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H-UMPH.RXa-0 REYNOLDS 

NATIONAL LIBRARY OF MEDICINE
        Bethesda, Maryland


              Gift of

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THE NEW YORK ACADEMY
 OF MEDICINE LIBRARY 
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THE NURSE'S SERVICE DIGEST
A MANUAL OF NURSING
HUMPHREY AND REYNOLDS 
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 rRSE'S SBBVICE DIGEST!
A MANUAL OF NURSING
^
LAURENCE HUMPHRY, M.A.,  M.D.,
         M.R.C.P., M.R.C.S.
PHYSICIAN, AND  FOEMERLY LECTURER TO
PROBATIONERS, AT  ADDENBROOKE'S  HOS-
PITAL, CAMBRIDGE, ENGLAND J TEACHER OF
PATHOLOGY AND  EXAMINER IN MEDICINE,
UNIVERSITY OF  CAMBRIDGE.
SECOND AMERICAN EDITION
    REVISED AND ENLARGED
BY
^
W. MYRON REYNOLDS,  M.D.,
FROM THIRTY YEARS OF RESEARCH
IN HOSPITAL, CLINIC  AND ACTIVE
PRACTICE  JN  NEW  YORK  CITY
/f
GEORGE SULLSJ1ND COMPANY
             New York 
     COPYRIGHT, 1918, BY
ORSAMUS TURNER HARRIS
        NEW YORK
  THE NURSE'S SERVICE DIGEST
FEB -51944
LIBRARY  i
  2Hi  °l/b 
 PREFACE TO THE TWENTY-NINTH ENGLISH EDITION
   The  following  pages are  based upon lectures
 given by me to the probationers at Addenbrooke's
 Hospital during  the  last  two years.   The plan
 adopted is to give a short account of the anatomy
 of each set of organs, and  immediately  afterwards
 to  treat of the diseases of those  organs and  the
 appropriate  nursing.    A  description   of  baths,
 enemata, poultices,  bandaging, and  various  nurs-
 ing appliances will be found  in the final chapters.
 An appendix  contains receipts of food suitable for
 invalids.
   The  symptoms and  management of common
 diseases and the  complications likely to occur  are
 (described in order to  assist  the  nurse  in follow-
 ing the course of  the malady  the  treatment  of
|which is assumed to be in the hands of a medical
(attendant.
   I am indebted  to  Sir Dyce Duckworth for  the
  se of his notes of Lectures to  Probationers  at
  t. Bartholomew's Hospital,  and  to  Mr. Croft of
     Thomas' Hospital for valuable hints on nurs-
   g in surgical cases.  The  chapter  on the man-
 agement of child-bed  contains many of the rules
 and directions drawn  up for  nurses at the General
 Lying-in Hospital, York Road.
   In addition to illustrations prepared expressly
 for the work,  permission  has kindly  been  given
 me to  utilize  some of the woodcuts  from Messrs.
 Caird and Oathcart's  Surgical Handbook, and  Dr.
 Thompson's Dictionary of Domestic Medicine.
                       LAURENCE HUMPHRY, M.D.
   Cambridge, England.
                        ili 
        PREFACE TO THE AMERICAN EDITION
  A  preface  is  for  explanation or  apology;  no
apology is necessary for the able way Dr. Laurence
Humphry has compiled  the English edition  of this
valuable aid  to  nurses; our  explanation  will  be
enlarged and incorporated in  the  American edi-
tion, gathered from thirty years of careful observa-
tion of others, and research in  hospital, clinic and
active practice by myself.
  An eminent member  of  the  Speakers'  Bureau
of the  American Medical  Association, in an able
address, contends undeniably,  that  "public  health
is a purchasable commodity, as truly as milk, flour,
sugar, or any other  article  of  commerce;" and
that "every  fifty  seconds a human life is needlessly
wasted."
  Also, Dr. Irving Fisher, Professor at Yale Uni-
versity, and President  of the  Committee  of One
Hundred on National Health, in his  masterly  ad-
dress before the  National  Congress of Physicians,
makes the  conservative and  amply proven  state-
ment,  that  out of 1,500,000 deaths  which  occur
annually in  the  United States,  "ait least 630,000
are preventable."
  The President  of the Life Extension  Institute,
writes:  "The life waste  in  war, enormous as it
is, is almost trifling  compared  to  the life  waste
in peace from ignorance, and  neglect,  of ordinary
preventive  measures."
  Every well informed physician knows the sad
truth of  the above  statements; notwithstanding
this stupendous death rate, admitted by the highest
medical  authority to  be chiefly preventable,  the
great majority of people are not interested in their
health, until they are sick and need  a physician.
  No prudent mechanic would run a  complicated
machine continually  without  a  frequent  careful
overhauling; he does not wait till it breaks down!
                        iv 
  The human system is the most complicated  and
delicate  machine  known to man;  moreover,  the
chief asset of the entire human race is good health;
many persons think they are  in good  health,  but
unknowingly are suffering from latent disease, that
could readily be discovered  and probably remedied
by a skilled physician.
  When we pause to think  that  scientific research
has made it possible  to prevent ninety-eight  per
cent of  the ordinary  ills, and nearly  one-half of
all the untimely deaths that occur, is it  any wonder
we  stand appalled, that more care is not taken to
prevent unnecessary sickness and untimely deaths.
  Nature provides but one way to nourish the  sys-
tem, and four ways to remove the waste material,
namely, the bowels, kidneys, pores of the skin  and
lungs.
  Is it not more wise  to prevent sickness, by the
occasional timely advice of  a competent  physician,
giving these organs more attention and  better care,
to keep them in  a  normal state of health, than by
neglect to  permit them to become impaired  by
disease?
  The well-informed nurse will see at a glance the
enormous field of usefulness that is open to her!
surely, such a work is akin to  Divine service.
  We shall be fully rewarded for the revision of
this work,  since we realize it will prove an  in-
dispensible  help  to the nurse, both in  the home
and at the  front, whose aid to the physician  and
surgeon  is so highly important.
  We have purposely  made  our comments  and
additions plain and comprehensive, realizing  that
herein  is  the  opportunity   of a lifetime for the
nurse, to relieve the sick  and  aid  the suffering,
and to all such we bid  a hearty welcome.
                    W. Myron Reynolds, M.D.
  New York, September, 1917.
                        v 
CONTENTS
               CHAPTER  I.
THE  GENERAL MANAGEMENT  OF  THE  SICK
      ROOM.......*
  The Sick-Room :—Temperature—Venti-
    lation—Nurse's Dress —Furniture-
    Flowers—Carpets—Bed  and Bedding
    —Water-Beds—Cleanliness—Quiet. At-
    tendance on  Patient:—Washing  and
    Personal Care—Bed-Sores—Changing
    Sheets—Draw-Sheet—Lifting and Mov-
    ing the Patient—Bed-Pans—Inspection
    of Excreta—Feeding-Cups—Medicine
    Glass—Hot-Water  Bottles—Bed-Rest.
    Observation  of  the  Sick:—General
    Suggestions—Administration of Food,
    Stimulants,  and Medicine — Arrange-
    ment of  Room for  Operations.

               CHAPTER II.
GENERAL PLAN OF THE  HUMAN BODY   .    .   21
  Anatomy :— Skeleton — Skull — Spine—
    Vertebra?—Thorax—Ribs—Sternum—
    Clavicle— Scapula—Humerus—Radius
    —Ulna— Carpus — Metacarpus—Pha-
    langes — Pelvis — Femur — Patella —
    Tibia—Fibula—Tarsus—Joints—Mus-
    cles—Fat—Internal Organs—Nervous
    System—Respiratory  System—Circula-
    tory  System—Digestive  System—Ex-
    cretory  System—Work  and Waste—
    Blood — Capillaries — Clotting—Blood
    Serum —Excretion — Temperature of
    Body.
                     vi 
CONTENTS
               CHAPTER  irr.
 DISEASES OF THE NERVOUS SYSTEM
  The Nervous System: — Brain —Spinal
    Cord—Membranes —Nerves—Motion—
    Sensation—Paralysis—Loss of  Sensa-
    tion—Reflex Action.
  Symptoms rnd Management of Brain Pa-
    ralysis : — Coma — Spinal  Paralysis —
    Bed-Sores—Nerve Paralysis—Infantile
    Paralysis—Locomotor Ataxy—Menin-
    gitis—Cerebral Tumours—Epilepsy—
    St.  Vitus's Dance—Hysteria—Delirium
    —Delirium Tremens—Insanity.

               CHAPTER  IV.
 DISEASES OF THE RESPIRATORY  SYSTEM .
  The Respiratory Tract and Respiration:
    —The Lungs—Air-Passages—Larynx—
    Trachea—Bronchi—Mechanism of Res-
    piration—The Respiratory Act—Impor-
    tance of  Ventilation—Cough and Dys-
    pnoea.
  Symptoms and  Management  of Laryngi-
    tis —Bronchitis—Asthma— Pneumonia
    — Pleurisy  — Empyema  — Pulmonary
    Consumption—Haemoptysis or  Spitting
    of Blood—and other Complications.

               CHAPTER  V.
DISEASES OF THE HEART  AND  BLOOD-VESSELS
  Heart, Pericardium — Valves — Aorta —
    Pulmonary  Artery — Systemic, Portal
    and  Pulmonary  Circulations —.Move-
    ments of  Heart — Pulse — Dyspnoea —
    Dropsy—Ascites.
  Symptoms and  Management  of Pericar-
    ditis :—Mitral  Valve Disease—Aortic
    Valve Disease—Angina Pectoris—Fatty 
viii
CONTENTS
    Heart—Congenital Heart Disease—and
    Aneurysm of Aorta.

               CHAPTER VI.
DISEASES OF THE DIGESTIVE SYSTEM  .     .  109
  The Organs of Digestion—The Mouth-
    Teeth— Tonsils—Pharynx—Epiglottis
    —Parotid  Glands—Gullet—Stomach-
    Liver   and  Bile—Intestines—Perito-
    neum—Foods—Digestive  Processes—
    Lymphatics—Indigestion—Vomiting—
    Haematemesis—Jaundice.
  Symptoms and Management of  Gastric
    Ulcer—Colic—Gall-Stones—Peritonitis
    —Typhlitis—Intestinal Obstruction—
    Diarrhoea—English  Cholera — Exami-
    nation of the Stools.

              CHAPTER VII.
DISEASES OF THE SKIN AND KIDNEYS  .     .  132
  SUin :—Structure—Sweat Glands—Seba-
    ceous Glands—Nails  and Hair—Corns
    and  Warts—Erythema—Nettle-Rash—
    Petechia?— Psoriasis— Pigmentation—
    Management  of Eczema — Herpes or
    Shingles—Na?vus—Pediculi or Lice—
    Scabies or Itch—Tinea or Ringworm—
    Chloasma.
  Kidney:—Structure—Ureters — Bladder
    —Examination of the Urine—Deposits
    —Tests for Sugar, etc.—Suppression of
    Urine—Symptoms and Management of
    Bright's Disease, Acute and Chronic—
    Albuminuria—Renal  Colic—Diabetes—
    Dietary for the Diabetic—Sweaty Feet.

               CHAPTER VIII.
 ON FEVERS.......156
   Fever—Different Forms of  Fever—Infec- 
CONTENTS
ix
    tious  Fevers—Germs—Contagion  and
    Infection—Isolation—Rules for  Disin-
    fection—Incubation and Invasion Pe-
    riods.
  Symptoms and Management  of Chicken-
    Pox—Scarlatina—Small-Pox—Measles
    —Typhus—Typhoid Fever and its Com-
    plications—Diphtheria—Mumps—Chol-
    era — Influenza — Rheumatic  Fever —
    Malarial Fevers—Ague.

               CHAPTER  IX.
DISEASE IN CHILDREN.....190
  Observation of Children—The Cry—Atti-
    tude  in  Bed—Complexion—History of
    Illness—Disorders  of Infancy—Wast-
    ing—Feeding—Artificial  Food—Teeth-
    ing—Convulsions.
  Symptoms and Management of Rickets—
    Congenital  Syphilis — Laryngismus —
    Thrush—Sore Throat—Gastric Catarrh
    — Constipation — Obstruction — Diar-
    rhoea—Infantile Cholera—Chronic Di-
    arrhoea—Typhoid Fever—Worms—Tu-
    bercular Meningitis — Water on the
    Brain.

               CHAPTER  X.
WOUNDS AND THEIR COMPLICATIONS.—ULCERS,
      BURNS, AND SCALDS  ....  214
  Incised and Lacerated Wounds—Healing
    by First Intention, by Granulation—
    Dressings—Scalp and Face Wounds—
    Cut Throat—Hemorrhage: Capillary,
    Venous,  and  Arterial—Arrest of  Bleed-
    ing—Inflammation and  Abscess—Pus
    or Matter.
  Symptoms and Management of Cellulitis
    —Erysipelas—Poisoned  Wounds—Py- 
X
CONTENTS
    aemia  or  Blood-Poisoning—Tetanus-
    Ulcers  and  Ulceration — Burns  and
    Scalds.

               CHAPTER XI.
FRACTURES   .         .....234
  Fracture by Direct and Indirect Violence
    —Simple, Compound, and Comminuted
    Fractures—Signs  of Fracture—Union
    of Bone—Setting Fractures—First aid
    in Fracture.
  Management  of  Fractured  Skull—Con-
    cussion and Compression of the Brain
    —Fractured  Lower Jaw—Spine—Pel-
    vis— Collar-Bone — Splints for Frac-
    tured  Arm—Colles'  Fracture—Thigh-
    Bone—Bones of Leg—Patella—Plaster
    of Paris  Case—Crutches—Compound
    Fractures—Sprains  and Strains—Dis-
    locations.

              CHAPTER  XII.
OPERATIONS AND SPECIAL SURGICAL CASES   .  251
  Preparing  Patient  for Operation—Asep-
    tic Preparations—Operating Room and
    Table — Sterilizing — Management  of
    Patient after Operation—Haemorrhage
    after Operation.
  Management of  Hare-Lip—Cleft Palate
    —Tracheotomy Cases—Gangrene—Am-
    putations—Retention of Urine—Cath-
    eters—Stone in  the Bladder—Lithot-
    rity—Lithotomy—Fistula—Piles—Her-
    nia—Ovariotomy—Skin Grafting.

              CHAPTER  XIII
THE MANAGEMENT OF CHILD-BED  .    .     .  274
  Before Labour—Lying-in Room—Prep-
    aration   of  the   Bed — Precautions 
CONTENTS
xi
    against  Infectious Diseases — Indica-
    tions  of  Commencing Labor—Pains—
    Stages of Labor—Management of Nat-
    ural  Labor — Antiseptic  Rules  for
    Monthly  Nurses — Management  after
    Labor — Lochia — Lactation— Preven-
    tion of  Puerperal Fever — Antiseptic
    Solutions.
  Management of the Infant—Separation—
    Washing and Dressing—Rashes—Navel
    —Eyes—Rupture—Snuffles.

              CHAPTER  XIV.
APPLIANCES.......291
  Baths:—Vapour  Baths—Wet Pack—Half
    Pack—Tepid Sponging—Enemata, Ape-
    rient  and Nutrient—Douche—Vaginal
    Injections—Nasal Douche—Ice Bags—
    Poultices—Mustard  Leaves—Fomenta-
    tions and Stupes—Counter-Irritation—
    Blisters—Leeches—Cupping, Wet  and
    Dry—Ointments— Suppositories—Eye-
    Drops — Collyria — Ear-Syringing —
    Throat Applications—Gargles—Sprays
    —Inhalations—Bronchitis Kettle.

               CHAPTER XV.
ANTISEPTIC TREATMENT—BANDAGING   .    .  316
  The Antiseptic Treatment—Method—Im-
    portance  of Cleanliness—The Dress-
    ings—Bandaging—The Roller Bandage
    —Rules for Bandaging—Simple Spiral
    —Reversed  Spiral—Figure-of-8—Spica
    — Capeline — Leg  Bandage — Finger
    Bandage — Stump   Bandage — Many-
    Tailed Bandage—T-Bandage—Slings—
    Pads—Sand-bags. 
xii
CONTENTS
              CHAPTER XVI.
ARTIFICIAL  RESPIRATION — APPLICATION  OF
      ELECTRICITY—MASSAGE     .    .    .  326
  Artificial  Respiration — Clinical  Ther-
    mometer—Hypodermic Injection—Bat-
    teries — Application   of  Electricity —
    Massage or Rubbing.

             CHAPTER  XVII.
COOKING FOR INVALIDS.....333
  Gruel—Arrowroot—Toast and Water—
    Barley  Water—Imperial  Drink—Lin-
    seed-Tea—Rice  Water—Lemonade—
    Orangeade—Egg-Flip—Liebig's   Quick
    Beef-Tea—Beef-Tea—Fluid  Beef—In-
    fusion of Raw Meat—Chicken Broth—
    Mutton Broth—Veal Broth—Meat Pa-
    nada—Meat Jelly—Peptonised  Milk—
    Peptonised  Beef-Tea—Tea—Revalenta
    Arabica — Chicken   Cream — Caramel
    Custard—Potato  Soup—Scotch Collops
    —Fish  Omelet—Filleted  Sole—Turbot
    Souffle—The Fin  of Turbot—Macaroni,
    Light Pudding—Calves'. Feet Stewed.
ILLUSTRATIONS.....345
INDEX             ,    ,    ,   t    ,   399 
ABBREVIATIONS
xiii
 aa..........................of each
 Ad>---.....................Add; let there be added
 Ad. lib.....................as much as  desired
 Alt. hor....................every second hour
 Alt. noc....................every other  night
 Ana........................equal parts of each
 1. c.........................before meals
 A. S........................left  ear
 A. D.......................right ear
 Aq.........................water
 Aq. adst...................ice
 Aq. bull....................boiling  water
 Aq. dest...................distilled  water
 Aq. font...................spring water
 Aq. ferv....................hot  water
 Aq. pluv...................rain  water
 Arg........................silver
 Bis in die  or  b. i.  d......twice a day
 Bull........................boil
 But........................butter
 B.  V.......................vapor bath
 c...........................with
 Cap.................,.......Let him  take
 Caps.......................a capsule
 Cerat.......................a cerate
 Charta.....................a paper  (medicated)
 Crib.......................food
 Comp......................compound
 Conf.......................a confection
 Contin.....................let it be  continued
 Decub......................^ving down position
 Det........................Jet it be given
 Dil.........................dilute
 Div. in p. aeq.............Let it be divided into
                            equal parts
 Emp....................... plnster
 Enem......................injection
 F..........................Fahrenheit
 Fac........................make
 Fl..........................Fluid
 Ft.........................Jet there be made
 Garg.,.....................gargle
 Inf.........................an infusion
 Inject......................injection
 Lb.........................a  pound
 Liq.........................Honor
M..........................rnliim
M..........................mix
Mfst........................mixture
N..........................at nisrht
No.........................number
01..........................oil
01. res.....................oleoresin
01. oliv.....................olive  oil 
 xiv            ABBREVIATIONS


 O.  N.......................every night
 O.  D.......................daily
 O.  M.......................every day
 Ov.........................an  egg
 Pil.........................a pill
 P.  C.......................after meals
 P.  r. n.....................as occasion arises
 Pulv.......................a powd.
 Q.  s........................as much as is sufficient
 Q.  1 h......................every h r.
<Q.  2 h......................every 2 hr.
'<}.  3 h......................every 3 hrs.
' Q.  4 h......................every 4 hrs.
 Q.  v........................as much as  you choose
 Quor.......................of which
 Quotid.....................daily
 R..........................take
 Rad........................root
 Sb..........................a half
 Semidr.....................a half drachm
 Sem........................seed
 Semih......................half an hour
 Sine........................without
 Sol.........................solution
 Solv........................dissolve
• S.  O. S....................Jf necessary
 Spr.........................spirit
 Stat............,...........immediately
 Syr.........................syrup
 Tal.........................such a  one
 t.  i. d.....................three times a dav
 t.  b. sim..................rub  well together
 Tr..........................tincture
 Troch......................lozenger
 Ung.......,................ointment
 Vin.........................wine
 v.  o. s.....................dissolved in  yoke of egg
 zz..........»...............ginger


           WEIGHT AND  MEASURE

 Gtt (mi)......................drop
 Gr............................grain
 Gm...........................gramme

 c-c............................cubic centimeter
 Drm.  (3)  1  teaspoonful..........drachm
 Oz. (5) two tablespoonfuls......ounce
 Scr.  O ).......................scruple

 O  ............................pint
 Qt............................quart
 C.............................gallon 
  THE NURSE'S  SERVICE DIGEST

                CHAPTER I.

  THE GENERAL MANAGEMENT OF THE SICK-ROOM.

The  Sick-Room:—Temperature—Ventilation—
  Nurse's  Dress—Furniture—Flowers—Carpets
  —Bed and Bedding—Water-Beds—Cleanliness
  —Quiet.   Attendance  on Patient:—Washing
  and  Personal  Care — Bed-Sores — Changing
  Sheets—Draw-Sheet—Lifting and Moving the
  Patient—Bed-Pans—Inspection  of  Excreta—
  Feeding-Cups — Medicine  Glass — Hot-Water
  Bottles—Bed-Rest.   Observation of the Sick:
  — General  Suggestions — Administration  of
  Food,  Stimulants,  and  Medicine — Arrange-
  ment of  Room for Operations.

  The  Sick-Room.—The selection of the  sick-
room does  not usually devolve upon the nurse,
but she may have opportunities of giving advice,
especially  as  to its  arrangement, ventilation,
warming, and furniture.
  The ideal sick-room should have a southern
aspect, a fair possibility of  sunshine, and should
be spacious and lofty, quiet, and well ventilated.
If possible, it should  be isolated  from the rest
of the house,  especially in infectious  cases.  It
is also a great advantage to have  a second room
opening into it, and a lavatory and closet on the
same floor.  It is needless to say that  the drain-
age should be in perfect order.
  With all such attendant advantages, the nurse
                      l 
THE NURSE'S SERVICE DIGEST
 experiences little difficulty in keeping the sick-
 room cheerful  and healthy.  It is, however,  in
 small houses and in  the dwellings of the poor,
 where the patient inhabits  a  dark,  close, and
 squalid chamber, that her resources are tried to
 the utmost, and her skill and efficiency are put
 to the severest proof.
  Temperature.—A  thermometer  is  the only
 safe guide as to the temperature of the room.
 It should be hung against the wall near the bed,
 and the record taken at intervals during the day.
 The  temperature should be  kept as nearly  as
 possible at 60°  F., and on no account be allowed
 to descend below 50°; but it should be remem-
 bered that infants and old people require more
 warmth  than adults.  In some laryngeal  and
 pulmonary complaints, again, as high a temper-
 ature as 70° F. may have to be maintained.
  The moisture of the atmosphere  can be regu-
 lated to a certain extent when desirable by a
 steam-kettle, or  by  the evaporation of  water
 placed in open dishes. An open fire-place is by
 far the best and healthiest means of warming a
 room;  stoves are not nearly  so  agreeable, since
 they  never  create sufficient ventilation, and have
 a tendency to produce dryness in the air.  This
 may, however,  be counteracted to a certain "ex-
tent by placing a dish of water on the stove and
 allowing it to  evaporate.  The  temperature of
 the room should be carefully ascertained to be
 sufficiently  warm before  the patient is washed
 or dressed,  or rises to have the bed made,  and it
is  advisable  to have a  flannel dressing-gown
ready for these occasions.
  In  hot  weather there  may  be  difficulty  in
 keeping the  room  sufficiently   cool,  especially
 when the sun is shining on  it.   A dark  green
linen shade, outside shutters,  or  Venetian  blinds
are the best protection. 
     MANAGEMENT OF THE SICK ROOM    3

  Ventilation.—The purity of the atmosphere
in the  sick-chamber is  of the highest impor-
tance;  it is secured by  ventilation, by which
means a constant  stream of fresh  air is admit-
ted to replace the air which has been rendered
unhealthy by the impurities poured into it from
many sources.   Elsewhere an account  will be
found of the changes which the air undergoes in
its  passage  through  the lungs,  whereby  the
amount of oxygen is  diminished, and  the car-
bonic acid and  organic  material  are increased
(see Expired Air).  In addition to these impur-
ities, there are emanations from the surface of
the body,  and  particles  of putrefying matter
from the surface of sores and ulcers, and from
the sputum and  excreta being constantly thrown
off.  These, together with the dust and impuri-
ties  from  the  combustion of gas  or  candles,
combine to render the air unwholesome and  un-
suitable for respiration.   Where many sick peo-
ple are  congregated together,  the fouling of  the
air is materially increased, and is at once  ob-
vious to any one entering the room from  tie
fresh air, if the ventilation is imperfect.  This
is most noticeable in the early morning,  espe-
cially if the windows and doors have been closed
during  the night,  as is  often the  case  in cold
weather.
  The process of ventilation consists in the  re-
moval of the warm foul  air,  and the introduc-
tion of  fresh air  to supply  its place.   Extrac-
tion of  the foul air is best accomplished by  the
chimney when there is a fire  burning, for noth-
ing ventilates a room so  well in all respects as
an open grate with a fire. A continual diffused
current of air  is  produced in the direction of
the chimney, and fresh air enters from all quar-
ters  to  take its place, so that the  air of  the
room  is frequently changed.  In  large rooms 
4     THE NURSE'S SERVICE DIGEST

there are frequently open gratings  or holes near
the ceiling, communicating with the outside, or
with shafts for the extraction of the warm foul
air which ascends by  reason of its warmth.
  The admission of  fresh air should be man-
aged  as  far  as possible  without  draughts; if
these cannot  be  avoided  altogether,  the  bed
should be placed so as to prevent currents of air
from passing over the patient.  When necessary,
screens  may  be arranged round the bed.   Air
should be admitted fresh  from the outside.  It
is  useless to open  the door and allow air to en-
ter from an ill-ventilated passage or staircase,
containing the foul air of the house.  The win-
dows are the proper means for obtaining a fresh
supply of air,  and in cold  or windy  weather,
those on the sides away from the  wind should,
of  course, be used. Less draught is produced by
opening a  window at  the  top, but in warm
weather it may be opened both at the bottom
and the top.
  How to Avoid Draughts.—It should be re-
membered that windows opened at the bottom
are likely to  create a draught on  a level with
the patient,  and  are, therefore, dangerous  un-
less  carefully  managed.   An  excellent  plan of
arranging an  open window is to open the lower
sash a  few inches from the bottom,  and  to
fasten a wooden board, eight to ten inches deep,
across  the lower opening; or to fit  a piece of
wood accurately  in,  and close the opening be-
neath the sash. The  air thus enters at the mid-
dle, where the raised lower sash  overlaps  the
lower end of  the upper  one, and the current is
directed  upwards  towards the ceiling, and is
thus gradually  diffused  through the room with-
out draught.  When the room does not admit of
ventilation by this means, other substitutes must
be employed.   For example,  the windows in ad- 
    MANAGEMENT OF THE SICK ROOM   5

joining rooms or passages may be opened and
air admitted, or the door may  be opened and a
current of air created  by shaking a  clean towel
or sheet about the room.  In very cold or windy
weather, when  it is impossible  to keep windows
always open, the room should  be aired  several
times a day; the patient being entirely covered
up, the window  may  be thrown open,  and,  if
necessary,  the  door also for  a few minutes,
until the air has been changed and  feels fresh.
If the  patient is  able to leave the room, advan-
tage should be taken of his  absence  to have  it
thoroughly aired and  warmed  again  before his
return. Amongst the  poor, the nurse will find
the greatest objection  to having windows  open,
partly  from ignorance  and partly from dread of
draughts,  and she will have to be on her guard
that the windows are not shut directly her back
is turned.  This is especially necessary at night,
when it is of the utmost importance  to keep the
air fresh.
  Nurse's  Dress.—The  uniform should  consist
of cotton, alpaca, or of some washable material
Of  light colour.   For  midwifery or infectious
cases,  a print dress should be  worn, being less
likely  to  become  contaminated with dust and
dirt, besides being more easily cleansed.  It  is
usual for a nurse to wear a neat cap, apron, and
cuffs;  she should also be provided with a pair
of quiet shoes  without  high heels, and should
abjure creaky boots.
  In surgical cases where constant  dressing of
wounds, or removal of  offensive discharges  is
required,  the arms should  be bare, or  linen
sleeves may be  worn,  which can be drawn off
and on.  The nurse should always be provided
with a good pair of  scissors, dressing-forceps, a
pin-cushion with needles and pins, and  a ther-
mometer. 
 6     THE NURSE'S  SERVICE DIGEST

  Furniture.—The  ordinary  furniture  of the
 room should be of a simple kind.  Those chairs
 are best which have a wooden framework with
 a cane  bottom.  Stuffed chairs  and sofas with
 coverings of woolen material only retain the
 dust, and may spread infection.  A light invalid
 couch with wheels is useful  in convalescence.
 The room should be made cheerful and pleasant
 to the eye, and arranged  as  little  like a bed-
 room as possible; the pictures  and wall-paper
 should be considered in cases  where the invalid
 has to keep the room for a great length of time.
  Flowers  with bright colours, and devoid of
 scent or strong odour, should be selected, and
 should always be removed at  night.  Some per-
 sons are very  sensitive in  this respect, and are
 rendered faint by the presence of flowers with a
 strong scent.
  Carpets  should  not extend over the  whole
 room, but are useful to  prevent  unnecessary
 noise; they should be light and  easily removed
 for cleaning;  but  India matting, especially in
 summer, is an  excellent substitute.  It should be
 remembered that  fluffy  mats and  long-haired
 rugs are most objectionable, and that in infec-
 tious cases  carpeting of  all kinds  must be ex-
cluded.
  Bed and Bedding.—The simplest form  of bed-
 stead, such as the  ordinary narrow iron frame,
is convenient;  but if of a larger  size, it has this
advantage that the patient can be moved to the
other side while the bed is  being remade.  Four-
 post beds with hanging curtains are out of place
in the sick-room; if the apartment is draughty,
 the patient may be  protected  by well-arranged
 screens.
  The bedstead should not be placed  with one
 side against the wall, as  the nurse should  be
 able to  attend  to the patient  on either  side of 
MANAGEMENT OF THE SICK ROOM    7
the bed.  The position should be adapted to the
situation of the windows when possible, so as to
avoid light falling on the eyes in cases in which
this is undesirable; but yet so as to enable a
convalescent or chronic invalid  to look  out of
the window, or, if preferred, to have the light
at the back when reading.
  The  mattress   may  be  of thin  horse-hair,
placed on another of similar material. A spring-
mattress, however,  or  a woven-wire bed is pref-
erable, and forms a clean, cool, comfortable bed.
If these are too expensive, some cheaper form,
such as a wool or flock mattress, will have to be
substituted.  The  undersheet should be  spread
smoothly, well  stretched and tucked in under the
mattress; nothing  is so uncomfortable as lying
on  wrinkled sheets. After food, the  bed should
be  carefully freed from  crumbs; and several
times during the day it should be aired by rais-
ing the covering twice or thrice, and  getting rid
of the close warm air  of the interior  of the bed.
Comfortable pillows,  not  too  soft, may  be ar-
ranged  according  to   the  patient's  liking;  it
should be borne in mind that the back requires
support when the patient is lying propped up.
  Heavy  bed-clothes should be avoided,  and if
extra warmth  is required a light quilt or cover-
let is  the best, eider-down being the warmest.
Counterpanes are heavy and bad for ventilation.
It is a luxury to the patients if the room is pro-
vided with a second bed, into which they can be
moved for a change during the day, while the
other is being  aired and remade.
  Water-Beds  and Air-Cushions.—In cases of
chronic illness, when the patient has to be kept
constantly in bed,  or where bed-sores are likely
to occur, a  water-bed  is invaluable.   The empty
water-bed  should   be  first placed on  the bed-
stead, and water  at  about 90°  F.  (or  less, 
8     THE NURSE'S SERVICE DIGEST

according to the time of  the  year) gradually
poured  into  it  until it is about  half-full or
rather more;  the rest may be distended  with
air.  A  folded blanket should  be placed over it
before the bed is made.  The water-bed should
never be lifted  with the  water in  it, and  it
should  always be carefully  handled,  as  it  is
easily damaged and  is expensive.   Care should
be taken before it is placed on the bed to see
that it  does not leak.  The water  may require
changing after a  time in cold  weather.   Water-
pillows  may be filled in the same way.
  Air-cushions are not  so serviceable,  but are
less expensive.
  Cleanliness.—The room should be dusted,
tidied, and cleaned every day.   The floor should
be swept with a hand-brush,  damped to avoid
raising  the dust; or old tea-leaves or  sawdust
may be used for the same purpose.  The dust
should not be allowed to accumulate under the
bed or in the corners of the room.  If the  room
is cleaned every day, there will be less need of
scrubbing the floor; but in long illness, when
this is necessary, it is desirable to move the pa-
tient into another room until the boards are dry.
  Quiet.—The nurse, as  before stated, should
never wear  rustling dresses  or creaking shoes
(felt slippers are the most desirable to  be  worn
in the sick  room), and should avoid heavy or
clumsy  movements, as all such noises are ex-
tremely  irksome.  In cases requiring to be kept
especially quiet,  there is often difficulty in lim-
iting the number of visits  from anxious friends
and relations; but the nurse should ask for defi-
nite guidance on this point from the medical at-
tendant, and will then have no difficulty in act-
ing on his instructions.
  In making up the fire at night,  or when the
patient  is asleep,  a stick may be used instead of 
    MANAGEMENT OF THE SICK ROOM   9

a poker, and the coal should be arranged pre-
viously ready for use  in paper  bags, or be put
on gently by hand, with a glove kept for the
purpose.
            Attendance on Patient.
  Washing and Personal Care.—The face and
hands should be washed night and morning, and
if the patient is not well enough to take a bath,
the whole body should  be sponged over with
warm  water and soap once a  day (see  Tepid
Sponging).  The teeth should be cleaned regu-
larly with the tooth-brush, or with a  piece of
lint fastened on to the end of a stick, and  moist-
ened with some mouth-wash.
  The   hair  should be  carefully  combed  and
brushed, and in female  patients neatly plaited
into braids.
  Bed-Sores : Prevention of.—The back should
be examined in all cases of chronic illness, es-
pecially in those in which bed-sores are  apt to
occur, and systematically dusted with violet pow-
der, or finely-powdered boracic  acid.  If  neces-
sary, the skin may be hardened by rubbing with
spirits of wine, eau-de-cologne, or brandy.
  Changing Sheets.—In severe illness, this has
to be managed without uncovering the patients
or removing them from the bed.  It is best done
from side to side in the following manner:—All
the upper bed-clothes should be  removed  except
the top sheet and one blanket; the top sheet is
then taken out, leaving the blanket next the pa-
tient.
  To change the under-sheet the pillow must be
removed,  and the patient gently turned on his
side to about the middle of the bed, the  soiled
sheet being folded close up to the patient's back.
A clean sheet, half-rolled, is then placed against
the soiled one, and the unrolled half is smoothly
laid on the bed and  firmly tucked in; the patient 
 10    THE NURSE'S  SERVICE DIGEST

is then turned over on to the clean sheet, the
soiled one removed from the other side; and the*
clean one then unrolled over the rest of the bed.
When  it is not possible to turn the patients on
their side,  the under-sheet may be changed in a
somewhat similar manner from head to foot.
  To change  the  upper-sheet spread the  clean
sheet over the covering blanket, and whilst hold-
ing it with one hand draw out the blanket, then
replace the remaining  bed-clothes.
  Draw-Sheet.—This has constantly to be used
in different cases in order  to  prevent the bed
from being  soiled.  It  consists  of a small  sheet
folded  lengthwise two or three times, so as to be
of sufficient depth to reach  from the middle of
the patient's back to the knees.  It should be
firmly  tucked in  on both  sides  under the mat-
tress, and  when soiled  it may be drawn away
underneath  by slightly raising  the patient, and
a clean part substituted,  the soiled part being
rolled up and pinned.  It is preferable, however,
to change the sheet altogether,  and not to leave
the soiled part inside the bed; this may be done
in the  manner above described in changing the
under-sheet.  If the patient cannot be turned on
one side, the nurse should carefully raise him,
whilst  an assistant draws underneath a clean
sheet, which has been temporarily fastened to
one  side of the  soiled sheet.   The  bed linen
should always be aired and warmed  before it
is used, and the airing should  be carried on in
another room.
  Lifting and Moving the Patient  in Bed.—
The  helpless patient requires lifting or moving
from time  to  time, in order to alter  the  posi-
tion, change the  bed, or  give the bed-pan.  If
the nurse is strong, she may Be able to lift the
body, single-handed,  by passing her arms well
underneath, one under the knees, the other un- 
    MANAGEMENT OF THE SICK ROOM  11

der the back  below the shoulders.  Heavy pa-
tients  may  be moved  and turned over on one
side by means of the  under-sheet or the  draw-
sheet.
  When a heavy  patient has to be  lifted any
distance, several persons are required; two of
them join hands under the upper and lower part
of the  patient, while a third takes charge  of the
head.
  Bed-Pans.—Those made of earthenware are
the cleanest and best.  Two forms are common-
ly used:  the round pan and the slipper; the
former being  suitable for men, the latter for
women.  A  flannel covering  should be adapted
to prevent the contact of the cold earthenware
with the  patient's body.  The  round pan can
easily  be passed  from the side under the pa-
tient's  body, which must be slightly raised.  In
order to pass the slipper, the patient lying on
her back  should draw up her  knees; and the
thin end of the slipper  can  be gently inserted
under  the back. When removed, the pan should
be immediately covered,  and carried out  of the
room.
  Urinals.—Special urine-bottles should  be ob-
tained for male patients  of such a form that the
urine is prevented from flowing back into the
bed.
  Disinfection.—After  the  bed-pan or  urinal
has been  emptied, it should  be  well  rinsed out
with some  disinfectant  solution (carbolic acid
1-20),  thoroughly cleaned with hot water by
means of a  bottle-brush or mop,  and wiped quite
dry. Disinfectant powder may be placed  In the
pan before  using, but strong fluids are  apt to
run over  the  sides  or otherwise reach the pa-
tient's skin, producing irritation and bed-sores.
This disinfection  should be rigidly observed in
typhoid and other infectious  cases. 
12    THE NURSE'S SERVICE DIGEST

