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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 & 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,—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—Dock and Nutting, Volume I.</li> + +<li>The Life of Florence Nightingale—Cook.</li> + +<li>The Life of Pasteur—Vallery-Radot.</li> + +<li>The House on Henry Street—Wald.</li> + +<li>Public Health Nursing—Gardner, Part I, Chapters I-III.</li> + +<li>Origin and Growth of the Healing Art—Berdoe.</li> + +<li>Medical History from the Earliest Times—Withington.</li> + +<li>Under the Red Cross Flag—Boardman.</li> + +<li>Report on National Vitality—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>—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>—<span class="smcap">Bacilli of Various Forms.</span> (<cite>Williams.</cite>)</span> +</div> + +<div class="run-in"> +<h4>Size.</h4><p>—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>—(<cite>Williams.</cite>) +</span> +</div> + +<div class="run-in"> +<h4>Motion.</h4><p>—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>—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.—Bacilli of Various Forms. (Williams.)" title="" /> +<span class="caption"> +<span class="smcap">Fig. 3.—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.—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.—Bacteria with Spores.</span> (<cite>Williams.</cite>) +</span> +</div> + +<div class="run-in"> +<h4>Spores.</h4><p>—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>—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>—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."—(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.—(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."—(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."—("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."—(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<!-- 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—Hill, Chapters I-IX.</li> + +<li>Health and Disease—Roger I. Lee, Chapters XV-XXIV.</li> + +<li>Principles of Sanitary Science and the Public Health—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—Frederic S. Lee, +Chapters II, IV-VI.</li> + +<li>Disease and Its Causes—Councilman, Chapter I.</li> + +<li>Preventive Medicine and Hygiene—Rosenau.</li> + +<li>Publications of the Life Extension Institute—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,—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.</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>—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>—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>—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>—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."—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.—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>—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.—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>—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."—(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."—(Chapin: The Sources and Modes of Infection, +p. 188.)</p> +</blockquote> + +<div class="run-in"> +<h4>Oral Hygiene.</h4><p>—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."—(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>—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>—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>—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."—(Ruth +Vories, in "Health News," Sept., 1916.)</p> +</blockquote> + +<div class="run-in"> +<h4>Elimination.</h4><p>—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>—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>—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>—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—Roger I. Lee, Introduction and Chapters +I, III-V, VII-IX.</li> + +<li>How to Live—Fisher and Fisk, Chapters I, III-V.</li> + +<li>The Human Mechanism—Hough and Sedgwick, Chapters V, +XXII-XXIX.</li> + +<li>Disease and Its Causes—Councilman, Chapters X, XII.</li> + +<li>Fatigue and Efficiency—Goldmark, Chapters II, III.</li> + +<li>Preventive Medicine and Hygiene—Rosenau.</li> + +<li>A Manual of Personal Hygiene—6th Edition, Edited by Walter +L. Pyle.</li> + +<li>Four Epochs of a Woman's Life—Galbraith.</li> + +<li>Hygiene and Physical Culture for Women—Galbraith.</li> + +<li>The Home and Its Management—Kittredge.</li> + +<li>Exercise and Health—F. C. Smith, Supplement 24 to the Public +Health Reports, Government Printing Office, Washington.</li> + +<li>The Sanitary Privy—Farmers' Bulletin 463, United States +Department of Agriculture, Government Printing Office, +Washington.</li> + +<li>Safe Disposal of Human Excreta at Unsewered Homes—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—New York State Department of Health, Albany.</li> + +<li>Milk and Its Relation to Public Health—Bulletin 56, Hygienic +Laboratory, Government Printing Office, Washington.</li> + +<li>Milk and Its Relation to Health—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>—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>—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>—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>—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>—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>—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>—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>—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>—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>—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>—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>—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>—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>—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> <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>—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<!