid nourishment tray.
+
+    4. Set a tray for light diet; for full diet.
+
+    5. Show how to place a tray for a patient unable to sit up but able
+       to feed himself; for a patient sitting up in bed.
+
+    6. What personal care should be given a patient just before meals?
+       just after meals?
+
+    7. How would you modify the diet of a patient inclined to
+       constipation? to diarrhoea?
+
+VII.
+
+    1. Describe effective household methods for removing dust.
+
+    2. Demonstrate the cleaning of a refrigerator.
+
+    3. Show how to ventilate a sick room while protecting the patient
+       from direct draughts.
+
+    4. Show how to clean a sick room with a minimum of disturbance to
+       the patient.
+
+    5. Explain how a patient with communicable disease should be
+       isolated.
+
+    6. Demonstrate the daily care of a room occupied by a patient with
+       communicable disease.
+
+    7. Explain methods of concurrent disinfection.
+
+    8. Explain methods of terminal disinfection.
+
+    9. Tell how the following should be disinfected: discharges from the
+       nose, throat, eyes, ears, bowels, bladder, wounds, and sores; bed
+       and personal linen; blankets; mattresses; dishes; utensils,
+       especially bedpans and urinals; clothing and person of the
+       attendant, especially the hands; furniture, rugs, and woodwork.
+
+VIII.
+
+    1. Name some of the most obvious symptoms of sickness.
+
+    2. Name some symptoms that would lead you to take a patient to a
+       doctor; to send for a doctor; to send for a doctor in haste.
+
+    3. Name some symptoms that are dangerous to neglect even though the
+       patient feels fairly well.
+
+    4. What are some of the symptoms of physical defects in children?
+       Name some conditions that are frequently caused by unremedied
+       defects.
+
+    5. Name some diseases commonly ushered in by symptoms resembling
+       those of a cold in the head.
+
+    6. What symptoms would lead you to isolate a patient?
+
+    7. Give as many illustrations as you can of the part played by good
+       and bad habits in determining health and sickness.
+
+IX.
+
+    1. How would you dress a cut? a burn? a sprain?
+
+    2. What would you do for a person suffering from colic? nausea?
+       diarrhoea? chill?
+
+    3. What are the symptoms of shock? heat stroke? heat prostration?
+       What treatment would you give in each case?
+
+    4. What would you do for a fainting person? for a person suffering
+       from nose bleed? from earache? from a cinder in the eye?
+
+    5. What course of action would you advise for a person troubled with
+       sleeplessness? frequent headaches? excessive irritability?
+       unusual depression of spirits? unfounded suspicions of other
+       persons' motives? a tendency to have the feelings hurt easily?
+       inability to control the emotions?
+
+X.
+
+    1. Why is it better to prevent sickness than to cure it?
+
+    2. Name the essentials of good hygienic conditions for babies, for
+       children, for grown people, for the aged.
+
+    3. How much of the sickness in the United States is preventable?
+
+    4. If part of the sickness is preventable, why is it not prevented?
+
+    5. What constitutes adequate care of the sick?
+
+    6. What proportion of the young men in your community who were
+       drafted have been rejected for physical disability? How many were
+       rejected for disabilities that might have been prevented?
+
+XI. (Answers to the following questions can generally be obtained from
+local health officers.)
+
+    1. What are the duties and powers of your local board of health?
+
+    2. How much did your city or town spend per person last year on
+       health protection? How does this amount compare with the amount
+       spent per person for police protection? for fire protection?
+
+    3. Who inspects the water supply in your town? the milk supply? the
+       food supply?
+
+    4. In your city, what was the number of deaths per 100,000 of the
+       population from tuberculosis each year for the last five years?
+       from typhoid fever?
+
+    5. Is there a tuberculosis sanitarium in your city or county? Are
+       nurses employed to supervise tuberculosis patients who remain at
+       home?
+
+    6. What provision does your community make for patients suffering
+       from other communicable diseases?
+
+    7. What measures are taken in your community to instruct school
+       children in matters of health? to instruct grown persons?
+
+    8. How does your community provide medical and nursing care for
+       persons unable to pay part or all of the cost of such service?
+
+XII. Explain why the following common beliefs are erroneous or
+unfounded:
+
+    1. That a damp cellar causes diphtheria.
+
+    2. That night air is harmful.
+
+    3. That one should "stuff a cold" and "starve a fever."
+
+    4. That almost everyone needs a tonic in the spring.
+
+    5. That the health of one's family would be endangered if a
+       tuberculosis hospital were placed on the next block.
+
+    6. That clearing up the back yard will protect the children of a
+       family from infantile paralysis.
+
+    7. That odorless and tasteless water is necessarily free from
+       harmful germs.
+
+    8. That all children should have the children's diseases, and have
+       them as early as possible.
+
+    9. That boils are a benefit to the system by removing impurities
+       from the blood.
+
+   10. That tomatoes cause cancer.
+
+   11. That consumption is inherited.
+
+   12. That dirt breeds disease.
+
+   13. That diseases come up drains.
+
+   14. That if a teaspoonful of medicine does you good, a tablespoonful
+       will do you more good.
+
+   15. That instinct teaches a mother how to care for her baby.
+
+   16. That low heeled shoes, though suitable for boys and men, cause
+       broken arches in women and girls.
+
+   17. That in one's own case, the rule that everyone needs regular
+       meals, regular hours of sleep, and daily exercise out of doors,
+       may be safely violated.
+
+
+
+
+APPENDIX
+
+
+The New York City Department of Health has kindly permitted us to
+include the following circulars of information issued by the Division of
+Child Hygiene.
+
+
+DEPARTMENT OF HEALTH THE CITY OF NEW YORK
+
+INSTRUCTIONS TO PARENTS REGARDING THE CARE OF THE MOUTH AND TEETH.
+
+The physical examination of school children shows that in many instances
+the teeth are in a decayed and unhealthy condition.
+
+Decayed teeth cause an unclean mouth. Toothache and disease of the gums
+may result.
+
+Neglect of the first teeth is a frequent cause of decay of the second
+teeth.
+
+If a child has decayed teeth, it cannot properly chew its food.
+Improperly chewed food and an unclean mouth cause bad digestion, and
+consequently poor general health.
+
+If a child is not in good health, it cannot keep up with its studies in
+school. It is more likely to contract any contagious disease, and it has
+not the proper chance to grow into a robust, healthy adult.
+
+If the child's teeth are decayed, it should be taken to a dentist at
+once.