  Excreta.—The  excretions  should  on no ac-
count be allowed to remain in the room, or hid-
den under  the  bed.  After being removed into
the lavatory or closet,  they should be kept cov-
ered and arranged for easy  inspection by  the
medical attendant.  Vomited  matters should al-
ways  be preserved, and the motions also in all
cases  connected with bowel or abdominal com-
plaints.  In any case of doubt, it is wiser not to
throw them  away  until they  have  been in-
spected.  The urine should be saved at first for
examination, and specimens when required from
day to day.  In  all cases before operation,  a
sample of the urine should be preserved.
  In infectious cases the excreta require special
treatment (see Fevers).
  Feeding-Cups.—Patients  unable  to  sit up in
bed will have to be fed by  a spoon, or,  more
conveniently,  by a  feeding-cup.  This  latter is
simply a half-covered   cup with a  spout and
handle, and when  the  patient's head cannot be
raised from the pillow, the spout should have
an extra curve, so that its mouth almost points
downwards. Too much fluid  should not be  put
in at  a time,  as it may run over the side when
the cup is  tilted.
  Medicine-Glass.—A  measured  glass to  con-
tain two or three ounces of  fluid is useful in
order  to measure  the  quantity of nourishment
or medicine to  be given.  The glass is usually
graduated,  and  marks  the different-sized spoon-
fuls and measures.
Thus: %i; or one ounce == two tablespoonfuls.
       Jss; or half an ounce = one tablespoon-
           ful.
       3i; or one drachm = one teaspoonful.
       3ij; or two drachms = one dessertspoon-
           ful.
       TiEi; or one minim = one measured drop. 
    MANAGEMENT OF THE SICK ROOM   13

  A  minim-measure, or a small measure-glass,
should be  used for drop-doses up  to  one tea-
spoonful.
  An  ordinary  wine-glass  holds  about  two
ounces, a small tea-cup four ounces, and a tum-
bler  about  half a pint of fluid.
  Hot-Water Bottles.—These  vessels  are es-
sential furniture  of   the   sick-room  in  cold
weather, and should always be  in readiness for
warming the bed after severe surgical  opera-
tions or in cases of collapse.  They may  be of
metal  or  earthenware, and should be  covered
over with flannel; the india-rubber form is soft
and  comfortable.  As  a substitute in emergen-
cies, hot bricks wrapped in flannel, hot  bran-
bags, or ordinary strong wine- or  beer-bottles,
filled with  hot water and  securely corked up,
may be used, it being carefully  ascertained that
there is no leakage.
  Caution.—In giving  hot-water bottles to un-
conscious  patients, or those who are paralysed
and  have lost  sensation, great  damage may be
done by the nurse carelessly placing a hot bottle
against the skin, and so producing a sore place
or slough.   In all cases a blanket should  inter-
vene, or the bottle hould be placed so as not to
be in  immediate  contact with  the patient.
  Bed-Rest.—During  convalescence,  and  for
those who are obliged to be propped up in bed,
some form of bed-rest is often  necessary.   Soft
pillows act very  inefficiently,  becoming  dis-
placed in a short time.  A firm  support, such as
the  hinged  bed-rest  with cane or carpet-back
is the best,  pillows being comfortably  adjusted
to the back  and head.   As  a substitute, a  light
chair  or stool may be placed  between  the pil-
lows and the head of  the bed.
  There is often a tendency on the part of the
patient to  slip down in bed, which may be par- 
14    THE NURSE'S SERVICE DIGEST

tially obviated by a firm support at the  feet;
or,  better still, by placing  a long firm "roller
pillow"  under the buttocks,  the ends  of the
pillow being  securely fixed  to the head of the
bed by strong tape.

           Observation of the Sick.
  General Suggestions.—On the visit of the
medical  attendant, the  nurse should  be  pre-
pared to give an account of  what has happened,
or what she  has observed during the time she
has  been on  duty.  True observation and cor-
rect statement of facts are only gained  by  prac-
tice  and close attention, and, when  carried out
with  precision and without  exaggeration, are
good proof of one of the most  valuable  qual-
ities in  a nurse.  It is an excellent plan for her
to write down her observations, and the time at
which they were noticed, as it will assist her to
give a clear report when  required.  At no time
is a nurse expected to offer an opinion  unasked
about the facts which she has observed.
  As the result of experience, a watchful nurse
will acquire  some instinctive knowledge of her
patients, and  of the course of special diseases.
She will be able to tell whether  progress is be-
ing  made, or  whether her patient is  getting
worse, and to recognise some of the more impor-
tant symptoms which denote the development of
complications in  the  disease, and the  peculiar
effects of some remedies on  susceptible patients.
Lastly,  she may  gain a very valuable instinct
which warns her that her patient is in danger,
when this is not obvious to an  inexperienced
person,  an instinct only gained after long prac-
tice and constant  attendance  on  the sick.
  Definite instructions as to  the diet,  nursing,
and medicines should be taken  by the nurse
when she comes  on duty, and must be handed 
MANAGEMENT OF THE SICK ROOM   15
on  by her to the nurse  or  attendant who  re-
lieves her.  The nurse who  is  on duty at the
time of the medical attendant's visit should be
prepared with  a report, not only of the hours
during which she herself has been  in attend-
ance on  the case, but  also  of  the whole time
since  his last visit.
  Report.—The report should comprise the fol-
lowing points:—
  1. Temperature-chart and state of pulse.
  2. Bowels, action of.
  3. Sleep, hours of.
  4. Symptoms,  notes of anything special, such
        as vomiting, rigors,  &c, with  the time
        at which each occurred.
  5. Diet, amount, and time  at which taken.
  6. Medicine,  time of giving,  and effects no-
        ticed.
  In addition to the report,  the excreta should
be ready in an adjoining room for inspection.
  Administration of Food and Stimulants.—
When the patient is well enough to take meals,
these   should  be brought  punctually.   They
should be  hot,  and not lukewarm, and nicely
and cleanly served.  When finished, the remains
should be  taken away  at once,  and  not left
about, creating an odour in  the room.
  If the patient is  able to  sit up in bed for
meals, these may be served  on a tray or on a
small  bed-table.  This  table  stands  on four
short legs, and one of its sides is scooped out. It
is placed on the bed with the legs on either side
of the patient's thighs, his body being received
into the hollowed-out portion.  A ledge running
round the three sides prevents things placed on
the table from  slipping off.  It may be used for
various purposes.
  Feeding   of   Helpless  Patients.—When  a
helpless patient  requires to be fed,  the nurse 
 16    THE NURSE'S SERVICE DIGEST

 should  gently raise them by passing  the  left
 arm behind the shoulders, or better, by passing
 the  hand behind  the  pillow, and raising  the
 pillow and head together, giving the fluid in a
 spoon or feeding-cup with the other  hand.   In
 all cases, a  napkin should be placed  under tne
 chin to prevent  wetting the night-dress  and
 the mouth should be wiped dry afterwards.
   Feeding in States of Exhaustion.—In cases
 of serious illness, nourishment may have to be
 given in small quantities and at  frequent inter-
 vals.  The nature of the food and the quantity
 should be previously ascertained  from the med-
 ical  attendant, and no  other food  should  be
 given without his sanction.  Feeding  is  often
 most difficult when most important, and the  life
 of the  patient may depend upon  care  in  this
 respect.  Two, three, or more ounces  of  milk,
 beef-tea, or  egg-flip,  every two,  three, or four
 hours, may  be ordered,  and it is  sometimes  im-
 possible to persuade the patient to take it. The
 nurse will thus have to  use her  discretion  and
 her tact by varying the  nourishment,  or giving
 it  in  smaller quantities oftener, thus managing
 to get down a fair  amount in the twenty-four
 hours.  A little stimulant given first may enable
 the patient to take nourishment better  after-
 wards.  When the mouth is dry and parched, or
 clammy with crusts, it should be cleansed with
 lemon-juice  and water, or rinsed with a weak
 solution of boracic acid,  before nourishment is
 given.
  During the night  a nurse must use her dis-
 cretion  and  avoid  waking  the patient  out of a
 good  sleep to administer nourishment;  but  in
 cases of great weakness  patients  should not  be
 allowed to sleep long without support.  It should
be remembered that the early morning is a time
when prostration  is much  more marked, and 
    MANAGEMENT OF THE SICK ROOM  17

that some stimulant or nourishment is specially
required then (see Nutrient Enemata).
  Stimulants should  be measured and diluted
with water  or milk to the taste of the patient,
and champagne  may be diluted with Seltzer or
Apollinaris  water.  They should be given at
regular intervals,  and alternate as  far  as pos-
sible with the nourishment.
  Administration  of  Medicines.—The  follow-
ing rules should be observed:—
  1. The directions on the label of the medicine
bottle should always be read before giving the
medicine, which should be given punctually at
the times ordered.
  2. The dose must be measured accurately in
a measure-glass, or by the marks on the bottle.
  3. Medicines  and external applications, such
as Liniment and Lotion, must  not be kept near
one another, as mistakes are apt to occur in the
dark, and fatal poisoning has thus resulted in
several instances.
  4.  Medicine should  be  shaken before  being
poured  out, and the bottle held with the label
side upwards, to prevent the directions from be-
ing soiled and rendered illegible.
  5. The  medicine-glass  must  be  carefully
cleansed after using,  and oily  or strongly-fla-
voured  medicines  should be administered in a
glass  kept separately for the purpose.
  6. The patient may wash out the mouth after
taking nauseous or acid medicines, and a crust
of bread or biscuit will assist  in removing the
taste,  or rinsing  the  mouth  with  peppermint
water.
  Times for Giving Medicine.—When medicine
is ordered to be taken three times a day with-
out special  directions  as to the hour, it should
be given about mid-way between meals—for in-
stance, about eleven,  four,  and seven  o'clock. 
IS    THE NURSE'S SERVICE DIGEST

During the night, sleep should not be broken in
order to give  medicines at  the exact time, un-
less  special orders  have  been  given.   There
should always  be  an interval of not less than
half  an  hour between the medicine and a meal;
but cod-liver oil, malt,  and tonics  of  iron and
arsenic are usually prescribed on a full stomach,
either at, or soon  after, a meal.  Aperients are
best  administered the last thing at night, or
early in the morning before breakfast.
  Drugs.—Effects of and overdoses.
  It  will  be the duty of  the  nurse during the
intervals  of the medical  attendance to  notice
the effects of any  remedies  prescribed.  This is
especially important where  strong medicines or
poisonous drugs are being employed. It is often
desired  to push these to  their full effects in
order to control the disease, and the physician
will  inform  the nurse what  symptoms to expect
and  when to  reduce or withhold the dose  be-
tween his visits.
  The symptoms which may follow large doses,
or the continued use of drugs in common use,
are as follow:—

Symptoms follotcing the use of certain Drugs.

  Antipyrin.—Papular  rash,   sweating,  faint-
      ness.
  Arsenic.—Watering of  eyes,  vomiting, and
      diarrhoea.
  Belladonna.—Dilated pupils, dry mouth, dif-
      ficulty in micturition, rose rash.
  Carbolic  Acid.—Brown or olive green  colour
      of urine, fainting, collapse.
  Digitalis.—Giddiness, faintness,  vomiting.
  Diphtheria Antitoxin.—Urticaria rash.
  Opium  and  Morphia.—Vomiting,  drowsiness*
      small pupils, dusky colour, sweating,  un-
      consciousness.
  Pilocarpine.—Sweating, faintness. 
    MANAGEMENT OF THE SICK ROOM   19

  Potassium Iodide.—Running at the eyes and
      nose,  frontal headache, acne rash.
  Quinine.—Giddiness, headache, noises  in  the
      ears,  deafness, vomiting.
  Salicylic Acid and Salicylate of Soda.—
      Noises in  the ears, deafness,  sweating,
      delirium, heavy  breathing, sweat rash.
  The effect of  medicines should be carefully
observed and noted down.
Poisons—See table,  page 408.
  Abbreviations.—The  following abbreviations
directing the use of remedies are frequently  ap-
pended to prescriptions:—
  Stat,  or  statim sumendus—to be  taken  at
    once.
  Eord, somni—at bedtime.
  P.  r. n.,  or  pro  re natd—as circumstances
    arise.
  Omni node,  omni mane—every night,  every
    morning.
  Tertid qudque  hord—every third hour.
  Quotidie—daily.
  Semel, bis, ter  die—once, twice, thrice daily.
  Repetatur—repeat.
  Scepe utendus—to  be used frequently.
  Applicetur lotio—apply the lotion.
  Regioni cordis or  prcecordio—to the region of
    the heart.
  See also front table,  xiii
  Arrangement of Room fob Operation in Pri-
vate  Houses.—Slight  operations, or  those of
minor importance, are performed while the pa-
tient  remains  in bed—this  having  been pre-
viously arranged with a rubber-sheet.
  For greater operations, or those taking a long
time, or requiring good light, an operation-table
can be devised.  A firm  wooden  table  about
three feet  high, four  feet long, and  two  feet
wide, such  as  a  dressing- or kitchen-table,  will
answer the purpose, provided it be strong  and 
 20   THE NURSE'S SERVICE DIGEST

 steady.  This  should be furnished  with blan-
 ket, pillows, and rubber-sheets arranged as  di-
 rected (see Operation-Table).  The table should
 be placed in a  room with a good light, and near
 the window. Where the room is a small one, it
 should be completely cleared  of all unnecessary
 furniture,  rugs,  hangings,  and  toilet utensils,
 and in all  cases there should be small tables
 ready at hand  for  surgical instruments, dishes,
 and necessaries for the operation.  It is conven-
 ient to  use a room adjoining the bed-room,  so
 that the patient does not see the preparations or
 instruments, which  should be  kept covered until
 the operator is ready to  use  them, but can re-
 ceive the anaesthetic in bed, and then be carried
into the operating-room. 
CHAPTER II.
      general plan of the human body

Anatomy:—Skeleton—Skull—Spine—Vertebrae
  —Thorax—Ribs—Sternum—Clavicle—Scapula
  —Humerus—Radius—Ulna—Carpus—Meta-
  carpus—Phalanges—Pelvis—Femur—Patella
  —Tibia— Fibula— Tarsus— Joints— Muscles—
  Fat—Internal Organs—Nervous System—Re-
  spiratory System—Circulatory System—Diges-
  tive  System—Excretory  System—Work  and
  Waste—Blood—Capillaries—Clotting—Blood
  Serum—Excretion—Temperature of  Body.

  Anatomy is the  science  which treats of the
structure,  form,  and  position  of the various
parts of the body.  The human body is obviously
separable into the head,  trunk, and limbs; and
if divided  down  the center from before back-
ward by a vertical line, the two halves  would
almost exactly resemble one another.
  If the limb of any animal be examined, there
will easily  be recognized an external  covering
of  soft  material,  and  of  varying  thickness,
termed the  soft parts, and an internal hard part
consisting of bone.  If the limb be dissected, and
the skin with the  fur be cut through and turned
aside,  the  pale red flesh is seen underneath,
arranged in  bundles or columns.  On tracing
these columns  of  flesh, they  will mostly be
found  to terminate at one  or  both  ends in a
firm white  cord attached to some part of the
bone.  These white cords  are called  tendons,
and the columns of  flesh, muscles.  Between the
muscles are soft white  threads, the nerves, run-
ning down  the limb  and giving off fine branches.
                     21 
22    THE NURSE'S SERVICE DIGEST

Close by the nerves are other threads, which are
really hollow  tubes or blood-vessels.  These ap-
pear of dark-reddish color when they  contain
blood, but are pale and flat when empty.
  All  these together make up the soft parts,
and they are  loosely bound to one another by a
fine delicate  material called  connective tissue,
and are arranged around the central bone of the
limb.
  The bones of the head and face,  in like man-
ner with the  limbs, have their covering of soft
parts,  but here  the bones are arranged in  the
form of a hard case enclosing a cavity, which
contains the main organ of the nervous  system,
the brain.
  The trunk  has its bony  framework,  and to-
gether with  the  soft parts includes a large cav-
ity  in  its interior, which serves  the purpose of
lodging and protecting the  various internal  or-
gans.
                The Skeleton.
  The  skeleton,  or  bony framework, forms the
main support  of the human body,  and  is com-
posed of upward of two hundred bones of vari-
ous  shapes and  sizes—long, flat, and irregular
(figs. 5, 6).
  Each bone has a covering of  thin tough mem-
brane,  called the periosteum, wherein the blood-
vessels which  go to nourish the substance of the
bone are distributed.  This bone-substance, or
tissue,  consists  partly of  animal matter,  like
gristle,  and  partly of earthy material,  such as
chalk and phosphate of lime, these latter giving
the  hardness  which  is characteristic  of  the
bones of adults.   In infants, the amount of this
earthy material  is  much  less; their bones,  ac-
cordingly, are  softer and more easily bend and
become curved, if not properly  cared for. 
       PLAN OF THE HUMAN BODY     23

  The  skeleton includes the bones of the head,
trunk,  and limbs.
  The Skull (fig. 7)  is formed of twenty-two
separate bones.   Eight of  these  compose the
brain-case,  or cranium, and fourteen  the face.
  The Cranium.—The  bones of the cranium are
—one Frontal; two Parietal; two Temporal; one
Occipital; one Sphenoid; one Ethmoid.
  The  Frontal bone forms the  forehead,  and
    surrounds the  eye-sockets at their upper
    part.
  The Parietal bones form principally the crown
    and side-walls of the skull.
  The  Temporal  bones surround the ear,  and
    contain in their  interior the organ of hear-
    ing.
  The Occipital bone forms the back and part of
    the floor of the skull, and presents at the
    lower part a large round hole, the foramen
    magnum, through which the spinal marrow
    or cord passes from the skull to the spinal
    canal.  On either  side of this hole, on the
    under surface of the skull, are two smooth
    projections, which  rest on the first or upper-
    most bone of the spine.
  The Sphenoid  bone  forms  also part of the
    floor of the skull,  and its wings extend to
    the side-walls,  acting in  the  manner of a
    wedge.
  The Ethmoid bone is situated at the root of
    the nose.  It is of spongy structure,  and
    is  perforated  by   numerous  small holes,
    through  which pass the nerves of smell to
    the nose.
  If the top  of the skull be  removed, and the
hollow interior in which the brain is contained
examined,  it is seen to be of oval shape from
before backward.  The vault and sides of the 
 24   THE NURSE'S SERVICE DIGEST

 cranium are fairly smooth, but the floor or base
 on which the brain rests is irregular, with sev-
 eral projecting prominences of bone.  The base
 of the  skull is also perforated with numerous
 apertures of different sizes, in addition to the
 foramen  magnum  already mentioned.   These
 apertures serve for the  exit or entrance of the
 several nerves and blood-vessels which have to
 pass through the skull to connect the brain with
 other parts of the body.  Some especially may be
 noticed—for instance, one  for the  optic nerve
 leading through  the back  of  the  orbit to  the
 eye; another for the nerve to the ear in  the
 ridge on the temporal bone; and others, again,
 near the foramen magnum for the carotid  ar-
 tery, jugular vein, and  the nerve to the heart
 and lungs.
  The Face is composed of fourteen bones, the
 more important of which are:—
  The  Nasal bones, forming the bridge of the
    nose,  and enclosing  the cavity  which con-
    tains the organ of smell.
  The Malar, or cheek-bones.
  The Upper Maxillary, or upper jaw-bone, con-
    taining  the upper teeth.
  The Lower Maxillary, or lower jaw-bone, con-
    taining the lower teeth.
  This is the only movable bone of the skull.
    and the joints are situated on either side of
    the base of the skull behind the ears.
  The bones of the skull  and face together form
cavities for the reception of the organs of spe-
cial sense, viz., the orbits for the eyes, the nasal
cavities for the nose, the mouth for the taste-
organs,  and  other  cavities for the  organs  of
hearing.  All the bones,  with  the exception of
the lower jaw, are united by  dented edges, fit-
ting together and called sutures.
  In infancy, the  bones of the  skull do not  meet 
        PLAN OF THE HUMAN BODY      25

 at the top of the head, and a soft place may be
 found there, under which the  brain can be  felt
 throbbing.  This soft spot is  called the fonta-
 nelle.
   The Trunk is naturally divided into the chest
 and the abdomen.  It supports the head, and
 gives attachment to the limbs on either side.
   The Spinal Column (fig. 8), the central sup-
 port of the whole skeleton, is a chain of thirty-
 three small bones, called vertebrae,  which  are
 placed one above the other:—
   The Cervical Vertebra? form the neck, and are
    seven in number.
   The Dorsal Tertebrce,  or  next twelve,  carry
    the twelve ribs on either side.
   The Lumbar Vertebrce, five in number, are sit-
    uated in the loin.
   The remaining  vertebrae are united  together
    in  the  adult, the upper five to form  the
    sacrum, the lower four to form the coccyx
    or tail-vertebrse.
   If one of the vertebrae from  the dorsal region
 be examined, the following parts may be  no-
 ticed:—The body or  solid portion;  a ring  of
 bone, surrounding a central aperture; and  three
 spikes or processes (fig. 9).
   The vertebrae  are placed one above the  other
 so that their bodies  form a strong continuous
 column, and their rings surround a central  canal
 which extends through the whole length of  the
 column, and in which is  contained the spinal
 cord.   Between  each of the  bodies is placed a
 cushion of gristle, called the inter-vertebral car-
 tilage, which forms an elastic  pad, preventing
 undue shocks or jars to the spine.
  The Processes project,  one  backward in  the
 middle,  the Spinous Process; and one  on  each
side,  the  Transverse  Process.   The  projecting
 spinous processes can eaily be seen  and felt 
26    THE NURSE'S SERVICE DIGEST

down the middle of the back in the naked body.
Thee processes serve for the attachment of the
powerful muscles of the back.
  The vertebrae are  all  firmly braced together
by strong bands or ligaments, which, whilst per-
mitting the various  movements of the column,
prevent displacement of  the  several  vertebrae
and  consequent injury of  the  delicate spinal
marrow contained in the spinal canal.
  The two upper vertebrae of the neck are spe-
cially modified for bearing the head, and for the
performance of  the more extensive  movements
in this region.
  The Sacrum, or  rump-bone,  is strong and
massive, and well adapted to form the base and
support of the column.  It gives attachment on
either side to the hip- or innominate-bones, and
these three, together with  the coccyx, form  a
kind of basin called the pelvis (fig. 10).  In the
outer side of each hip-bone is a deep cup, called
the acetabulum, which receives the head of the
thigh-bone.
  The Thorax,  or Chest, is a cavity situated
between  the neck  and  the abdomen.   It  is
formed by the  spinal column  behind,  the ster-
num or breast-bone in front, and by the ribs on
either side.  This important cavity contains  the
heart, lungs, and large blood-vessels,  and is sep-
arated from  the abdomen  below  by a  strong
muscular partition, the diaphragm.
  The Ribs, twelve  on each  side, pass round
from  the dorsal  vertebrae behind,  and  give
strength to the  side walls of the Thorax.
  The seven upper, or true ribs,  are connected
    by their own  cartilages directly with  the
    sternum.  The  five  lower  or called  false
    ribs; of these the upper three are connected
    only indirectly with the sternum; while the 
       PLAN OF THE HUMAN BODY     27

    two lower are quite free in front, and are
    termed floating ribs.
  The Sternum, or breast-bone, is the broad
flat bone which can be felt in the middle of the
front of  the chest.  It has attached to it the
true ribs on  either side.
  The Clavicle, or collar-bone,  exends from the
outer edge of the sternum to the shoulder.
  The Abdomen is formed by the lumbar verte-
brae and lower ribs above, and by the pelvis be-
low; the cavity being completed by the muscles
and soft parts. It contains the bowels and vari-
ous other viscera.
  The Limbs.—Two upper,  the arms, and two
lower, the legs, obviously exhibit a rough corre-
spondence in their divisions,—the thigh and up-
per arm, the leg and  fore-arm, the ankle and
wrist, the fingers and toes.
  The Upper Limb is attached to the trunk by
means of the shoulder-blade.
  The Scapula, or shoulder-blade (fig. 11), is a
triangular bone, situated at the back of the tho-
rax, and  covering the upper ribs. Its point and
sharp edge may easily be felt on the back in the
naked body.   A cup-shaped depression may be
noticed at  its outer angle,  the glenoid cavity,
which receives the head of the upper arm-bone.
  The Humerus, or upper arm-bone, is one of
the  long  bones.   Its  upper end, or head,  is
rounded,  and fits into the glenoid cavity forming
the shoulder-joint.  Its lower end is shaped to
receive the upper ends  of the two bones of the
fore-arm, and forms the elbow-joint.
  The fore-arm is composed of two bones, the
Rudius and the Ulna (fig. 12).
  The Radius is  attached to the humerus and
    ulna  above, and expands below to carry the
    hand. 
28   THE NURSE'S SERVICE DIGEST

  The  Ulna is connected by a hinge-joint with
    the lower end of the humerus, and projects
    backward  to form  the  prominence at the
    back  of the elbow-joint,  called  the  ole-
    cranon.
  The Carpus, or wrist, is composed of eight
small bones  arranged in two rows, and with the
lower end of the radius forms  the  wrist-joint
(fig. 13).
  The  palm of  the  hand is formed by  five
longer  bones, called metacarpal bones, which fit
on to the second  row of the small wrist-bones.
  The Phalanges, or digits,  constitute the fin-
gers and thumb.  Each  finger has three  digits,
the thumb two.  The last digit carries the nail.
  The Lower Limb is attached to the trunk by
the pelvis.
  The Femur, or thigh-bone  (fig. 14),  is the
longest and  strongest bone in the body.  Its up-
per end or head is rounded, and is received into
the deep cup of  the acetabulum, in which it is
retained by  a strong ligament called the round
ligament.  Its lower end terminates in two semi-
circular prominences called the outer and inner
condyles, which rest upon the upper  end  of the
leg-bone, and form the knee-joint.
  The Patella, or knee-pan (fig. 15), is a small
    three-sided bone lying in front of, and form-
    ing part of,  the knee-joint;  it is  connected
    below with  the  leg-bone by a strong liga-
    ment.
  The Tibia and Fibula are the two bones of
the leg (fig. 16).
  The  former is  by far the stouter and stronger
    of the two,  its front margin is very sharp
    and is known as the shin.  The lower ends
    of the tibia and  fibula project strongly on
    either side of the ankle-joint. 
       PLAN OF THE HUMAN BODY     29

  The foot  (fig. 17)  is built on the  same plan
as the hand.
  The Tarsal bones are seven in number.
  The largest, or os calcis, projects backward to
    form  the heel;  another  fits  between the
    lower ends  of the tibia and fibula in the
    ankle-joint,  and  the  rest are  arranged in
    rows  to carry the next set of  bones, the
    five  metatarsal  bones.  These  have  each
    their  three digits, which form  the toes, ex-
    cept the first  metatarsal bone  or great toe,
    which, like the thumb, has only two digits.
  The hand and foot  are admirably adapted for
the work  which they have to perform.  In the
hand, the bones  have greater mobility for the
purpose  of  prehension,  or grasping, and the
thumb can be easily  apposed to any  of the fin-
gers.  In  the foot, they are firmly massed to-
gether to  form a good support,  and in walking
the arch of the instep, situated between the heel
and the ball of the great toe, enables  the weight
of the body to be received and distributed with-
out risk of jarring or jolting.
  The Joints  are devised to give easy  move-
ment  between the bones which  enter into  their
formation.  There are several different kinds of
joints.  The  hip-joint is a good instance of the
balhand-socket joint,  and is one of the  most se-
cure; the shoulder-joint, of  the same  kind, is
much more liable to displacement on  account of
the shallowness of the receiving cavity.
  Another form of joint is the  hinge-joint, an
instance of  which occurs in the  eblow.   The
ends  of the bones which move one upon the
other inside the joints have a thin covering of
gristle or cartilage, and are enclosed in a kind
of sac,  which also lines  the side  walls of the 
30    THE NURSE'S SERVICE  DIGEST

joint, and contains a thin oily fluid, the synovial
fluid, which lubricates the  interior of the joint.
In addition, the bones are held together by firm
bands and covering of strong membrane,  called
ligaments,  which serve  to keep  them  in their
proper position.  The movements of the  joints
are in great  measure limited  by  the shape and
nature of  the bones of which they are com-
posed; some joints, like the shoulder, having
very  free movement  in  almost all directions;
others, as the elbow,  being more confined.  Ex-
tension or straightening,  flexing or bending, ro-
tation, and movement to one or other side com-
prise most of the ordinary  movements  of  a
joint.
  Muscles, or flesh, constitute a  large portion
of the soft parts of the body.  By means  of
these are produced all the  movements of which
the organism is capable.  A muscle Is connected
with the bone at one or both ends by a tendon;
if one of these muscles be carefully traced out
near a joint, one end will be found to be at-
tached to the upper bone, and the other end to
the lower bone.  Now, when  a muscle acts, it
becomes thicker and also shorter,  thus  its ends
approach nearer  together,  and with them the
two  bones to which these are attached, and  so
movement is  produced at the joint. All move-
ments are produced by the shortening or con-
traction of the muscles,  and  this mechanism is
variously  adapted to the requirements of the
different parts.  The set of muscles, by whose
action a  joint is straightened or extended, are
called extensors, those which bend the joint are
called flexors.  The muscles  are of two varie-
ties :  voluntary and involuntary.
  The Voluntary muscles act under the influ-
ence of the will; by them such  movements  as
walking, grasping, etc., are produced. 
       PLAN OF THE HUMAN BODY     31

  The Involuntary muscles are independent of
the will; for instance, the heart, and the mus-
cles of the alimentary canal, arteries, and vis-
cera.
  Fat, or Adipose Tissue, exists in the body in
various situations, and there is in all persons
between  the skin and  the muscle a layer of
varying thickness.  It is also stored up in other
part of the interior of the body, assists in pre-
serving the bodily warmth, and is in  a measure
an indication of the state  of nutrition of the
individual.
             The Internal Organs.
  The Internal organs are contained in the in-
terior of the  several cavities which  have been
mentioned  as included by the bones of the skel-
eton and the soft parts.  They are grouped into
different systems according to the nature of the
work which they have to perform, thus:—
           The Nervous System.
           The Respiratory System.
           The Circulatory System.
           The Digestive System.
           The Excretory  System.
  The Nervous  System comprises  the brain,
spinal cord, nerves, and the sympathetic system.
  The Brain and Spinal Cord constitute the cen-
tral  organs of the  nervous  system.   They are
contained in the long cavity  and canal formed
by the bones of the skull and the arches of the
vertebrae which have been already described.
  The Nerves, slender white cords, serve to con-
nect  the central organs of the nervous system
with  all the distant parts of the body, tissues
and organs of all kinds.
  The Sympathetic System to a great  extent
governs and controls the working of the internal
organs in   conjunction  with nerves  from the
brain and  spinal cord.   It forms  a chain of 
32    THE NURSE'S SERVICE  DIGEST

small masses of nerve  matter and  nerve-fibers
on either side of the vertebral column, and from
it numerous fine threads pass off to the different
internal organs and along the vessels.
  The Respiratory System.—The organs of res-
piration are the lungs.
  Lungs.—They are  two in number,  and occupy
by far the greater part  of the cavity of the tho-
rax, lying on each side of, and the lower part of
the left lung partially covering over, the heart.
The air-passages commence at the  mouth  and
nose, and comprise the larynx, or voice organ,
the trachea, or wind-pipe,  and the two bronchial
tubes.  The larynx  and the wind-pipe  may be
easily felt in the middle line of the front of the
neck. The cartilage  of the larynx is very prom-
inent, and is popularly called "Adam's Apple."
  The Circulatory  System.—The main organ
of the circulation is the heart.
  The Heart is situated in the middle lower left
of the thorax.  It is an  involuntary muscular
organ, and  pumps  the  blood into the  vessels,
which are distributed through the most distant
parts of the body. How true to nature are the
scriptures, that tell us that out of the heart are
the issues of  life.   Those vessels which  carry
blood from the heart are  called arteries; those
which return it to the heart are called veins.
  The Digestive  System  commences  at  the
mouth where mastication  is  effected.  The food
is then conveyed down the oesophagus, or gullet.
This tube lies in the  neck, behind the wind-pipe,
and in the thorax, close to the spine.  It passes
through a hole in the diaphragm and opens into
the stomach.
  The Stomach is a  bag in  which the food re-
mains for some hours;  it opens into the intes-
tines, or bowels, which  finally terminate in the
rectum. 
        PLAN OF THE  HUMAN BODY     33