-- 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>—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>—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>—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>—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>—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>—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>—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.</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—Holt.</li> + +<li>The Care and Feeding of the Baby—Truby King.</li> + +<li>The Baby's First Two Years—R. M. Smith.</li> + +<li>The Care and Feeding of Children—J. L. Morse.</li> + +<li>Preventive Medicine and Hygiene—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—Supplement No. 10 to the Public Health +Reports, 1913, Government Printing Office, Washington, +D. C.</li> + +<li>Your Baby: How to Keep It Well—New York State Department +of Health, Albany.</li> + +<li>Publications of the American Association for the Study and +Prevention of Infant Mortality—1211 Cathedral Street, +Baltimore, Md. (Free on request.)</li> + +<li>Publications of the National Committee for the Prevention of +Blindness—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>—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.—<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>—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.—Taking the pulse at the wrist. Note the position of arm.</span> (<cite>From +"Elementary Nursing Procedures," 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,—whether weak or strong,</p> + +<p>3. Its rhythm,—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>—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>—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>—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> <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> <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> <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> <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> <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> <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> <h4>vomiting</h4> <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>—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> <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> <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>—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>—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> <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>—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">℥</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">℥</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>—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>—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>—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>—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."—(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—Emerson, Chapters XVI, XVII.</li> + +<li>The Human Mechanism—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—Florence Nightingale, Pages 105-136.</li> + +<li>Why Worry?—Walton.</li> + +<li>Those Nerves—Walton.</li> + +<li>Tuberculosis: Its Cause, Cure, and Prevention—Otis.</li> + +<li>Publications of the National Association for the Study and +Prevention of Tuberculosis—105 East 22d Street, New +York City. (Pamphlets free on request.)</li> + +<li>Publications of the National Committee for Mental Hygiene—50 +Union Square, New York City. (Pamphlets free on +request.)</li> + +<li>Publications of the Mental Hygiene Committee of the State +Charities Aid Association—105 East 22d Street, New York +City. (Pamphlets free on request.)</li> + +<li>Publications of The American Society for the Control of +Cancer—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>—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>—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>—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>—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>—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>—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>—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—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.)</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—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.</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—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>—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—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>—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>—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>—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>—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>—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>—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> <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>—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>—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>—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>—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.—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.—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>—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>—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>—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> <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.