+
+The teeth should be brushed after each meal, using a tooth brush and
+tooth powder.
+
+The following tooth powder is recommended:
+
+  2 oz. powdered precipitated chalk.
+  1/2 oz. powdered Castile soap,
+  1 dram powdered orris root.
+  Thoroughly mix.
+
+This prescription can be filled by any druggist at a cost not to exceed
+fifteen cents.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+Instructions to Parents Regarding the Care of the Nose
+
+The physical examination of school children shows that in many instances
+they breathe through the mouth because they cannot breathe properly or
+sufficiently through the nose.
+
+This may be due to bad habits in regard to keeping the nose clean, or,
+in a majority of instances, to a growth which is known as "adenoids" and
+which stops up the back of the nose. In either case, the air is not
+breathed through the nose, and the child becomes what is known as a
+"mouth breather."
+
+Constant breathing through the mouth causes the child to become pale,
+restless in its sleep and dull in its actions. The child often speaks as
+though it had a cold in the head. Frequently there is an almost constant
+discharge from the nose.
+
+Mouth breathing renders a child especially liable to contract
+tuberculosis and other infectious diseases; in fact, the child has very
+little resistance to disease of any kind.
+
+Every child should be given a handkerchief, and be taught to thoroughly
+blow the nose several times each day. If, after doing this regularly,
+the child is still unable to breathe properly through the nose, it is
+probable that an adenoid growth is present. Such children should be
+taken to the family physician or to a dispensary for further advice and
+treatment.
+
+Do not wait too long in the hope that the child will outgrow the
+condition, for the effect of adenoid growths persisting throughout
+childhood may injure the person for life.
+
+Have your child's throat and nose examined one month after measles,
+scarlet fever, or diphtheria.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+Instructions to Parents on the Care of Children's Hair and Scalp
+
+Children affected with vermin of the head are excluded from school. The
+following directions will cure the condition:
+
+Mix one-half pint of sweet oil and one-half pint of kerosene oil. Shake
+the mixture well and saturate the hair with the mixture. Then wrap the
+head in a large bath towel or rubber cap so that the head is entirely
+covered; the head must remain covered from six to eight hours.
+
+(Tincture of larkspur may be used instead of oil mixture. The directions
+for use are the same.)
+
+After removing the towel, the head should be shampooed as follows:
+
+To two quarts of warm water add one teaspoonful of sodium carbonate
+(washing soda). Wet the hair with this solution and then apply Castile
+soap and rub the head thoroughly about ten minutes. Wash the soap out of
+the hair with repeated washings of clear warm water. Dry the hair
+thoroughly.
+
+Nits: If the head is shampooed regularly each week as above described,
+it will cure and prevent the condition of "nits."
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+DIET FOR CHILD FROM 12TH TO 18TH MONTH
+
+FIRST MEAL--ON RISING.
+
+(1) 1 to 2 ounces juice of a sweet orange
+
+or
+
+Pulp of 6 stewed prunes
+
+or
+
+1 ounce pineapple juice.
+
+(2) 8 ounces milk with either zwieback, or toasted biscuits or stale
+toasted bread.
+
+Note: Fruit must be given either 1/2 hour before or 1/2 hour after milk.
+
+SECOND MEAL--DURING FORENOON.
+
+Milk alone or with zwieback.
+
+NOON MEAL.
+
+(1) 6 ounces soup
+
+or
+
+3 ounces beef juice.
+
+Note: Soup may be made of chicken, beef or mutton.
+
+(2) Stale bread may be added to the above.
+
+FOURTH MEAL--AFTERNOON.
+
+Milk or toasted bread and milk.
+
+EVENING MEAL.
+
+(1) 4 ounces thick gruel mixed with 4 ounces top half milk.
+
+Taken with zwieback.
+
+Note: Gruel may be made of oatmeal, farina, barley, hominy, wheatena, or
+rice.
+
+(2) Apple sauce
+
+or
+
+Prune jelly.
+
+Total milk in 24 hours, 1 to 1-1/4 quarts.
+
+Note: 8 ounces is equal to a half pint.
+
+
+DEPARTMENT OF HEALTH CITY OF NEW YORK
+
+DIET FOR CHILD FROM 18TH TO 24TH MONTH
+
+BREAKFAST.
+
+(1) Juice of one sweet orange
+
+or
+
+Pulp of six stewed prunes
+
+or
+
+Pineapple juice (fresh or bottled) 1 ounce.
+
+(2) A cereal such as cream of wheat, oatmeal, farina, or hominy
+preparations with top milk (top 16 ounces) sweetened or salted. A glass
+of milk, bread and butter.
+
+Note: If constipated give the fruit 1/2 hour before breakfast with
+water; if not, they may be given during the forenoon.
+
+Raw fruit juice must be given either 1/2 hour before or 1/2 hour after
+milk.
+
+FORENOON.
+
+A glass of milk with two toasted biscuits or zwieback or graham
+crackers.
+
+DINNER.
+
+(1) Broth or soup made of beef, mutton, or chicken, and thickened with
+peas, farina, sago or rice
+
+or
+
+Beef juice with stale bread crumbs; or clear vegetable soup with yolk of
+egg
+
+or
+
+Egg soft boiled, with bread crumbs, or the egg poached, with a glass of
+milk.
+
+(2) Dessert: apple sauce, prune pulp, with stale lady-fingers or graham
+wafers
+
+or
+
+Plain puddings: rice, bread, tapioca, blanc-mange, junket or baked
+custard.
+
+SUPPER.
+
+Glass of milk, warm or cold; zwieback and custard or stewed fruit.
+
+Total milk in 24 hours, 1-1/2 quarts.
+
+
+DEPARTMENT OF HEALTH
+
+CITY OF NEW YORK
+
+DIET FOR CHILD FROM TWO TO THREE YEARS
+
+BREAKFAST.
+
+(1) Juice of 1 sweet orange
+
+or
+
+Pulp of 6 stewed prunes
+
+or
+
+1 ounce pineapple juice (fresh or bottled)
+
+or
+
+Apple sauce.
+
+(2) A cereal such as oatmeal, farina, cream of wheat, hominy or rice,
+slightly sweetened or salted as preferred, with the addition of top milk
+(top 16 ounces)
+
+or
+
+A soft boiled or poached egg with stale bread or toast.
+
+(3) A glass of milk.
+
+Note: If constipated give the fruit 1/2 hour before breakfast with
+water; if not, they may be given during the forenoon.
+
+Milk and raw fruit juice must not be given at same meal.