   The Bowels form a tube between thirty and
thirty-six feet in length, through which the food
is slowly  passed along by  a wormlike move-
ment.   They lie in coils, and  occupy a  large
amount of the abdominal cavity.
   The Parotid  and  Submaxillary  Glands are
salivary glands  c:- organs which aid digestion,
the former situated near the ear, the latter in
the floor of the  mouth.  Each gland has a duct,
or tube, through which the fluid is conveyed
into the mouth.
   The Liver is not only  the largest organ but is
one of the most important in the human  body.
Its weight  in the healthy adult is about four
pounds; it  is brownish-red in color, occupying
the right upper quarter of the abdominal cavity,
having a most complicated structure and a very
momentous  function.
   Shaped somewhat like an inverted bowl, with
its convex surface fitting into the cavity of the
diaphragm, while its concave  surface  lies in
contact with the intestines,  stomach and  right
kidney.
  It is not in one whole mass, but divided by a
firm ligament into two unequal parts, and from
its under  surface  three small  pieces  project;
from its under surface is attached a small sack,
called the gall-bladder, which serves as a reser-
voir for accumulated bile.  This sack  is  fre-
quently the seat of a very painful inflammatory
disease, attended with  the formation of  solid
calcareous material, called gall-stones.
  Like all the other abdominal organs, the liver
is completely covered by an expansive mem-
brane called the peritoneum.  The liver is abun-
dantly supplied with veins, arteries, nerves and
lymphatics; the essential part of this structure
is that of a secreting organ which contains mil-
lions  of small  bodies called  hepatic lobules, 
 34    THE NURSE'S SERVICE DIGEST

 about a tenth of an inch in diameter, composed
 of liver cells, which are closely packed  together
 throughout the organ.
   Each  lobule contains near its border a small
 branch from  the large portal vein, that  brings
 to the liver from the stomach, spleen, pancreas,
 and small  intestine, the  blood that has been
 charged with the products of digestion.
   Each  of these  branches  send out  smaller
 branches to the interior  of the lobule; there
 they unite in one vein, to connect with  the gen-
 eral system of the liver veins.  The product of
 these  cells  of the  lobules  is a  brownish-green
 fluid called bile, which is  gathered up by  the
 minute bile-canals  surrounding  the  cells, then
 delivered into  larger canals, and  finally dis-
 charged  into a large duct or canal, which passes
 from the lower surface of  the liver into the up-
 per part of the small intestine.
   It is in the obstruction of these minute cells
 of the liver, either from overeating or habitual
 use of alcoholic stimulants, that is the cause of
 its disarrangement, and that of other important
 organs;  in fact, of the  whole system,  starting
 with fermentation,  then irritation, and inflam-
 mation follows, which, if  allowed to continue,
 becomes  a slow but sure  poison  to  the entire
 organism.
  The  bile is a very  complex  substance, con-
 sisting of important mineral salts and  organic
 matter, which  plays a  very important  part  in
 aiding the process  of digestion and assimila-
 tion.
  An adult of average size  and weight secretes
 about two pints of  this fluid daily.  One of the
important functions of the liver is that it serves
as  a reservoir for  glycogen, or animal sugar,
brought to the liver in the form of glucose by
the large portal vein from  the digestive  organs. 
       PLAN OF THE HUMAN BODY     35

  The glucose are being continually changed by
the chemistry  of the liver into glycogen,  then
back  into glucose when needed, which are car-
ried in the blood to each portion of the body
where required.
  The joy of living depends on the liver; many
a good disposition has been  ruined by it;  even
the best liver needs watching.  Look well to the
liver!
  The Pancreas is  a small triangular-shaped
^land about six inches long and one and a half
inches wide; it is  placed transversely  across
the abdominal cavity, situated between the first
section of  the small  intestine  and spleen; its
weight in the adult  is from four to six ounces.
  Although  it is small, it is exceedingly active,
and absolutely essential to assimilation and di-
gestion.  This gland pores its secretion into the
upper section  of the small intestine, immedi-
ately  below where the bile is discharged from
the liver.
  Its  secretion  is called pancreatic  juice, and
contains albuminoid  substances,  which have
powerful action in  emulsifying  the  fats  that
have  come through the stomach to the small in-
testine undigested.
  This fluid also contains powerful  ferments,
which convert the starchy elements of food into
sugar and  prepare both the starches and fats
for better  assimilation and  absorption.
  It also has a certain amount of powerful ac-
tion in digesting albumen; in the healthy adult
more  than  a pint of  this fluid is secreted daily
by this active little gland.
  As  starches and fats from the principal  part
of the food  of  a very large majority of the in-
habitants of the civilized  world, we can read-
ily see what a  tremendous influence  this busy
little  organ  must have on animal life. 
36    THE NURSE'S  SERVICE DIGEST

  The Spleen  is somewhat  like the  liver and
pancreas, but, unlike the other two organs, it is
a gland having its secretion, but without a duct
or canal by which its  secretion is discharged.
  This  organ  is ore  of  a  group of  ductless-
glands,  which  includes the pineal, thyroid and
the supra-renal capsules.
  Just what the exact functions of  the spleen
are  we do  not yet fully  know; it  is  certain,
however, its  secretion  is taken up by the blood
currents and carried  to the different  parts of
the body and utilized, where it is most needed.
It is the belief of many physicians that it has
some important  influence  upon  the digestive
process, as an extract  obtained from the spleen
of animals is frequently used in the treatment
of indigestion.
  The spleen, like the  other organs of the body,
is subject to  disease and tumors  of  various
kinds. In malerial climates, and where typhoid
fever is prevalent,  it  is frequently  greatly en-
larged, and often becomes disorganized.
  The spleen resembles a  bean in shape; it lies
in contact with the extremity of the stomach,
below the diaphragm,  and close to the bend of
the large intestine.
  In  the adult the spleen is about five  inches
long,  three to four inches wide,  an inch and a
half thick, weighing about seven ounces.
  Its chief importance is that it is one  of the
sources of, or the origin of, the white blood cor-
puscles.
  In addition to  the separate digestive organs,
the wall of the stomach  and intestine contain
small glands, which secrete  fluid for digestive
purposes.
  The Lacteals and Lymphatics are distributed
in the walls of  the alimentary canal,  and assist
in absorbing  the  nutrient material after it has 
       PLAN OF THE HUMAN BODY     37

been  prepared by digestion.  The food enters
these lacteals and is ultimately  collected into a
tube called the thoracic duct, which ascends the
back  of  the abdomen near the spinal column,
and finally  opens into one of  the large veins
near  the neck.  The lymphatic  vessels in their
course frequently join small  masses  of gland-
material called lymphatic glands, in which they
become closely connected with small blood-ves-
sels.
  The Excretory System comprises the glands
and their accessory parts, by means  of which
the blood is  enabled  to  get  rid  of the waste
products.
  The Skin contains in its deeper parts numer-
ous small  glands, sweat-glands, which excrete
the fluid called sweat, or perspiration.
  The Urinary Organs comprise the  kidneys,
ureters, bladder, and urethra.
  The Kidneys are the largest and most impor-
tant of the excretory glands.  They are two in
number, of  dark-purple color,  and in shape like
a French bean.  They are situated in the loins
at  the back of the abdominal  cavity, one  on
either side of the lumbar vertebrae of the spine.
A duct called the ureter passes down from each
kidney and opens into the bladder.  The bladder
forms a bag, which  lies in the  pelvis in  the
lower abdomen.  The  urine is secreted by  the
kidneys,  passes down the ureters, and is col-
lected in the bladder, being  got rid of from
time  to time through the urinary passage,  or
urethra.
              Work and Waste.
  During  life the body, or  some  part of it, is
constantly moving and performing work, either
obviously  with the voluntary muscles, or less
appreciably, as in the  beating of the heart,  the
movements  of respiration, and  other  vital  ac- 
38    THE NURSE'S SERVICE DIGEST

tions which  continue  during sleep.  This  me-
chanical work involves a loss or expenditure of
material, and a giving off of heat attended with
the production of waste substances, such as car-
bonic acid  and water,  a chemical process simi-
lar to combustion. In order to  prevent wasting,
new material has to be supplied in the form of
food and water; and in order to preserve the
heat of  the  body, the supply  of  oxygen must
constantly  be renewed, but  waste-products in-
jurious to it  need to be removed.
  The same  principles  may  be applied to the
constituent parts of  the  body;  a single muscle,
such as the heart or  biceps, in doing work gives
off heat, water, carbonic acid, and other waste-
products, and loses substance.  It then requires
to be built up again with new  material, and to
receive fresh supplies of  oxygen, while  the
waste material has to be got rid of.  The proc-
esses of combustion, nutrition, and excretion are
thus brought into play in  every  muscular  con-
traction.
  Blood  and  Capillary  Circulation. — The
changes which have  just been  described as oc-
curring  during   a  muscular  contraction  are
brought about by the agency of the blood.   The
muscular tissue  is permeated at  every  part by
minute thin-walled tubes in which the blood cir-
culates.  The small arteries break up  in the
muscle, and divide and subdivide to form a fine
branching  net-work  of minute tubes or capil-
laries;  these collect and  form  into a  small
trunk, the  vein,  which returns  the  blood to the
heart.  The muscle is by this means constantly
supplied with a  stream of  fresh blood.  All the
tissues of the body are in like manner perme-
ated by  capillary blood-vessels.  These  can be
easily  studied by examining under the micro-
scope the web  of a  frog's foot arranged  in  a 
       PLAN OF THE HUMAN BODY     39

suitable  manner, when the blood  can be seen
coursing through  the  small channels (figs.  20,
21).
  The blood is kept moving through the body by
the action of the heart, which pumps out a cer-
tain quantity into the arteries at each  beat,
pushing onward the column of fluid through the
already full vessels into the capillaries.   The
veins receive the blood, and their walls are pro-
vided at intervals with  minute pocket-valves,
which are attached so as  to permit the passage
of the blood toward the heart, but which  be-
come filled  out  and obstruct  the vessel if the
blood flows in a backward direction (fig.  22).
  The Blood when drawn from  the  body in
moderate amount is a fluid of deep-red color,
but it is pale when seen  in a thin layer.  If a
drop  be examined under the  microscope  (fig.
23), it will be seen to contain a multitude of
minute  bodies,  or corpuscles,  floating  in the
liquid part.  These corpuscles are of two kinds,
red and  white.  The red are the most  numer-
ous;  they  are very minute, of circular form,
and flattened on either side, like a disc, when
seen separately; but they  have a great tendency
to cling  together  and  look like rolls of coins.
They impart the  red  color to  the blood,  and
have  the power  of absorbing oxygen in large
quantities,  and  distributing  it  to  the various
tissues of the body. The white corpuscles are
larger than the red, but  only exist in the pro-
portion  of  three or four white to a  thousand
red.  They  are  round, not  flattened, but  have
the power of moving and of altering their shape.
  Clotting of the Blood.—Blood is fluid when
first drawn,  but soon  becomes  solid,  unless it
is stirred up, or constantly  whipped.  By  beat-
ing or whipping up, a stringy substance called
fibrin is removed, without which it cannot clot.
If  blood is  allowed  to  remain  standing for 
40    THE NURSE'S SERVICE DIGEST

some time in a  basin, the clot forms and then
gradually contracts, while a thin yellowish fluid
exudes, which is called the "serum."  The  clot
itself is  formed of corpuscles held together by
the fibrin.  While circulating through the heart
and healthy  vessels,  the blood remains  fluid;
but in certain diseases, and under some condi-
tions, it clots in the vessels and  causes  grave
symptoms. Clotting of the blood  is one of the
most  important  agents in the arrest of hemor-
rhage.
  Blood  Serum.—If the fluid which has exuded
from  the clot be put in a test-tube, and heated
over a spirit lamp, it will soon become opaque,
thick, and finally almost solid.   Like the  white
of egg, it coagulates on boiling, because it con-
tains the substance known as  albumen.  Albu-
men is  a proteid substance,  and  is chemically
composed of nitrogen, carbon, hydrogen, and ox-
ygen; when burnt  with  oxygen,  this  latter
unites with the carbon to form carbonic acid,
and with the hydrogen to  form water,  and the
nitrogen and hydrogen  combine  to form  am-
monia.   This combustion,  or process of exida-
tion,  of  albumen is constantly  going on in the
tissues,  and in  the muscles whenever they con-
tract, and is accompanied by the production of
ammonia, carbonic acid, and water.  The blood-
corpuscles contain, besides albumen, small quan-
tities of other  chemical elements,  such as  sul-
phur, phosphorus, iron, potassium, sodium,  cal-
cium.
  Nutrition.—The blood supplies  material for
the nutrition of the tissues, carrying oxygen in
the red corpuscles for oxidation purposes,  and a
store of  material of various kinds,  proteids  and
minerals, to help in building up and restoring
the worn-out parts.  The blood also requires to
be fed, since it is constantly deprived of its oxy- 
        PLAN OF THE HUMAN BODY     41

gen  and nutriment.   Provision  is,  therefore,
made for the restoration of its oxygen by means
of respiration, while  the  nutritive material is
supplied from the alimentary canal.
  The capillaries which  line the  walls  of  the
minute air-vesicles of the lung are only separat-
ed from the air by the thinnest membrane, and
the red corpuscles are thus enabled  to  absorb
the oxygen from the air, carrying it to the  tis-
sues.   The  blood is also fed by the food after
this has been digested and made soluble during
its passage through the alimentary canal.  The
capillaries are disseminated through  the walls
of the different parts of  the digestive  tract,
ready  to suck in the nutritive fluids.  Water is
easily  absorbed in large quantity to assist  in
supplying the fluid part of the blood,  and some
of the minerals and sugar are easily soluble and
pass into the blood in a fluid form.  The ma-
jority  of foods, as meat,  bread, starchy  mate-
rials,  fats and oils, have to be submitted to  the
secretions of the alimentary canal, and undergo
digestion before they can be absorbed.
  The term osmosis is used to denote the prop-
erty possessed by substances of passing through
an animal membrane in a fluid or gaseous form,
and it is by this process that the oxygen in the
lungs,  and the nutritive material in the alimen-
tary canal, pass into the blood through the thin
walls  of the capillary blood-vessels. By similar
means the interchanges  between the blood and
the tissues take place, only here the blood gives
up its oxygen and nutriment to the tissues.
  Excretion is the process by which the body
gets rid of  the waste materials.   In the oxida-
tion or combustion of the tissues, such as takes
place  during  a  muscular  contraction,  certain
waste-products are formed of no further use  in
the economy.  Some of these—namely, carbonic 
 42    THE NURSE'S SERVICE DIGEST

 acid, ammonia, and a  substance, urea, closely
 allied to ammonia—are actually injurious, when
 accumulated in any quantity.  The water, which
 is also a product of combustion, is got rid of in
 considerable quantity, holding in solution much
 of the soluble waste material.  The waste mate-
 rials are  excreted  from  the  blood  mainly
 through  three channels:  the  lungs, the skin,
 and the kidneys:—
  The lungs,  at each  expiration, send out air
    charged with carbonic acid and water.
  The skin,  by means of small glands embedded
    in it, called sweat glands, pours forth water
    containing in  solution a small quantity of
    salts.
  The kidneys excrete the greater part of  the
    water, and also  the ammonia, urea,  and
    salts.
  By these  different  means the blood coming
from the  tissues charged with waste-products
becomes purified after it has passed through the
capillary circulation in  these excretory organs.
  Temperature of the  Body.—A large amount
of heat is produced by the constant combustion
of the food and tissues, and is distributed to all
parts of the body by the blood-current.  On  the
other hand,  by the radiation of heat from  the
surface of the boay, and by the warming of  the
cold air  which  is  received  into the lungs at
every breath, the  blood  is robbed of its heat.
There is then a source of constant loss as well
as a constant supply of  heat.  If the tempera-
ture of the  body in a healthy  person be noted
with a thermometer at  different  times in  the
twenty-four  hours,  it will be found to be  ap-
proximately  at 98.4° F., showing that there is a
regulation of heat in addition to production  and
loss.
  The temperature of the interior of the body 
       PLAN OF THE HUMAN BODY     43

taken in the mouth or rectum is nearly a degree
higher than that  of  the  surface, taken in the
axilla, or arm-pit.  Again, there is a slight vari-
ation between the morning and evening temper-
ature,  the  latter being, perhaps, half a degree
higher.   The  temperature is commonly lowest
at between four and six o'clock a. m., a time in
the sick and  aged when  the vitality is  at its
lowest.
  In fevers and inflammation  there  is an in-
crease in heat-production, and loss of balance in
regulation, so that the temperature rises, and
perhaps  varies to the extent of several degrees
at short intervals (see Fever). 
CHAPTER III.
       diseases of the nervous system.

The Nervous  System:—Brain—Spinal  Cord—
  Membranes—Nerves—Motion—Sensation—Pa-
  ralysis—Loss of Sensation—Reflex Action.
Symptoms and Management of Brain Paralysis:
  —Coma—Spinal Paralysis—Bed-Sores—Nerve
  Paralysis — Infantile  Paralysis — Locomotor
  Ataxy—Meningitis—Cerebral  Tumors—Epi-
  lepsy—St. Vitus'  Dancer—Hysteria—Delirium
  —Delirium Tremens—Insanity.

     Introduction:—The Nervous System.

  The central organs of the nervous system, the
brain and spinal  cord, are invested with mem-
branes, which form a complete covering, and
also line the interior of the bony cavity  in
which they lie.
  The Membranes  are  three in number:  the
Pia Mater, the Arachnoid,  and the Dura Mater.
  (a)  The Pia Mater, the innermost, is a deli-
cate membrane, containing a large number of
fine blood-vessels,  which penetrate the substance
of the nerve-matter of the brain and cord.
  (b)  The  Arachnoid  lies  between  the  pia
mater and dura mater, and secretes a thin fluid
called the Arachnoid fluid.
  (c) The  Dura  Mater, a strong, tough mem-
brane, lining the interior of the skull and spinal
canal, forms a protective  covering to the deli-
cate organs, and  contains numerous blood-ves-
sels.
  The Brain is divided  into  the Cerebrum (or
Large Brain), the Cerebellum (or Little Brain),
and the Medulla Oblongata (fig. 25).
                    44 
     DISEASES OF  NERVOUS SYSTEM   45

   (a)  The Cerebrum forms the greater mass,
and is  divided  lengthwise  by  a deep cleft or
fissure into two hemispheres; a band of nerve-
substance,  called the  corpus  callosum,  joins
these together.
  The  outer  surface of  each  hemisphere  is
mapped out into a number of folds, or convolu-
tions, separated by clefts.  In the  interior, the
brain-matter is  white, and encloses the central
cavities, which are a continuation  upward of a
small channel in the center of  the spinal cord.
Normally these  cavities contain a  small quan-
tity of fluid, like the arachnoid fluid.
  The nerve-substance, or "gray matter," cov-
ering the  convolutions on the  exterior of the
brain is of  gray color,  and differs  from the
deeper parts, which are white.
  From the under-surface of the brain  may be
seen white threads  passing  through the small
holes at the base of the skull.   These  are the
cerebral nerves; amongst them are the nerves
for smell,  sight and  hearing.
   (b)  The Cerebellum,  or little brain,  lies be-
neath the  back  of the large brain, and is also
partially divided into halves.
   (c)  The Medulla Oblongata is the continua-
tion upward of  the  spinal cord into the brain.
It is about one  and a half inches  in  length,  is
situated at the base of the brain just above the
foramen magnum  (see p. 23), and is covered by
the cerebellum.   A large number of important
nerves leave the  brain  at this spot, and the
nerve-matter in its interior is so intimately con-
nected with  the regulation  of  the vital func-
tions of the heart and lungs that destruction of
the medulla is immediately fatal.
  The Spinal  Cord is a column  of gray and
white  nerve-matter  from  sixteen  to eighteen
Inches in length, extending from the  top of the 
46    THE NURSE'S SERVICE  DIGEST

spinal column to the upper lumbar region, where
it terminates in a fine thread.  The membranes
covering it are similar to those which have been
described as investing the brain.
  In the center  of the spinal cord is  a minute
channel which extends along its  whole length,
and opens above into the cavities of the brain.
Two  fissures partially  divide the  cord  into
halves from above downward—one on the front,
the other on the hind  surface.  Attached on
each side are two parallel series  of bundles of
fibers, one set situated in a plane in front of
the other.  They join together, and pass out of
the spinal canal through apertures between the
adjoining vertebrae.   These two sets  of fibers
are called the anterior and posterior roots, and
they  join  together to  form  a  spinal  nerve.
There  are  in all thirty-one  pairs  of  spinal
nerves.
  The Oray Matter lies in the interior of the
cord,  and when  cut across has the  shape of a
crescent or half-moon in each half, joined by a
central band.  One horn of the crescent lies in
front, and is  connected  with the fibers of the
anterior  root, the other receives the  fibers of
the posterior root of the spinal nerve (fig. 26).
  The  Spinal Nerve, after leaving the  spinal
canal, divides and splits up into branches, which
terminate in the muscles and skin.
  In the performance of any  voluntary move-
ment, such as that of a limb, all three parts of
the nervous system—brain, spinal cord,  and
nerves—are concerned.  The motor impulse, as
it may be called, is started in  the gray matter
of the convolutions of the brain,  traverses the
tracts of white matter  in its interior, through
the medulla, down the spinal cord, and emerges
at one of the anterior or motor roots of the
spinal nerves, passing  to  the  particular  mns- 
     DISEASES OF NERVOUS SYSTEM   47

cle, or set of  muscles, which performs the nec-
essary movement.  It is possible by  means of
experiment to trace to a considerable extent the
course taken by this impulse.  For instance,  it
is found that  the movements of one side of the
body are chiefly governed by the opposite side
of the brain,  so that the  nerve impulses  must
cross  at some part.   In the case of the motor
impulses, this crossing is found  to take place in
the medulla oblongata.
  If the  path of the motor  impulse is inter-
rupted, either in the brain cord or nerve, loss of
power of voluntary  movement or paralysis oc-
curs :  thus, if the nerve to a muscle be cut, the
muscle will be paralyzed.  In the same way,  if
the spinal cord  be crushed, all  the muscles be-
low that part will be paralyzed.  Again, if the
motor path in the right hemisphere of the brain
be diseased or damaged, there will be paralysis
on the left side  of the body.
  The motor impulses have been shown to travel
from the brain to the distant parts.  A sensory
impulse,  or sensation, on the other hand, passes
in the opposite direction. The prick of a needle
on the skin sends an impulse traveling up a sen-
sory nerve by the posterior root to  the spinal
cord;  here it crosses over to the opposite side of
the cord, and ascends to the brain.   If a sen-
sory nerve is  cut, there is loss  of sensation, or
anaesthesia, in the part it supplies; or, if the
cord is  destroyed, the body loses sensation be-
1 w the injury.  Destruction of the sensory path
in the brain causes loss of sensation on the op-
posite side of the body.
  Thus,  the  spinal  cord is seen to  be a  con-
ductor of impulses both to and  from the brain,
but it also has, under  certain  conditions, the
independent and peculiar power of reflecting a
sensory as a  motor impulse, a process to which 
48   THE NURSE'S SERVICE DIGEST

the term reflex action has been applied.  If, for
instance, we tickle the sole of the foot of a pa-
tient who has received an injury damaging the
spinal cord, the leg is immediately drawn up or
moved;  yet the individual is unconscious of any
sensation, and is quite incapable of voluntary
movement in that limb.

    Nervous Diseases:  Their Symptoms and
                Management.

  The ordinary forms of nervous diseases with
which a nurse should be acquainted may be ar-
ranged,  for the  sake of  convenience, into Par-
alytic Affections; Chronic Diseases of the Spin-
al Cord; Meningitis and Cerebral Tumors; Epi-
lepsy, Chorea, Hysteria,  and Insanity.

          (A)   Paralytic Affections.

  The following are common instances of par-
alytic affections:—
     Hemiplegia, or  Brain Paralysis;
     Paraplegia, or Spinal Cord Paralysis;
     Neuritis, or Nerve Paralysis.
  Hemiplegia (= a stroke on one  side,  or one
half, of the body), Apoplectic  fit,  or a  stroke,
are terms  constantly applied to this form  of
paralytic seizure.
  Symptoms.—"The onset is sudden, and usually
due to  the bursting  of  a blood-vessel  or the
blocking of a vessel in the brain.  The person
may be in good health at the time of the at-
tack, when suddenly he feels pain in the  head
and falls on one side, or,  as  frequently  hap-
pens, falls down on getting out of bed.  One
side of  the body is found to be paralyzed, and
perhaps to have lost sensation.   The face may
be  drawn on one side,  and if  the paralysis is 
     DISEASES OF NERVOUS SYSTEM   49

on the right side there is  often loss of speech,
or aphasia.   The attack may be attended with
loss  of consciousness, complete or  partial,  or
the senses may be perfectly  retained. In most
cases,  the loss of consciousness is  temporary,
but the paralyis continues  for some time after-
ward,  gradually  lessening  until  power  is  re-
stored; or else the limbs remain  in a state of
incomplete recovery, accompanied,  perhaps, with
stiffness, contraction, or trembling.
  "In severe cases, the loss  of consciousness is
more profound and increases, the breathing  be-
comes heavy and  stertorous, or "snoring," the
face grows  pale or livid, and after a time the
patient dies."
  Coma.—The  term  "coma" is given to this
condition of  profound  unconsciousness.   In
many cases  of nervous disease, or other diseases
in which death takes place through  the nervous
system, it is preceded by the onset  of coma.
  "During  apoplectic  fits  the temperature  re-
mains unaltered or  rises slightly, but in some
fatal cases death is preceded by a considerable
rise  in the temperature."
  Management.—"The  patient  should be  un-
dressed with as  little  disturbance  as possible,
and  placed in bed with the head slightly  raised
on a pillow.  No stimulant need be  given, espe-
cially if there  is any insensibility.  If there is
profound coma with much  stertorous breathing,
and  accumulation of phlegm in the throat when
the  patient  is lying on the back,  he may  be
turned over  partially on one side, and kept so
by means of pillows or some form  of support.
If the coma continue for any length of time, it
is important also to ascertain if any urine has
been passed, as the bladder  will become over-
filled, and constantly overflow, keeping the bed
wet.  The medical man should  be informed of 
50    THE NURSE'S SERVICE DIGEST

this and also of the condition of the  bowels,
that he may determine whether it is necessary
to draw off the urine, or order an enema.  As
consciousness  returns, there may  be vomiting
and some faintness, with confusion of the  intel-
lect, and if there is aphasia the patient is un-
able to explain  what he wants, failing  to find
the right words to express himself, or  making
use of wrong ones.  The nurse will soon  be able
to understand him by means of signs. The na-
ture of the diet, and the stimulant  (if any is
necessary),  will be  prescribed by  the  medical
man.   Milk or some other form of fluid  nour-
ishment may be given at first, and this, if  there
is any paralysis of the muscles of the face, may
be noticed  to  dribble out of the mouth  on the
paralyzed  side.
  "There is nothing special  in the after-treat-
ment  that  requires notice.   The patient is, of
course,  more or less helpless, and care  should
be taken to keep the paralyzed limbs warm, as
they are apt to become cold.  If there is loss of
sensation  in a  limb, especial care should  be
taken in the use of hot-bottles or other  hot ap-
pliances not to scald the skin, as the patient ia
quite  unable to judge of the temperature; other-
wise very troublesome sores may be produced.
The nurse should first ascertain  the tempera-
ture with the  back of her own hand,  and inter-
pose a blanket or flannel between the bottle and
the patient's limb.
  "Convalescence is  often  slow, and in favor-
able cases  the leg recovers before the arm; in
unfavorable cases, great weakness and  loss of
power remain, and  the limbs become stiff, con-
tracted, and useless; or the memory is defec-
tive, the mental powers fail, and imbecility su-
pervenes.   There is  often  a  tendency to  a re-
currence of the fit." 
     DISEASES  OF NERVOUS SYSTEM  51

  Paraplegia, or spinal paralysis, may be sud-
den, and is due to inflammation of the cord, in-
jury or disease of the spine, or anything caus-
ing damage to the cord.
  Symptoms.—In  paraplegia  there  is loss  of
voluntary movement and of sensation below the
diseased part, but reflex action may be obtained
in  the  paralyzed limbs.   There  is sometimes
pain at  or  above the spot affected,  extending
round the body.
  Loss of control over the bladder and rectum
is also  observed; the urine dribbles away,  or
the  bladder  may become  full and  then over-
flow, and the bowels may  act  unconsciously in
the bed.
  There is,  further, a tendency (much greater
in some cases than in others)  to the formation
of  sore places, or  bed-sores,  in  the paralyzed
regions, on the back or sacrum, hips, shoulders,
or heels, or any  prominent part which presses
against  the  bed.
  The course of the disease is usually long, and
the symptoms are very distressing.  In the more
favorable cases recovery,  complete  or partial,
takes  place.   In   others,  the   inflammation
spreads upward as high as the neck, and death
occurs from paralysis of the diaphragm and res-
piration, or gradual exhaustion supervenes from
bad  bed-sores, inflammation of the bladder,  or
lung complications.
  The temperature is  often above the normal,
and  when the disease affects the higher parts
of the spine, remarkable elevations of the tem-
perature are apt  to occur.
  Management.—There are no  cases more diffi-
cult to nurse well than bad cases of paraplegia,
with great tendency to bed-sores.  The sores may
have begun or advanced to any stage in neg-
lected cases before the nurse  has to deal with 
52    THE NURSE'S SERVICE DIGEST

them, and to cure them may seem hopeless.  At
first,  the  constant dribbling of the  urine  and
incontinence  of faeces greatly increase the lia-
bility to their formation, and together with the
complete helplessness of the patient combine to
make their  avoidance almost an  impossibility.
But a very great deal may be  done,  and if the
case is well  managed from the beginning,  and
the proper appliances can be obtained,  success
is  almost certain.
  Prevention of Bed-Sores.—Of first importance
is  prevention,  and  to  attain  this  two main
points should be  attended to:  to remove pres-
sure; to  keep the patient dry.
  1. To Remove  Pressure.—The  first  may be
best managed by placing the patient on a water-
bed,  or an air-bed, at the commencement; fail-
ing this,  a water-cushion  or  ring-shaped  air-
cushion should be placed  under the pelvis,  and
by this means any undue pressure at one spot
will be prevented.  If none of  these  appliances
are to be obtained, the  patient's position in the
bed must be altered frequently,  and pressure
removed  by  ring-shaped  pads  adapted to en-
circle the prominent bone or tender spot.
  2. To keep the  patient dry, a utensil of  suit-
able shape may be arranged to catch the urine
as it constantly dribbles away, and a draw-sheet
smoothly laid under the pelvis, and moved when
requisite (see Draw-Sheet).
  The nurse should every day examine the  back
for tender  or  reddening  spots,  and  should
cleanse the parts with soap and water  and dry
them  thoroughly, dusting with zinc-, starch-pow-
der or finely powdered  borax;  or they may be
rubbed with  spirits of  wine or brandy, which
helps  to  harden the skin.   Perfect cleanliness,
dryness,  and constant  attention  to  the draw-
sheet are essential.  In any case, if the  skin 
     DISEASES OF NERVOUS SYSTEM   53

become red, or rawness  appear,  or if  black
spots or sloughs  form, the medical  man must
be informed, as suitable dressings  will be  re-
quired, and the treatment  should be  carried on
under his directions.
  The condition of the urine requires attention,
as the bladder is very liable to inflammation, a
state which  is usually associated  with turbid
and  offensive urine.   The catheter has  often to
be used, and the bladder washed out. The urine
should be saved, in order that it may be exam-
ined or analyzed from time  to time.  One of
the first changes noticed is that it becomes alka-
line, and  turns red litmus paper blue; a smell
of ammonia  may be also observed,  and a white
sediment  is  apt to form at the  bottom of the
utensil;  all  these are indications of  bladder-
trouble.
  Neuritis, or nerve paralysis, is due to inflam-
mation or disease  of the spinal  nerves.   The
most common cause is constant overindulgence
in alcohol, and the affection more often attacks
intemperate  women than  men.  It  may,  how-
ever, also occur as the result of lead poisoning,
cold, or an attack of diphtheria.
  Symptoms.—It commences with  pains  and
tenderness in the legs  or arms, with gradually
increasing loss of power.  It may  progress un-
til  the patient  is quite unable  to walk, with
tenderness and loss of sensation in the  feet and
legs; the arms become affected in the same way,
and more or less distortion of the limbs ensues.
The intelligence is  often obscured, the appetite
impaired, and the digestive organs disordered.
  The greater number of  patients  recover  par-
tially or  completely,  even when  bedridden and
almost  entirely paralyzed,  if proper treatment
be adopted sufficiently early.  In alcoholic cases
total abstinence is essential. 
54    THE NURSE'S SERVICE DIGEST

  Management.—In  the  management  of these
alcoholic cases, especially in private houses, the
nurse has to adopt every precaution, and to be
constantly on the alert to ascertain that the pa-
tient  (generally a female)  does not continue to
indulge her  craving by means  of friends  or
servants, as she will pursue any means to get
the stimulant in some shape,  and will take spir-
its of wine or eau-de-Cologne, if nothing else is
obtainable.
  The feeding is very important, and as the ap-
petite returns a  liberal diet is usually recom-
mended.   There is often much wasting of the
muscles,  and general emaciation in these cases,
and if the patient has to be confined to bed for
any  length  of  time, a water-bed  is desirable.
Mental derangement of various forms is not an
uncommon complication in this disease, but is
usually of a temporary character.
  When  improvement  commences,  assistance
should be given  to the  paralyzed limbs and
wasted  muscles by  shampooing, massage, and
electricity, all  of  which have  commonly to be
applied by the nurse.   To be  thoroughly  com-
petent to manage these cases, therefore, a nurse
should have studied both massage  and electric-
ity  (see Batteries  and  Massage).
  (B)  Chronic Diseases of the Spinal Cord.
  This class includes such affections as:—
          Chronic Spinal  Paralysis;
          Infantile Paralysis; and
          Locomotor Ataxy.
  Paralytic Forms.—In these the chief symp-
toms are wasting and loss of power in particu-
lar  groups of muscles,  or the muscles of  one
extremity,  and in extreme cases of nearly all
the voluntary muscles in the body. 
     DISEASES  OF NERVOUS SYSTEM   55

  The  paralysis is often  attended  with distor-
tion of the limb, due to the contraction of the
unparalyzed muscles, or the limb becomes rig-
idly bent at the  joints, or  there is shaking or
tremor which cannot be controlled.
  Infantile Paralysis is a common cause of the
many instances of club-foot which  have to be
dealt with surgically,  and its  onset is usually
attended  with  a  feverish attack,  after which
there is  generally weakness in one  or  more
limbs.
  Management.—The treatment of these paraly-
ses frequently involves rubbing or electrical ap-
plications to  keep up the nutrition  of the par-
alyzed muscles.  In children, the distortion re-
quires special  boots or splints, or  perhaps the
division of tendons before it can be rectified.
  Locomotor Ataxy  is  the name  given  to  a
common disease of the spinal  cord, because of
its  most  prominent symptom,  the  patient's in-
ability to control or direct the movements of his
legs in walking.
  Symptoms.—There may be various degrees of
want of muscular control, from slight difficulty
in walking in the dusk, in turning round quick-
ly, or in standing upright with  the feet together
and the eyes  closed, to the most  exaggerated
want of control of the muscular movements, the
legs being jerked out in all directions in the
attempting to walk.  Other symptoms are: se-
vere pains in the limbs, or in the abdomen; im-
pairment of sight  and of sensation; and bladder
disorder.
  The  malady is very chronic, lasting for years.
In  many cases there  is some improvement or
arrest of the symptoms, if taken in hand early;
complete  cure  is rare; in others there is slow
progression of  the disease. 
56    THE NURSE'S SERVICE DIGEST

  Management.—Pains in the stomach and bow-
els,  and in the limbs,  are often  some  of  the
most distressing symptoms of the malady, and
are very obstinate.  The bowel-pains are some-
times increased  by constipation, which  may  be
relieved by aperients.  Mustard-plasters may be
applied to the stomach  or limbs.
  The condition of  the bladder is important,
and  it should be well emptied; the use of  the
catheter may be  necessary.   Sore  places and
eruptions which require attention may  appear,
lest they should enlarge and form  troublesome
complications.
  Corns on the feet should never  be  cut,  as
deep ulcers are apt to follow.
  In all nervous cases, when there is much ema-
ciation, precautions  should  be taken to  avoid
bed-sores, and, if the patient is likely to be  en-
tirely confined to bed, a  water-bed is advisable.
   (C)   Meningitis and  Tumors of the Brain.