—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>—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.—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—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>—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.—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>—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.—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>—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>—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> <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>—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—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,—once every waking +hour is not too often if the body is emaciated,—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>—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.—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.—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.—Adjustable Table.</span> +</div> + +<div class="run-in"> +<h4>Bedpans</h4> <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> <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> <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> <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> <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>—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>—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—Roger I. Lee, Chapter II.</li> + +<li>The Human Mechanism—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—Florence Nightingale, Pages 63-79.</li> + +<li>How to Live—Fisher and Fisk, Chapter II.</li> + +<li>Bodily Changes in Pain, Hunger, Fear and Rage—Cannon, +Chapter I.</li> + +<li>Food for the Invalid and the Convalescent—Winifred S. Gibbs.</li> + +<li>Practical Dietetics—Pattee, Chapters IV, V.</li> + +<li>Feeding the Family—Rose.</li> + +<li>Diet in Health and Disease—Friedenwald and Ruhrah.</li> + +<li>Feeding Children from Two to Seven Years Old—New York +City Department of Health.</li> + +<li>American Red Cross Text Book on Home Dietetics—Ada Z. +Fish.</li> + +<li>Emergency Cooking—Pamphlet 708, American Red Cross.</li> + +<li>War Diet in the Home—Pamphlet 706, American Red Cross.</li> + +<li>Red Cross Conservation Food Course for Children and Special +Classes—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>—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>—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>—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>—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,—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>—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>—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>—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> <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>—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—Roger I. Lee, Chapter VI.</li> + +<li>How to Live—Fisher and Fisk, Supplementary Notes, Sections +IV, V.</li> + +<li>Scientific Features of Modern Medicine—Frederic S. Lee, Chapters +III, VIII.</li> + +<li>The Human Mechanism—Hough and Sedgwick, Chapter XX.</li> + +<li>The Conquest of Nerves—Courtney.</li> + +<li>Primitive Psychotherapy and Quackery—Lawrence, Chapters +I-V.</li> + +<li>Nostrums and Quackery—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>—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.—"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.—"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.—"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.—"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>—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>—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>—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>—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.—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>—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>—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>—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>—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—Emerson, Chapter I.</li> + +<li>The Human Mechanism—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>—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>—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>—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."—("Preventive Medicine and +Hygiene," Rosenau.)</p></blockquote> + +<div class="run-in"> +<h4>Care During More Serious Infections.</h4><p>—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>—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."—(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>—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>—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> <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>—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>—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>—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>—"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.)</p></div> + +<div class="run-in"> +<h4>Termination of Quarantine.</h4><p>—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>—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>—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—Rosenau.</li> + +<li>The New Public Health—Hill, Chapters VII-XVII.</li> + +<li>Essentials of Medicine—Emerson, Chapters XII-XV.</li> + +<li>Health and Disease—Roger I. Lee, Chapter X-XIV.