+
+DINNER.
+
+(1) Broth or soup made of chicken, mutton or beef, thickened with
+arrowroot, split peas, rice, or with addition of the yolk of an egg or
+toast squares.
+
+(2) Scraped beef or white meat of chicken, or broiled fish (small
+amount)
+
+or
+
+Mashed or baked potatoes with fresh peas or spinach or carrots.
+
+(3) Dessert: apple sauce, baked apple, rice pudding, junket or custard.
+
+SUPPER.
+
+(1) A cereal or egg (if egg is not taken with breakfast) with stale
+bread or toast
+
+or
+
+Bread and milk or bread and cocoa or bread and custard.
+
+(2) Stewed fruit.
+
+
+DEPARTMENT OF HEALTH
+
+CITY OF NEW YORK
+
+DIET FOR CHILD FROM THREE TO SIX YEARS
+
+BREAKFAST.
+
+(1) Fruits: an orange, apple, pear or stewed prunes.
+
+(2) Cereal: oatmeal, hominy, rice or wheat preparations, well cooked and
+salted, with thin cream and sugar
+
+or
+
+Egg: soft boiled, poached, omelet or scrambled.
+
+(3) Milk or cocoa.
+
+DINNER.
+
+(1) Soup: beef, chicken or mutton.
+
+(2) Meat: chicken or beefsteak or roast beef or lamb chops or fish.
+
+(3) Vegetables: spinach or carrots or string beans, peas, cauliflower
+tops, mashed or baked potatoes, beets or lettuce (without vinegar)
+
+Macaroni, spaghetti.
+
+Bread and butter--not fresh bread or rolls.
+
+(4) Dessert: custard, rice or bread or tapioca pudding, ice cream (once
+a week) cornstarch pudding (chocolate or other flavor) stewed prunes or
+baked apple.
+
+SUPPER.
+
+(1) Milk toast or graham crackers and milk
+
+or
+
+A thick soup, as pea, or cream of celery with bread and butter
+
+or
+
+A cereal and thin cream with bread and butter.
+
+(2) Stewed fruit; custard or plain pudding; jam or jelly.
+
+
+
+
+GLOSSARY
+
+(For complete definitions of the following words the student is referred
+to general and scientific dictionaries)
+
+
+A
+
+ANTISEPTIC.--A substance which prevents or hinders the growth of
+micro-organisms.
+
+ANTITOXIN.--A substance that neutralizes the action of a toxin.
+
+ASEPTIC.--Free from living germs.
+
+AXILLA.--The armpit.
+
+
+B
+
+BACILLUS (pl. bacilli).--A rod-shaped or elongated bacterium.
+
+BACTERIAL.--Relating to bacteria.
+
+BACTERICIDE.--An agent having the power to destroy bacteria.
+
+BACTERIOLOGICAL.--Relating to bacteriology.
+
+BACTERIOLOGY.--The science dealing with microorganisms.
+
+BACTERIUM (pl. bacteria).--A unicellular vegetable micro-organism.
+
+
+C
+
+CARRIER.--An apparently healthy person who harbors pathogenic germs in
+his body.
+
+COCCUS (pl. cocci).--A bacterium of spherical or nearly spherical shape.
+
+COUNTER-IRRITANT.--A substance or agent which if applied to the skin
+causes irritation and thereby relieves an abnormal condition in another
+part of the body.
+
+
+D
+
+DEGENERATION.--A deterioration in cells or tissues of the body so that
+they become less able to perform their proper functions.
+
+DEGENERATIVE.--Pertaining to degeneration.
+
+DEODORANT.--An agent that destroys odors.
+
+DIGESTIVE TRACT.--The entire alimentary canal, including the mouth,
+oesophagus, stomach, and the small and large intestines.
+
+DIPLOCOCCUS.--A form of coccus in which two individuals remain attached
+after cell division has taken place.
+
+DISINFECT.--To destroy the germs of disease.
+
+DISINFECTANT.--An agent that destroys the germs of disease.
+
+DISINFECTION.--The process of destroying the germs of disease.
+
+
+E
+
+EMETIC.--A substance used to induce vomiting.
+
+ENEMA.--An injection of fluid into the rectum.
+
+
+F
+
+FECAL.--Pertaining to feces.
+
+FECES.--Matter discharged from the bowels; bowel movement.
+
+FERMENTATION.--Decomposition produced in an organic substance by the
+action of certain living agents.
+
+FISSION.--The process by which a cell divides into two parts.
+
+FLAGELLUM (pl. flagella).--A long hair-like appendage, by the action of
+which certain micro-organisms are enabled to move.
+
+FLEX.--To bend at a joint.
+
+FOMENTATION.--See _Stupe_.
+
+
+G
+
+GASTRIC JUICE.--The fluid secreted by the glands of the stomach.
+
+GERM.--A minute unicellular organism, either animal or vegetable; a
+micro-organism; a microbe.
+
+GERMICIDE.--An agent having the power to kill germs.
+
+
+H
+
+HOST.--An animal or plant in or upon which another organism lives.
+
+
+I
+
+IMMUNE.--Not susceptible to a particular disease; also, a person who is
+not susceptible to a particular disease.
+
+IMMUNITY.--The state in which an individual is not susceptible to a
+particular disease.
+
+IMMUNIZE.--To render immune.
+
+INCUBATION.--The interval between exposure to an infectious disease and
+the first appearance of symptoms.
+
+INFECT.--To communicate disease germs.
+
+INFECTION.--An agent by which disease may be communicated from one
+individual to another; also, an infectious disease.
+
+INOCULATE.--To introduce any biological product directly into the
+tissues of the body.
+
+INOCULATION.--The process of inoculating.
+
+INTESTINAL TRACT.--The small and large intestines.
+
+
+M
+
+MICROBE.--See _Germ_.
+
+MICRO-ORGANISM.--See _Germ_.
+
+MUCUS.--The substance secreted by mucous membranes.
+
+MUCOUS MEMBRANES.--The membranes lining certain cavities of the body,
+especially the digestive and respiratory tracts.
+
+
+N
+
+NUTRIENT.--One of several chemical groups to which the essential
+constituents of food belong.
+
+
+O
+
+ORGANIC.--Derived from or relating to an organism.
+
+ORGANISM.--An individual that is or has been alive.
+
+
+P
+
+PARASITE.--An individual that lives in or upon another individual.
+
+PASTEURIZATION.--The process of pasteurizing.
+
+PASTEURIZE.--To subject milk to a temperature of 142 deg.-145 deg.