   Meningitis,  or inflammation  of the  mem-
branes of the brain.—The causes of meningitis
are various.   In many  cases  it proceeds from
the spreading of inflammation from the neigh-
boring parts, either from disease of the bones,
or of the dura mater of the skull.  The exten-
sion of inflammation from disease of  the bones
of the ear inside the  skull is  a familiar in-
stance.   It  may  arise from  blood-poisoning,
blows on the head, or drink.
  Tubercular meningitis is a very common form
of the disease.   It occurs often in the children
of consumptive parents,  and attacks adults who
are the subjects of consumptive complaints.
  Symptoms.—There may be  considerable  va-
riety in the onset in different  cases, and in the 
     DISEASES OF NERVOUS SYSTEM   57

symptoms presented; but  the following may be
taken as a fair example of a fatal case of men-
ingitis,  following  ear-disease.  A young man,
who has had a discharge of  matter and been
partly deaf in one  ear since an attack of scarla-
tina in  childhood,  is seized with violent head-
ache and vomiting; the pulse is 100,  the tem-
perature 104°, and he has some shivering.  The
tongue is foul, the bowels are confined, and the
appetite  is bad.  He is irritable in manner, re-
sents being disturbed, and is inclined to be de-
lirious at night, though he does not sleep.  The
headache is  intense  and  persistent,  there  is
some intolerance  of  light, and  the  vomiting
comes on regardless of food.  In a day or two
he becomes stupid and rather drowsy, and un-
able to see well.  The pulse has become slower,
80 or 60, and  the temperature remains about the
same; he is noticed to pick at the bed-clothes.
A convulsive  attack comes on and lasts for sev-
eral minutes, and  he is completely unconscious
for some time after;  as consciousness  returns,
he is found to have some  paralysis on one side
of the face and arm.  Further attacks of con-
vulsions  ensue, and he gradually becomes more
deeply unconscious; his breathing becomes ster-
torous and  irregular,  sometimes  stopping for
half a minute,  and then becoming exaggerated.
He passes everything unconsciously under him,
the face becomes pale and dusky, profuse per-
spiration breaks out, and he gradually sinks, or
dies in a convulsive seizure.
  Tumors of the Brain, arising from constitu-
tional diseases, from  an abscess, or from can-
cerous affections, give rise to symptoms of much
the same kind as those referred to in meningi-
tis, but the course is much less acute,  and the
disease may extend over months or even years,
  Symptoms.—The headache is often very in- 
 58   THE NURSE'S  SERVICE DIGEST

 tense, and may  attack  one particular  part  of
 the head; vomiting may be present or absent,
 and  the  general symptoms are often obscure.
 There may be few or many signs of affections
 of the special cranial nerves,  such as loss  of
 eyesight,  squint,  or drooping of the upper eye-
 lid, and loss of power in any of the voluntary
 muscles of the body  occurs, or there  may  be
 loss of memory or  mental derangement, or con-
 vulsive seizures  limited to certain muscles,  or
 affecting  the muscles  generally.
   Acute inflammatory  affections of the head are
 very dangerous,  but recovery  takes place  in a
 certain number of  cases.  The tubercular form
 of inflammation is, however, generally fatal. In
 some of .the chronic diseases depending  on par-
 ticular  constitutional  poisons  recovery  takes
 place under treatment  by appropriate drugs. In
 others,  such as abscess  and some  kinds of tu-
 mors, an  operation is  performed by which the
 skull is opened and the  abscess  enabled to dis-
 charge, or the tumor  is removed.
  Management.—The  room which  the  patient
 occupies should be kept quiet,  cool, and dark-
 ened, especially if there is  intolerance of light.
 Headache is often  one of the most  distressing
 symptoms  of  the  disease,  and  the hair  will
 probably have  to be cut, or  the head shaved,
 and cold applications  placed on  it.   The appli-
 cation of  cold  to the  head may best be  man-
 aged by  means  of  ice  broken  up into small
 pieces and tied up in a  thin  sheet of  rubber,
 the ice being renewed  from time to time.  Spe-
cial ice-bags made  of india-rubber are often
employed.   Less  efficient substitutes are  cold
 water applications,  or  lint steeped  in evaporat-
ing lotions, all of which have to be very  fre-
quently renewed.  In many  instances, especially
 with children,  it  is impossible to keep the ice- 
     DISEASES  OF NERVOUS  SYSTEM   59

bag or  application in  position, the head being
constantly moved to and fro.  If the cold appli-
cation has to be persisted in, some other method
must  be adopted, such as an ice-cap, which fits
onto the head, and through which a stream of ice-
cold  water can be kept constantly  flowing, by
means of tubes, from a receptacle above the bed
into one below  (see Ice-Bags).
  The removal of blood from the  head by means
of lee»hes is sometimes  required, either  from
the temple or behind the ear (see Leeches).
  Feeding  is best carried  on by  giving cold
fluids,  and iced  drinks  containing milk  and
soda-water, and  to allay  the vomiting small
pieces of ice  to suck are useful.   An enema will
probably  be  required  for the bowels, or they
may  be evacuated by  giving a  heaping table-
spoonful of phosphate of soda, dissolved in hot
water, then cooled.
  If convulsive seizures occur, the nurse should
watch them  carefully, noting, if possible, the
part  of  the  body in which they seem to com-
mence,  and  whether they are confined to one
particular part, or to  one-half of the body and
face,  or whether they  affect the  body generally.
Also she should observe the position of the head
during  the attack, and, if possible, the direction
of the eyeballs, or anything else  peculiar in the
patient's appearance.  It often happens that the
nurse is the only person present who can give
any intelligent account of the seizure, and her
report  may be of considerable value to the at-
tending physician (see Epilepsy).
   In the  course  of acute  head-affections, and
 sometimes even  a short time before  death, it
 may  happen  that a patient, previously quite un-
 conscious, wakes  up and takes notice  of things
 around  him,  speaks  to  and  recognizes  his
 friends, appearing as  if he  were going to re- 
60    THE NURSE'S SERVICE DIGEST

cover; but shortly afterward he relapses into a
state  of unconsciousness, from which he  never
recovers.  This delusive amendment is not very
uncommon, and  is sometimes  called the "lucid
interval."
     (D)  Epilepsy,  Chorea,  and  Hysteria.
  Epilepsy.—Epileptic  fits are  commonly  di-
vided  into two classes:  the severe,  or  grand
mal, and the slight, or petit  mal.  The  severe
form is attended with loss of  consciousness and
extensive spasm of  the muscles.  In  the petit
mal there is mere temporary  loss of conscious-
ness.
  Symptoms.—The severe  epileptic fit is some-
times preceded by a warning, by which the pa-
tient knows that an attack is impending. The
warning, or  "aura," varies in character,  from
mere dizziness to a sensation commencing in an
extremity, or at the  pit of the stomach.  At the
time of  the  fit  the  patient perhaps cries out,
and suddenly falls down; his body and  limbs
become set fast in a violent muscular contrac-
tion, the head and eyes turn to one  side, and
the features  are distorted.  The  face, pale at
first, becomes gradually livid as the respiration
is stopped, and  foam mixed with blood  issues
from the mouth.   The pupils  become  widely
dilated as the lividity  increases, and the urine
Is perhaps passed unconsciously.  The muscles
then become slightly relaxed  and jerky  move-
ments  occur, the respiration commences  again,
the lividity lessens, and the spasm is at an end.
The patient  remains senseless  and prostrate,
and often passes off into a deep sleep for some
time.  In awaking it is found perhaps that he
has  bitten  his  tongue,   and  received  other
wounds or abrasions from his fall. 
     DISEASES OF NERVOUS SYSTEM   61

  In the slight fit,  or petit mal, the individual
loses consciousness for a brief interval, and per-
haps stops in his  occupation, looks strange or
staring, becomes pale, and then recovers.  He
is often dull for a  time afterward, and unable
to recollect what  has  been happening.  Occa-
sionally he becomes violent or maniacal.
  The  severe and  the slight fits frequently oc-
cur in the same  individual.  The petit mal is
also common  in  children and  young  persons,
and is apt to  be  mistaken for a  fainting fit.
Epilepsy may  attack persons at  any  time of
life, but  its onset is most common at  from ten
to twenty  years of age.  It may be inherited,
or it may  be brought on by mental excitement
or fright.  There is sometimes only one attack,
but more usually others follow.  The night  is a
very common time for  fits to occur.  In some
cases the  fits  do  not occur again,  but in the
majority, once established,  they  are  more or
less likely to  recur  throughout life,  probably
lessening in  frequency  after middle age.   The
risk to life is not great, and the convulsive at-
tack is rarely fataL  The main danger is from
accidents, such as falling into the water or  into
the fire,  or from the face becoming turned over
on to the pillow, when  the fit occurs during the
night.  The mental condition of the confirmed
epileptic often deteriorates, varying from  loss
of memory and moral control to complete imbe-
cility.  The most serious and dangerous compli-
cation is Epileptic  Mania, in which the patient
becomes violent, and may commit assaults and
murder.
   Management.—If the  fit is  preceded by a
warning, the patient should be quickly put into
a safe  position, and  made to  lie down, the
clothes being loosened about the neck and body.
During the fit nothing particular  can be done 
62    THE NURSE'S SERVICE DIGEST

except to prevent the tongue from  being bitten
by  placing a  piece  of india-rubber or several
folds of  a  pocket-handkerchief  between  the
teeth, the lower jaw being held down, and the
tongue pushed in, if  it is already caught.  After
the  attack the  patient  should be allowed  to
sleep for a short time, if so inclined.  No drink
or fluid of any kind  should be given during the
fit.   In  some cases where the aura or warning
begins in the hand  or foot, a  ligature may  be
tied tightly round the limb at some part above,
as this occasionally prevents the convulsion.  In
the intervals, moderate bodily and mental exer-
cise is good,  and excitement should be avoided.
Moderate diet with some animal  food,  absti-
nence from stimulants, and careful attention to
the bowels is needful. An outdoor occupation is
best, and one in which the individual is not ex-
posed in dangerous situations, in case of an  at-
tack.
  Chorea, or  Saint  Vitus' Dance, is a disease
that  occurs  usually in  young  persons.  It is
more common in girls than boys, is  sometimes
brought  on by mental excitement,  school-work,
or  fright, and  is  frequently  associated  with
rheumatism or  rheumatic fever and heart-dis-
ease.
  Symptoms.—The   first  symptom's  are  often
weakness and jerky  movements of the limbs on
one side of the  body.  The muscles of the face,
too, are perhaps noticed to twitch, the lips are
moved about, and there is  a tendency to drop
things out of the  hand, and  ordinarily quiet
movements are  performed in a jerky, irregular
manner.  All these  symptoms are increased by
excitement and observation, and cease during
sleep.  They are often  accompanied  by mental
■dulness and  general debility.
  In milder  cases the movements  are less vio- 
     DISEASES  OF NERVOUS SYSTEM   63

lent, and perhaps only affect  one side of the
body, or are more marked on one side than on
the other.
  In severe cases the jerky and irregular move-
ments  become excessive, and there is complete
loss of self-control; the muscles  of  the trunk
become involved, and the body and  limbs are
twitched and jerked about to such  an extent
that they become bruised and damaged by strik-
ing  against surrounding objects; feeding  be-
comes  difficult,  and  sleep  is  interfered with.
There  is great weakness, and  the mind is  af-
fected.  In  a few instances  the patient becomes
maniacal.   This condition  occurs more  com-
monly  in puerperal women,  or  male adults in a
first attack.
  Young persons who have had  one attack of
chorea are  very liable to a  recurrence; but the
majority get well, some in  a few weeks, while
in  others the attacks are more  obstinate.  In
adults the  severe attacks sometimes terminate
fatally;  these are usually first attacks, and as-
sociated with  mania or with heart-complica-
tions ;  sometimes the patient dies  from want of
sleep and  inability  to take sufficient  nourish-
ment,  or from  bed-sores.
  Management.—Complete cessation from men-
tal and  physical fatigue is essential.  Lessons
should  be  discontinued, and  emotional excite-
ment  and  much  playing with other  children
should be avoided.  A temporary  rest in bed is
desirable and usually very beneficial, but should
not be continued so long as  to cause depression.
In  weak, pale children a good diet is essential.
In  severe  cases when the movements are very
violent, it is most important to prevent bruising
and sore places which are very liable to occur,
and prove very troublesome, or even the cause
of  death.   For this purpose a padded room is 
64   THE NURSE'S SERVICE DIGEST

desirable, or,  in emergency,  the  adjacent ar-
ticles of furniture should be removed, and the
mattress placed  on the floor in a corner of the
room, the walls  being covered with cushions or
mattresses, and the limbs of the patient may be
protected with pads of cotton batting, and gently
held in check by the  nurse. The feeding is very
important and often difficult.  The nurse will
have  to feed the patient with a  spoon and
steady the head, and assistance may be neces-
sary.
  The bed should be  kept scrupulously clean, as
the evacuations may be passed unconsciously
when there is much  mental failure.
  Hysteria is the term applied to a disordered
state of the nervous system which is far more
common  in women than men; the term  hypo-
chondriasis being  used  for an allied condition
in the male sex.   It should be understood that
the word "hysteria" implies  medically  a real
malady,  and is not  employed to denote mere
simulation of symptoms, or for imposture,  as it
frequently  is  by the public.   It would  be im-
possible even  to mention here all the various
phenomena which may  occur in hysteria;  in
fact,  there  is hardly any  function or  organ
which  may  not be  implicated in different in-
stances.
  Symptoms.—In  the  more  ordinary class  of
cases, the individual exhibits continuously some
mental peculiarity, either imperfect self-control,
irritability, or depression; on the other hand, in
a few  there is complete mental balance.  Then
from time to time there is a  paroxysm or out-
break of hysteria, which may take some  well-
marked form  and simulate one or another or-
ganic affection.  For instance, there may  be a
convulsive seizure, paralysis,  or vomiting.
  The patient will,  perhaps, complain  of the 
     DISEASES  OF NERVOUS  SYSTEM   65

sensation of a lump in the throat, and a fixed
pain in one temple, and there may be vomiting,
or spitting of blood-stained juice in  the  morn-
ing ; she may refuse all food, and deny that she
has  slept for  nights.  The bowels are usually
constipated, and  the monthly periods often ir-
regular.  The urine is often copious in amount
and  very light  colored, and the patient may
have the idea that she is unable to  pass it.
There  is never incontinence.  There  is often a
peculiar loss of sensation,  affecting one limb or
perhaps the  whole of one  side of  the  body,
which  has a remarkable tendency to  change its
position from  time to  time.  There may  be pa-
ralysis  of one or  more limbs, and  rigid con-
tractions of joints, with tenderness  and great
complaint of pain.  Loss of voice, or a whisper-
ing  voice,  called "hysterical  aphonia," is also
common.  The convulsive  seizures or fits vary
in character.   In some the patient is boisterous,
crying out and throwing  the limbs  and body
about, but careful not to fall down and hurt
herself; obviously in  full  possession of her
senses,  conscious of pain when hurt,  and exag-
gerating the paroxysms when  under observa-
tion.  In others  the fits have a very close  re-
semblance to an  epileptic  attack, and the term
Hystero-epilepsy  is applied to them.
  Management.—The attack will probably cease
as soon as the patient  is left  to herself, and
removed from observation, but will continue or
increase as long as she is under the influence of
anxious and sympathetic  friends.  The  nurse
should treat the patient with firmness and kind-
ness, assuring her that there is no cause  for
alarm,  and that the attack will soon subside.
She may give a  little water or sal-volatile, or
distract her attention in some other way until
she  has calmed down.  A  cold douche of water 
66    THE NURSE'S SERVICE DIGEST

or  more  severe  measures  should not be  em-
ployed except under medical advice.
  In cases of imposture the nurse will have to
watch the patient  carefully,  in  order to  as-
sist in clearing up the  doubtful symptoms; for
instance,  she should  watch  whether  patients
who decline their meals contrive to obtain food
by other means;  whether a limb supposed to be
paralyzed is moved when the patient  thinks she
is unobserved; or if blood expectorated is pro-
duced by  artificial means.
  In hysterical aphonia and other hysterical af-
fections  the  interrupted  current is of great
value, but should only be  used  under medical
direction  (see Batteries).

            Mental Derangements.

  Delirium is an acute mental derangement oc-
curring often in the course of the specific  fe-
vers,  pneumonia, or other feverish states; it is
also  common  in  brain-disease,  kidney-  and
heart-affections,  in  inanition  consequent  on
wasting diseases,  and after severe haemorrhage.
  Delirium may  be "quiet" or  "active."   In
quiet delirium there are  delusions of sight, the
patient fails  to  recognize his friends, and he
talks constantly  in  a  low monotonous voice, a
condition termed "low muttering delirium."  In
the "active delirium" the patient tries to act on
his own ideas;  he may get out of bed, try to
walk downstairs, put on his clothes,  or attempt
to jump out  of the window; when more violent
he may attack his attendants or commit suicide.
  In some there  is  "busy delirium," during
which the patient is constantly moving  about,
under the impression he is at his  work.
  Delirium Tremens is  the result of  alcoholic
excess, or occurs in an intemperate subject in 
     DISEASES OF NERVOUS SYSTEM   67

the course of  disease or  after severe injury.
After a  few days  of  disturbed  sleep, loss of
appetite,  and irritability, the patient is attacked
with delirium,  horrible dreams, and visual de-
lusions.  He  imagines  he sees  animals, insects,
or devils in the room  under his bed, and tries
to brush them  away.  There is marked tremor
about the hands, the lips,  and  tongue; and the
delirium  is often busy, active,  violent, and as-
sociated  with extreme restlessness and picking
at the bed-clothes.  The  temperature may or
may not be raised, and should in all cases be
tested  by the thermometer.
  The  majority of uncomplicated cases get well,
others  sink from exhaustion, an attack of pneu-
monia, or other causes.
  Management.—Attendance on   delirious  pa-
tients requires  the utmost tact,  care, and watch-
fulness.  The nurse should endeavor to humor
them by  listening to them, and must avoid an-
noying  them  by  contradiction  or  harshness.
They may often be persuaded  into doing what
is wanted by  management, and  by utilizing
their own ideas.
  The  delirium of exhausting  diseases and fe-
vers is common at  night,  and may be dimin-
ished  or  controlled by  the administration of
food or  stimulants  at bed-time.   In  all cases
sleep is  of the utmost  importance, and quiet
should be obtained by the exclusion of friends,
and  the  light may be  obscured in  the daytime.
Tepid sponging or the  application  of cold  to the
head is often useful.
  In active or violent delirium measures  must
be taken to  prevent the patient from injuring
himself  or  his  attendants.   The fire-irons,
knives, razors, or crockery will have to  be re-
moved from the room, and the windows secure-
ly fixed  or fitted with stays to prevent the pa- 
68    THE NURSE'S SERVICE DIGEST

tient  jumping out.  More than  one attendant
may be required, or men should be ready with-
in call in case of need, especially at night-time.
For  violent  patients it may  be necessary to
have  resort  to mechanical  restraint, by  the
straight-jacket, and  the restraining-sheet.   The
jacket is of canvas fastened with tapes at the
back;  the sleeves  are  made  to  extend  be-
yond  the  fingers, and should be tied up at the
ends,  and further secured  by a bandage round
the wrist.  The patient  is then  placed on the
bed with  the arms  crossed,  and each hand is
tied to  the opposite side of the bed.  A folded
sheet  is passed across the  legs and  ankles  and
fastened to the sides of the bed.  The patient is
covered in the bed-clothes, and the restraining-
sheet  is then fastened over the top  to the bars
of the bedstead, care being taken not to fix it
too tightly over  the chest.
  When all food is refused, it will be necessary
to feed with  the stomach pump or with a tube
passed through the nose.
  In delirium tremens it  is  of the  utmost im-
portance to the patient that he  should be fed
constantly, and this  may be difficult as there is
often  great loathing of food.  Stimulants must
be withheld unless specially ordered.
  Insanity.—Under  the heading of Lunacy  and
Unsoundness  of  Mind may be included various
mental disorders, to which different terms are
applied,  according to  the special  characters
manifested in each.  Mania, melancholia,  de-
mentia, paralysis of the insane, idiocy, and im-
becility are some of the more common disorders.
  Management.—The treatment  and  manage-
ment  of these cases is usually undertaken in an
asylum, as they cannot be satisfactorily treated
at home.  In  cases of violence,  restraint is  nec-
essary (see Active Delirium). 
     DISEASES OF NERVOUS SYSTEM   69

  The  laws relating to the custody of  lunatics
are very stringent, and certain formalities are
necessary before a patient can be placed in a
lunatic asylum.
  For  a pauper lunatic, application should be
made to the courts of the district; and  a cer-
tificate is required to be signed by a magistrate
and one medical man.
  In private cases it is necessary for two medi-
cal men to  examine the patient separately and
sign the regular certificates before he can be
removed to  an asylum.  In cases of urgency, the
signature of one medical  man is sufficient for
temporary restraint. 
CHAPTER  IV.
     DISEASES OF THE RESPIRATORY SYSTEM.

The Respiratory Tract  and  Respiration—The
  Lungs — Air-Passages — Larynx — Trachea-
  Bronchi—Mechanism of Respiration—The Re-
  spiratory  Act—Importance  of  Ventilation—
  Cough and Dyspnoea.
Symptoms  and  Management  of Laryngitis—
  Bronchitis—Asthma—Pneumonia—Pleurisy—
  Empyema—Pulmonary  Consumption—Haemo-
  ptysis or Spitting of  Blood—and other Com-
  plications.

  Introduction:  The Respiratory Tract  and
                 Respiration.

  Reference has already been  made to the scar-
let-red color of the  arterial blood on its way to
the capillary circulation,  and to the purple  or
dark-blue tint of the venous blood as it returns
to the heart.  The  change of  color takes place
during the passage of  the blood through  the
capillary circulation, and is due to the loss of
oxygen which has been abstracted from it  for
oxidation  in the tissues.  At the same time,
waste-products,  such  as carbonic acid,  water,
and urea have been entering  it from all sides,
so that the  blood,  on  returning  to  the right
chambers of the heart, is loaded with these im-
purities.
  Respiration is  the process  by which the  im-
pure purple  blood  is purified and replenished
with  oxygen, and  the  lungs  are the  organs
which perform this function.
  The Lungs are two large  spongy structures
                     70 
DISEASES OF RESPIRATORY  SYSTEM  71

of pinkish color, surrounding the heart, and oc-
cupying the greater part of the  cavity of the
thorax.  The  right  lung is divided  into three
lobes,  the  left into  two, and each lung  has a
covering  of  delicate  membrane,  called  the
pleura, which also lines the inner wall of the
cavity of the thorax. The internal structure of
the lung consists of a number of sacs or blad-
ders,  small air-tubes and blood-vessels, and the
air finds an entrance to  the interior by the air-
passages, which first merit description.
  The  Aib-Passages.—The air enters by the
nose and mouth, then passes through  the larynx
down the wind-pipe, or  trachea.
  The Larynx, or voice-box, is  situated at the
top of the wind-pipe, and can easily be felt as
a  hard prominence  in  the front  of the neck,
popularly called "Adam's Apple."  In its inte-
rior are the vocal cords,  and the passage for air
between them is a narrow slit.
  The Trachea, or wind-pipe, is the continuation
of the passage downward, and is provided on
the front  and sides with rings  of  cartilage,
which serve to protect and keep it open.   Soon
after  entering  the chest, the  wind-pipe divides
into two tubes, called the bronchi, one going to
each  lung.  The tubes  and  passages are  pro-
vided with a soft lining, the mucous membrane,
which exudes a fluid called mucus,  serving to
keep the surface slightly moist.
  The Bronchus, on reaching the lung, divides
and subdivides into  a large number  of smaller
tubes, and these again divide and subdivide into
still smaller ones, while the smallest passages
finally end in the minute  air-sacs which make
up the spongy lung-tissue.  The lungs thus  con-
sist of millions of minute air-sacs, or vesicles,
with small tubes opening into them,  which are
covered and surrounded by  blood-vessels,  and 
 72   THE NURSE'S SERVICE DIGEST

 are only  separated from the air in the interior
 of the air-sac by the thin wall of the sac itself.
   The blood-vessels,  or small divisions of the
 phlmonary  artery, break up into capillaries in
 the walls of the air-sac, and carry the impure
 venous blood through  this  delicate membrane,
 thus facilitating the  exchange of gases  between
 the blood and  the air in the air-sac.   The car-
 bonic  acid  and some other impurities are re-
 moved, and the blood receives  a  fresh supply
 of oxygen from the air, and is then returned by
 the pulmonary vein as arterial blood to the left
 side of the heart, ready to be again distributed
 through the tissues of the body.  It will be ob-
 served that in the lung is the only instance of a
 vein carrying  arterial,  and  an artery  venous
 blood.

        The Mechanism of Respiration.

   It is obvious that  the air in  the air-sacs of
 the  lung  must lose oxygen  and become loaded
 with carbonic  acid,  requiring on this  account
 constant renewal.
  The  movements of respiration ensure the con-
 tinuous passage of air in and out  of  the lungs
 in the  following manner:—
   The  cavity  of  the Thorax  is  an  air-tight
 chamber, having for its floor the roof or arch of
 the Diaphragm. The lungs fill this cavity, hav-
 ing their  outer surfaces closely  applied to  the
 walls of the cavity and to the diaphragm—not
 being adherent, but kept in contact by  atmos-
pheric  pressure.
  During  the  process  of  breathing,  the  dia-
phragm is constantly  ascending and descending;
 by its  descent  the cavity  of the thorax is  en-
 larged, and by its ascent diminished.  The lungs
follow  the movements of the chest  closely,  be- 
DISEASES OF RESPIRATORY  SYSTEM  73

coming expanded when the diaphragm descends,
and contracted  when it ascends.   This expan-
sion and contraction of the lung  causes a con-
sequent entrance and exit of air,  which consti-
tutes respiration.  In addition to the action of
the diaphragm,  there are  other muscles  which
assist  in the  movements of  respiration,—the
most  important being  the  intercostal  muscles,
which extend from rib to  rib, and by their ac-
tion draw  up the ribs and help  further to ex-
pand  the cavity of the thorax.
  The Respiratory Act is divided into two parts
—inspiration, during which the lung is expand-
ing, and the air being drawn-in down the wind-
pipe; and expiration, during which the lung is
contracting  and air  being  forced-out  of  the
wind-pipe.
  In  a healthy adult,  the number of respira-
tions  varies from fourteen to eighteen a min-
ute; in children,  from  twenty to twenty-five;
while  in infants the number may amount to
thirty or forty in a minute.  But the number of
respirations is greatly  increased by excitement
or exertion.
  Importance of Ventilation.—The  expired air
differs from the inspired, or pure atmospheric,
air in the  following  particulars:—
  1. The air  expired is nearly as  hot as the
blood,  and  contains almost as much watery va-
por as it can hold.
  2. There has been, roughly speaking, a loss of
five per cent, of oxygen, and a gain of five per
cent, of carbonic acid.
  3. It also contains a greater quantity of de-
caying animal matter.
  It is estimated that about four hundred cubic
feet of air are passed through the lungs of an
adult  taking no exercise in the course of twen-
ty-four  hours.   This air is charged with car- 
74   THE NURSE'S SERVICE DIGEST

bonic acid, watery vapor, and  decaying animal
products, and deprived of a large amount of its
oxygen.  It is clear,  therefore, that the air in a
small room with people in it soon becomes quite
unfit for  breathing, and  requires constant  re-
newal  to prevent its becoming actually poison-
ous.  The importance  of  ventilation in pulmo-
nary affections,  in which the air soon becomes
vitiated, cannot  be over-estimated (see Ventila-
tion) .
            Cough and Dyspnoza.

  These two symptoms are of common occur-
rence and of extreme importance in  all affec-
tions of the respiratory  organs.  They present
peculiarities in character according  to  the part
of the tract affected,  and may occur in disor-
ders other than  those of the respiratory organs
—as, for instance, in disturbance of the diges-
tive system.  It is, therefore, necessary that a
nurse should pay particular attention  to their
special characters.
  Coughing is the sound produced by  a sudden
and forcible expiration, arising from an irrita-
tion  of the  sensitive nerves distributed to the
various parts  of  the respiratory  apparatus,
usually by too  sudden a change of  atmosphere
or from exposure  to  wet, acting  on  the  un-
healthy or enfeebled system as the  seat of the
incipient disease.
  Cough depends upon an  impression  received
by the nervous  center; the purpose is the  re-
moval  of  some  irritating substance from  the
mucous membrane or the air passages; it may
be  sympathetic, from  some  disease  of  the
stomach  or other  abdominal  viscera,  as  fre-
quently occurs, or from inflammation of the  vo-
cal cords  and larynx.
  The glottis is especially sensitive,  for the pur- 
DISEASES OF RESPIRATORY  SYSTEM  75

pose, no doubt, of guarding the entrance to the
air passages  from  injurious  agents, dust, or
other foreign  substances entering them.
  There is a wide diversity in the character of
the cough, which receives  names  corresponding
with the peculiarities  of the disease.
  We have the dry cough without,  and moist
cough  with, expectoration.  The  dry  hacking
cough, resulting from irritation, which indicates
a want of proper secretion; then  we have the
violent  spasmodic,  convulsive  cough, which, if
allowed to continue beyond the incipient stage,
frequently becomes first acute, then chronic. It
is vexatious and exhausting to the patient, as
well as annoying  to  others who hear it; it
often  produces spasmodic contraction  of the
larynx, with a feeling of suffocation to  the pa-
tient.
  Don't neglect coughs and colds!  They should
be treated at once, while in their incipiency; if
not, they often lead to serious consequences.
  In  laryngeal  disease,   the  cough is  often
hoarse  and croaking,   the  latter especially, if
there is obstruction to the passage of air.
  In  bronchitis, the  cough may  be attended
with wheezing or rattling sounds.
  In pleurisy, the cough is usually short, sharp,
and staccato.
  In whooping-cough, a number of short coughs
succeed one another, rapidly followed by a long-
drawn inspiration—the same series being  often
repeated  several  times.   The long-drawn  in-
spiration may  be crowing or "whooping" in
character, or the whoop may be absent.
  Dyspncsa, or difficulty in breathing.—In the
simplest form the number of respirations is in-
creased to twenty, thirty, or more in the min-
ute,  and the  breathing is usually shallow in
character, as in pneumonia. 
 76   THE NURSE'S  SERVICE DIGEST

   In laryngeal disease, inspiration may be diffi-
 cult, and accompanied by a  whistling, crowing,
 or stridulous noise—a  feature  of  groat  impor-
 tance especially in children, as it  indicates  ob-
 struction to the entrance of  air  through  the
 larynx.
   In bronchitis and asthma, expiration may be
 difficult, prolonged, and accompanied by wheez-
 ing sounds.
   In some cerebral cffections, or at the close of
 Bright's disease,  and in some heart  affections,
 a  peculiar form of breathing supervenes. The
 respiration ceases at times altogether for a few
 seconds, and then recommences—being at first
 rapid and  shallow,  afterward deeper and slow-
 er, and  then ceasing again.

      Diseases of  the Respiratory System.