</li> + +<li>Disease and Its Causes—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>—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> <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>—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> <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> <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> <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> <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—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> <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> <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> <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> <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>—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>—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> <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> <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> <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>—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> <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> <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>—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>—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>—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> <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—Lynch.</li> + +<li>Immediate Care of the Injured—Morrow.</li> + +<li>Prompt Aid to the Injured—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> <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> <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>—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>—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> <p>have been considered on <a href="#Page_44">page +44.</a></p></div> + +<div class="run-in"> +<h4>Posture.</h4><p>—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.—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.—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.—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.—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.—Round +Shoulders.</span> (<cite>Goldthwait, from Pyle's "Personal Hygiene."</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.—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.—"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>—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."—(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—Tracy.</li> + +<li>Occupation Therapy—Dunton.</li> + +<li>Handicrafts for the Handicapped—Hall and Buck.</li> + +<li>When Mother Lets Us Make Toys—Rich.</li> + +<li>Amusements for Convalescent Children—New York State Department +of Health, Albany.</li> + +<li>Essentials of Medicine—Emerson, Chapter IX.</li> + +<li>Civics and Health—Allen.</li> + +<li>How to Live—Fisher and Fisk, Chapter III, Section II; and +Supplementary Notes, Section III.</li> + +<li>Health Work in the Schools—Hoag and Terman.</li> + +<li>Medical Inspection of Schools—Gulick and Ayres.</li> + +<li>The Hygiene of the Child—Terman.</li> + +<li>Posture of School Children—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—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—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—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—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>—A substance which prevents or hinders the +growth of micro-organisms.</p> + +<p><b>Antitoxin.</b>—A substance that neutralizes the action of a toxin.</p> + +<p><b>Aseptic.</b>—Free from living germs.</p> + +<p><b>Axilla.</b>—The armpit.</p> + +<h3>B</h3> + +<p><b>Bacillus</b> (pl. bacilli).—A rod-shaped or elongated bacterium.</p> + +<p><b>Bacterial.</b>—Relating to bacteria.</p> + +<p><b>Bactericide.</b>—An agent having the power to destroy bacteria.</p> + +<p><b>Bacteriological.</b>—Relating to bacteriology.</p> + +<p><b>Bacteriology.</b>—The science dealing with microorganisms.</p> + +<p><b>Bacterium</b> (pl. bacteria).—A unicellular vegetable micro-organism.</p> + +<h3>C</h3> + +<p><b>Carrier.</b>—An apparently healthy person who harbors pathogenic +germs in his body.</p> + +<p><b>Coccus</b> (pl. cocci).—A bacterium of spherical or nearly spherical +shape.</p> + +<p><b>Counter-irritant.</b>—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>—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>—Pertaining to degeneration.</p> + +<p><!-- Page 327 --><span class='pagenum'><a name="Page_327" id="Page_327">[327]</a></span> +<b>Deodorant.</b>—An agent that destroys odors.</p> + +<p><b>Digestive Tract.</b>—The entire alimentary canal, including the +mouth, œsophagus, stomach, and the small and large intestines.</p> + +<p><b>Diplococcus.</b>—A form of coccus in which two individuals +remain attached after cell division has taken place.</p> + +<p><b>Disinfect.</b>—To destroy the germs of disease.</p> + +<p><b>Disinfectant.</b>—An agent that destroys the germs of disease.</p> + +<p><b>Disinfection.</b>—The process of destroying the germs of disease.</p> + +<h3>E</h3> + +<p><b>Emetic.</b>—A substance used to induce vomiting.</p> + +<p><b>Enema.</b>—An injection of fluid into the rectum.</p> + +<h3>F</h3> + +<p><b>Fecal.</b>—Pertaining to feces.</p> + +<p><b>Feces.</b>—Matter discharged from the bowels; bowel movement.</p> + +<p><b>Fermentation.</b>—Decomposition produced in an organic substance +by the action of certain living agents.</p> + +<p><b>Fission.</b>—The process by which a cell divides into two parts.</p> + +<p><b>Flagellum</b> (pl. flagella).—A long hair-like appendage, by the +action of which certain micro-organisms are enabled to move.</p> + +<p><b>Flex.</b>—To bend at a joint.</p> + +<p><b>Fomentation.</b>—<a href="#Stupe">See <i>Stupe</i>.</a></p> + +<h3>G</h3> + +<p><b>Gastric Juice.