+Fahrenheit for thirty minutes.
+
+PATHOGENIC.--Disease-producing.
+
+PERTUSSIS.--Whooping-cough.
+
+PROTEID.--One of the complex nitrogenous substances constituting the
+essential parts of animal and vegetable tissues.
+
+PROTOZOON (pl. protozoa).--An animal organism composed of a single cell.
+
+PUS.--The fluid product of inflammation; matter.
+
+PUTREFACTION.--Decomposition of nitrogenous organic matter brought about
+by micro-organisms and accompanied by a foul odor.
+
+
+R
+
+RESISTANCE.--See _Immunity_.
+
+RESPIRATORY TRACT.--The air passages, including the nose, mouth, larynx,
+trachea, bronchial tubes, and lungs.
+
+
+S
+
+SAPROPHYTE.--A vegetable organism that lives on decaying organic matter.
+
+SARCINA.--Literally, a bundle. Applied to bacteria grouped in bundles or
+packets.
+
+SEPTIC.--Putrefying or decomposing; infected by pus-producing bacteria.
+
+SEQUELA.--A disease or unhealthy condition following another disease or
+unhealthy condition.
+
+SERUM.--The fluid which separates from the clot after blood has
+coagulated; especially, that containing an antitoxin.
+
+SEWAGE.--Any substance containing urine or fecal matter; also, the
+substance which passes through sewers.
+
+SPIRILLUM (pl. spirilla).--A variety of bacteria having spirally twisted
+cells.
+
+SPORE.--A resting stage, characterized by great resistance, into which
+certain germs enter when conditions become unfavorable for their growth.
+
+SPUTUM.--Spit; expectoration.
+
+STAPHYLOCOCCUS.--A variety of bacteria that group themselves in masses
+resembling bunches of grapes.
+
+STERILE.--Free from living germs; aseptic.
+
+STERILIZATION.--The process of rendering sterile.
+
+STERILIZE.--To render sterile.
+
+STREPTOCOCCUS.--A variety of bacteria that arrange themselves in chains.
+
+STUPE.--A cloth wrung out of hot water and applied to the surface of the
+body.
+
+SUSCEPTIBLE.--Lacking resistance to a disease.
+
+SUSCEPTIBILITY.--The condition in which resistance to a disease is low.
+
+
+T
+
+TETRAD.--A variety of bacteria that arrange themselves in groups of
+four.
+
+TISSUE.--A collection of cells having the same function.
+
+TOXIN.--A poison produced by the action of micro-organisms.
+
+
+U
+
+UNICELLULAR.--Composed of a single cell.
+
+UTERUS.--The womb.
+
+
+V
+
+VACCINATE.--To inoculate with a poison in order to bring about immunity
+to a disease.
+
+VACCINE.--Any substance which if introduced into the body causes the
+formation of protective substances.
+
+VOMITUS.--Vomited substances.
+
+
+
+
+INDEX
+
+
+A
+
+  Abdomen, 68
+
+  Abdominal binder, 68
+
+  Action of drugs, 200
+
+  Adenoids, 284
+
+  Aged, care of, 303
+
+  Ailments and emergencies, 257
+
+  Air, 72
+
+  Alcohol, 160
+
+  Appliances,
+    bed cradles, 173
+    bedpans, 176
+    rubber utensils, 138
+
+  Applications, local, 220
+    cold, dry, 231
+    cold, moist, 235
+    hot, dry, 225
+      bricks, 226
+      flannel, 226
+      salt or sand, 226
+      water bags, 225
+    hot, moist, 227
+      fomentations, 229
+      poultices, 227
+      stupes, 229
+
+  Attendant, 127
+
+
+B
+
+  Bacteria, 1, 4, 5
+    bacilli, 5
+    coccus, 4
+    effects produced by, 3
+    entrance into the body, 9
+    food of, 2
+    immunity, 13
+    in food, 19
+    in water, 19
+    methods of study, 1
+    motion, 5
+    origin of communicable diseases, 3
+    parasites, 3, 8
+    saprophytes, 2
+    shape, 4
+    spirillum, 4
+    spores, 7
+    structure and development, 4
+    where found, 8
+
+  Bacteriology, 1
+
+  Baths, 42, 154
+    bed, 156
+    cleansing, 171
+    cold tub, 97, 171
+    daily, 24
+    foot, 165
+      mustard, 165
+    hot, 97
+    infant's, 78
+    sitz, 176
+    tub, 154
+
+  Bed cradles, 173
+
+  Bedmaking, 132
+
+  Bedpan, 176
+
+  Bed-rooms, care of, 84
+
+  Beds, 132
+    care of, 134
+    dimensions, 133
+    rubber pillow cases, 138
+    rubber sheets, 138
+    selection of, 132
+    wooden, 132
+
+  Bed sores, 169
+
+  Birth registration, 63
+
+  Blankets, 140
+
+  Bleeding, 272
+
+  Blindness, 33
+
+  Breast feeding, 73
+
+  Bruises, 276
+
+  Brush burn, 278
+
+  Burns, 277, 278
+
+
+C
+
+  Cancer, 111
+
+  Carriers, 17
+
+  Charts, 10, 246
+
+  Chickenpox, 236
+
+  Childhood, see Infancy, 60
+
+  Children, care of, 280
+    with adenoids, 284
+    with defective hearing, 285
+    with defective teeth, 286
+    with enlarged tonsils, 284
+    with eyestrain, 284
+    with incorrect posture, 286
+    with physical defects, 283
+    with predisposition to nervousness, 292
+
+  Chills, 270
+
+  Chronic patients, care of, 299
+
+  Circulars of information, 318
+    Department of Health, City of New York, 318
+      care of hair and scalp, 321
+      care of mouth and teeth, 318
+      care of nose, 320
+      diet of child twelfth to eighteenth month, 322
+      diet of child eighteenth to twenty-fourth month, 323
+      diet of child two to three years, 324
+      diet of child three to six years, 325
+
+  Cleaning room, 126
+
+  Cleanliness, personal, 41
+
+  Clothing, 47
+    disinfection of, 95
+    of infants, 68
+
+  Coccus, 4
+
+  Cold applications, 220
+
+  Cold, prevention of common, 241
+
+  Colic, 266
+
+  Compresses, cold, 232
+
+  Constipation, 52, 193, 266
+
+  Convalescents, care of, 294
+
+  Convulsions, 260
+
+  Counter irritants, 233