  A  nurse should  be  familiar  with the com-
 moner  varieties  of  these  affections—for  in-
 stance,  with  the inflammatory forms attacking
 both air-passages and lungs,  including Catarrh,
 Laryngitis, Bronchitis,  Pneumonia, and  Pleur-
 isy ;   also with  Asthma and Pulmonary  Con-
sumption.
  Catarrh, or  a  catarrhal  cold, are the most
 common affections of the respiratory tract.  An
 ordinary cold in the head is an inflammation of
 the mucous membrane  lining the  nostrils and
 upper part of the throat.  The membrane is at
 first swollen  and reddened, and  then secretion
 takes place—the mucous fluid being poured out
 in a larger quantity than is normal.  In some
cases, a cold passes away without any special
 treatment,  but it  may be the commencement of
 a more  serious illness, and should not be neg-
 lected.  A neglected cold in a delicate person is
 liable to develop into one or other of the more 
DISEASES OF RESPIRATORY SYSTEM  77

severe inflammatory  disorders of the respira-
tory system.
  Laryngitis is an inflammation of  the larynx
or voice-organ, and may  result from cold and
exposure or from an  irritant, or it may super-
vene in the course of  some other affection, such
as tubercle or cancer.
  The inflammation  affects the  vocal  cords,
causing fever with hoarseness of the voice and
cough, and there may be such narrowing of the
orifice that the breathing becomes difficult, as
in croup.
  Symptoms.—Dyspnoea,  such as has been de-
scribed, occurs  in extreme cases;  there is great
distress,  the face is flushed and  livid, the lips
are blue and the eye-balls prominent; the cough
is harsh and  croaking,  often  accompanied  by
mucous expectoration.  The urgent symptoms
have a great tendency to come on at  night-time,
or to  increase during  the night.   In milder
cases  there is  often  fever with  hoarseness of
voice and cough, but no difficulty  in breathing.
  There is  always greater cause for  anxiety in
the case  of children than of adults,  the urgent
symptoms  of  dyspnoea  in the former  arising
rapidly and soon becoming dangerous.
  Management.—The  temperature of the room
should be maintained at 65°, and the  air kept
moist in the patient's neighborhood by means of
steam from a bronchitis-kettle.
  The  bed-clothes should be kept away from
the mouth  and nose,  and the head  and  shoul-
ders should  be raised  by  means of pillows,
if there is  any difficulty  in breathing.  But if
the symptoms of dyspnoea increase, the surgeon
should at once  be informed, as suffocation may
be imminent, and tracheotomy  prove necessary
to save life.  (See Tracheotomy.)
  Bronchitis.—Inflammation  of  the  mucous 
78    THE NURSE'S SERVICE DIGEST

membrane lining the bronchial tubes and  their
divisions is usually the result of cold, and may
take either an  acute or chronic form.
  Acute  bronchitis,  if  extensive, is a  serious
affection when  it occurs in feeble old people or
young children.
  Symptoms  are:   feverishness,  dyspnoea,  or
shortness of breath, cough, and tightness on the
chest.  The  dyspnoea is often considerable, ex-
piration  being  difficult and accompanied  by
wheezing sounds.  Cough  is  frequent, with ex-
pectoration, and in the early stages the phlegm
is white, watery,  and frothy, as  the mucus in
passing through the air-tubes becomes mixed up
with air-bubbles; it is also occasionally streaked
with blood.  In  the later stages, the phlegm in-
creases in quantity,  comes up more easily, and
becomes  yellowish or greenish-yellow in color,
or else  is  viscid, tenacious, of dirty-white or
yellowish appearance,  and adheres  closely to
the sides of  the vessel.  The majority of pa-
tients recover  in  a few  weeks,  but when the
Inflammation spreads to the smallest bronchial
tubes, or to the  alveoli  of  the  lung, causing
broncho-pneumonia,  the danger  is  greater, as
this  extension  proves fatal in a  large number
of delicate or rickety children.
  In  chronic bronchitis,  the symptoms are of
much the same  character  as  in the acute form;
but the  fever and the other symptoms are less
severe, though  perhaps of longer duration.  The
chronic forms of bronchitis are often recurrent
at the colder seasons of the year, and may be-
come more  or less  permanent, complicated by
over-distension of the lungs  or emphysema (in-
filtration of air into the  interstices of the con-
nective  tissues), asthmatic seizures, or dilata-
tion and weakness of the heart
   Management.—The temperature of the room 
DISEASES OF RESPIRATORY  SYSTEM  79

should  be  maintained  at from  65°  to  70°.
Draughts should be carefully  avoided, and  ven-
tilation managed as far from the patient's bed
as possible, the atmosphere being kept moist by
means of  steam  (see  bronchitis-kettle).   The
position  most comfortable for the patient—es-
pecially  if  there is much dyspnoea—is on the
back  with the  head and  shoulders  raised; in
some cases sitting up in bed is preferable.  The
sputa or phlegm should be noticed as  to quan-
tity and appearance, and the nurse should espe-
cially pay  attention to  the extent of lividity of
the  lips and face,  or  other  symptoms of the
dyspnoea becoming  dangerous.
  The remedies in  common use which will have
to be  administered by the nurse  are:  inhala-
tions,  poultices, and the  medicines  prescribed
(see Inhalations, Poultices). The effect of these
upon the  cough,  expectoration, and dyspnoea,
must be noticed,  and  also whether nausea or
sickness is produced;  if  opiates  are  ordered,
watch should be carefully kept against stupor,
mental wandering,  or  increase of lividity.  In
cases  of exhaustion,  plenty  of fluid  nourish-
ment will  have to be administered,  and stimu-
lants, if prescribed.  During  convalescence, the
avoidance  of chills is absolutely  essential, as
bronchitic patients are very susceptible to sud-
den  change in temperature.  On first going out,
a respirator or  some covering over the mouth is
a useful precaution.
  Asthma, or asthmatic attacks, are often as-
sociated with the chronic form  of  bronchitis,
but  may exist  independently in the spasmodic
form.
  Symptoms.—An  attack  of  asthma very  com-
monly occurs in  the night or early  morning.
The person wakes with a feeling of constriction
about the chest, sits up in bed with the knees 
80    THE NURSE'S SERVICE  DIGEST

drawn up and the elbows on them, and begins
to gasp for breath.  The air is drawn in by a
long, deep inspiration,  the chest seems to  re-
main expanded, the expiration is long and dif-
ficult,  and attended with a  wheezing or whis-
tling sound.  There is often a great desire for
fresh air, and suffocation  seems to  be  immi-
nent ; but after a time the attack subsides, and,
perhaps, a cough  commences with some expec-
toration, or  without this the breathing becomes
again easy and natural.
  Management.—Asthma  is  more  distressing
than  dangerous;  a fatal  termination is  very
rare,  so that  the  patient may be assured that
the attack will pass off.  Various remedies are
employed in different cases, and many sufferers
are acquainted with the  remedies that relieve
them most, whether it be a cup of strong coffee,
the fumes of  nitre papers, or the vapor of  ni-
trate of armyl (see  Inhalations and Throat'-Ap-
plications).  In many instances  some error in
diet  is liable to start an attack,  and this is  es-
pecially  the  case with  children, consequently
such articles as sweets  and jam  should always
be avoided where there is a tendency to asthma.
  Pneumonia.—Inflammation of  the  lung-sub-
stance, like  bronchitis, is frequently the result
of cold or chilling of the surface of the body,
and is most common in the spring-time. It may
also  be produced by the inhalation of irritant
particles, or poisonous gases, or it may arise as
a complication in the course of rheumatic or ty-
phoid fever, heart-disease,  or any of the infec-
tious fevers.
  In its acute  form,  attacking a healthy person,
pneumonia should  be treated promptly and vig-
orously;  do not delay until it presents well-de-
fined  characteristics or runs a  fairly definite
course. 
DISEASES  OF RESPIRATORY SYSTEM  81

  Symptoms.—After a day or  two of premoni-
tory  illness,  the  invasion  of  the disease is
marked by a sense of chilliness or a sudden and
severe rigor, or less commonly  a succession of
rigors.  Such  a condition should  be  met  vig-
orously and treated by a skilled physician. The
temperature is found to be raised often to 103°
or 104°, and this is accompanied by other signs
of fever.  In the course of the day, fresh symp-
toms supervene, such as rapid breathing, cough,
and pain in  the affected side. When the disease
has developed, the patient lies  in  bed, usually
on the  back—the  cheeks  are flushed, the nos-
trils working,  and sometimes  a patch of ves-
icles of herpes appears about the lips.  The res-
pirations are shallow and rapid, out of propor-
tion to the pulse  (30-40 in the minute),  and
temperature 103-104, often  accompanied  by  a
sucking sound.
  There is usually cough, which increases the
pain,  and the expectoration is  viscid  and tena-
cious.  The  color of the sputum is often char-
acteristic, being of reddish-brown, or rusty hue,
due to the intimate admixture of blood.
  The urine is scanty and high colored, and the
skin in dry,  pungent, and  sometimes slightly
tinged with jaundice.
  Nervous symptoms in the form of tremulous-
ness,  and a tendency to delirium, especially at
night,  are often present.  In  favorable cases,
improvement  takes  place from the fourth or
fifth to the eighth or ninth  day, and the  tem-
perature comes down suddenly at the  crisis, the
skin becomes moist,  and the other symptoms of
fever disappear (see fig. 30).  The  cough, how-
ever,  often  continues  for some  time, and  the
expectoration gradually diminishes and loses its
color.  Cases vary  extremely  in severity, and in
the more unfavorable ones the dangerous symp- 
82    THE NURSE'S SERVICE DIGEST

toms depend greatly on the condition and phy-
sique of the person attacked.
  In old and  feeble people,  death  may  take
place from exhaustion; the pulse becomes rapid
and weak, and  the appetite fails.  The tongue is
dry and brown, crusts appear on the lips, there
is delirium, and the strength gradually fails.
  In persons of broken-down constitution, there
is danger of gangrene of  the  lung.  The symp-
toms of general debility are present with those
of pneumonia;  but the sputum rapidly changes
and becomes of "plum-juice," greenish, or dirty-
yellow color, and gives off a foetid odor.
  In drunkards, the nervous  symptoms of the
disease are accentuated; tremulousness and de-
lirium appear  early,  while in others delirium
tremens, or mania of a violent kind, develops
(see Delirium Tremens).
  If the amount of lung  affected be  great,  or
the disease attack the other lung, there is dan-
ger  of asphyxia and the symptoms  indicating
dyspnoea—such  as rapidity  of the  breathing,
with  dusky complexion and  profuse  sweats-
increase.   The  patient becomes restless,  and
wants to be lifted higher in the bed.
  In pneumonia secondary to rheumatic fever,
or the specific  fevers, the access is often  very
insidious—a rise in temperature with increased
frequency of respiration being the only indica-
tions of  the inflammation having attacked the
respiratory organs.
  Management.—The  nursing  in pneumonia  is
of the highest importance.  The patient should
be placed in bed at once, and  will soon find for
himself the  most  comfortable  position.  The
room should be warm and well ventilated.  The
temperature,  pulse, and  respiration should  be
carefully registered, and  the  character of the
cough, of the expectoration,  and of any  com- 
DISEASES OF RESPIRATORY SYSTEM  83

plaint of pain in the chest noted.  The clothing
on the bed should be light and warm. Absolute
quiet should be insisted on,  and the patient re-
strained from talking more than necessary. The
diet should be fluid, and some beverage  may  be
kept  ready, as  the patient  often  suffers from
thirst.  The pain may be relieved  by mustard
poultices, and  a cotton-batting  jacket may  be
used  to cover the affected side afterward. At-
tention should be paid  to the bowels and kid-
neys, both of which should be thoroughly acted
on to give as quick relief as possible to both,
and  a bed-pan should  be used, as the patient is
not allowed to get out of bed.
   The crisis may be expected with sudden fall
of temperature, and moist skin from the fifth  to
the tenth day.
  Where there is great exhaustion in debilitat-
ed subjects, or feeble old persons, the strength
has to be maintained by constant nourishment
and stimulants.  The delirium is  often increased
by weakness,  and is especially  troublesome  at
night. The character and smell of the sputum
should be noticed,  and,  if offensive, should be
disinfected  or deodorized and  constantly re-
moved.  Bed-sores should be  guarded against by
a water-bed or other means.
  In drunkard's pneumonia, if there is delirium
tremens, or a tendency to violent mania in pow-
erful patients,  the  nurse should insure  that
there is assistance at hand in case of necessity,
and  this especially at night, to guard against
damage to herself or the patient.  Food should
be administered  freely,  and stimulants  if or-
dered by the medical attendant.
  If  sedatives or opium have to be given, the
effect should  be carefully watched  for  symp-
toms  of  stupor, blueness,  dyspnoea, or profuse
sweating, and the dose omitted or lessened ac- 
84    THE NTRSE'S SERVICE  DIGEST

cording to discretion, if there is  no opportunity
of referring to the medical attendant.
  Pleurisy, or inflammation  of  the pleura, or
membrane covering the lung, may be due to cold
or exposure, or may result from injury to the
chest or from broken ribs.  It is also a compli-
cation of rheumatic fever, scarlet fever, and
pulmonary consumption, and may be secondary
to any inflammatory disease of the  lung itself.
  Symptoms.—Inflammation of  the pleura in
the first stage is called  "dry pleurisy"; the sur-
faces of the membrane are roughened, and are
incapable of gliding easily over one  another.
The  symptoms are: fever,  sometimes preceded
by a sense  of chilliness;  a short, sharp cough,
and  acute pain in  the  chest on  expanding the
lungs.  The pain is described  as "stabbing" or
cutting  in character, and  is increased by draw-
ing a deep breath; it is much intensified by any
sudden expiration, as coughing or sneezing. The
patient  endeavors,  as far as  possible,  to keep
the affected side of the chest fixed,  and usually
lies  in bed  on  the  back,  or on the sound side.
The  attack  may  not increase  beyond the first
stage, and with general treatment and vigorous
counter-irritation gradually subsides.
  The pain  may be lessened by the application
of counter-irritation, by a mustard  poultice, or
by painting  with iodine (see Leeches and Coun-
ter-Irritation).
  The second stage is that  of  effusion of  fluid,
or "pleurisy  with  effusion."   The  inflamed
membrane pours out  a  fluid, which is received
into  the cavity of the pleura  between the lung
and  the chest-wall.   As the fluid increases, the
lung  is  pressed on and collapses, the air being
gradually squeezed out of it, until more or less
of the lung is  rendered airless,  and therefore
useless.   If  the fluid becomes excessive, other 
DISEASES OF RESPIRATORY  SYSTEM  85

organs, as the heart or liver, are pushed out of
place.   The pleural cavity is capable of con-
taining a large  quantity of fluid, several pints
in young persons, and several quarts in the full-
grown adult. The symptoms of the second stage
are usually characterized  by diminished pain,
but a continuance of fever and increasing diffi-
culty  of breathing.  There may be little or no
cough.  The main danger to be apprehended is
from  the dyspnoea,  or faintness  from  embar-
rassed breathing and displacement of the heart.
The patient will probably now be unable to lie
on the sound side, since that side of  the chest
has to be left free to move, and to carry on all
the breathing,   as  the affected lung  becomes
more  and more  pressed on by the fluid, and he
may prefer to be propped up in the bed.
  Management.—The patient should be kept in
bed, and any   sudden movement  or  exertion
avoided, as liable to increase the dyspnoea, or
bring  on faintness.   It is usual  to apply strong
counter-irritation to  the affected side by iodine,
in order  to  promote  the  absorption  of fluid.
The bowels should be kept freely open, and the
skin encouraged to  perspire.   If  the dyspnoea
become at all  urgent,  the surgeon should  be
summoned, as relief from any danger can  be
afforded by the  operation of tapping the chest.
  Aspiration, or tapping the chest,  consists in
the introduction of  a hollow  needle  into  the
pleural cavity, between the ribs.  A tube leads
from the needle into a bottle, which can be ex-
hausted by a pump.   By this means the neces-
sary amount of  fluid is drawn out of the chest,
and the needle withdrawn.  If this operation is
required,  the nurse  should have  in  readiness
some carbolized  oil for the needle, a measured
glass  (capable of holding a pint) to receive the
fluid, and a pad of antiseptic gauze, with collo- 
 86    THE NURSE'S SERVICE DIGEST

 dion and strips of plaster to close over the seat
 of the puncture.   A few pieces of ice and salt
 to render the skin insensitive may be kept in
 readiness, and a broad flannel bandage is some-
 times applied afterward (see fig. 31).
   In simple serous effusion, the fluid drawn off
 is seen to be watery, and of greenish or straw-
 colored  hue.   Recovery  may take place  after
 one aspiration,  but the operation may have to
 be repeated more than once.       '
   Empyema is the  term used when the fluid con-
 sists of matter, or  "pus," and the case may have
 a somewhat different aspect from  simple effu-
 sion.  In young children pleural effusion is com-
 monly purulent, and  may arise after scarlet fe-
 ver or other acute  illness; the fluid is very rap-
 idly  formed,  and  urgent dyspnoea  soon super-
 venes unless relief  is afforded.  In adults pus is
 less common, and  is rather an indication of a
 debilitated subject.  The temperature is  often
 higher  than  in  simple effusion, especially  at
 night, and may  be associated with hectic fever
 and rapid emaciation.
   Management.—The treatment adopted for em-
 pyema is to drain  the pleural cavity, by means
 of a free opening and drainage tubes.
 ^  Draining of the  Pleural  Cavity.—The opera-
 tion is  rather more  extensive than aspiration.
 The patient is commonly given  an anaesthetic,
 and the chest being uncovered, a mackintosh is
 arranged under the affected side, which should
 be previously cleansed with  carbolic lotion.  The
 nurse should be prepared  with dishes of suit-
 able shape,  to catch the discharge of matter
 which issues from  the wound,  as soon as the
 pleural cavity is  opened.   Several india-rubber
drainage tubes of various sizes should be ready
in carbolic   solution  for  insertion  into  the
weund.  A threaded needle  and slips of plaster 
DISEASES  OF  RESPIRATORY SYSTEM  87

for maintaining  the  tubes in position  should
also be prepared.  The dressings  to be  used
should be ascertained beforehand from the sur-
geon,  and as the discharge is very copious  at
first,  and will  soon work  through,  the  wound
will require dressing  frequently for  the first
day or two.   In  all cases  of  operation for
pleural effusion, the fluid withdrawn should  be
saved  by  the nurse,  in  order that it may  be
examined.  The temperature of the body usual-
ly descends after the  removal of the purulent
matter from the chest, and when the fluid has
freely drained away for  a day or  more, the
temperature sinks to the normal.  A fresh rise
of temperature and return  of feverish symptoms
would be an indication that there was some  in-
terference  with the escape of the  matter, pos-
sibly  from the tube having become blocked with
the more solid flakes  of the  discharge;  or the
matter may become offensive, and change from
yellow to green or  greenish-yellow,  owing to an
unhealthy  condition of the pleural  cavity, and
it may be necessary that  it  should be washed
out by the  surgeon with an antiseptic solution.
An irrigator or  a  funnel  and an  india-rubber
tube are required for the purpose, and the anti-
septic fluid should be ascertained to be of the
right temperature,  about 100° F., before its  in-
troduction.
   The shape of the chest, especially in children,
is  altered after empyema.   The affected side
becomes contracted and smaller, and the  spine
curved in cases of long  standing.
   Pulmonary   Consumption — Phthisis.—The
popular term, "decline," is often used to denote
this fatal malady, which  carries off more vic-
tims  than  any other disease in this country.
The disease-material is  called tubercle,  a little
nodule deposited in the organ affected, which is 
88    THE NURSE'S SERVICE DIGEST

most commonly the lung; but it may attack al-
most any organ in the body, producing symp-
toms peculiar to the part attacked.  The  nod-
ules may combine  together in the  lung to form
masses, which create inflammation, breakdown,
and carry away parts of the diseased lung-tis-
sue, leaving  holes in the damaged lung.  The
tubercular-nodule  has  a  great  tendency  to
spread and infect neighboring parts, and it  may
be carried by the  blood into distant regions  of
the body, setting up inflammation in these also.
Hereditary taint has been observed to exist in a
very large number of those attacked; but in ad-
dition there  is often some other  cause  which
has determined the onset of the malady.   For
instance, cold, want,  overwork,  drink, and ex-
cess are sometimes the exciting causes, both in
the hereditary form  and that acquired  by dis-
ease.   When  there is hereditary taint in both
parents, the liability to its development in the
offspring is much increased.
  Pulmonary  consumption may be either acute
or chronic; in either form its symptoms may be
very diverse  in different individuals.
  (a)  The Acute Form more commonly attacks
persons under  twenty-five or thirty years of
age, and may prove fatal in  less than three or
four months,  or even in a few weeks.
  Symptoms.—The onset  may be  preceded by
emaciation  and cough, accompanied  by  sudden
fever  with rigors, and  symptoms resembling
those of pneumonia  develop.  The cough  and
sputum may  be pneumonic in character, or de-
note bronchial irritation.   The temperature  is
high,  hectic in character, and there  is a  ten-
dency to lividity and sweats, along with great
weakness, tremulousness  of  the limbs,  and
sometimes nocturnal  delirium.  A variety of
other symptoms  may  be  present, and apparent 
 DISEASES OF  RESPIRATORY SYSTEM  89

 improvement take place for a while; but the tu-
 bercular  disease, once fairly established, soon
 terminates fatally.
   (b)  Chronic Pulmonary Consumption, as  the
 name  implies,  has  a longer duration, lasting
 from several months to years.  The disease may
 commence at any period of life; but the greater
 number of consumptives are attacked between
 the ages of fifteen and thirty-five.
  The  onset is  usually  gradual;  a  neglected
 cold, or a troublesome cough not much noticed,
 may be the starting-point. In other cases, spit-
 ting of blood, followed by cough, is the first in-
 dication;  the cough increases,  and there is  ex-
 pectoration  of  yellowish  or  frothy sputum; at
 the same time other symptoms begin  to super-
 vene.  There  are  often gastric  derangement
 with retching,  white fur  on  the tongue, loss of
 appetite, and gradual  emaciation.
  At night, or on awaking in the early morning,
 the body  is covered with profuse  perspiration.
 There  is  shortness  of breath; the sputum  be-
 comes  thicker,  and when expectorated  into the
 vessel, forms  round  masses of  a yellow  or
 greenish-yellow color.  From the beginning the
 temperature is often above  normal,  especially
 toward evening, and a bright flush is noticed on
 the cheek; the pulse-rate is also  increased. Af-
 ter a varying time, the  symptoms  begin to de-
 crease, the night-sweats diminish,  the  appetite
 improves,  the cough is less frequent,  and there
 is  less expectoration.  The patient gains flesh,
 and strength returns, though  the cough may not
 altogether disappear. During all this  time cer-
 tain changes are  going  on in the lung.  Tuber-
cular material  is being deposited in the upper
part of one or the other lung; this breaks down
or softens, and is coughed up and expectorated
through the bronchial  tubes.  This process is 
 90    THE NURSE'S SERVICE DIGEST

 accompanied by the progressive symptoms above
 described.  When  this has  been accomplished,
 and there is no further increase in the disease,
 the lung is left  with a hole or cavity at that
 part, which gradually contracts and heals up in
 favorable  cases,  though the lung  tissue is not
 reproduced.  In  a  few instances there may be
 no return of  the disease,  and the person  lives
 on with a slightly damaged lung.  In the  ma-
 jority of cases the improvement is only partial
 or temporary, and  after a varying interval an-
 other portion  of  the same lung, or a portion of
 the other lung, is attacked in like manner,  and
 a  similar series of  symptoms supervenes;  until,
 finally, the lung  becomes riddled with cavities,
 and the patient sinks from exhaustion, or from
 one of  the numerous complications incident to
 this disease.
   Management.—Those invalids  who, for vari-
 ous reasons,  are able to do so, should seek a
 higher altitude and drier air, as such a climate
 is  better suited to their condition, and to make
 such changes  in  their mode of  living as may
 tend to remove, as far as possible, any injuri-
 ous influences which may have been productive
 of the disease, or which in  any case  serve to
 increase it.  Amongst these  hurtful influences
 are:—
  1. A damp atmosphere.
  2. Occupations where dust  or small particles
 fill the  air, and cause bronchial  irritation;  for
 instance, the  trades  of  stone-masons, miners,
and grinders.
  3. Overwork, excitement, bad  habits, such as
indulgence  in  stimulants,  and  excess of  any
kind, are also predisposing causes.
  4. Defective  ventilation  and  over-crowding,
again,  produce the same result,  and  are  the 
DISEASES  OF RESPIRATORY  SYSTEM  91

most  important factors in exciting  tubercular
complaints.
  On  the other hand, ventilation and plenty of
fresh  dry air  are potent preventives, and  in-
valids should be instructed to keep  their win-
dows  open in  the day and, when possible, at
night, and should  be encouraged to go out of
doors when the weather is sufficiently fine.
  For the poorer classes an out-of-door occupa-
tion is the most healthy.  A dry bracing atmos-
phere, with plenty of sun and free from wind,
is the most favorable, and  a residence situated
on  a  hill,  protected from the north and east,
with  a dry soil,  is most  suitable.
  Want of food  and defective  assimilation di-
minish the power of resistance and  hasten the
disease, and loss of flesh may precede the devel-
opment  of  the  consumptive  symptoms  when
plenty of food can be  obtained, but  is not di-
gested.  A  careful diet—with  plenty of  milk,
cream, and butter—is  suitable,  but  has to be
varied according to idiosyncrasy.  Cod-liver oil
is  commonly prescribed,  when it  can be di-
gested, and is best taken soon  after  a meal in
orange-wine, lemon-juice, or some other vehicle,
commencing  with a teaspoonful and increasing
the dose to a tablespoonful or more, if it can
be assimilated.  Nausea and a tendency to diar-
rhoea  would indicate  that the dose  should be
diminished.
  Symptoms which call for special  alleviation
are:  cough, high  temperature,  profuse sweat-
ing, and pain in the chest
  Cough.—For this some cough-mixture will be
prescribed by the physician;  or simple rem-
edies, such as barley-tea,  slippery-elm tea, or
equal parts of glycerine, honey and water, with
a small portion  of camphorated tincture of
opium added,  may be  given.   A respirator of 
92    THE NURSE'S SERVICE DIGEST

Coghill's form, or one in which a few  drops of
some antiseptic solution can be introduced, worn
in front of the mouth often relieves the cough.
  Sputum.—The sputa should  be carefully pre-
served  for inspection and  examination.   The
spittoon used by the patient  should be frequent-
ly  emptied into  another receptacle  and  the
sputa saved for  the twenty-four hours.  It is
important that  this  secretion should  be care-
fully disinfected by mixing it with 1-20 carbolic
solution.  Consumptive patients living  at their
own homes should be warned that their expec-
toration may  convey the disease to others  of
the household, and should be instructed how to
disinfect it, or burn it.
  High  Temperature and heat of the skin may
be  alleviated  by  tepid  sponging,  or  different
parts of the body may be so treated while  the
rest is kept covered  (see Tepid Sponging).
  Profuse Perspiration.—Apart from the treat-
ment by special drugs and tepid sponging, it is
advisable that a light flannel garment should be
worn next the skin, so that the moisture does
not soak the linen night-dress, a source of great
discomfort.  The  flannel  should be changed and
dried every morning, or during the night in bad
cases.
  Pain in the chest is usually caused by an out-
break of dry pleurisy, and  may be  relieved by
the application of iodine to the skin over  the
painful  part,  or by  a light coating of equal
parts of essential oil of mustard and  menthal,
or some other form  of  counter-irritation (see
Counter-Irritation).
  Complications  of  greater or less   urgency,
which require  special attention, are  liable to
supervene in the course of pulmonary consump-
tion.  Pneumonia and  pleurisy  produce  their
particular symptoms; others,  such as Haemo- 
DISEASES OF RESPIRATORY  SYSTEM  93

ptysis,  Pneumo-thorax,  Tubercular  laryngitis,
Meningitis,  and Ulceration of the  bowels, re-
quire special mention.
  Hemoptysis, or spitting of  blood, is  a com-
mon incident in consumption, but may also oc-
cur in heart disease and congestion of the lungs.
It is  necessary to distinguish  it from bleeding
from  the stomach or haematemesis (see  Hcema-
temesis).   The  blood comes  up  in  mouthfuls
and  is  coughed up,  not vomited; it  is  bright
red,  often  frothy, mixed  up with phlegm, and
the quantity  of  blood is variable.  In slight
haemoptysis there is a mouthful or two of blood
occasionally; in moderate cases a few  ounces
or  a quarter  to half  a  pint  are gradually
brought up at intervals; in profuse haemoptysis
a pint of blood or more is expectorated in  a
short time;  but  in  the  suffocative  form,  the
blood comes up so rapidly and profusely that
it is inhaled back into the lungs  with each in-
spiration,  and death from suffocation takes
place in a few minutes.
  Management—The  nurse may assure  the pa-
tient  that  the bleeding will soon cease of its
own accord, as it is sure to do in the majority
of cases, and she will send for a  medical man.
  In the meantime, the patient should be placed
sitting up in bed, or on a chair, in a  cool room.
The dress may be loosened about the chest, and
ice applied externally, while small pieces of ice
are given to suck. No speaking, excitement,  or
moving about should be allowed.   After the im-
mediate  attack has  subsided, the  sputum  is
usually  blood-stained  for  some days.   The diet
should be light, without stimulants.   The bow-
els should  be thoroughly relieved, and  perfect
rest  maintained for  some  time afterward.  In
fatal  cases the rapidity of bleeding is so great
that  nothing can  be done.  The patient gets 
94    THE NURSE'S SERVICE DIGEST

breathless, begins to look blue, becomes fidgety
and very  anxious, the eyes staring widely, the
blood pouring  from mouth  and nostrils  in  a
constant stream.  Death takes place in three or
four minutes  from suffocation, and  the urine
and faeces are sometimes passed unconsciously
in the  bed.  In  profuse haemoptysis,  the  ten-
dency to bleed  is diminished when fainting and
depression are induced.   Great care  should be
taken not  to excite a fresh outbreak by over-
stimulation.
  Pneumo-Thorax,  or air in the pleural cavity,
is a serious complication, produced by an open-
ing in the surface  of the lung, through which
the air is  able to pass out into the cavity of the
pleura.  This cavity becomes distended with air
and  the lung  collapses; this  may  occur sud-
denly.
  Symptoms.—After a sudden movement or ex-
ertion, the patient feels a sharp pain in the af-
fected  side,  and   suffers from shortness  of
breath.  In severe cases the dyspnoea increases
and  becomes  urgent, accompanied by lividity,
perspiration, and collapse.
  The nurse should assist the patient into as
comfortable a  position  as possible, and obtain
assistance, since  relief  may in some cases be
afforded by aspirating the chest and removing
the pent-up air.
  Tubercular  Laryngitis.—The deposit of tu-
bercles in  the larynx, and consequent inflamma-
tion, add very greatly to the gravity of the dis-
ease,  and  tend to shorten the duration of the
life to a considerable extent.
  Symptoms   are:   hoarseness,  weakness  of
voice, and  a husky, somewhat metallic, cough.
  The emaciation seems to progress  more rap-
idly in these cases,  and there is greater general
weakness.   The irritation in the larynx  is  a 
DISEASES OF RESPIRATORY SYSTEM  95

constant source of discomfort; and when ulcer-
ation has taken place, there may be much pain,
and perhaps difficulty in  swallowing.
  Tubercular  meningitis and tubercular  ulcera-
tion  of the bowels may supervene in the course
of pulmonary consumption. The symptoms  are
described elsewhere (see  Meningitis and Ulcer-
ation of Bowels). 
CHAPTER  V.
  diseases  of the heart and blood-vessels.

Heart, Pericardium — Valves — Aorta — Pulmo-
  nary  Artery—Systemic,  Portal and  Pulmo-
  nary  Circulations — Movements of Heart —
  Pulse—Dyspnoea—Dropsy—Ascites.
Symptoms  and  Management of  Pericarditis-
  Mitral Valve Disease—Aortic Valve Disease—
  Angina  Pectoris — Fatty Heart — Congenital
  Heart Disease—and Aneurysm  of Aorta.

  Introduction:  The Heart and Blood-Vessels

  The Heart (fig. 33) is a pear-shaped organ,
weighing, in the  adult, from eight to ten ounces.
It is situated near the left center of the thorax
slightly left of the breast-bone, with  the  broad
end or base upward and the pointed end or apex
downward  and toward the left.
  The Pericardium is a  thin serous membrane
or bag, which surrounds the heart, and contains
a small quantity of  fluid, which  lubricates  the
interior and permits the  easy  movement of  the
heart.
  The heart  itself is of  muscular structure of
the involuntary  kind, a  wise provision of  the
Great Creator, otherwise some in a  moment of
despondency  might command the heart to stop
beating.  It  contains four cavities in its inte-
rior.  A partition from  the  base to the apex
divides  it into halves—the right  side receiving
venous, and the  left side arterial, blood.  Each
half is again divided by another partition into
an upper and a lower chamber.
  The two upper chambers are called the Auri-
cles, the two lower the Ventricles.
                     96 
        DISEASES OF THE HEART      97,
                                            ,y
  The Right  Auricle receives  the  two  veMs
which bring the blood back from the upper Jpid
lower parts of the body,  and at its lower ^part
is  an orifice opening  into  the  right  ventricle,
guarded by valves (fig. 34).            J ,
  The Right Ventricle has thicker walls than
the auricle, and in its interior may be seen the
valves just mentioned.   They are  triangular
flaps  of  delicate  membrane,  attached by thin
threads to projecting pillars of the ventricle;
they are three in number, and called tricuspid.
When the ventricle  contracts,  the valves are
floated  up  and  close the  orifice  between the
auricle and ventricle, preventing the blood from
passing back  again.   Another  opening in the
right  ventricle leads into  the pulmonary artery,
which also has three valves to guard its orifice.
Each  valve is  half-moon  shaped,  or semilunar,
and forms a pocket on the wall of the artery.
After the ventricle has contracted, these three
semilunar valves fill  out, and their edges come
together,  thus preventing any return  of  blood
into the ventricle.
  The Left  Auricle  receives  the  pulmonary
veins  from  the lungs, and opens into the left
ventricle  (fig. 35).
  The Left Ventricle has  a very thick wall, and
is  the most powerful part of the heart.  The
orifice from the auricle  is guarded by  valves
similar to those in the right ventricle; they are,
however,  only  two in number, and are called
bicuspid, or mitral.  The other opening from the
left ventricle  is  into the aorta.
  The Aorta has thicker  walls than the pulmo-
nary  artery, and its orifice is similarly guarded
by three semilunar valves.  Behind two of these
valves are two small openings in the arterial
wall,  which are  the  mouths  of  the coronary
vessels, through which  the heart  is  supplied
with  blood. 
98    THE NURSE'S SERVICE DIGEST

           The Circulatory System.

  The General or Systemic Circulation com-
mences with the aorta,  one of  the large vessels
which springs  from the broad end  or base of
the heart.  The aorta leaves the left  ventricle,
and then forms an arch, from  which important
vessels  are derived—namely, the carotid arter-
ies  to the  head and neck, and the subclavian
arteries to the upper limbs.   The main trunk
then  descends  through the  thorax and abdo-
men,  giving off vessels  to  the  different  viscera
and to the walls of the trunk.  In the pelvis it
divides  into two main trunks, which supply the
two lower limbs.
  The blood-supply to the upper limb is  carried
by the subclavian  artery, which passes through
the arm-pit as the  axillary  artery, and on to the
inner side of the arm, forming the brachial  ar-
tery.  At the elbow it divides into two branches
—one, the  ulnar, which descends along  the  in-
ner side of the fore-arm; the other, the radial,
which passes down the thumb  side,  and unites
with  the ulnar in  the palm of the hand, form-
ing an arch from which vessels are given off to
the fingers.  The pulse-beat in the  radial artery
may be easily felt in the wrist close above the
thumb.
  The main artery to the  leg  is called  the  fe-
moral, and can be felt beating  in the middle of
the groin  or hollow  of the thigh;  the vessel
then  curves  round to  reach  the  back  of  the
knee,  where  it is called  the popliteal  artery.
It then divides into branches, which  descend
the leg  and unite, forming an  arch in the sole
of the foot, from which the toes are supplied.
  The veins  collect  the blood  from  the capil-
laries through all the tissues of the body.  The
jugulars from  the head and neck unite with 
        DISEASES OF THE HEART      99

the subclavian, or veins from the arms, to form
the superior vena cava, a large trunk opening
into the right auricle.  The femoral veins from
the legs pass up into the pelvis, and  open into
a  large main  trunk,  the inferior  vena  cava,
which  ascends  the  abdomen,  gathering  veins
from the  interior and viscera before opening
into the right auricle.
  The  Portal Circulation is a branch of the
general circulation;  the  stomach,  intestines,
pancreas, and spleen receive  their arteries from
the aorta; and  the  blood, on leaving these,  is
received into various veins, uniting to form the
portal  vein; this enters  the substance of the
liver and  breaks up  into numerous capillaries.
The blood is then collected by the hepatic vein,
which  opens into the inferior  vena cava  just
before the vessel enters the right auricle.
  The Lesser  or  Pulmonary Circulation.—
The pulmonary  artery, carrying impure venous
blood, leaves the right ventricle and divides into
two branches,  one for each lung.  Inside the
lung this vessel breaks up into small  branches,
which form  a network round the alveoli, or air-
cells.  The  pure oxygenated blood is collected
by  the pulmonary vein and  carried to the left
auricle.
  The Movements of the Heart.—In the healthy
adult the heart  beats from sixty to eighty times
in a minute; in children and  infants the  beat
is more frequent, varying from a hundred  to a
hundred and forty in  a minute.
  The  two  auricles  contract  together,  and
squeeze the blood into the ventricles; the two
ventricles then  contract, and the tricuspid and
mitral valves close their  orifices,  the  blood be-
ing forced on into the large vessels—the pul-
monary artery  and  the  aorta—the  semilunar
valves then  closing.  The  blood cannot get from 
100   THE NURSE'S SERVICE DIGEST

the right  side of the heart to the left without
passing through the lungs,  or lesser circulation;
neither can the blood get from the left side of
the heart to the right without passing round
the general, or portal,  circulation.  The beat of
the heart  is often perceptible against  the front
of the chest, especially when beating with un-
due force and  frequency.
  The Pulse is caused by  the alternate disten-
sion and  contraction  of  the arteries  at  each
beat of the heart, and  this beat can be felt and
counted in those vessels which lie near the sur-
face of the body, such  as the  radial, carotid, or
temporal arteries.  The number of beats should
correspond to those of the  heart, and should be
regular in time and force; irregularity in  this
respect is a common feature of heart-disease.