</b>—The fluid secreted by the glands of the +stomach.</p> + +<p><b><a name="Germ" id="Germ">Germ.</a></b>—A minute unicellular organism, either animal or +vegetable; a micro-organism; a microbe.</p> + +<p><b>Germicide.</b>—An agent having the power to kill germs.</p> + +<h3>H</h3> + +<p><b>Host.</b>—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>—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>—The state in which an individual is not susceptible +to a particular disease.</p> + +<p><b>Immunize.</b>—To render immune.</p> + +<p><b>Incubation.</b>—The interval between exposure to an infectious +disease and the first appearance of symptoms.</p> + +<p><b>Infect.</b>—To communicate disease germs.</p> + +<p><b>Infection.</b>—An agent by which disease may be communicated +from one individual to another; also, an infectious disease.</p> + +<p><b>Inoculate.</b>—To introduce any biological product directly into +the tissues of the body.</p> + +<p><b>Inoculation.</b>—The process of inoculating.</p> + +<p><b>Intestinal Tract.</b>—The small and large intestines.</p> + +<h3>M</h3> + +<p><b>Microbe.</b>—<a href="#Germ">See <i>Germ</i>.</a></p> + +<p><b>Micro-organism.</b>—<a href="#Germ">See <i>Germ</i>.</a></p> + +<p><b>Mucus.</b>—The substance secreted by mucous membranes.</p> + +<p><b>Mucous Membranes.</b>—The membranes lining certain cavities +of the body, especially the digestive and respiratory tracts.</p> + +<h3>N</h3> + +<p><b>Nutrient.</b>—One of several chemical groups to which the essential +constituents of food belong.</p> + +<h3>O</h3> + +<p><b>Organic.</b>—Derived from or relating to an organism.</p> + +<p><b>Organism.</b>—An individual that is or has been alive.</p> + +<h3>P</h3> + +<p><b>Parasite.</b>—An individual that lives in or upon another +individual.</p> + +<p><b>Pasteurization.</b>—The process of pasteurizing.</p> + +<p><!-- Page 329 --><span class='pagenum'><a name="Page_329" id="Page_329">[329]</a></span> +<b>Pasteurize.</b>—To subject milk to a temperature of 142°-145° +Fahrenheit for thirty minutes.</p> + +<p><b>Pathogenic.</b>—Disease-producing.</p> + +<p><b>Pertussis.</b>—Whooping-cough.</p> + +<p><b>Proteid.</b>—One of the complex nitrogenous substances constituting +the essential parts of animal and vegetable tissues.</p> + +<p><b>Protozoön</b> (pl. protozoa).—An animal organism composed of +a single cell.</p> + +<p><b>Pus.</b>—The fluid product of inflammation; matter.</p> + +<p><b>Putrefaction.</b>—Decomposition of nitrogenous organic matter +brought about by micro-organisms and accompanied by a foul +odor.</p> + +<h3>R</h3> + +<p><b>Resistance.</b>—<a href="#Immunity">See <i>Immunity</i>.</a></p> + +<p><b>Respiratory Tract.</b>—The air passages, including the nose, +mouth, larynx, trachea, bronchial tubes, and lungs.</p> + +<h3>S</h3> + +<p><b>Saprophyte.</b>—A vegetable organism that lives on decaying +organic matter.</p> + +<p><b>Sarcina.</b>—Literally, a bundle. Applied to bacteria grouped +in bundles or packets.</p> + +<p><b>Septic.</b>—Putrefying or decomposing; infected by pus-producing +bacteria.</p> + +<p><b>Sequela.</b>—A disease or unhealthy condition following another +disease or unhealthy condition.</p> + +<p><b>Serum.</b>—The fluid which separates from the clot after blood +has coagulated; especially, that containing an antitoxin.</p> + +<p><b>Sewage.</b>—Any substance containing urine or fecal matter; +also, the substance which passes through sewers.</p> + +<p><b>Spirillum</b> (pl. spirilla).—A variety of bacteria having spirally +twisted cells.</p> + +<p><b>Spore.</b>—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>—Spit; expectoration.</p> + +<p><b>Staphylococcus.</b>—A variety of bacteria that group themselves +in masses resembling bunches of grapes.</p> + +<p><b>Sterile.</b>—Free from living germs; aseptic.</p> + +<p><b>Sterilization.</b>—The process of rendering sterile.</p> + +<p><b>Sterilize.</b>—To render sterile.</p> + +<p><b>Streptococcus.</b>—A variety of bacteria that arrange themselves +in chains.</p> + +<p><b><a name="Stupe" id="Stupe">Stupe.</a></b>—A cloth wrung out of hot water and applied to the +surface of the body.</p> + +<p><b>Susceptible.</b>—Lacking resistance to a disease.</p> + +<p><b>Susceptibility.</b>—The condition in which resistance to a disease +is low.</p> + +<h3>T</h3> + +<p><b>Tetrad.</b>—A variety of bacteria that arrange themselves in +groups of four.</p> + +<p><b>Tissue.</b>—A collection of cells having the same function.</p> + +<p><b>Toxin.</b>—A poison produced by the action of micro-organisms.</p> + +<h3>U</h3> + +<p><b>Unicellular.</b>—Composed of a single cell.</p> + +<p><b>Uterus.</b>—The womb.</p> + +<h3>V</h3> + +<p><b>Vaccinate.</b>—To inoculate with a poison in order to bring about +immunity to a disease.</p> + +<p><b>Vaccine.</b>—Any substance which if introduced into the body +causes the formation of protective substances.</p> + +<p><b>Vomitus.</b>—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> +<div style='display:block;margin:1em 0;'>This file should be named 32250-h.htm or 32250-h.zip</div> +<div style='display:block;margin:1em 0;'>This and all associated files of various formats will be found in https://www.gutenberg.org/3/2/2/5/32250/</div> +<div style='display:block; margin:1em 0'> +Updated editions will replace the previous one—the old editions will +be renamed. +</div> + +<div style='display:block; margin:1em 0'> +Creating the works from print editions not protected by U.S. copyright +law means that no one owns a United States copyright in these works, +so the Foundation (and you!) can copy and distribute it in the United +States without permission and without paying copyright +royalties. 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