+
+  Croup, 271
+
+
+D
+
+  Degenerative diseases, 20, 24
+
+  Development of child, 64
+
+  Diaper, 69
+
+  Diarrhoea, 266
+
+  Diphtheria, 245
+
+  Disinfectants, 251
+
+  Disinfection, 248
+
+  Drainage, 40
+
+  Draughts, 32
+
+  Dust, effect upon health, 36
+
+
+E
+
+  Ear, disorders affecting, 268
+
+  Emergencies, 257
+
+  Enemata, 210
+    directions for giving, 210
+    for baby, 212
+
+  Environment, 29
+
+  Eruptive diseases, 236
+
+  Excreta, disinfection of, 249
+
+  Excretions, 52
+
+  Expectoration, 249
+
+  Eye, ailments, 267
+    compresses for, 232
+    foreign bodies in, 267
+
+  Eyestrain, 284
+
+
+F
+
+  Fainting, 259
+
+  Fatigue, 53, 106, 181
+
+  Feeding of infants, 73
+
+  Filtration of water, 50
+
+  Flies, as carriers of disease germs, 38
+
+  Floors, 120
+
+  Fomentations, 229
+
+  Food, 35, 48, 188
+    classification of, 48
+    for children, 78
+    for infants, 72
+
+  Foot bath, 165
+
+  Fumigation, 254
+
+  Furniture, 120
+
+
+G
+
+  Garbage, 37
+
+  Glossary, 326-330
+
+  Growth of child, 64
+
+
+H
+
+  Habits, 82
+
+  Hair, care of, 163
+
+  Handkerchiefs, 239
+
+  Hands, 11, 12, 43, 250
+
+  Headache, 257
+
+  Heat, application of, 220
+    exhaustion, 264
+
+  Heating, 54
+
+  Heredity, 27
+
+  Hiccough, 265
+
+  House, cleanliness of, 33
+
+  Humidity, 31
+
+  Hygiene, oral, 44
+    personal, 19, 28
+
+
+I
+
+  Immunity, 13
+
+  Infancy (and childhood), hygiene of, 60
+    air, fresh, 72
+    baths, 78
+    care of eyes, 80
+      of mouth, 81
+      of nostrils, 81
+      of genital organs, 81
+    clothing, 68
+    cry, significance of, 82
+    diet, 74
+    mother's milk, danger of substitutes, 72
+      water, 75
+      weaning, 75
+    excretions, 67
+    exercise, 83
+    growth and development, 64, 65
+      length at birth, 64
+        increase, 65
+      muscular development, 64
+      special senses, 66
+      speech, 66
+      teeth, 66
+      weight at birth, 64
+        increase, 65
+    habits, 82
+    mortality, 61
+    nursing bottles, 75
+      nipples, 75
+    play, 84
+    pulse, 96
+    respiration, 99
+    sleep, 70
+    toys, 85
+
+  Infection, 1, 43
+
+  Inflammation, 220
+
+  Inhalation, 213
+
+  Insects, 38, 270
+
+  Insect bites and stings, 270
+
+  Inunction, 214
+
+  Isolation, duration of, 247
+
+  Ivy poisoning, 270
+
+
+K
+
+  Kitchens, 34
+
+
+L
+
+  Light, 33, 124
+
+  Linen, 251
+
+  Lysol, 251
+
+
+M
+
+  Malaise, 106
+
+  Mattress, 135
+    care of, 136
+
+  Measles, 246
+
+  Medicines and remedies, 200
+    action of drugs, 200
+    amateur dosing, 202
+    enemata, 210
+    inhalation, 213
+    inunction, 214
+    patent remedies, 205
+    sprays and gargles, 213
+    suppositories, 209
+
+  Medicines, administration of, 206
+
+  Menstruation, profuse, 275
+
+  Mental condition, 104-112
+
+  Microorganisms, 9
+
+  Milk, 51
+    pasteurization, 51
+
+  Mouth, care of, 160
+    wash, 182
+
+  Mustard paste, 233
+    leaves, 233
+
+
+N
+
+  Nausea, 265
+
+  Nipple, bottle, 77
+    care of, 77
+
+  Non-communicable diseases, 20
+
+  Nosebleed, 274
+
+
+P
+
+  Pain, 105
+
+  Parasites, 3, 4, 8
+
+  Patent remedies, 205
+
+  Patient, care of,
+      with communicable disease, 236
+      with colds and slight infections, 238
+      with more serious infections, 242
+    changing sheet, 147
+    changing, 146
+    lifting, 146
+    mouth, 160
+    moving, 152
+
+  Personal hygiene, 19
+
+  Pillows, 137
+    covers, 138, 140
+
+  Poisonous drugs, 215
+
+  Posture, 286
+
+  Poultices, 227, 228
+
+  Prenatal care, 62
+
+  Prickly heat, 269
+
+  Protozoa, 8
+
+  Public agencies, 107
+
+  Public sanitation, 19
+
+  Pulse, 96
+
+  Purification of water, 50
+
+
+Q
+
+  Quarantine, termination of, 252
+
+
+R
+
+  Records, 107
+
+  Recreation, 55
+
+  Rectum, 93
+
+  Respiration, 99
+
+  Rest, 53
+
+  Rooms, 27
+
+
+S
+
+  Saprophytes, 2
+
+  Scalds, 277
+
+  Scarlet fever, 246
+
+  Sewage, 39
+
+  Sheets, 137, 138, 142
+
+  Shock, 261
+
+  Sick-room, model, 118
+
+  Sleep, 55, 70
+
+  Sleeplessness, 258
+
+  Small-pox, 246
+
+  Special senses in sickness, 101
+
+  Spores, 7
+
+  Sprains, 275
+
+  Sprays and gargles, 213
+
+  Stimulants, in emergency work, 263
+
+  Stupes, 229
+
+  Styes, 267
+
+  Sunstroke, 264
+
+  Suppositories, 209
+
+  Symptoms, 88
+
+
+T
+
+  Teeth, 45, 160
+    defective, 286
+    treatment, 46
+
+  Temperature, 92
+    method of taking, 92
+    normal, 95
+
+  Temperature of baths, 79, 155
+    of house, 30, 124
+    sponging for, 177
+    variations, 114, 206
+
+  Thermometer, clinical, care of, 92
+
+  Tonsils, enlarged, 284
+
+  Tuberculosis, 27-107
+
+
+U
+
+  Urine, 103
+
+
+V
+
+  Vaccination, 13, 25
+
+  Ventilation, 29, 123
+
+  Vomiting, 265
+
+
+W
+
+  Water, 49
+    filtration, 50
+
+  Weaning, 75
+
+  Weight, 65
+    loss of, 64
+
+  Whooping cough, 246
+
+  Wounds, 272
+
+
+
+
+[Transcriber's Note:
+
+
+Punctuation errors (e.g. missing period at end of sentence, missing
+quotation marks, etc.) and letters printed upside down have been
+corrected without note. Except where noted, inconsistencies in
+hyphenation, capitalization, and spelling (e.g. travelling and
+traveling) have not been changed. The original index had numerous
+errors, such as references to terms that do not appear in the text.