         Symptoms  of Heart-Disease.
  In  the  different  forms of heart-affections
there are  many symptoms  varying in  character
and  importance which present themselves  dur-
ing the several stages of the disease, and which
will be mentioned subsequently. There are  two,
however, in which the  attentive care of a nurse
is specially necessary, and  which are commonly
present, either  separately or  together, in the
later  stages of most forms of heart-affections—■
namely, dyspnoea and dropsy.
  Dyspncea. — Management. —  Difficulty  of
breathing in heart-affections  is very  much in-
creased by  exertion; and  when  the patient  is
able to go about,  he finds  that walking uphill
or  hurrying  produces palpitation  and rapid
breathing,  which cease when he  has  remained
quiet for a time.
  In more advanced cases, dyspnoea is apt to be
a  constant and distressing feature, even when
the  patient  is in bed  and remaining quiet. 
        DISEASES OF THE HEART     101

There may be paroxysms of the bad breathing,
and  the respiration is often panting and gasp-
ing in character. The patient is intolerant of a
recumbent position, and prefers to be propped
up in the bed, with the shoulders well raised,
but  the  heart's  action is  always relieved  by
placing  the  body  in  a  recumbent position.
Others have  a great desire to  get out of  bed
and  sit in a chair, or to  let their legs hang
down;  the breathing may  be much relieved by
this  position, care being taken that the body is
properly  covered up, and  the legs wrapped in
blankets.
  Dyspnoea from  pulmonary congestion  is  a
common  complication secondary to  heart-dis-
ease, and  is usually accompanied by cough. The
lividity in these cases is often very intense—af-
fecting the lips, face, ears, hands, and feet.
  Dropsy is  caused by the more fluid parts of
the  blood escaping from  the blood-vessels  and
capillaries, and  filling up the spaces in the con-
nective-tissue of the body, or collecting in the
cavities of the abdomen or thorax.  Difficulty in
the  return of blood to the heart is a common
cause of dropsy.
  CEdema is  the term given to dropsy of the
subcutaneous tissues, and  by Ascites is under-
stood a  collection of  fluid in  the peritoneal
cavity of  the abdomen.
  Dropsy  from heart-disease commonly appears
first as a slight swelling  about the  ankles or
insteps, which comes on toward evening; if the
parts are firmly pressed by the  finger for a few
seconds  a  dent  is  left.   The  swelling,  or
"oedema," may extend up the leg and appear in
all  parts  of the  subcutaneous tissues, being
more marked where the skin is loose, as in the
eyelids, beneath the eyes, and through the scro-
tum. 
102   THE NURSE'S SERVICE DIGEST

  Management.—The  dropsical   condition  is
sometimes severe enough to prevent the patient
from getting out of bed, or even moving himself
in bed,  and bed-sores are apt to form on parts
where there is much pressure, which  should
always  be guarded with  care.
  Heavy and dropsical patients are very help-
less, and the nurse requires  assistance in mov-
ing and raising them.  Some help  may be given
by a rope  fastened to a ring firmly fixed into
the ceiling above  the patient's head, by which
he is enabled to pull himself  up by his hands.
  In some  cases the skin, which has been first
thoroughly  cleaned  and  oiled,  should be fre-
quently  anointed with  some stimulating absorb-
ent which should be recommended by  the med-
ical attendant, the object being to drain off the
fluid from  the parts, through the pores  of  the
skin.
  The nurse will have to attend  constantly  to
the bed, which becomes  wet unless the exuda-
tion  is  soaked up in absorbent cotton batting,
and  she must watch the skin, observing  great
cleanliness,  as cellulitis  or  erysipelas may  su-
pervene.
  Ascites causes distension of the abdomen with
fluid; this distension may become so great as to
interfere with the breathing  by pressing on the
diaphragm.
  Management.—Tapping the abdomen may  be
necessary, for which the nurse should be pre-
pared with  a broad flannel  binder of  sufficient
breadth to reach  from the  lower  part of the
sternum  to  the  pubes, of sufficient  length  to
pass once and a half or  twice round the  body,
and  arranged to  fasten  with safety pins  or
tapes.  A pad of antiseptic gauze and collodion
will  be  necessary  for  the puncture, and  large
pails to catch the fluid,  which may amount  *o 
         DISEASES OF THE HEART     103

several gallons.  In the  case of  a female pa-
tient, the nurse should draw off the urine im-
mediately before the operation.  The bed may
be prepared with a mackintosh sheet under the
body, and the patient  should occupy a position
on one side, so that the protuberant abdomen
projects over the edge of the bed.

            Diseases of the Heart.
  The common causes  of heart-affections are:
rheumatic  fever,  over-strain,  bronchitis, and
emphysema.  Of  these, rheumatic fever takes
the first place.  In the course of  the fever, in-
flammation  may attack the valves or the peri-
cardium, and lay  the  foundation of a disease
that  is permanent, and produces  more or less
obstruction  to the circulation through the cav-
ities  of the  heart.
  Pericarditis.—Inflammation of the interior of
the pericardium interferes with the action  of
the heart, and is  a common and serious com-
plication of  rheumatic  fever, and of pyaemia.
  Symptoms.—The symptoms of the acute form
are:  fever,  pain in the region of the heart, dif-
ficulty in breathing, and  feeble  pulse.  If effu-
sion  of fluid takes place,  filling the pericardial
sac, graver  symptoms are present; the pulse is
more affected, there is  a  tendency to faintness,
and the dyspnoea is urgent and accompanied by
lividity and sweats.   The disease  may  begin
very  insidiously in children, and the inflamma-
tion may advance considerably without any spe-
cial complaints having been made.
  Management.—Apart  from  the  special man-
agement of  rheumatic fever, patients  suffering
from  pericarditis  with effusion should not be
allowed to sit up in  bed,  move suddenly,  or ex-
ert themselves in any  way, as fainting may be
induced, with fatal termination.  For the relief 
104  THE NURSE'S  SERVICE DIGEST

of pain,  blisters or some form of counter-irri-
taion over the heart are useful.
  Valvular Disease of the Heart.—As the re-
sult  of inflammation of the valves, changes are
produced which interfere with the  circulation
of the  blood through  the different orifices, and
cause enlargement of the  walls  of  the heart.
There are two sets of  valves which suffer in the
majority of cases: the  mitral and  the aortic
valves.  The course and  symptoms of the two
affections have in many respects quite different
characters.
  Mitral Valvular Disease. — Symptoms. — A
large number  of individuals suffer from minor
degrees of disease of  the mitral valve, but are
able to engage in the ordinary affairs of life,
exercising rather more care than a healthy per-
son.  In this way they may attain a fair age,
though their lives are checkered with intermit-
tent periods of illness, and they  should  be ex-
amined at frequent  intervals by  a competent
physician, whose advice may add many years to
their lives.  It  is in the course of the  many
complications  to  which they are liable,  or to-
ward the end  of their existence, that they may
require the  care of a  nurse.
  Complications of mitral  disease are dropsy
(see Dropsy) and congestion or inflammation of
the lungs.
  The  pulmonary complications are  among the
most common, and are caused by bronchitis or
congestion of the lungs.
  Symptoms.—Cough,   difficulty  of  breathing,
and  lividity, with perhaps  slight  oedema of the
feet, and a trace of albumen in the urine, which
should be analyzed at frequent intervals.
  Management.—A patient with mitral disease
exhibiting these symptoms should stay in bed,
keep to light  diet,  and  take some preparation 
DISEASES OF THE HEART     105
that will act on the liver and bowels, until the
bowels  are  freely  relieved.   The  attack  may
subside with these simple  measures,  or  the
symptoms may tend to increase, and the dys-
pnoea become more urgent. It is not uncommon
for haemoptysis to come on in these cases  with
sometimes considerable relief to the pulmonary
symptoms (see Bronchitis, &c).
  Digitalis is a  drug constantly  employed in
the treatment  of heart-disease, steadying  and
strengthening the action of the heart and pulse,
and increasing  the  quantity of the  urine.
  Symptoms  of Overdose.—The nurse should be
acquainted  with the  symptoms  indicating  an
overdose or an accumulation of the drug in the
system.  In  such cases  the patient complains
of nausea, loss of appetite, and a sense of  flick-
ering in front  of the  eyes; he feels giddy and
sick, and the pulse  becomes very irregular, vom-
iting  and faintness may occur, and the urine is
diminished in  quantity.   Patients  taking  digi-
talis, especially  if the drug is  being pushed,
should  remain in bed, or lie down, and avoid
suddenly raising the head.  If symptoms  arise
indicating  an accumulation of the drug in the
system, the nurse should omit the dose until the
physician's visit.
  Fatal terminations in mitral  disease are
usually preceded by severe  attacks of one or
the other of these complications, or by failure
or  dilatation of the walls of the heart.  Sudden
death in the ordinary  acceptation of the term is
uncommon.
  Aortic  Valvular Disease.—Males  are  infi-
nitely more  subject to this form of heart-dis-
ease  than females.  When  severe, it  is  most
dangerous to life, and sudden death is not un-
common termination.  It may result from over- 
106   THE NURSE'S SERVICE DIGEST

work, rheumatic fever, or excess, and it may be
associated with disease of other valves.
  Symptoms.—Persons  suffering from  this  af-
fection are usually pale, though well-nourishod,
and  complain of shortness of breath, with per-
haps  pain in the chest and  a feeling of faint-
ness, especially  on exertion; sleeplessness and
great restlessness are also common features.
  Management.—In aortic disease, sudden death
may occur from syncope or  faintness,  and  pa-
tients suffering from this disease should avoid
hurrying, especially uphill, should eschew heavy
or large meals and excesses of any kind.  If
these is faintness, they  should lie down,  the
head being placed  as low as, or lower than,  the
body.
  Angina Pectoris,  or  pain in the chest, is  the
name given to a painful and dangerous symp-
tom,  sometimes occurring in connection with
aortic disease, or some other heart-affection.
  Symptoms.—It is characterized by a more or
less  sudden spasm of pain in the region of  the
heart, with dyspnoea, and a  sense of approach-
ing  death.  The pain is of  a peculiar  nature,
often described as  "crunching,"  and  radiates
down the left arm to the fingers, and  into  the
back, producing a sensation  of numbness.  In
severe attacks the breathing is much  affected,
the  face becomes  pale  or livid, and is covered
with drops  of sweat   In a  short time, the se-
verity of the pains usually  passes off; but in
some instances the attack proves fatal.
  Management.—Since  the attacks are very li-
able  to  occur after exertion, any unnecessary
strain should  be avoided.   The  state of  the
stomach seems in  some  cases  to  influence  the
attacks; and heavy meals, especially at a late
hour, are unadvisable, and must be avoided.
  The greatest relief is  sometimes experienced 
        DISEASES OF THE HEART      107

during the attack from the inhalation of nitrite
of amyl.  This fluid has the odor of pear-drops,
and  when a few  drops have been inhaled,  a
warm sensation is  felt over the surfacevof the
body, and the face and neck become flushed, the
spasm in many cases  being  cut  short  or im-
mensely relieved by the inhalation. Five or ten
drops may be used at a time  on a pocket-hand-
kerchief,  but  is better inhaled from  a small-
sized bottle, and repeated, if necessary, until the
full  effect is produced  or relief  gained.   It is
better for the patient  to be recumbent when
using the inhalation.
  Dilatation of the Heart and  Fatty  Degen-
eration of the walls may exist apart from val-
vular disease, and are  often fataL
  The former may supervene upon long-stand-
ing bronchitis and  emphysema; the latter  from
drink and various other causes;  both these af-
fections frequently end in sudden death.  Pul-
monary complications or dropsy often appear at
a late stage in the disease.
  Congenital Malformation  of  the Heart.—
The  subjects of this affection  are born with an
imperfect condition of the heart, the cavities be-
ing  sometimes incompletely  separated  on the
two  sides.
  The marked features in these cases  are: ex-
tensive  blueness, lividity, and coldness  of the
lips,  face, ears, and extremities.   There  is dys-
pnoea,  and sometimes  the ends of the  fingers
and  toes  are knobbed or "clubbed,"  as  it is
called, the last digit being rounded and larger
than is normal.  The majority of these patients
die in childhood, either with convulsions  or pul-
monary  complaints.  They suffer much  from
cold  and impeded circulation,  and require to be
well wrapped  up,  the extremities being  kept
warm. 
108   THE NURSE'S SERVICE DIGEST

  Aneurysm  is  a disease  of  the  arteries, and
may  affect almost any  vessel,  although it  is
much more common in regions where the artery
is exposed to strain.  Disease  or an injury cre-
ates weakening  of the wall of the vessel, and
bulging at the part  affected.  The swelling in-
creases and forms a tumor, varying in size,  in
which pulsation  can  be felt.
  The aorta,  subclavian,  femoral,  and  popliteal
arteries are common sites for  aneurysm.
  Aneurysm  of  the Aorta is a very grave af-
fection, and  may  produce a  variety of symp-
toms  from pressure on  the  many important
structures near  it.   Among these, pain, diffi-
culty  in swallowing or breathing,  loss  of voice,
and swelling  of  the  arm and  neck are not un-
common.  Sudden death may occur from rup-
ture of the aneurysm and  haemorrhage into in-
ternal parts.
  Management.—Attempts  are sometimes  made
to cure the disease by absolute rest in  bed, and
restricted diet;  in these cases the nurse may
have  difficulty in insuring that the patient  at-
tends to the  rules and restrictions,  which are
irksome, and are perhaps infringed as soon  as
her back is turned.
  Aneurysm of the Vessels of the Extremities
is treated by rest, or surgically by pressure  or
operation  (see Pressure and Hcemorrhage After
Operation). 
CHAPTER VI.
      diseases of the digestive system.

The  Organs  of  Digestion—The Mouth—Teeth
  — Tonsils— Pharynx— Epiglottis— Parotid
  Glands—Gullett—Stomach—Liver and Bile—
  Intestines — Peritoneum — Foods — Digestive
  Processes—Lymphatics—Indigestion— Vomit-
  ing—Haematemesis—Jaundice.
Symptoms and Management of Gastric Ulcer—
  Colic—Gall-Stones—Peritonitis—Typhlitis—
  Intestinal  Obstruction — Diarrhoea — English
  Cholera.

          The  Organs of Digestion.
  The tube through which  the food  passes  is
called the  Alimentary Canal,  and consists of
several divisions.  The upper part, into which
the food passes from  the back of the mouth is
the Pharynx.  Below the pharynx is the oesoph-
agus, which is situated in  the neck behind the
windpipe, and descending the hind part of the
thorax  pierces  the diaphragm and opens into
the Stomach.  The stomach lies in the upper
part of the abdomen  and  opens into the Intes-
tine,  which  finally terminates in the Rectum
(see fig. 38).
  The  Mouth.—The  interior  of  the mouth
should be inspected in order that the  main fea-
tures may  be identified.
  The Teeth.—The complete permanent  set  in
the half of each jaw  counting from the middle
                     109 
110  THE NURSE'S SERVICE  DIGEST

line are as follows:—Two incisors, one canine,
two bicuspids, and three molars, making in all
thirty-two in both jaws.
  The  Teeth, were intended to remain  for  our
use as long as the body should last, and would
probably do so, if our food was properly  selected
as nature intended,  and  they were given  the
care they  required for  the  exacting service de-
manded of them.
  They are  the  first  of   two  all important
agencies, that of  mastication  and  insalivation,
consisting in cutting and grinding the food, by
their action it is reduced to a minute subdivis-
ion, during this process  the salivary glands, situ-
ated in the cavity  of  the  mouth,  inject their
fluid into the mass being  triturated, this fluid
softens and lubricates the  food,  aiding  mate-
rially in deglutition and the first stage of diges*
tion.
  Next to the  beauty  of  the eye, the clean,
healthy teeth, stand forth prominently claiming
our admiration, materially  adding  to  the at-
tractiveness of the features, besides preserving
the contour of  the jaws, by rounding  out  the
symmetrical shape of the entire face.
  Nothing  is  more unattractive  than  coming
face to face with  a person  showing a mouthful
of decayed, broken and discolored  teeth.
  Unfortunately,  like  the  neglect of  bodily
health, many pay  little or no attention  to their
teeth,  until they  begin to  ache, which  usually
occurs only when decay has exposed the  pulp
of the tooth, which contains a nerve, an artery
and vein.
  In the case of children, they  should have their
teeth examined by a competent dentist every six
months, and adults at  least once a year; when
decay  is discovered,  in either case, the cavity 
    DISEASES OF DIGESTIVE SYSTEM  111

 should be properly filled to arrest the decay,
 and prevent the entire destruction of the tooth.
   Decay of the teeth is caused by particles of
 food remaining between them after mastication;
 the food held in  this position  decomposes,  and
 soon does its deadly work of destroying one or
 both of the teeth.   These  particles  of  food
 should always be  promptly removed with a stiff
 quill pick, or with floss-silk, after each meal.
   The wooden  tooth-picks,  furnished in some
 hotels and  restaurants, should not be used, as
 they are too thick to pass between the teeth
 properly, besides  they splinter on the used end,
 and these sharp  splinters wound  and irritate
 the gums.
   The teeth should be brushed after  the morn-
 ing and evening meal; a four- or five-row brush
 is  best for  the use of adults, and a three-row
 brush  for  children's  use.   The brush  should
 never  be passed  back  and forth over the sur-
 face of the teeth;  the upper teeth should always
 be brushed dotvn,  giving the brush a rotary  mo-
 tion, both  inside  and out and the lower teeth
 brushed upward, giving the same rotary motion
 to the brush.  In  this w ly, the bristles pass be-
 tween  the teeth, removing the particles of food
 lodged between them; this way of brushing may
 appear awkward at first, but with a little prac-
 tice, will become very  easy,  and is  far more
 beneficial.  While brushing from front  to back
 of the mouth, the bristles run in the depressed
 parts of  the teeth, close to the gums, where the
 enamel is thinest, and in time  this process of
 brushing, will wear through the  thin  enamel,
 often making the  teeth unnecessarily sensitive.
  A tooth-paste,  or  dentifrice,  should not  be
used more than once a day, preferably after  the
evening meal. 
112   THE NURSE'S SERVICE DIGEST

  The tongue occupies  the floor of the mouth
and  its surface is covered with  raised papilla3
or projections,  some at  the back being of large
size; under the tongue is a thin band of  mu-
cous membrane, the fraenum, and on either  side
of this may  be seen the two small orifices of
the  salivary  ducts,  the  glands  of which  are
situated underneath the floor of the mouth.  The
palate, or hard  part of the roof of the mouth,
forms  an arch  between  the upper teeth;  the
soft  palate, depending from the  back,  rises  and
falls  with the  breathing.   The  uvula hangs
down as a projection  from  the  middle of  the
soft  palate, and  on either side are the  pillars of
the throat  or fauces, from the  sides  of which
project  two rounded bodies, the  tonsils.   The
posterior nares are the  openings at the back of
the nostril behind and above the soft  palate.
  The  Pharynx is  the  cavity at  the  back be-
hind the fauces into which open  the upper  end
of the windpipe and the top of  the gullet  (see
fig. 39).
  The  Epiglottis.—Situated at the root of  the
tongue is a flap of cartilage, hardly visible on
looking into the inside of the mouth, which  cov-
ers  over the opening of  the glottis or larynx
in the act of  swallowing, and  prevents food
from passing into it and "going the wrong way."
  If  food, or any foreign body,  enters the  lar-
ynx  by  accident,  a violent expiratory effort,
"choking"  or coughing,  is  produced to  dis-
lodge it.
  The Parotid Olands are situated  one in front
of each  ear;  they  are  salivary  glands,  and
their secretion is carried to the mouth by  a
duct  which opens  on  the inner  side of  the
cheek.  It is  the swelling  and inflammation of
these glands which produces the enlargement of
the face  in the disease known as "Mumps." 
    DISEASES OF DIGESTIVE SYSTEM  113

  The Oesophagus, or gullet, conducts the food
into  the  stomach;  its  length is about  nine
inches, and it is lined by mucous membrane.
  The Stomach is a large bag capable of hold-
ing two quarts;  it lies  transversely  below the
diaphragm; its left larger end being connected
with  the gullet;  the right is  narrower and be-
comes constricted where it opens  into  the first
part  of the  small intestine.   The  constricted
portion is called the Pylorus  or Pyloric Valve,
and when closed prevents the food from pass-
ing out of the stomach.  The mucous membrane
of the stomach  presents a honeycomb appear-
ance,  and contains millions of  little tubes, which
are really  glands, producing  a fluid  called the
gastric juice, which  is  constantly poured  out
into  the  stomach, and  contains  a  substance,
pepsin, which digests the proteids.
  The Intestines, or bowels,  form the remain-
der  of the  alimentary  canal, and  are from
twenty-eight  to  thirty-six feet in  length, being
divided into  the small and large intestine.
  The Duodenum, or the first part of the small
intestine,  commences  at the pylorus  and re-
ceives the bile duct.  The remainder forms nu-
merous coils, terminating in the caecum, or first
part  of  the large intestine,  its  orifice being
guarded by a valve.
  The Liver  is the largest and most important
gland in the body, and is situated  below  the
ribs  on the  right side.   It  secretes  the  bile
which is stored  up in the Gall Bladder on the
under surface of the  liver.  The  bile duct is
joined by  the duct from the Pancreas, another
gland, and conveys the bile and pancreatic fluids
into the duodenum, small intestine (see fig. 40).
  Caecum and Large Intestine.—The first part
of the large intestine, or the caecum,  is a pouch
situated in the right iliac region.  A small trap-
.., £> 
114   THE NURSE'S SERVICE DIGEST

like tube, with a closer extremity opens into the
caecum, and is called the Vermiform Appendix.
The large bowel, or Colon, then ascends, crosses
the abdomen above the navel, and descends the
left side to end in the rectum or lower bowel, its
orifice being controlled by muscular fibers or a
sphincter  at the anus.  The interior of the in-
testines is lined by mucous membrane  contain-
ing glands of  various kinds in the different re-
gions.   Those in  the intestine called  Peyer's
glands are noteworthy, as being inflamed in ty-
phoid fever.
  The walls  of  the  alimentary  canal  contain
muscular  fibers,  which by their action  cause a
"worm-like" movement of the tube called peris-
talsis,  the food being forced onward.
  Peritoneum.—The many  feet  of  bowel are
coiled up, filling the greater part  of the cavity
of the  abdomen,  and are  covered  by  a fine,
delicate, elastic  membrane,  the  "peritoneum,"
which also lines the interior of the wall of the
abdomen,  and  serves to attach the bowels to the
vertebral  column.

                    Food.
  The diet of  a healthy individual Is commonly
a mixed diet, and contains  different forms of
foodstuffs.  A fair average  daily  diet  for  a
grown man would  be—
  Bread, 12 ounces; butter, 1 ounce.
  Meat, 6 ounces (dressed) ; potatoes, 6 ounces
(dressed).
  Rice, sago, tapioca,   or bread pudding,  6
ounces.
  Milk, tea, coffee,  or beer, 1 pint.
  A mixed diet should  contain  foodstuffs ca-
pable of restoring  the waste of the tissues, and
keeping up the  heat of  the body, and should
never be more than what could be fully digest- 
    DISEASES  OF  DIGESTIVE  SYSTEM  115"

ed;  any excess only  adds to surplus fat and
obesity, and if not assimilated, acts as  an irri-
tant, sometimes passing off in diarrhea.
  The different foods may be classified  as pro-
teids, fats,  and amyloids.
  Proteids  contain  carbon, hydrogen,  oxygen,
and nitrogen; under this head  may be men-
tioned meat, flour, egg or albumen, cheese, gel-
atine,  etc.;  being rich in nitrogen, they  are
sometimes called nitrogenous foods.
  Fats are  composed  of carbon, hydrogen, and
oxygen, and include oils, vegetable and animal
fatty matters—best suited for cold-weather diet.
  Amyloids  contain less hydrogen than the fats,
and comprise starch, sugar,  bread, rice, sago,
arrowroot, potatoes, etc., best  suited for  warm
weather.
  In addition to these foodstuffs,  water and
minerals enter largely into the composition of
the body.

              Digestive Processes.
  Digestion.—The processes in the  alimentary
canal by which  the  different foodstuffs are pre-
pared  for absorption  and made use of  in  the
economy of the body  are  called  "digestion."
  The proteids  are acted upon by the  gastric
juice, which is  acid and  contains the ferment
pepsin,  the  albumens  being  transformed  into
peptones.
  The  fats  are  reduced to an emulsion by  the
action of the bile.
  Of the amyloids sugar is easily dissolved, and
requires no  further  change to enable it  to pass
into the blood.   Starch, on the other hand, is
useless  and  insoluble until it has been  acted
upon by the saliva, which contains  a ferment,
ptyalin,  possessing  the  power  of  converting
starch  into  sugar. 
116   THE NURSE'S SERVICE  DIGEST

  During a  meaL a  mouthful  of bread  and
meat, for instance, is ground up by the teeth,
rolled  over  in the mouth by  the tongue,  and
should be thoroughly mixed up with the saliva,
which converts much of the starch in the bread
into sugar.   The  mouthful is then swallowed
and  received into  the stomach, where  the  gas-
tric  juice acts upon  the  proteids contained in
the  meat and  bread,  and converts them  into
soluble peptones.   The food now  rendered more
fluid, passes  through the pyloris  into the duo-
denum,  where it becomes mixed  with  the  bile
and  pancreatic juice.
  The  bile converts the fats  into an  emulsion
which can pass into the lymphatic vessels,  and
the pancreatic juice acts upon the  rest of the
starch  which has  escaped the saliva,  and  also
assists further to  complete the other  digestive
processes.  The food, now in the  form of  a
creamy-looking fluid, called Chyle, is forced on-
ward through the intestines by  the peristaltic
action, the most soluble parts being absorbed at
once by  the blood-vessels, while  the fatty par-
ticles are taken up by the other vessels of the
lymphatic system.
  Lymphatic System.—The mucous membrane
lining the alimentary canal is abundantly sup-
plied with minute  tubes;  those of the intestine
being called  Lacteals,  because  the fluid  they
contain, and which they have absorbed from the
chyle,  is of  milky  appearance.   The  lacteals
unite together to form  larger vessels,  which
finally  open  into  a duct called  the  Thoracic
Duct.  The thoracic duct ascends the  trunk in
front of  the spinal column, and opens into the
left subclavian vein, pouring its contents of nu-
tritious  milky  fluid  directly  into the  blood
stream.
  The water and minerals are readily  absorbed 
   DISEASES OF DIGESTIVE SYSTEM  117

by   the   blood-vessels  without  any  further
changes.
      Diseases of the Digestive System.
  Diseases of the Alimentary Canal.—There
are certain symptoms which are common to a
large number of disorders of the digestive sys-
tem ;  for instance, indigestion,  vomiting, heema-
temesis,  and jaundice.   These  may  be consid-
ered  separately,  but they  will  receive  notice
under the particular diseases  in which they
occur.
  Indigestion, or Dyspepsia, means difficulty to
digest, and  is  indicated  by a group  of  minor
symptoms, one  of the most  common being pain;
loss  of appetite,  furred  tongue,  fetid breath,
flatulence, pain and burning sensation  in the
region of the stomach, tension,  dull headache,
drowsiness after eating.
  It is one of the most prevalent diseases  of the
day, and may be caused by whatever interferes
with  the healthy action of  the stomach and in-
testines.   That this  disease is becoming  more
prevalent year by  year is  plainly seen by the
careful observer.
  An eminent practitioner has  said that no per-
son could be persuaded to pay due attention to
his  digestive organs until death  was staring
him in the face.
  There  is little doubt that the increase of dys-
pepsia is caused by the present imperfect  way
of living; as the mode of living apparently can-
not be changed, we must provide other means to
correct the  evil as we  find it
  Happily, of  all the organs  of  the body, the
stomach is the one on which we can exert the
most powerful  action,  both directly  and indi-
rectly.
  The pain  varies  in  character, affecting the 
118   THE NURSE'S SERVICE DIGEST

left  side  and the  back between  the shoulder
blades,  and it  usually  bears some  relation to
the meals and the kind  of food eaten, commenc-
ing a few minutes or an  hour or more after-
ward.   Flatulence,  or  gas in the stomach or
bowels,  often accompanies the other symptoms
of indigestion,  and is apt to cause palpitation
of the heart.  Flatulence is often increased by
potatoes, green vegetables, or strong tea.  Pain
and  a sense of fulness  are frequently due to a
large meal eaten hurriedly.
  Indigestion may  be a symptom  of grave dis-
ease of the stomach, such as ulcer  or  cancer,
but commonly it is a functional disorder.   The
common causes of indigestion are:  indigestible
food, constipation, chills, overwork, or excess in
alcohol.
  Food  may be  indigestible from being improp-
erly cooked or  deficiently masticated,  and the
kind  of food unsuitable to  one dyspeptic may
agree with another, so  that no one rule applies
to all cases.
  It is  doubtless true  that the  stomach  occa-
sionally requires the assistance of medicine to
enable it  to act efficiently, for we must  remem-
ber  the battle  of life is often severe,  and the
digestive organs, which are usually overworked,
are the first to sympathize  with the depressed
mind and fatigued  body.
  Management.—Inquiry should be made to as-
certain  the cause  of the  indigestion, in order
that it  may be  removed.   A healthy mode of
life, regular habits, and attention to the bowels
are  of  first importance.   When  there  is much
acidity  or burning in the throat, sugars, sweets,
and wines should be avoided.
  Vomiting,  or  the ejection of the contents of
the stomach by  the mouth, is frequently preced-
ed  by a sense of nausea, and may be accompa- 
    DISEASES OF DIGESTIVE SYSTEM  119

nied by faintness.  In many cases it is an effort
of nature to get rid of obnoxious material from
the  stomach,  and  the effect  is  salutary.   A
glass of hot water  with a teaspoonful of table
salt will evacuate the  stomach and  will often
bring the  quickest relief.  In others  it is  a
symptom  of  serious  malady,  either  of  the
stomach or a remote part, but the sympathy of
the stomach with other organs is so  close that
vomiting is a  common accompaniment of  dis-
ease of the brain, kidney, and uterus.
  In  hysteria  frequent vomiting  may  be nat-
urally present,  or it may be artificially produced
by the patient  by means of emetics or mechani-
cal irritation  of the  back of the  tongue  or
fauces.
  Management.—Points to be noted are the time
at which the vomiting occurs in relation to food
or  to the kind of food;  whether the vomiting
was preceded by pain, and  whether the pain is
relieved by vomiting; whether the vomiting oc-
curs at a particular time  of the day,  as, for in-
stance,  the early  morning; in suspected hys-
teria, whether  the patient seems to induce vom-
iting by tickling the fauces or  by efforts at eruc-
tation.
  Matters Vomited.—The vomit should  always
be  inspected and put aside to be examined by
the medical attendant.  In many cases it merely
consists of  partially  digested  food, and  has a
sour-smelling odor,  due to the gastric juice.   In
continuous vomiting,  there is often  much  bile
mixed  with the vomit,  of yellow,  green,  or
brownish color.  In the persistent vomiting of
intestinal  obstruction,  the fluid has  a dark
brown color, is of the consistency of  gruel,  and
very  offensive, becoming  faecal in odor  in  se-
vere cases.  In cancer and cases of dilatation of
the stomach, the fluid  is  thrown up  sometimes 
120   THE NURSE'S SERVICE DIGEST

in very large quantities, a quart or more  at a
time.   It is apt to remain in the stomach for a
long time,  until  fermentation and  some decom-
position has  taken place before it is ejected,
and it is frothy and mixed with gas; in  such
cases  a glass of hot salt water  often gives im-
mediate relief after the stomach has been evac-
uated.
  HjEMAtemesis.—Vomiting of  blood is a  com-
mon symptom in ulceration of  the  stomach, or
in congestion from disease of  the liver.  The
vomiting is of ten preceded t»y a sense of fulness
or pain in the stomach, and some faintness; on
recovering  the faintness, the blood  is promptly
vomited from half  a pint to a  quart or more.
The appearance of  the blood varies slightly; it
may be dark red, black, or dark brown in color,
like "coffee grounds," the dark color being  due
to the action of the gastric juice,  and there is
often  some food mixed with the  blood.  The
attack may be and  is usually a single one, but
it may be followed by repeated  haemorrhage,
and, if profuse, is dangerous to life.
  Management.—Nothing should be given by the
mouth except a lktle ice or iced water, and in
severe cases no food whatever until  the stomach
has had a  complete rest; where there is much
syncope, the head should be kept  low, and an
ice bag may be placed over the stomach.   For
some  time afterward great caution should be
taken in giving food by the mouth, the strength
being  maintained by nutrient injections.  Haema-
temesis is often feigned by malingerers, or hys-
terical females,  a small quantity  of blood be-
ing ejected usually  in the morning.  The blood
is produced from the mouth, throat, or gums by
sucking or  wounding the mucous membrane.  It
has the appearance of  plum juice,  and  is a
glairy, watery fluid  mixed with  saliva.  In some 
    DISEASES OF DIGESTIVE  SYSTEM  121

cases the haematemesis is due to bleeding at the
back  of the nostril, the blood being swallowed
during sleep and vomited in the  morning; this
is more apt to occur in children.   After haema-
temesis the  motions should  be  examined  for
blood (see Melaena).
  Jaundice.—A slight  degree  of jaundice ac-
companies several kinds  of  fevers,  blood-dis-
eases, and occasionally  pneumonia.   Intense
jaundice occurs in diseases which obstruct or
close the common  bile duct, as in  gall-stones. It
is also present in  varying .degrees in several of
the diseases of the liver and alimentary canal.
In  such cases, the liver should  be treated ac-
tively by  stimulating the natural  secretions un-
til  the  flow of  bile is  again started, the liver
stimulant  should  be  kept up for several days,
or  even a week,  until  the alterative effect is
gained.
  It  is  first noticed as  a yellow  tinging of the
whites of the eyes and the skin of the body, and
itching  of the skin is often complained of.   The
urine is high colored, amber colored, or of va-
rious hues of  dark green or dark  brown, ac-
cording to the degree of the jaundice, indicating
that  the whole system has been poisoned by the
stoppage  and absorbtion of the  bile  and other
secretions that nature  is trying to discharge
through the pores.   The sweat  is yellow,  and
stains the linen.   The motions,  on  the other
hand, are of light clay color,  drab,  or almost
white, constipated, and  unusually offensive.
   In cases of closure of the bile duct, the jaun-
dice  is intense, and the secretions correspond-
ingly affected, with great depression of spirits,
loss  of appetite, nausea,  and  vomiting.   There
is emaciation,  great  weakness, and  the itching
of  the  skin is  intolerable, and  aggravated by
warmth in bed. 
122  THE NURSE'S SERVICE DIGEST

  Management.—Some relief from the  itching
may be obtained by tepid  sponging, or  with  a
lotion of weak carbolic acid, or equal parts of
glycerine and water.   In jaundice due to chill
or constipation,  the condition of the bowels re-
quires constant attention, and in most  cases the
bowels are confined, and should be freely evac-
uated.
  Gastritis and Gastric Ulcer.—Ulcer of the
stomach is prone to attack  young women suffer-
ing from anaemia.  The patients are not  uncom-
monly  domestic servants of pale aspect, who
suffer from chronic indigestion.
  The  Symptoms  of  gastric ulcer are  mainly
those of indigestion, but  the  pain is usually
much more acute,  with tenderness over  the pit
of  the  stomach, and  intolerance of  pressure.
The pain is aggravated by  solid food,  and vom-
iting often relieves the pain.   In some cases
there is an attack of haematemesis, followed by
melaena (see Haematemesis).
  Perforation of the Stomach is a catastrophe
which  occurs in  a certain number  of these
cases, and is fatal either  within a few hours
from collapse and shock,  or subsequently in  a
few days from severe peritonitis.
  The  patient,  usually a  young woman,  with
symptoms of gastric ulcer,  or indigestion, is at-
tacked after a meal with severe, agonizing pains
in the abdomen, attended  with faintness, vom-
iting, and collapse, the abdomen being  distended
and extremely tender; the pulse fails, the face
becomes pinched, the eyes  sunken; and  the ex-
tremities cold,  and copious perspiration breaks
out, death occurring usually in from  twelve to
forty-eight hours.
  Management.-—The diet of a  patient suffering
from gastric ulcer is of the highest importance;
solid food  should be  avoided,  and  cool  and 
    DISEASES OF DIGESTIVE SYSTEM  123

easily  digestible fluids  only  allowed.  If there
is severe pain, or  haematemesis,  the feeding
should be carried on by nutrient injections,  and
nothing but a little ice allowed by the  mouth.
Counter-irritation to the epigastrium often gives
relief,  and rest in bed should be insisted on in
severe cases.  The vomit should be saved,  and
the motions inspected for blood. A heavy meal,
indigestible  food, or exertion may cause  the ul-
cerated wall of the stomach to give way.
  When perforation  has occurred, the drug ad-
ministered is either  opium or morphia, to allay
the pain,  and soothing  fomentations to the ab-
domen (see Peritonitis).  An abdominal  opera-
tion performed  early  has saved  life in some
cases.
  Intestinal  Colic—Symptoms.—The pain is
of a griping character, and is situated  in  the
bowels. The common cause is constipation  and
flatulence, or the presence of some indigestible
material in  the intestines.  The pain is relieved
by pressure and warmth, and after an aperient
and free action of the bowels, is removed.  The
temperature is not usually raised  unless there
is some further complication.   Intestinal colic
may be a  symptom in obstruction of the bowels,
or inflammation of the caecum.
  Management.—The safest method of acting on
the bowels in all doubtful cases is  to make use
of a heaping tablespoonful of phosphate of soda
in a cup of water as hot  as it can  be  taken, or
by an  enema, if found necessary.
  Hepatic or Gall-Stone Colic is due  to  the
presence of  a gall-stone in the bile  duct.
  Symptoms.—The agony may be intense during
the attack, the sufferer lying curled up or roll-
ing over  with  the  pain; there is  often  faint-
ness, vomiting, and  profuse  perspiration when
the pain is at its worst.  The pain extends over 
124   THE NURSE'S SERVICE  DIGEST

the  upper part of the  right side of the abdo-
men and down to the navel.   The attack may
subside suddenly,  and may be followed by jaun-
dice, which usually occurs  when the stone  ob-
structs the bile duct.
  Management.—The best  relief In gall-stone
colic is obtained by the hypodermic injection of
morphia, or by opiates; hot fomentations sprin-
kled with laudanum, or a hot bath will assist
in alleviating  the  pain.  In case of suspected
gall-stones the motions  should  be examined  for
stones,  and for this purpose  it  may be neces-
sary to break  up the evacuations and pass them
through a sieve.
  The common gall-stones  vary  much  in size,
are  of dark  brown or black  color,  and  are
marked with facets when there are several, as
is usually the case; more rarely they are single
and  crystalline.
  Peritonitis.—The  peritoneum,  or  delicate
membrane covering the outer  surface  of  the
bowels, is liable to inflammation, as  the result
of cold or an  injury, or it  may arise as a com-
plication in puerperal fever, typhoid fever,  or
other bowel complaints, or from  perforation of
the stomach or bowels.
  Symptoms.—Simple peritonitis is usually  at-
tended  with  fever,  abdominal pain, vomiting,
and  constipation.  The  pain varies in severity,
is more or less general over the abdomen, and
is accompanied by  much  tenderness  on pres-
sure.   Most  patients  recover in the  simple
forms, but the severe cases are dangerous, and
the  patient lies on the back  with the knees
drawn up, and apprehensive of the least pres-
sure, even of the bed-clothes.  Distension of the
abdomen occurs after a time,  and pain in mic-
turition, or after any movement, is complained
of.   The tongue may be red,  with a tendency 
    DISEASES OF DIGESTIVE SYSTEM  125

to  dryness, and there is considerable  thirst.
The face looks drawn,  the eyes  sunken,  the
tongue brown,  and crusts collect on  the  lips.
Death  may be  preceded by  delirium, and is
often sudden.
  Management.—Great care is required in mov-
ing patients suffering from peritonitis, the bed-
pan should always  be used, and getting  out or
sitting up  in bed  should be forbidden.  The
pressure  of the bed-clothes may  be kept off the
abdomen by a cradle,  and any applications,  such
as poultices, bran-bags, or fomentations,  should
be made  as light as possible.
  The  vomiting  may be allayed by  ice, and
nourishment should be given in a  fluid form in
small quantities.  Purgatives  are injurious in
the majority of cases, and opium or morphia is
usually administered  in order  to keep  the bow-
els at  rest,  and to allay  pain, large quantities
of  these drugs  being well  borne.   Stimulants
will be required in cases  accompanied  by much
exhaustion.   In women careful  inquiry  should
be made  with regard to the catamenia or vagi-
nal discharges, as the peritonitis may be asso-
ciated  with disease of the reproductive organs.
It is frequently found desirable to explore the
abdomen by operation in peritonitis  and ob-
scure cases of internal inflammation.
  Typhlitis.—Inflammation of  the caecum  or
vermiform  appendix is often attended with lo-
cal peritonitis in the right flank.
  Symptoms.—Pain in the abdomen, with con-
stipation and vomiting,  are the leading symp-
toms,  and  the  temperature  may  be  raised,
though it is often normal.
  The  bowel may be loaded, and there is  pain
and tenderness in  the right side  of the lower
part of the abdomen.
  Management.—The  bowels are often very ob- 
126   THE NURSE'S SERVICE DIGEST

stinate, but no purgatives should be allowed ex-
cept under the express directions of the medical
attendant.  Warm enemata are useful, either of
oil or simple, and should be given  carefully and
slowly,  always as warm  as can be borne, the
result  being  noted.  In  other respects  these
cases require the same  management as in peri-
tonitis (see Peritonitis).  Perforation is some-
times a fatal complication,  or an  abscess may
form in connection with  the  caecum  and burst
into  the bowel, matter being discharged  with
the evacuations.
  Intestinal  Obstruction.—Acute obstruction
of the bowels  is a most  formidable  and  fatal
malady.  In addition to the strangulation of the
bowel in hernia,  there  are other causes of ob-
struction inside the abdomen  (see Hernia).
  Symptoms.—As in strangulated hernia, obsti-
nate and more or less complete constipation is
present, and after a time vomiting supervenes.
The  abdomen becomes  distended to a varying
extent, and pain  is often  felt round the navel.
The  sickness increases, the vomited matter soon
becomes bilious, dark brown,  offensive, and af-
terward of  faeculent odor.  In  a  few days  or
more, if no relief is obtained, the patient dies
from exhaustion.
  Management.—The administration of enemata
of various kinds is often undertaken by the
surgeon himself in these cases, and  the  long
rectal tube may have to be used.  If left to the
nurse, she should understand the importance of
giving the enema  warm  and  in a thorough man-
ner  (see Enema, &c).  The nurse should notice
if the fluid is returned immediately or how long
retained, and whether  it Is  colored by  faecal
matter, or if there are any hard lumps or other
substances.  If there is  any result,  the  fluid
should be  saved for inspection.  The amount of 
    DISEASES OF DIGESTIVE SYSTEM  127

urine  is often diminished  in these cases;  in
some to a  very great extent.  The temperature
of  the body should  be ascertained, but it is
commonly  at or  about normal.  Vomiting and
hiccough are  very distressing  symptoms, and
can only be allayed by ice, small quantities of
fluid only  being given to allay  thirst and dry-
ness of the  mouth,  while  rectal alimentation
may  have to  be  employed  to keep  up  the
strength.  The vomiting often appears to  be al-
layed in these cases after opium has been  given,
or  after the amount of fluid taken has been
greatly reduced,  but  returns  again  if  the
amount of nourishment is increased.  The  ab-
dominal distension may be partially relieved by
hot applications or turpentine stupes.  Purga-
tives  are  usually  avoided,  and should not be
given by the nurse except under special  medical
direction.   In  the more favorable cases,  the
bowels are relieved after a time, and the vom-
iting  ceases,  and  the  patient  recovers.  In
others, the operation of  abdominal section  is
performed  in the hope of finding and removing
the obstruction to the bowel.
  Chronic  Obstruction of the Bowels.—The
symptoms are much the same as in the  acute
form, but of  less immediate urgency.  In some
cases,  due  to cancer  of the bowel or the pres-
sure of tumors  from without, the obstruction is
not complete,  and the  motions are small and
constipated, and perhaps contain blood  or mu-
cus. The case may extend over a considerable
period, with intervals of partial or temporary
improvement.  In others, the amount of vomit-
ing is not great, but the bowels cease to act, no
motion being passed for a month, or even  more,
without any great distension of the abdomen.
  Diarrhoea is a symptom of  irritation or dis-
ease of the intestines, and consists in frequent 
128   THE NURSE'S SERVICE  DIGEST

and urgent calls to relieve the bowels, the evac-
uations being for the most part of a liquid char-
acter,  often  nature's way of  relieving the sys-
tem during a torpid liver.
  The causes of  simple diarrhoea are various,
the commonest being unsuitable  or indigestible
food, cold, and epidemic  influences;  constipa-
tion is also a frequent  source of diarrhoea, ow-
ing to the irritation of the intestine by the hard
lumps.  The  bowels  may  be merely relaxed, or
there may be copious purging  with griping pain
and  constitutional disturbance.
  English Cholera,  or  Summer  Diarrhcea,
may prevail  during  the summer and autumnal
season, and is sometimes epidemic or coincident
with infantile diarrhoea.
  Symptoms.—It is characterized by severe pain
and  cramps in the abdomen,  vomiting, profuse
purging,  and attended by collapse indicated by
drawn and pinched features, sunken eyes, cold-
ness of  the  extremities,  feeble  pulse,  and  al-
tered voice.   The symptoms have a close resem-
blance to Asiatic  cholera, but are less  sudden
and  severe, and the motions contain some bile,
being often  of a  greenish  color  (see Cholera,
Infantile Diarrhoza).
  Diarrhoea  is an important symptom in  ty-
phoid, dysentery, tubercular and other forms of
ulceration of the bowels.
  Management.—Motions:—The   nurse  should
notice the character of  the motions in all cases
of diarrhoea,  whether watery, or of thick fluid
consistence, or  if the fluid is  mixed with hard
lumps  or "scybala";  whether frothy or  yeast-
like, indicating fermentation, or  if containing
slime or mucus as  in dysenteric affections. The
color and odor are also of importance.
  MeUsna.—Black  stools may  be caused by the
presence of  blood which  has been altered in 
    DISEASES OF DIGESTIVE SYSTEM 129

color by the action of the gastric juices, unless
the  blood  comes from the lower  part of the
large bowel, in which case it may be bright red.
Melaena  is  often  significant  of ulceration of
some part of the alimentary canal (see Gastric
Ulcer).   It should be remembered that  some
medicines,  such as  bismuth  and iron, give  a
dark color to  the evacuations.
  Management.—Simple diarrhoea due to consti-
pation and indigestible material may be relieved
by  a dose of phosphate of soda or some simple
aperient, or if the diarrhoea continue after the
aperient has acted some form of chalk mixture
is useful.  Continued  or  severe  forms of  diar-
rhoea, perhaps indicating typhoid or some ulcer-
ative condition of the  bowel, should not be neg-
lected,  and medical   advice  should  be sought
promptly.  In the  meantime, warmth may be
applied to the feet  and abdomen by  means of
fomentations  and hot-water  or  bran-bags, and
the  patient should be advised to remain  lying
down.
  Diet.—Partial  or complete abstinence  from
foods, to give the stomach a complete rest,  is
essential for a time, and  subsequent limitation
to  a simple  dietary of milk, arrow-root,  corn-
flour, biscuits, or farinaceous puddings.
  In acute cases, iced water, barley  water, or
brandy  may be administered.
  Persons subject to attacks of diarrhoea should
avoid partaking in hot weather of  much  fruit,
vegetables, sweets,  pastries, or indigestible ma-
terial.
  In chronic diarrhoea beef-tea is injurious, but
meat juice,  raw meat, or pounded  meat can
often be  taken  instead  (see  Infantile  Diar-
rhoea).
  The  Stools.—Examination of the  Stools, or 
130   THE NURSE'S SERTICE DIGEST

Fwccs.—The following  points  should  be  no-
ticed :—
  Consistence.—Solid and natural, small round-
ed  masses  (scybala),  semi-solid,  loose, slimy,
fluid, watery.
  Amount.—Scanty or copious.
  Color.—Dark brown  and natural,  bright yel-
low, drab, putty color, white, greenish, black.
  Odor.—If peculiar or highly offensive.
  Constituents.—Undigested  food,  grape-skins,
currant seeds, fruit-stones, &c.
  Foreign Bodies accidentally swallowed.
  Intestinal Worms.— (See Worms).
  False Membranes.—Shreds,  or casts of mu-
cous membrane.
  Gall-Stones and biliary secretions.  Search for
gall-stones should  be made by breaking up  the
motion  in water and straining  through muslin.
  Appendicitis.—Symptoms.—Fermentation,  ac-
cumulation  of  gas,  irritation,  inflammation,
putrefaction, which is usually followed by gan-
grene.
  This  malady  has become so prevalent  and
fatal, owing to the habitual use of improper
food and lack of outdoor exercise, which is  the
cause of the sluggish condition of the liver se-
cretions, or  complete stoppage, or the retention
of the bile in the liver, together with the reten-
tion and  impacting of  the  excrement in  the
bowels.
  It is  a comparatively easy  and very  simple
matter to wholly avoid  the above series of com-
plications that so  frequently distress the indi-
vidual and poison the entire system, the cause
of which  is so plain and so easily prevented,
but is increasing in an alarming degree, espe-
cially in large cities,  where  the very large ma-
jority ride to business in the morning and again
home at night  If they go out in the evening, 
    DISEASES  OF DIGESTIVE  SYSTEM  131

instead  of  taking a brisk  walk  to  promote
health,  they  prefer  to  go  to some place  of
amusement.
  We have only to read  the daily papers to see
that appendicitis  claims by  death,  even with
operations,  many  citizens from all classes  of
society.
  Dr. Charles E. Page, one of Boston's leading
physicians, writes: "An operation for  appendi-
citis should be called a criminal operation, and
as such  should be prohibited by law."  What
Dr. Page probably means is that proper atten-
tion to the liver and bowels, to keep the flow of
secretions of  the  liver active, and  to  properly
keep the bowels regular, would make  such an
operation wholly unnecessary.  He is quite cor-
rect in saying,  "It seems hardly necessary  to
cite the long list of deaths following these oper-
ations, and this list is truly appalling."
  Where  a torpid condition  of the liver and
stoppage of its secretions exists it may be rem-
edied either by the use of medicine, or by a sur-
gical  operation; if by medicine,  the liver can
best be acted  on in one of two ways, viz.: by
stimulating the natural secretions, which can be
done by  the use of a  vegetable compound, with-
out griping or distress to the  patient, or by ir-
ritating the liver,  as  may be done by the use of
calomel,  a preparation of mercury, 
CHAPTER  VII.
      DISEASES  OF THE SKIN AND KIDNEY.

Skin — Structure — Sweat  Glands — Sebaceous
  Glands—Nails and Hair—Corns and Warts-
  Erythema—Nettle-Rash—Petechias—Psoriasis
  — Pigmentation — Management  of  Eczema —
  Herpes or Shingles—Naevus—Pediculli  or Lice
  —Scabies or Itch—Tinea or Ringworm—Chlo-
  asma.
Kidney—Structure—Ureters— Bladder— Exami-
  nation of  the Urine—Deposits—Suppression
  of  Urine — Symptoms  and  Management  of
  Bright's  Disease, Acute end  Chronic—Albu-
  minuria—Renal   Colic—Diabetes—Tests  for
  Sugar—Dietary for Diabetics.

             Structure of the Skin.
  The Skin.—The outer or superficial layer of
the skin is composed of scales, which are con-
stantly  being rubbed off in the  shape  of  fine
white dust, and as constantly reproduced from
the deeper layers.   These scales, or epithelium,
may be  shaved  off or rubbed off without causing
bleeding, and it is this layer which is raised by
a blister; it is  called the cuticle.
  The deeper layer, the cutis, or true skin, con-
tains numerous small blood-vessels,  and  fine
nerve fibers enclosed in connective tissue.  The
surface is raised into ridges,  and has countless
minute  projections called papillm, containing the
nerve endings,  which impart to it its delicate
sense of touch; and its  readiness to  bleed  i»
                     132 
     DISEASES OF SKIN AND KIDNEY  133

owing to the very free supply of capillary blood-
vessels.
  The skin  not  only  acts as a  covering to the
body, but it is also an  organ of excretion,  and
contains glands which serve this purpose, name-
ly, the sweat  glands  and the sebaceous  glands.
  The Sweat Glands consist of little tubes open-
ing into the  surface of the  skin, and  having
their ends coiled up in the deeper parts.  Water
and  sundry impurities  are  extracted from  the
blood and poured on  to the surface of the skin
in the form of sweat.
  The Sebaceous Glands supply a fatty  or  oily
fluid which lubricates the skin.
  Nails and Hair are modifications of the su-
perficial layer  of the skin. The nails are formed
of scales arranged in compact layers containing
horny material  to which the hardness is due.
The  hair  arises from a root imbedded  in  the
deeper layer of the true skin, and has a super-
ficial scaly outside and a central pith.   It con-
tains pigment which  gives the  hair its  special
color.

            Diseases of the Skin.
  Corns and  Warts are little tumors  of  the
skin, and are formed by outgrowth and enlarge-
ment of its natural  papillae,  with an increase
and thickening of the cuticle. They may occur
on almost any part of the body; a favorite sit-
uation being the hand  where they  are  apt to
grow in large numbers.  They  bleed easily if
wounded, but are merely a disfigurement.  They
sometimes  disappear of their own accord, or
they may  be destroyed by nitric or  acetic acid,
or some other form of caustic.   Their growth is
increased by dirt and occupations giving rise to
irritation  of the skin.
  Erythema is the name given  to an inflamma- 
134   THE NURSE'S SERVICE DIGEST

tory redness of the skin, which may be local or
general.  Local erythema is well exemplified in
an  ordinary chillblain,  and in addition to the
redness there  is often swelling, heat,  and itch-
ing.   A similar  condition may be produced on
any  part of the body by an irirtant,  new flan-
nel,  acid secretions,  counter-irritants,  or eating
some kinds of  acid fruits.
  General or  constitutional erythema, or rose
rash, may appear on the body, as the result of
a chill during perspiration, or from  dyspepsia,
and  is liable to attack  persons of a  rheumatic
temperament.
  The form of erythema common in rheumatism
takes the shape of large raised oval patches, sit-
uated usually  over the  shin or fore-arm, which
are tender to  the touch.  The color changes to
purple or violet, and fades into a yellow  tint
before disappearing.  This same  form  is  fre-
quently seen in young  women associated  with
the catamenia.
  In the local forms of erythema the  source of
irritation  should be ascertained and  removed,
when the rash will probably subside; the prick-
ing and itching may be allayed by cooling  lo-
tions.  The constitutional form requires suitable
treatment if due to  rheumatism or any special
taint.  The simple affection from dyspepsia or
chill  may be  treated by saline  aperients  and
the warm bath.  The close resemblance of the
rash to scarlatina, or in some cases to measles,
should be remembered.
  Urticaria, ob  Nettle-Rash.—The appearance
of the rash is similar to that produced by the
sting of a nettle, namely, a white wheal on a
red ground.  The itching is intolerable, and the
rash may be local or scattered in patches over
the body.  There is  not usually much constitu-
tional disturbance,  sore throat, or affection of 
     DISEASES OF SKIN  AND KIDNEY 135

the air passages, though  the rash may  appear
on the palate and  fauces.  Common causes of
urticaria  are:  irritation of the  skin,  strong
mental emotion, indigestible food, shell-fish, and
various drugs.
  The itching may be allayed by the application
of equal parts of tincture of benzoin and water.
  Petechle is the name given, the small points
of haemorrhage under the skin, which leave a red
stain not  obliterated by pressure  of the finger.
They are common as  the  result  of flea-bites,
and  in such diseases  as  scurvy,  purpura, and
rheumatism.
  Psoriasis is a scaly eruption, commonly found
in its  simple form about the elbows, knees, or
other parts of the body.  The scales are of sil-
very white color, heaped  up on patches  of red-
dish color on the surface of the  skin, varying
in size from a dime to a quarter dollar piece.
  Pigmentation -of the skin may  be the result
of using certain ointments or of psoriasis.  It is
not uncommon in catamenial disorders.  In Ad-
dison's Disease it is a symptom of the first im-
portance,  the common situations being about the
neck, axilla,  mamma, navel, thighs, bend of the
knees and elbows; at the  garter below the  knee,
and  about the female genitals.
  Eczema may  he  either  acute or  chronic.
There  is inflammation of  the skin,  and an  erup-
tion presenting  a variable appearance.   It may
be papular,  vesicular, pustular, or a combina-
tion of all, but its  most  characteristic appear-
ance is that of a raw, moist surface more or
less  covered  with crusts, and known as  moist
or weeping eczema.  The fluid is derived  from
the broken vesicles, and  the crusts are  formed
by  the  dried  exudation,  and the epidermal
scales  which have been shed, and  adhere to the
sticky  discharge.  In  the dry form of eczema, 
136   THE NURSE'S SERVICE DIGEST

this moisture is absent, and there are red, dry
patches covered with thin scales.
  The acute form is  attended  with  some  de-
gree of constitutional disturbance, and there is
much redness and swelling of  the skin,  and a
large area may be attacked.
  Soreness and itching  accompany the different
forms of eczema, and other discomforts accord-
ing to the part of the  body attacked.  It is a
very common disorder  in children and infants,
attacking the scalp (eczema  capitis),  and caus-
ing enlarged glands in  the neck; or it appears
behind  the  ears,  or in the  folds of the skin
about  the neck,  or in  the  creases  about  the
thighs and genital organs.
  In adults it may attack any  part of the skin,
but is common about the forehead, nostrils, au-
ditory canal, scrotum,   breasts, palms  of  the
hands, and soles of the  feet.
  The causes of  eczema are  numerous, some
constitutional,  others   local;  for  the  latter,
search should be made for some cause of  irrita-
tion, common examples  being dirt, friction, lice,
and other parasites, and in babies the constant
wetting of the unchanged napkins.
  Management.—After  the  irritating material
has been discovered and removed, the attention
should be directed toward the  local  treatment,
which  should be  applied in  a  systematic man-
ner.  It is useless to smear ointments over the
thick  scabs, or on the matted hair covering the
raw surfaces, and expect them to heal.   The
following directions given by  Dr. Liveing should
be observed:—
  1st. To remove the crusts: lubricate well with
oil or apply  rags  thoroughly soaked in oil for
an hour or two; then use a hot  bread-and-water
poultice.  If the  scabs  are hard,  the poultice
may be left  on for several  hours.   When  the 
     DISEASES OF SKIN AND KIDNEY 137

crusts are  softened, they  should  be  removed
with a piece of card or the edge of a stiff quill
toothpick, and any hairs attached  to them cut
with sharp curved scissors.  The parts affected
should be then well cleaned with a weak solu-
tion of boracic acid  or hand sapolio and  water.
It is  best applied by dipping a piece of flannel
in warm water, laying a portion of  soap upon
it, and then  rubbing the part well  until a good
lather is formed.
  2nd. Ointments should  not,  as a  rule,  be
merely rubbed on the eczematous  surface, but
applied  carefully on strips of linen rag,  which
should be changed at least once in  every  twelve
hours, and kept in position by a bandage, night-
cap, or strapping, and the  air excluded.  The
stronger ointments should be simply rubbed in
with the finger.  A weak solution of hypozone is
probably the best treatment  to he found.
  Lotions should generally be applied  on linen
rag thoroughly  soaked  and covered with oil-
silk, and should never be allowed to get dry.
  In  all cases of eczema the ordinary  washing
with  water or soap must be forbidden,  especial-
ly in the later  stages.   Frequent dusting with
starch powder  and  moderate friction  may be
substituted for  washing, or fine powder of bi-
chlorate of soda may be used with a little soft
water.   The  friction  of flannel or  scratching
must be avoided, and children should wear soft
gloves, or have  their hands  tied up at night to
prevent this source  of irritation.
  Herpes is a vesicular  eruption; the vesicles
appear in  groups, and the contents rapidly be-
come milky, drying  up,  and  forming  scabs.
There are several forms of this complaint, the
two  commonest  being   Herpes  labialis  and
Herpes  zoster, or Shingles.
  Herpes labialis is apt to accompany attacks 
138   THE NURSE'S SERVICE DIGEST

of inflammation of the lung,  and occurs about
the lips and sides of the nose; a little poultice
and zinc ointment is all that is necessary for its
local treatment.
  Herpes zoster,  or  Shingles,  is often preceded
by severe neuralgic  pain round one side of the
chest, with  perhaps some  constitutional  symp-
toms.  After a time the vesicles of herpes ap-
pear  over the painful  area,  and extend  from
the spine round  the side  of  the chest to the
sternum.  It is almost always confined to one
side of  the  chest, and a second attack is un-
usual.  The pain  may  continue with consider-
able severity for some time  after the eruption
has disappeared.
  During the eruption the  vesicles may  be
painted over with flexile collodion or smeared
with  carbolized oil.
  Nsjvus is  the name given to the various port-
wine  marks, red  stains, and  small red  tumors
consisting of  dilated capillaries.  These small
nsevus tumors are very common in children, and
are only of consequence from producing  disfig-
urement in  exposed situations.  Surgical treat-
ment is then called for, and is most suitable and
best done when the child is young.  A common
practice is to pass hare-lip needles through the
base,  and then constrict the tumor by a thread
tightly tied  round, until the tumor after a time
sloughs off.   Dressings should be applied after-
ward, and  care  taken after the operation to
avoid friction or  sudden  tearing  off  of the
tumor.
  Animal Parasites—Pediculi.—Lice frequent
the human  body, especially in the case of the
unwashed, and produce an eruption  of slightly
raised papules accompanied  by  much itching.
There are three  varieties: one affects the hair
of the head, another the hair of the pubes and 
     DISEASES OF SKIN AND KIDNEY 139

armpits, the third the body.  The animals have
the  appearance of  little  crabs,  and  may  be
easily  seen, if carefully  searched for,  by the
naked  eye, or a magnifying glass.  In the head
their existence is shown by  their  eggs, like
small white beads sticking  to  the sides of the
shafts  of the  hairs;  the eggs are called nits
and  the lice pediculi; the latter may be found
secreted under the hair, especially at the back
of the  head and nape  of the neck.
  The  second  form inhabits  the small hairs on
the body, armpits, and pubic region.
  The  body lice are more difficult to find; they
live  in  the folds and creases of the under gar-
ments, where  they should be searched for. The
two  latter forms  infest mainly adults of both
sexes.   The head  lice  also attack children, and
produce eruptions of varying character and  se-
verity  about the scalp and neck, with scabs and
enlargement of the glands.
  Management.—One  of  the  most unpleasant
duties  of the  hospital nurse  is attending to the
hair of the poor and unclean.  The head should
always be examined,  and if the  nits are seen
on the hairs the presence of lice is a certainty,
and  special ablutions will be required.
  It will often be necessary first  of all to  re-
move a good deal of hair, and then after soak-
ing and combing  out  with a warm solution of
carbolic acid and water (1-60), the head should
be washed in  abundant soap  and water. The
clothes must also be removed and disinfected or
baked.
  White precipitate ointment or chloroform will
kill the pediculi, but cases of children with sore
heads should be treated under  medical advice.
  Scabies, or  The Itch, is a contagious disease
of the skin, due to a small parasite which bur-
rows in  the  skin and sets up irritation.   A 
140  THE NURSE'S  SERVICE DIGEST

vesicle is formed, which  causes  great  itehii:-.
with inflammation  of the skin, and  pustules
often form and break, causing scabs.
  The  parts  of  the body  most frequently  at-
tacked  are between  the fingers and toes, wrists,
armpits,  thighs,  and abdomen, but it often  be-
comes general, with the  exception of the face,
which usually escapes. Children are very liable
to the disease, and  convey it  to one another by
sleeping together.
  Management.—The   whole  body  should  be
thoroughly washed  in warm soap  and  water,
and the patient  should take a warm bath, and
soak in it for an hour.  When thoroughly dry,
the skin over the whole  body, except the head
and face, should be treated with sulphur oint-
ment.  The strength  of  the  ointment  must be
adapted somewhat to  the particular case.   For
adults with thick skin the pharmacopoeial oint-
ment of sulphur may  be  used.
  For  children,  or individuals  with  delicate
skins, or where  there is  much inflammation or
eczema, a weaker ointment or one diluted with
equal parts  of  vaseline  should be  first used.
The  ointment in all cases should be thoroughly
rubbed into every part at  bedtime, and a long
nightdress with  gloves and socks should be  af-
terward  put  on, and  the person should remain
in bed for ten or twelve hours.   A warm bath
may be  taken  in the morning, and the  same
process  repeated  the  next and  following night.
If the ointment has been thoroughly rubbed in,
two  or  three applications  are  commonly suffi-
cient
  Eczema may be produced by the sulphur, and
in most cases some  eruption remains for a time
after the itch mite has been destroyed,  and may
be alleviated by the  use of vaseline  or some
simple ointment  The clothes and underclothing 
    DISEASES OF SKIN AND KIDNEY 141

of those  affected should be baked to a tempera-
ture of 200° F., or fumigated with sulphur, and
in families the children should be carefully iso-
lated.

             Vegetable Parasites.
  Tinea  Tonsurans, or Ringworm,  is a conta-
gious  and parasitic affection which appears in
two forms:  one, common in children, attacks
the hairy scalp; the other attacks the skin of
the body.
  Ringworm of the scalp  commences with  faint
red, circular, scurfy patches  having a tendency
to itch, and on close  observation the hairs are
noticed  to be  short  and easily broken.   The
roots  of  the broken hairs under the microscope
show  the minute spores of the fungus, and the
fibers of  the hair are seen to split up.
  Ringworm of the body takes the form of cir-
cles or fairy  rings with  slightly  elevated, red
margins,  and  the surface is covered with  fine,
dry scurf.
  The patches increase in size and  multiply,
and are attended with itching.
  Management.—This consists in destroying the
parasite,  and is a simple matter in ringworm of
the body.  The patches may be  painted  with
acetic acid or sulphurous  acid, or white precipi-
tate ointment may  be  used.
  Ringworm of  the scalp is far more  obstinate
than ringworm of the body,  especially in  long-
standing  cases.  The hair should first  of all be
cut quite close  for an inch  round each patch,
and strong acetic  acid or hypozone applied to
the surface,  and   repeated  twice daily,  well
rubbed in at  night, and washed off with  soap
and water in the morning.  Careful  and  con-
stant  applications may cure  the  disease  in a
few weeks, if taken at the commencement.  In 
142   THE NURSE'S SERVICE DIGEST

long-standing cases, the patches may be painted
with  hypozone  three or four times a  day,  and
will always yield to this treatment.
  In children the general health  often requires
attention, and they should be kept from school
on account of the contagiousness  of the disease.
  Chloasma is another parasitic disease, show-
ing itself in fawn-colored  patches, covered with
fine scurf, most commonly on the  chest, back, or
abdomen.  It may be removed by  vigorous fric-
tion  every day  with flannel, soap and  water,
and sponging with full-strength hypozone.