+Except where noted below, it has been left as printed.
+
+The following corrections were made:
+
+p. viii: Records, 105. to Records, 107. (under Chapter IV)
+
+p. ix: Care of the Patients with Communicable Diseases to Care of
+Patients with Communicable Diseases (under Chapter XII)
+
+p. ix: Care of liver, 251. to Care of linen, 251. (under Chapter XII)
+
+p. 15: innoculation to inoculation (Vaccination and inoculation have
+saved thousands of lives.)
+
+p. 16: principle to principal (principal causes which diminish
+resistance), to match cited text
+
+p. 37: gerns to germs (through which disease germs)
+
+p. 40: From "_The Human Mechanism_." to _From "The Human Mechanism."_
+(to match format of other captions)
+
+p. 41: perferably to preferably (preferably, chloride of lime.)
+
+p. 77: runnnig to running (thoroughly cleansed under running water)
+
+p. 82: symptons to symptoms (other symptoms of distress)
+
+p. 96: thay to they (taken together they are)
+
+p. 108: 8:30 to 8:30 a.m.
+
+p. 111: develope to develop (may develop into cancer)
+
+p. 115: missing degree symbol added (At noon his temperature was 101 deg.)
+
+p. 132: illnes to illness (unless his illness is slight)
+
+p. 136: servicable to serviceable (makes a serviceable cover)
+
+p. 150: paitent to patient (ready for the patient.)
+
+p. 150-151: removed duplication of text in captions for Fig. 14 and Fig.
+15 (CHANGING THE DRAW SHEET, and CHANGING A PATIENT FROM ONE BED TO
+ANOTHER)
+
+p. 161: erroneous italics removed from "patient" and "her" (even a
+patient unable to sit up can brush her teeth)
+
+p. 167: added missing "bath" (to give a cool sponge bath)
+
+p. 175: ahould to should (the protection of the abdomen should)
+
+p. 177: expecially to especially (if it is especially difficult or
+undesirable)
+
+p. 177: patients' to patient's (between the patient's back and the pan;)
+
+p. 178: deoderant to deodorant (a properly kept pan needs no deodorant)
+
+p. 183: invarably to invariably (casual visitors almost invariably
+offend)
+
+p. 189: nurtients to nutrients (pancreatic juice acts upon all three
+nutrients)
+
+p. 195: solied to soiled (is always superior to soiled linen.)
+
+p. 205: appy to apply (apply even more strongly to using patent
+medicines.)
+
+p. 211: 166 to 176 (the directions on page 176.)
+
+p. 216: selzer to seltzer (seltzer aperient)
+
+p. 226: slighest to slightest (there is the slightest possibility of
+scalding)
+
+p. 227: accidently to accidentally (see that the switch is not
+accidentally)
+
+p. 228: cohers to coheres (when the mixture coheres)
+
+p. 229: annoint to anoint (anoint it with vaseline)
+
+p. 233: dicharge to discharge (If there is discharge from the eye,)
+
+p. 242: chould to should (visitors should be rigidly)
+
+p. 245: himelf to himself (safeguard the patient himself.)
+
+Table between pp. 246-247: diappearance to disappearance (Two weeks
+after onset and one week after disappearance)
+
+Table between pp. 246-247: pa-patient to patient (after child last saw
+patient.)
+
+p. 250: If to It (It may be necessary to provide two bedpans)
+
+p. 266: 216 to 193 (discussed on pages 193 and 52.)
+
+p. 280: etter to better (no better place)
+
+p. 300: attenom, to attention (constant attention must be given)
+
+p. 300: rotion to room, (hygiene of the sick room,)
+
+p. 301: salutory to salutary (making the salutary small adjustments)
+
+p. 308: querelous to querulous (sometimes become querulous)
+
+p. 329: Putrifying to Putrefying (Putrefying or decomposing)
+
+p. 331: bed-cradles to bed cradles (Index sub-entry, under "Appliances")
+
+p. 331: Bed-cradles to Bed cradles (Index entry)
+
+p. 331: Bed-sores to Bed sores (Index entry)
+
+p. 331: Brushburn to Brush burn (Index entry)
+
+p. 332: Foot-bath to Foot bath (Index entry)
+
+p. 333: Pre-natal to Prenatal (Index entry)
+
+p. 334: oss to loss (Index entry for "Weight, loss of")
+
+A fold-out table was facing p. 247 in the original book. For the plain
+text versions, it has been split into several smaller tables, with the
+"DISEASE" column repeated in each section. In the third section,
+"POLIOMYELITIS" has been hyphenated (POLIO-MYELITIS) to save space.
+
+The footnote pertaining to the table is immediately after it, not at the
+end of the chapter as usual.
+
+For the Lat-1 and ASCII versions, the oz. symbol has been replaced with
+oz., and oe ligatures have been changed to oe/OE.
+
+For the ASCII version, the following diacritics were removed or changed:
+o diaeresis (cooperation, cooperate, protozoon, PROTOZOON); ae ligature
+to ae/AE (aesthetic, anaemia, SARCINAE, sarcinae, septicaemia, sequelae,
+trichinae); o circumflex (role); e acute (regime). The degree symbol has
+been changed to deg., except in tables, where it has been removed.]
+
+
+
+
+
+End of the Project Gutenberg EBook of American Red Cross Text-Book on Home
+Hygiene and Care of the Sick, by Jane A. Delano and Anne Hervey Strong and American Red Cross
+
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diff --git a/old/32250.zip b/old/32250.zip
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+    "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
+
+<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
+  <head>
+    <meta http-equiv="Content-Type" content="text/html;charset=iso-8859-1" />
+    <meta http-equiv="Content-Style-Type" content="text/css" />
+    <title>
+Communicable Diseases Among Children&mdash;Rules for Isolation and Exclusion
+from School
+    </title>
+    <style type="text/css">
+
+p {
+    margin-top: .75em;
+    text-align: justify;
+    margin-bottom: .75em;
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+
+table {
+border-collapse:collapse;
+border-color:#000;
+empty-cells: show;
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+
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+font-weight:normal;
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+tr.mid {vertical-align:middle;}
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+
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+div.footnote {margin-left: 10%; margin-right: 10%; font-size: 0.9em;}
+.fnanchor {
+    vertical-align: super;
+    font-size: .8em;
+    text-decoration: none;
+    font-weight:normal;
+}
+
+p.fl {float: left;
+    clear: left;
+    width:20em;}
+p.fr {float: right;
+    clear: right;
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+
+span.pad-l {padding-left: 8em;}
+span.med {font-size: 115%;}
+.center   {text-align: center;}
+.smcap    {font-variant: small-caps;}
+.sm {font-size:85%;}
+
+    </style>
+  </head>
+<body>
+
+<div class="bigtable">
+
+<p class="smcap center">New York State Department of Health<br />
+<span class="med">Communicable Diseases Among Children</span><br />
+Rules for Isolation and Exclusion from School</p>
+
+<p class="fl"><span class="smcap">Herman M. Biggs, M.D.</span><br />
+<span class="pad-l">Commissioner</span></p>
+
+<p class="fr center">Issued by the<br />
+Division of Public Health Education</p>
+
+<table rules="all" frame="hsides" cellpadding="2" summary="NY Dept. of Health's rules for isolating
+children with communicable diseases">
+
+<thead>
+<tr class="mid">
+<th class="smcap" rowspan="3">Disease</th>
+<th class="smcap" rowspan="3">Principal Signs and Symptoms</th>
+<th class="smcap" rowspan="3">Method of Infection</th>
+<th class="smcap" colspan="5">Exclusion from School</th>
+<th class="smcap" colspan="5">Duration of Exclusion from Date of Onset</th>
+<th rowspan="3">Remarks</th>
+</tr>
+
+<tr class="mid">
+<th rowspan="2">Patient</th>
+<th class="sm" colspan="2">OTHER CHILDREN OF SAME HOUSEHOLD</th>
+<th class="sm" colspan="2">OTHER SCHOOL CHILDREN ESPECIALLY EXPOSED</th>
+<th rowspan="2">Patient</th>
+<th class="sm">PATIENT GOES TO HOSPITAL</th>
+<th class="sm" colspan="2">PATIENT REMAINS ISOLATED AT HOME</th>
+<th rowspan="2">Children exposed at school</th>
+</tr>
+
+<tr class="mid">
+<th>Non-<br />immunes</th>
+<th><a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>Immunes</th>
+<th>Non-<br />immunes</th>
+<th><a name="FNanchor_3_3b" id="FNanchor_3_3b"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>Immunes</th>
+<th>Other children of the same household</th>
+<th>Other children who remain at home</th>
+<th>Children who leave household as soon as disease is discovered</th>
+</tr>
+</thead>
+
+<tfoot>
+<tr class="no-bb"><td colspan="14">
+<a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3">[3]</a> Immunes are those who have had the diseases or in smallpox, who have been successfully vaccinated within a year.
+</td></tr>
+
+<tr class="no-bb"><td colspan="14">
+<span class="smcap">Disinfection:</span> The cleansing and disinfection of the person includes washing the entire body and the hair with soap and water; thorough brushing of the teeth; rinsing the mouth; gargling the throat, and douching and spraying the nose with an antiseptic
+solution; and finally, a complete change of clothing (or a change of underwear and a thorough shaking and brushing of the outer garments out of doors before these are put on again). (<a href="redcross.html#Page_247"><i>Facing p. 247</i></a>)
+</td></tr>
+</tfoot>
+
+<tbody>
+<tr>
+<th>CHICKENPOX</th>
+<td>Rarely begins with fever. Rash appears on second day as small pimples,
+which in about a day become filled with clear fluid. This fluid becomes
+yellow colored, a crust forms and the scab falls off in about 14 days.
+Successive crops of papules appear until tenth day.</td>
+<td>Contact with discharges from nose and throat of a patient.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Until all scabs are shed and disinfection of person; at least 12 days.</td>
+<td colspan="3">Exclude if non-immune until 21st day after child last saw patient.</td>
+<td>Exclude from school if non-immune during 11th to 22d days after child
+last saw patient.</td>
+<td>A mild disease and seldom any after effects.</td>
+</tr>
+
+<tr><th>DIPHTHERIA</th>
+<td>Onset may be rapid or gradual. The back of the throat, tonsils, or
+palate may show patches. The most pronounced symptom is sore throat.
+There may be hardly any symptoms at all.</td>
+<td>Contact with discharges from nose and throat, occasionally by drinking
+infected milk.</td>
+<td align="center">Yes</td> <td align="center">Yes</td> <td align="center">Yes</td>
+<td align="center">Yes</td> <td align="center">Yes</td>
+<td> Until patient is recovered and has two cultures from throat and nose
+which contain no diphtheria bacilli; cultures not to be taken until 9
+days from date of onset. Disinfection of person. </td>
+<td colspan="3"> Until two cultures at least 24 hours apart are reported negative. Those
+showing diphtheria bacilli should not necessarily be immunized unless
+symptoms appear.</td>
+<td></td>
+<td> Very dangerous, both during attack and from after effects. When
+diphtheria occurs in a school all children suffering from sore throat
+should be excluded and the health officer notified. The medical school
+inspector or health officer should take cultures from all inflamed
+throats and noses. There is great variation of type, and mild cases are
+often not recognized, but are as infectious as severe cases. There is
+frequently no immunity from further attacks.</td>
+</tr>
+
+<tr>
+<th>MEASLES</th>
+<td>Begins like cold in the head, with running nose, sneezing, inflamed and
+watery eyes and fever. Mulberry-tinted spots appear about the third day;
+rash first seen behind the ears, on forehead and face. The rash varies
+with heat; may almost disappear if the air is cold, and come out again,
+with warmth.</td>
+<td>Contact with discharges from nose and throat of a patient.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Until recovery and disinfection of person; at least 7 days from onset.</td>
+<td colspan="3">Exclude non-immunes until 15th day after child last saw patient.</td>
+<td>If non-immune exclude from school during 8th to 15th day after child
+last saw patient. </td>
+<td>After effects often severe. Period of greatest risk of infection three
+days, before and after the rash appears. Great variation in type of
+disease. Dangerous in children under 2 years of age. During an outbreak
+all children having a temperature over 99°F. should be sent home and the
+health officer notified.</td>
+</tr>
+
+<tr>
+<th>MEASLES
+(LIBERTY)</th>
+<td>Illness usually slight. Onset sudden. Lymph nodes in back of neck
+enlarged. Rash often first thing noticed; no cold in head. Usually have
+fever, sore throat, and the eyes may be inflamed. Rash sometimes
+resembles measles and scarlet fever, variable.</td>
+<td>Same as above.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Until recovery and disinfection of person; at least 8 days.</td>
+<td colspan="3">Exclude if non-immune until 22d day after child last saw patient.</td>
+<td>Exclude from school if non-immune during 11th to 22d days after child
+last saw patient.</td>
+<td>After effects slight. Regulations strict, because frequently confused
+with scarlet fever.</td>
+</tr>
+
+<tr>
+<th>MUMPS</th>
+<td>Onset may be sudden, beginning with sickness and fever, and pain about
+the angle of the jaw. The parotid glands become swollen and tender.
+Opening the mouth is accompanied by pain.</td>
+<td>Same as above.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Two weeks after onset and one week after disappearance of swelling and
+after disinfection of person.</td>
+<td colspan="3">Exclude 15th to 22d day after child last saw patient.</td>
+<td>Exclude from 15th to 22d day after child last saw patient.</td>
+<td>Seldom leaves after effects. Very infectious. Inflammation of genital
+organs of male or female may occur.</td>
+</tr>
+
+<tr>
+<th>POLIOMYELITIS</th>
+<td>Onset sudden, fever, excitable, pain on bending neck forward, pain on
+being handled, headache, vomiting. Sometimes sudden development of
+weakness of one or more muscle groups.</td>
+<td>Contact with discharge from nose, throat or bowels of a patient or
+carrier.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td>
+<td align="center">Yes</td><td align="center">Yes</td>
+<td>Until patient is recovered. Disinfection of person at least 21 days.</td>
+<td>14 days from time child last saw patient.</td>
+<td>Until 14 days after quarantine raised.</td>
+<td>14 days from time child last saw patient.</td>
+<td></td>
+<td>Disease is most communicable in the early stages. After effect is
+paralysis of certain muscle groups, transitory or permanent. Death is
+due usually to paralysis of respiratory muscles.</td>
+</tr>
+
+<tr>
+<th>SCARLET
+FEVER</th>
+<td>The onset is usually sudden, with headache, fever, sore throat, and
+often vomiting. Usually within twenty-four hours the rash appears as
+fine, evenly diffused, and bright red dots under skin. The rash is seen
+first on the neck and upper part of chest, and lasts three to ten days,
+when it fades and the skin peels in scales, flakes, or even large
+pieces.</td>
+<td>Discharges from nose and mouth, suppurating glands or ears of a patient.
+Milk may convey infection.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td>
+<td align="center">Yes</td>
+<td>At least 30 days and until discharges have ceased and disinfection of
+person.</td>
+<td>Seven days from time child last saw patient.</td>
+<td>Until seven days after quarantine has been raised.</td>
+<td>Seven days from time child last saw patient.</td>
+<td></td>
+<td>Dangerous both during attack and from after effects. Great variation in
+type of disease. Slight attacks are as infectious as severe ones. Many
+mild cases not diagnosed and many concealed. A second attack is rare.
+When scarlet fever occurs in a school, all cases of sore throat should
+be sent home and health officer notified. Most fatal in children under
+ten years.</td>
+</tr>
+
+<tr>
+<th>SMALLPOX</th>
+<td>Onset sudden usually with fever and severe backache. About third day
+upon subsidence of constitutional symptoms red shot-like pimples, felt
+below the skin, and seen first about the face and wrists most on exposed
+surfaces, develop. They form little blisters and after two days more
+become filled with yellowish matter. Scabs form which begin to fall off
+about the fourteenth day.</td>
+<td>All discharges of a patient and particles of skin or scabs.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">Yes</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Recovery and disinfection of person at least 14 days.</td>
+<td>Exclude if non-immune until 21st day after child last saw patient, or 7
+days successful vaccination and disinfection of person.</td>
+<td>Exclude if non-immune until 20 days after quarantine has been raised or
+7 days after successful vaccination and disinfection of person.</td>
+<td>Exclude if non-immune until 21st day after child last saw patient, or 7
+days after successful vaccination and disinfection of person.</td>
+<td>Exclude 20 days unless they have been successfully vaccinated within 1
+year in which case they may return at once.</td>
+<td>Peculiarly infectious. When smallpox occurs in connection with a school
+or with any of the children's homes all persons exposed must be
+vaccinated or quarantined for a period of 20 days. Cases of modified
+smallpox in vaccinated persons, may be, and often are, so slight as to
+escape detection. Fact of existence of disease may be concealed. Mild or
+modified smallpox is as infectious as severe type.</td>
+</tr>
+
+<tr>
+<th>SORE THROAT,
+ACUTE, SEPTIC</th>
+<td>Begins with sore throat and weakness. Throat diffusely reddened and may
+show patches like diphtheria.</td>
+<td>Discharges from nose and mouth of a patient.</td>
+<td align="center">Yes</td><td align="center">No</td><td align="center">No</td>
+<td align="center">No</td><td align="center">No</td>
+<td>Until recovery.</td>
+<td colspan="3"></td><td></td>
+<td>Often leads to serious results, affections of heart, kidneys, etc. Very
+apt to occur in epidemics due to milk contaminated by a patient
+suffering from the disease.</td>
+</tr>
+
+<tr>
+<th>WHOOPING
+COUGH</th>
+<td>Begins with cough which is worse at night. Symptoms may at first be very
+mild. Characteristic "whooping" cough develops in about 2 weeks, and the
+spasm of coughing sometimes ends with vomiting.</td>
+<td>Discharges from nose and mouth of a patient.</td>
+<td align="center">Yes</td><td align="center">Yes</td><td align="center">No</td>
+<td align="center">Yes</td><td align="center">No</td>
+<td>Eight weeks or until 1 week after last characteristic cough and
+disinfection of person.</td>
+<td colspan="3">Fourteen days provided no cough develops.</td>
+<td></td>
+<td>After effects often very severe and disease causes great debility.
+Relapses are apt to occur. Second attack rare. Specially infectious for
+first week or two. If a child vomits after a paroxysm of coughing, it is
+probably suffering from whooping cough. Great variation in type of
+disease. Often fatal in young children.</td>
+</tr>
+</tbody>
+</table>
+
+</div>
+</body>
+</html>