                The  Kidneys.
  The Kidneys  (fig 42)  are two in number, of
the shape  of a  French bean, measuring about
four inches long by two inches across,  and situ-
ated one in each loin below the level of the ribs.
They  are of  reddish-brown color, glandular in
structure, and may be compared  to the skin in
possessing  numbers of  tubes like  the  sweat
glands, surrounded  by small  capillary   blood-
vessels.  The function of  these tubes is  to  sep-
arate  the  constituents  of the urine  from the
blood, in a fluid form, the fluid being collected
into  a special  part  of  the kidney, into  which
opens a duct called the ureter.  The ureters are
long tubes  which descend  one from each  kidney
in the hinder  part of the abdomen, and finally
open below into the bladder.
  The Bladder forms a bag or reservoir, and is
situated  in the  pelvis in front of the rectum.
It receives the  urine drop  by  drop  from the
ureters,  and  when full it is emptied.  If the
bladder is  fully distended, it forms a rounded
swelling  in front of the lower part of  the abdo-
men,  between the navel and the pubes.
  The function of the kidneys is to purify the 
     DISEASES OF SKIN AND  KIDNEY  143

blood of waste  substances and water, many of
which, if retained, act as poisons.
  Examination   of  the Urine.—The  amount
and quality  of  the  urine are the main guides
to the detection of  the  various diseases of  the
kidney and bladder, and it is important for  the
nurse  to be  acquainted  with the condition of
the  urine  in health.
  The quantity  passed in the twenty-four hours
should average  from two to three pints.  Most
healthy adults do not as a rule pass water  af-
ter going  to bed at night until  rising in  the
morning.
  The urine  in  health  should be transparent
and clear when  passed, but after standing  there
may be a faint cloud of  mucus at  the bottom of
the vessel. The reaction should be acid.
  The reaction  is determined by  litmus paper,
red and  blue. The blue paper is turned red by
acid urine, and  the  red  paper blue by alkaline
urine.   If  the urine is  neutral, neither paper
changes.
  The specific gravity, taken by the urinometer,
varies from 1015 to  1025.  The average  may be
taken to be 1020.
  There  are  many deviations from the  normal
standard without any actual disease of the kid-
ney being present; thus a temporary increase in
the quantity  of the  urine, light color, and low
specific gravity,  may be  due  to excitement, cold
weather, or hysteria.  A temporary diminution
in the amount of the urine, high color, increased
specific gravity,  and  cloudiness after standing is
common, occurring in hot weather, and in  fe-
verish conditions.
  Deposits in the urine  are often the  result of
dyspepsia,  gout,  and bladder troubles;  or are
due  to disease of the urethral passages, or to 
144   THE NURSES SERVICE DIGEST

vaginal discharges in females.  Common depos-
its are:  urates, phosphates, uric acid  and pus.
  Urates usually form a deposit in considerable
quantity of reddish-brown or brick-red color in
concentrated urine on becoming cool.  If placed
in a test-tube and warmed, they  gradually dis-
appear and the urine becomes clear.
  Phosphates may  form  a deposit in alkaline
urine; when boiled, the turbidity  or cloud is in-
creased, but disappears on  adding a few drops
of acetic or nitric acid.
  Uric Acid may be deposited as a fine  red sand
at the bottom of the  glass, or may adhere to
the sides, or form a ring at the surface of  the
urine; the urine is commonly  very acid.
  Mucus and Pus.—The former gives rise to  a
flocculent or  cloudy  deposit  of  whitish  color.
The latter is thick,  heavy,  and of  whitish,
greenish,  or  yellowish  color.   The   urine  is
usually alkaline,  and does not clear up on boil-
ing or adding acid.
  Hematuria.—Blood in small quantities gives
a smoky tinge,  but  in larger  quantities  a red,
scarlet, or  bright red hue, or it may  appear
dark brown or porter-colored.  When intimately
mixed with  the urine,  the  blood  commonly
comes  from the kidneys; when passed  in clots,
or  by itself  before  or  after  micturition,  its
source is probably the urethra or bladder.
  Bile imparts  a yellow,  golden, greenish, or
dark olive color to the urine,  and is associated
with  jaundice;  when  spilt  on  the clothes,  it
gives  a yellowish stain.  The amount of  bile in
the urine in a case of jaundice may vary con-
siderably in the twenty-four hours.
  To Test for Pus, add a little liquor potassae to
the sediment, when,  if  pus be  present,  it  be-
comes  thick  and ropy.   Mucus may be  distin- 
     DISEASES OF SKIN AND KIDNEY  145

guished from pus, becoming thin on the addition
of liquor potassae.
  Tests for Albumen.—Cold  nitric acid test.—
Pour a small quantity of nitric acid into a  test
tube, slant  the  tube, and pour a few drops of
urine very gently down; if albumen is present,
a white ring appears where the urine joins the
acid.
  Heat Test for Albumen.—Fill a test tube two-
thirds full of urine.  Boil  the upper third.  If
the  boiled portion  is cloudy, and  it  does  not
clear up  with  the addition of a few drops of
ascetic acid, albumen is present.
  Test  for Blood.—Pour about  a  drachm of
ozonic ether into a test tube, add a few drops
of tincture of  guaiacum, shake them  together,
slant the tube, and pour down very  gently  a
few  drops of urine; if blood is present, a blue
ring appears where the urine joins the ether
and  guaiacum.
  Test for  Bile Pigment.—Pour  a little urine
onto  a white  plate;  dip a  glass pipette into
strong nitric acid, and drop it on the urine; at
the point of contact, if bile is present, a play of
color is obtained—green,  yellow, violet, blue.
  Tests for Sugar.—There are many  tests for
sugar in the urine.  The usual test is known as
the Copper test, in which a blue solution of cop-
per,  on  being  boiled  with the  diabetic  urine,
changes to a yellow or orange-red color.   There
are different .ways of applying the test. A small
quantity of Fehling's solution is boiled in a test
tube to make sure of its purity, as  it is liable
to decompose with keeping; it should retain its
blue color on  boiling; add  to this a few drops
of the urine, boil  the mixture, when the charac-
teristic color will  appear, if sugar be present, in
the  form  of  a copious  precipitate.  Another
method is to boil a small quantity of the urine 
146  THE NURSE'S SERVICE DIGEST

with an  equal quantity of liquor potassae, and
then add a few drops of a dilute solution of sul-
phate of copper,  when -the  reddish-yellow pre-
cipitate will appear  on further boiling if sugar
is present  A third  method,  also useful  as giv-
ing an estimate of  the  amount  of sugar con-
tained  in the urine,  is known as  the Fermenta-
tion test.  It may be applied as follows:—
  Fill two specimen glasses with the urine; into
one put  a  small piece of German yeast; cover
both glasses with a  piece of  paper coming well
over the sides of  the glass.   Place  the two
glasses side by side in a warm place, for twenty-
four hours.  At the end  of  that  time the fer-
mentation  process  is complete.   The  specific
gravity of both specimens is  now taken, that of
the unfermented urine being  the standard.  The
fermented  urine  will be  found  to  have lost
some degrees of specific gravity according to the
amount of  sugar present.  The difference in the
specific gravity of the two specimens, the fer-
mented and the unfermented, will give the num-
ber of  grains of sugar contained in an ounce of
urine.  Thus, if the unfermented  specimen has
the specific gravity  1035, and the fermented
specimen only marks 1020, it contains about  15
grains  of sugar in each ounce of urine.   This
method is  roughly  accurate, and  is useful for
ordinary working purposes.
  Suppression of  Urine is a symptom of consid-
erable  danger,  and  may  indicate a failure  on
the part of  the  organs to  excrete the urine.
Suppression may  occur in acute kidney  disease,
or in cholera and some other bowel affections,
and  must  be  distinguished  from retention  of
urine, in which the  bladder  is full or contains
urine, but  there is  some impediment to  its be-
ing discharged from  the bladder (see Retention
of Urine). 
     DISEASES OF SKIN AND KIDNEY 147

           Diseases of the Kidneys.
  Bright's Disease, or Inflammation of the
Kidney.—Acute Bright's disease is induced  by
cold, scarlatina, and other «eute affections,  or
may occur in pregnancy.
  Symptoms.—In  the  severer  cases the  onset
may be sudden, with  fever, marked chilliness,
vomiting,  headache, pain in the loins, and gas-
tric  disturbance.   The  urine is scanty, or may
be temporarily suppressed, and what is passed
is turbid or high colored,  or mixed with  blood.
The  eyelids  and face  are soon noticed  to  be
puffy,  also the skin  about the ankles, genital
organs, and  the dependent parts of the body.
The  skin has a whitish, waxy appearance, and
readily pits on pressure.  The vomiting may  be
troublesome,  and the pain in the loins severe;
and in unfavorable cases complications  may oc-
cur—dyspnoea from oedema  of the larynx  or
lungs;  or inflammation of various  organs, the
lungs, pleura, or pericardium; or coma and con-
vulsions may set in.  The onset is often mild
or insidious;  the condition of  the  urine  is the
most marked  feature.
  Albuminuria.—The urine contains albumen,
and  should  be  saved  for examination in all
cases where  there  is any  suspicion of  the dis-
ease, or where it  is known to be likely  to su-
pervene, as after scarlatina or diphtheria (see
p. 177).
  Management.—In all cases of  acute  Bright's
disease the patient should be kept in bed, and
a flannel nightdress may  be wt)rn  with advan-
tage in cold  weather.  The  condition of the
bowels, skin,  and  the  urine requires attention,
and the diet is of the highest importance.   Free
action  of  the bowels is imperative, and  active
purging may  be necessary  in some cases.
  Perspiration should  be  encouraged, and free 
148  THE NURSE'S SERVICE DIGEST

action  of the skin promoted by warm or hot
bottles, the wet pack, or preferably the vapor
bath (see Baths).  The  urine should  be saved,
and  the  quantity  passed in  the  twenty-four
hours  measured and  recorded  on a chart kept
for the  purpose.   The  patient  should be  di-
rected  to pass water before the bowels act, and
after all the urine has  been collected together
and measured,  a specimen may be set apart in
a urine glass, or, if desired, one specimen of the
day and another of the  night may be arranged
separately; but a  specimen  of what  has  been
passed during  the  entire twenty-four  hours is
always preferable.  The conical specimen  glass
should be used, in order that  the deposit may
be collected at  the  bottom and obtained for mi-
croscopical purposes.
  Diet.—Many  physicians  allow only  milk and
bland drinks such as barley water or rice water
throughout  the attack, and  for a considerable
period  afterward.  If albumen appear in the
urine of a patient convalescent from scarlatina,
the nitrogenous food should be discontinued, and
milk and farinaceous food substituted.   A plen-
tiful supply of fluids  assists the  action of the
kidneys, and a more  copious  flow  of urine is
promoted.  During convalescence there is  often
great  pallor and debility, and care should be
taken on first going out to avoid cold winds and
wet.  The patient seldom requires alcohol, and
on  resuming  a  more liberal diet  the "urine
should be examined  at  intervals for albumen,
and the state of the bowels regulated.
  Chronic  Bright's  Disease.—There  are two
forms  of  this disease, which are very  different
in appearance and  symptoms.  The one is  more
liable to attack persons  in the first half period
of life, either  commencing  insidiously or fol-
lowing on the  acute form. 
     DISEASES OF SKIN AND KIDNEY  149

  The Symptoms  may be  said  to correspond
very much with those of the acute disease, but
it  runs a slow  course, showing  a special ten-
dency to produce anaemia, dropsy, vomiting, and
gastric troubles.  The other is decidedly  a dis-
ease of more advanced life, commencing usually
over forty, and is  commonly the result of over-
indulgence in alcohol, or  overwork.  The term
granular or gouty kidney is sometimes applied
to this form of the disease, and its symptoms
are: loss of nutrition, giddiness, and headache;
shortness of breath, and copious micturition, es-
pecially at night; the urine being light in color
and of  low specific gravity.  Attacks of gout
may be associated with the disease, but  dropsy
is not common in the early  stages.   Death may
occur  from   dyspnoea,  cerebral  haemorrhage,
uraemic convulsions, and coma,  or from exhaus-
tion.
  Management.—The  same rules as in  the acute
form will apply  to  the  clothing,  but  except
dropsy is present or other serious complications
the patient is not  always  confined to bed.  The
urine should he  measured, and  specimens saved
for examination, and the  effect of  remedies on
the amount of  the urine will have to  be ob-
served and  noted.  The condition  of  the skin
and the encouragement of perspiration by vapor
baths is  important.  This latter is  the most ef-
ficient means of diminishing the  dropsy, and
may have to be carried out by the nurse for  a
considerable period (see Baths).
  Flannel should  be  worn  from head to foot
next the skin, and the feet especially should be
kept warm and dry by woollen stockings.  Warm
baths, or Turkish  baths,  during convalescence,
and moderate exercise help to  promote the ac-
tion of the skin.
  The severe complications of excessive dropsy, 
150  THE NURSE'S SERVICE DIGEST

dyspnoea, and lung affections, or ura?mic coma
and  convulsions,  are  commonly   fatal  (see
Dropsy, Dyspnoea,  Coma, Convulsions).
  Diet.—Milk is the chief article  of  diet,  but
greater freedom  has to  be  allowed  in  many
cases where the milk is badly taken or does not
agree.  Four to eight pints may be  taken in the
twenty-four  hours,  when  nothing  else is  al-
lowed; or with less quantity, nutritive broths,
fat  meats,  such  as  bacon  or  pork,  fish and
white meat -may be substituted; rice and green
vegetables are only permissible.  Potatoes, eggs,
and  much  butcher's meat should  be avoided.
Headache, palpitation, or indigestion  are signs
that the diet is unsuitable.
  Renal Colic, or pain in the kidney, is usually
the result of a stone in the kidney or ureter.
The pain is felt in the loin of the side affected,
working  its  way  round  to  the abdomen and
flank,  and  perhaps  extending  down the  thigh
and  toward the genital organs.  The pain varies
from a dull ache to  an acute almost unbearable
paroxysm,  during  which the thigh is  flexed to
relax the abdominal wall; the patient is  sick,
or has a rigor, and becomes faint, breaking out
into a profuse sweat  The urine may be  re-
tained, or  there  may be a  constant  desire to
micturate,  only a small quantity being passed
at a time; it often contains  blood,  or  a deposit
of various  crystalline forms.
  Management.—During the attack, hot  appli-
cations to the affected part sprinkled  with lau-
danum help  to relieve the pain and spasm, or
the hot bath gradually raised to as high a tem-
perature as can be borne is  useful, the patient
remaining in during the intensity of the attack.
The length  of the attack varies from a few to
many  hours, and  in many cases relief Is only
obtained by  the use of morphia given hypoder- 
    DISEASES OF SKIN AND KIDNEY  151

mically.  The urine should always be carefully
saved, as the presence of blood or crystalline
deposit is of much assistance in determining the
nature of the complaint.
  Diabetes.—Although not a disease of the kid-
ney, the urine in this  complaint is  altered in
character by the presence in it of sugar.
  When  describing the assimilation of the dif-
ferent foodstuffs in digestion,  the  easy  absorp-
tion of sugar by the blood, and the transforma-
tion of all starchy  material into sugar by the
salivary  juice was mentioned.  The  amount of
sugar  passing into the general circulation in
health would be very great, were it not for a
special function of  the liver to  prevent a con-
siderable quantity from  doing so.  When  this
function of the liver is at fault, or in some way
deranged,  the  sugar  is discharged  with the
blood circulating in the body, and  finds an out-
let through the kidney.  The urine in diabetes
contains sugar in  varying amount,  and the com-
plaint is attended in addition with other symp-
toms  of importance.
  Symptoms.—The onset is mostly insidious, and
commences with an increase in the quantity of
urine, the patient having to get out of bed once
or  more often during the night.   The appetite
may be increased, but  loss of weight and mus-
cular weakness  are noticed, and thirst and dry-
ness of the skin are complained  of.
   Urine  in Diabetes.—The quantity is much in-
creased ; from two to six quarts or more is com-
mon.   The color  is clear  or  greenish-yellow.
The  specific gravity often  marks as high as
1030-1045,  and  the urine,  on  examination,  is
found to contain sugar (see p. 145).
  The course of the disease is essentially chron-
ic,  more acute  and fatal in young adults, but
more favorable  in persons over 40  years of age 
152   THE NURSE'S SERVICE DIGEST

Danger is indicated  by increase in the severity
of the symptoms, and a large quantity of water
containing  much  sugar.  The fatal termination
is in  many cases preceded by drowsiness, and
heavy, deep  breathing, gradually passing  into
coma.  Other complications are:  carbuncle and
boils,  neuralgic pains,  pulmonary  inflammation,
albuminuria, and gangrenous  inflammation of
the extremities.
  Management.—Diet is the first and chief point
to be  attended to, and it is necessary  to dimin-
ish or exclude saccharine and starchy material,
which accentuate the symptoms  and  keep up
the activity of the disease.  Almost all kinds of
animal food, flesh, fish,  and fowl may be  con-
sumed by the diabetic, but  the cooking should
be carefully supervised, and the cook informed
upon  every point in  the  serving up of  made
dishes, soups, etc.  Soups  must  not  be thick-
ened  by farinaceous matter, joints basted with
flour,  or jellies sweetened  with sugar or syrup.
Many  vegetables  are obnoxious, potatoes in par-
ticular, but many green vegetables  may be al-
lowed.  Bread is injurious, and is  the  most
difficult article of everyday food for which to
find an efficient  and palatable substitute.  Milk
agrees  well with many  diabetics, but contains
sugar of  milk,  so  that  large  quantities  may
prove  harmful.  Owing to the great emaciation
accompanying the disease, it is important that
the diabetic should  be well fed,  and from the
great  restriction  necessary  much ingenuity  is
required to provide  a  tempting variation in the
bill of fare  from day to  day.   In some  cases
when  there is  great loathing  of  the  restricted
diet,  greater latitude  has  to be allowed, as re-
striction is harmful, selecting foods most easily
assimilated and  least  liable to aggravate the
disease. 
     DISEASES OF SKIN AND  KIDNEY  153

  Dietary.—The  following  dietary  is useful,
containing most  of the  articles of  food and
drink that a diabetic may partake of:—
  Poultry, game,  and fish of all kinds.  Beef
tea,  broths,  and  animal  soups  not thickened.
Eggs, dressed in different ways.
  Cheese, cream cheese, butter, and cream.
  Substitutes for bread are:  graham or gluten
bread, or brown bread thoroughly toasted.
  Vegetables—greens,  spinach, turnip-tops,  cel-
ery,  endive,  lettuce,  water-cress, mustard and
cress.
  The following vegetables should only be taken
in small quantities, and  should  be boiled in  a
large quantity of  water:—
  French beans,  Brussels sprouts,  cauliflower,
asparagus, and vegetable marrow.
  No vinegar—fruit acid  instead.
  Jelly,  flavored,  but not sweetened.  Savory
jelly, blanc-mange, custard without  sugar.
  For drink:  tea, cocoa, milk,   or  buttermilk,
Sauterne, hock, soda-water, Burton  bitter  ale.
  The following must  be  avoided:—
  Sugar in  any  form.   Rice, arrowroot, corn-
flour,  oatmeal, sago, tapioca,  macaroni, vermi-
celli.   Potatoes,   carrots,  parsnips,  beet-root,
peas.  Pastry and all puddings.  Fruit of all
kinds, fresh  and  preserved.   Sweet ales, porter
and  stout, cider, sweet wines, sparkling wines,
port wine, liqueurs.
  Some variations  will have to be made in dif-
ferent instances, certain  articles being apt  to
disagree with each individual.
  The nurse will  have  to keep  a  very  strict
watch on patients under her charge  with  re-
gard to the diet.   In hospital practice, many of
the patients  do not understand the  importance
of the restrictions, and  wilfully break  through
the  rules, and  even  the best-intentioned will 
154   THE NURSE'S SERVICE DIGEST

sometimes  covertly obtain forbidden food.   An
unexpected increase in  the sugar in the urine,
or an accentuation of  the symptoms without
due cause,  should raise  a suspicion that contra-
band  articles are introduced in some way or
other.
  Worry,   anxiety,  and  overwork  should  be
avoided as far as possible, and the attention of
the patient should be distracted from the dis-
ease.   Exercise and fresh air  should be  ob-
tained regularly,  but hard travelling discour-
aged.
  Free and regular action of the bowels is  ab-
solutely essential, and  warm baths will assist
the action of the skin.
  Thirst may be assuaged by acid drinks, con-
taining lemon juice, and a fair quantity of fluid
must  be allowed when the thirst is excessive.
  The symptoms are controlled either  partially
or entirely after  the diet has been  restricted
for a short  time;  the  amount of urine dimin-
ishes, as also the quantity of sugar contained.
The  patient  gradually  regains  flesh   and
strength, and as long as the diet is adhered to,
continues to  improve, or remains stationary.
  The drugs which exert  most influence in al-
laying the symptoms are: opium,  codeine, or
morphia; and cod-liver oil is  beneficial  as a
food,  if it  can be  retained and assimilated.
  Dangerous or fatal complications may be pre-
ceded by an  increase in the symptoms of thirst
and emaciation, or  by  pulmonary  disorders;
constipation, shortness  of breath, and drowsi-
ness may indicate the approach of coma; albu-
men in the urine is also a grave symptom.
  All accidents and acute diseases  are exces-
sively fatal in the diabetic.  From the tendency
to gangrene in the older patients, wounds of the
extremities  should be  carefully attended  to, 
     DISEASES OF SKIN AND KIDNEY  155

and  corns should not be cut with the knife, or
strong caustics applied.
  Sweaty  Feet.—Excessive  sweating of  the
soles of the feet is a common affection among
domestic servants.  It is frequently  associated
with a most unpleasant odor, which is almost
characteristic  of the affection, and  permeates
all the surroundings of  persons suffering from
it, and even  clings to  the  room  which  they
have left.
  Management.—It may be cured by care  and
attention in the following way:  The old boots
and  shoes  previously  worn  will  be found to
have an offensive odor; the insides may be well
powdered with boracic acid powder, or, if much
tainted with the discharge, the lining should be
removed  and new cork soles introduced.  A so-
lution should  be  prepared by adding powdered
boracic acid to a quart or  more of  hot water
until the water ceases to dissolve it, and some
powder remains  at the  bottom.  This may be
allowed  to  cool.   Several  pairs  of  stockings
should be placed with the feet in the solution,
and, when  soaked, should be afterward dried.
The  stockings are  now ready  for  use,  and
should be changed several times in  the day in
bad  cases.  The feet of the  stockings should be
replaced  in  the solution after they  have  been
worn.  The  cork soles  may  be also  soaked in
the  solution,  if  they  become offensive,   and
dried.
  The  patient's feet  should  be  washed  every
night, and the soles anointed with zinc or sali-
cylic ointment. 
CHAPTER  VIII.
                 ON FEVERS.

Fever — Different Forms of Fever — Infectious
  Fevers — Germs — Contagion and Infection —
  Isolation—Rules for  Disinfection—Incubation
  and Invasion Periods.
Symptoms  and Management of Chicken-Pox—
  Scarlatina—Small-Pox— Measles— Typhus—
  Typhoid Fever  and Its  Complications—Diph-
  theria—Mumps—Cholera—Rheumatic  Fever—
  Malarial Fevers—Ague.

          Different Kinds of Fever.
  The word fever denotes a more  or less con-
tinued elevation of temperature, and is said to
be moderate when it does  not exceed 103°; high
when it stands at 105°; and very high or hyper-
pyrexial when it continues above 105°.
  The course  of fever has certain characteris-
tics in different diseases; it is termed continued
when it runs a prolonged  course with but little
intermission; remittent when it fluctuates every
day, but does not regain  the normal until the
disease is at an end; intermittent when there is
an interval  of some duration in which the tem-
perature remains  at  the  normal  between  the
periods of fever.   Hectic denotes  a remittent
form of temperature common  in affections as-
sociated with suppuration  and abscess forma-
tion,  and is usually accompanied with a pink
flush on the cheeks, pallid face, and a profuse
perspiration when the  temperature descends.
                     156 
ON FEVERS
157
  Accompanying these varieties of feverishness
there is  frequently a sense  of chilliness, or a
rigor when the temperature ascends, and a dis-
turbance of the bodily functions, a quick pulse,
increased rapidity of  respiration, headache, las-
situde, and digestive  derangement
  The Infectious Fevers form a separate class
owing to the fact that they are communicable
from person to person.
  Terms have been used to classify fevers, such
as specific or zymotic, according to the views
held as  to the nature of .the  poison.  But the
doctrine  accepted at  the present day  ascribes
these diseases  to  the agency of minute  organ-
isms called germs, which are exhaled from the
body of the patient.  These float in the air, mix
with the dust, or are carried in water, milk, or
food, and thus conveyed to human beings, in
whom they may  produce an  outbreak of the
same disease from which they originated.
  Contagion  and  Infection.—Contagion implies
communication  by contact  with  the  affected
person, but infection  is a more convenient term,
and includes all methods through which the dis-
ease .may .be  spread from  person  to person,
whether  by close  intercourse,  or at a  distance,
by the dissemination of small particles in air,
water, or other media.
  There  is some difference among the infectious
fevers in the degree  of infective powers  of the
emanations from  the different  parts of the
body;  thus, in diphtheria, measles, and  in the
early period of scarlatina the breath is a ready
means of infection.  In small-pox, and in des-
quamation after scarlatina, the skin carries the
poison, while in typhoid and cholera  the dis-
charge from the  bowels are  loaded with the
germs of the disease. 
158   THE NURSE'S SERVICE DIGEST

  Precautions to Be Adopted to Prevent the
             Spread of Infection.
  Separation and Isolation of the Sick Per-
son.—The first thing to be done in the  case of
infectious illness is to remove the sick  person,
and isolate him completely from others.
  At the commencement of an epidemic  or out-
break, and where the initial symptoms of ill-
ness are unpronounced, such a proceeding may
not be possible until the appearance of the rash.
When epidemic or infectious fever is prevalent,
or when it has already attacked a household or
school,  measures  for  isolation  can  often  be
taken at the earliest onset of the disease.
  A rigor or feverish symptoms may denote the
onset of any fever; in measles, discharge from
the eyes  and  nose, sneezing, or  coughing  in
scarlatina, sore throat and pain in swallowing
are early  signs, and the contagious material is
active from the commencement.  In a  school or
public institution the patient should be removed
to the sick house or sanatorium, where isolation
is easily managed. In a private house, the most
secluded region should be chosen,  a room  at
the top of the house for the bedroom,  and, if
possible, the  whole floor should be kept exclu-
sively for him  and for those in attendance  on
him.  The rooms may be previously stripped of
all  unnecessary furniture,  curtains, carpets,  or
wooUen material  likely  to retain particles  of
contagious matter. No one else should  be per-
mitted to enter the room,  and the inmates  of
the house should  be kept from all communica-
tion.  The attendants should avoid unnecessary
intercourse with the household, and the  needful
crockery and utensils should be kept exclusive-
ly for the patient's use,  and instead of being
sent downstairs, they should be washed by his
attendant.  The food should be plaeed  outside 
ON FEVERS
159
the door and taken in by the nurse, the uneaten
remnants being  destroyed.
  Disinfection  has for its object the destruc-
tion of the morbid particles or germs  thrown
off  from the sick person.   Disinfection is nec-
essary for the room, the patient, and for every-
thing that has been in the same room with him.
Some general rules have been laid down by the
medical officers  of  health  as usually applicable
in all cases of infectious illness.

            Rules for Disinfection.
  1. The room occupied by the patient must be
well ventilated,  the windows kept partly  open,
and, when the season will permit, a fire should
be  kept  burning in an open grate.  The  floor
must be cleaned every  day, and  sprinkled  with
disinfectant fluid.
  2. The  door  should  be  closed, and  a sheet,
kept constantly  wet with a solution of carbolic
acid (1-40),  may be hung as a curtain outside,
so as to cover all the crevices.
  3. All  bed  and body  linen after use and be-
fore leaving the room should be left to soak for
at least an hour in the  carbolic solution.  These
should then  be  boiled  in water, and well ex-
posed to the  air.
  4. All  discharges from  the  patient—phlegm,
vomit, urine, aeces—should be received into ves-
sels containing  some disinfectant powder.   Af-
ter use, some more of the disinfectant should be
added before carrying the vessel  out  of  the
room and emptying it  into the  closet.   Pieces
of  rag  used for  wiping  away  the discharges
from the patient  must be  burnt immediately
after use (see Bed-Pans).
  5. All  crockery,  knives, forks, etc.,  used by
the patient should  be placed in disinfectant so-
lution, and subsequently washed  in hot water. 
160   THE NURSE'S SERVICE DIGEST

  0.  The patient's body should  be kept scrupu-
lously clean,  and the bed ventilated during the
day.  If scales  or  crusts form upon  the skin,
they may be  smeared with ointment or oil, con-
taining antiseptics,  to prevent their dispersion.
  7.  Nurses or  attendants  should,  if  possible,
be of mature age, or such as have already had
the patient's disease;  their dress should  be of
cotton or material  that  will  wash easily.   Bo-
fore taking meals and before leaving the room,
the hands should be carefully  washed in car-
bolic  solution.   They  should avoid,  as far  as
possible,  inhaling their patient's breath or  the
emanations from the skin or other discharges.
They should  avoid  all unnecessary communica-
tion  with the other members of the household.
On ceasing attendance, they should observe the
rules for the disinfection of their clothing, and
disinfect themselves by warm baths, paying par-
ticular attention to the cleansing of  the hair.
The  skin should be  well sponged all over with a
warm solution  of   carbolic  (1-40),  and  then
washed all over with soap  and  water.   The
nails should be cleaned with the solution, and a
nail  brush used.
  8.  If visitors  have to be  allowed  under  ex-
ceptional circumstances, they should be made to
conform  to the  rules  observed  by those in at-
tendance.
  9.  The patient must not be  allowed to mix
with  others  until  he has  received permission
from the medical attendant, and until he has
been disinfected by the use of warm baths, and
sponging with  carbolic solution.   Clothes  that
have been exposed to infection  must not  be
worn until they have been  thoroughly disin-
fected.
  10. Disinfection of the Room,  Clothing, and
Contents.—When the patient  is  convalescent 
ON FEVERS
161
and has left  the sick-room,  all  the  articles
which  cannot be  dealt with at  home, such as
bedding, drapery,  curtains, and  outer clothing,
should  be sent  away to the "oven," which  is
usually  provided  in  certain  districts  by the
health authorities for purposes of disinfection,
and who will remove them if applied to.  There
they are subjected to a heat of from 212°-250°
F. for  several hours.
  Clothing  and other  materials  remaining in
the room should be spread out and hung upon
lines fastened  across the room, and all  other
articles exposed; the doors, chimneys, windows,
and all openings must be well closed and cov-
ered by  pasting brown paper over the crevices
before fumigation.  For fumigation, take half a
pound  or more of  sulphur, according to the size
of  the  room, break  it into small  pieces, and
place it in an iron dish or pan, and then  set  it
on  fire with a few live coals.  The dish should
be  supported over a pail of water by  placing
the tongs across  as  a precaution  against fire.
The attendant should  at once leave the  room
on lighting the sulphur, and close the door. The
room may  be  kept  shut up  for  twenty-four
hours.   At the end of this time the room should
be  freely ventilated  by  opening the windows
and doors,  and  all its  contents exposed to the
air.  The floor should be  well scrubbed, and re-
papering, painting, and white-washing would be
extra precautions.
  Sinks and closets which have been used dur-
ing the illness  should be  well flushed with dis-
infectant  solution, and  afterward thoroughly
scrubbed down and ventilated.
              Infectious  Fevers.
  The  Infectious   Fevers  are  chicken-pox,
scarlatina, small-pox, measles,  typhus, typhoid,
diphtheria, mumps, and cholera. 
162   THE NURSE'S SERVICE DIGEST

  Incubation and Invasion Periods.—The infec-
tious fevers have several characters  in common.
After the  entrance  of  the infectious material
into the body, a period of time elapses in which
no  symptoms of illness are apparent; this  qui-
escent interval is called the incubation period.
The length  of  this period varies  in the differ-
ent fevers, and is apt to be inconstant.  At the
end of incubation, the period of invasion com-
mences with symptoms of illness of  varying in-
tensity.  There is commonly  chilliness,  loss of
appetite, lassitude, or headache.  In  some pa-
tients a rigor denotes the onset, or  in children
convulsions or vomiting.   The temperature is
elevated and the pulse quickened,  and  the other
symptoms of feverishness appear.
  The rash or exanthem will come out a day or
more after the illness commences, the  length of
the invasion period being peculiar  to each fever.
  Varicella, or Chicken-Pock, is  most common
in children, but may attack adults.   The incu-
bation period is usually from a week to a fort-
night.  The invasion is often so mild as to es-
cape  notice,  and the rash  appears  in twenty-
four  hours.  The eruption takes the  form of
minute  papules and vesicles  appearing on the
chest and  trunk, head and limbs.  They often
come out in crops, increase in size, become  flat-
tened, and  the fluid inside is  of milky color.
They burst and  dry up,  forming scabs,  which
finally disappear, but may leave some slight
scarring.  The  crops last four or five days each,
and the course of the whole disease from a fort-
night to three weeks.
  Management.—The disease is a  mild one, and
not usually attended with  severe symptoms or
high  fever.  The patient  should  be  separated
from other children, and  put on light diet.  No
special treatment is  necessary.  Children should 
ON FEVERS
163
be prevented  from  scratching  or picking the
vesicles,  which  may ulcerate  and  cause sore
places, in which case  simple dressings will be
required.
  Scarlatina, or Scarlet Fever, is a disease
which attacks children and adults in preference
to older  people;  it is  frequently epidemic, and
highly infectious.   The  incubation period is
often short,  less  than a week, and  the rash
comes out on the second day of the illness.  The
invasion is  sudden, and  usually  marked  by
chills, vomiting, and sore throat.  The rosy or
red rash appears first  on the chest,  and is seen
early on the  flexor aspect of  the  joints.   It
becomes  general in the  course of  forty-eight
hours, and is fully developed  on the third or
fourth day.  The other symptoms continue or
increase  during  the development of the  rash,
and  the throat presents a dusky red appear-
ance, with swelling of the tonsils.  The tongue
may present the characteristic strawberry-like
appearance, a white fur with  red papilla?  pro-
jecting.   The rash begins to fade  on the fourth
to the sixth day of the disease, and disappears
in a day or  two; the other symptoms also de-
cline, and the  temperature comes down.   Peel-
ing  of  the skin  or  desquamation next  com-
mences  on the chest  and other  parts of the
body, and lastly on the limbs, and hands and
feet.
  In a mild  epidemic  of the disease the  symp-
toms are of  slight character;  indeed,  in  some
patients  they escape notice, and the rash  itself
may be  overlooked.   Some desquamation may
be observed afterward, and the disease in this
way is easily spread.
  In others the  attack is severe, and  in  some
dangerous or fatal.  The rapidly fatal cases die
from profound  nervous  complications,  such as 
164   THE NURSE'S SERVICE DIGEST

delirium or coma, or else from extreme prostra-
tion, a few days after the onset; such cases are
termed  "malignant" and are usually associated
with defective sanitary arrangements.
  In severe cases the throat symptoms are pre-
dominant,  the  tonsils being  much  swollen  or
ulcerated,  with  sloughing patches.   Complica-
tions  liable to occur are rheumatism, pericar-
ditis,  inflammation  of the internal ear, and em-
pyema.   During convalescence, inflammation of
the kidney with  albuminuria  and  dropsy may
appear in the third or fourth week.
  Management.—Immediate  separation  of the
patient  from  other individuals should be  in-
sisted on,  and an  observance of  the ordinary
precautions for  the management  of infectious
cases  (see Isolation and Disinfection).  In mild
cases  no particular remedies are used, and the
fever  will run its course.   In those complicated
with severe sore throat, and where there is dif-
ficulty  in  swallowing,  pieces of  ice  may  be
given  to suck, or steam  inhaled, or the throat
washed  out with chlorine-water. Warm milk is
usually  well taken,  and in cases where there is
much  depression some form of stimulant, usual-
ly a milk punch or egg-nog, is required.  During
convalescence in the third  and fourth week  a
careful  watch should be kept  on the  condition
of the  bowels  and urine, as  kidney-complica-
tions  are apt to ensue.   This would  be  indi-
cated  by the  presence of blood in  the urine, or
by albuminuria,  with perhaps some  gastric dis-
turbance, and dropsy  of the  eyelids,  face,  or
feet.  The  urine should be examined  for  albu-
men constantly, and if this begin to  appear, the
medical attendant should be informed.  Cold or
chills  should be scrupulously  avoided by con-
finement to bed, the bowels should be freely
open,  and  the diet restricted, the nitrogenous 
ON FEVERS
165
elements, such as meat, being avoided; beef-tea,
milk and eggs are preferred  for nourishment.
  Desquamation.—The  surface  of  the  body
should be well oiled with carbolized oil to dis-
infect  the  skin  before it peels.   Warm baths,
and  the use  of carbolic acid soap, are a great
assistance to the peeling, which often continues
for six or more weeks after the fever.   In any
case, the patient is not safe as long as desqua-
mation persists, and the hands and feet should
be carefully  inspected before he  is allowed to
mix  with others (see Disinfection).
  Small-Pock, or Variola.—Before the discov-
ery of vaccination, this  disease was  one of the
most dreaded scourges of the country, owing to
its great fatality, and from  the extreme disfig-
urement  of  many who  survived the  attack.
Nowadays, in those  who have been efficiently
protected by vaccination, small-pock assumes a
modified  form, in some of a very mild charac-
ter.
  The  incubation period is from twelve to  four-
teen days.   The invasion is  often sudden,  with
rigors, vomiting, headache,  and pain more or
less  intense in the lumbar region of the spine.
On the third day the eruption appears in the
form of small reddish papules on the face,  neck,
and  wrists, and gradually spreads to the other
parts of the body.  The spots are hard,  and feel
like  shot under the skin, and  enlarging in two
or three days become vesicular, and in six days
contain pus.  At this time the surrounding skin
becomes  inflamed and red   and swollen.   The
pocks then subside and dry  up, forming scabs.
  The  constitutional  symptoms and fever  vary
greatly in intensity, but on the first appearance
of the rash these all subside  in  a  marked de-
gree, until the sixth  or seventh  day, when the
vesicles mature and  become pustular;  there is 
166   THE NURSE'S SERVICE DIGEST

again an increase  in  the fever,  and the consti-
tutional symptoms may be more severe than at
the commencement, and attended with delirium
and a dry tongue.  The rash also appears in the
throat and fauces, and may cause great sore-
ness and pain in swallowing.
  Management.—A large,  airy, well-ventilated
room  should  be procured,  if possible, and  the
precautions for isolation rigidly adopted.  The
nurse selected should  be one who either has had
the disease, or has been thoroughly protected by
vaccination.
  In mild or  modified cases the disease runs  its
course without  occasioning any anxiety.    In
the "confluent," or  severe forms,  a  fatal  re-
sult is common in the unvaccinated,  or symp-
toms of the gravest kind may  be present.
  When there is great soreness of the  throat,
warm bland  drinks may be given, and if there
is much discharge from the nostrils or  fauces,
some  mild astringent wash may be used.  The
local treatment of the rash is important  to pre-
vent abscesses, and  to modify the soreness of
the pustules.   The patient should be kept clean,
and frequently sponged with tepid water.  The
condition of the eyes should be watched, as pus-
tules  may form on the conjunctiva.   The sur-
face of the body may  be anointed over  with car-
bolized or olive oil  every day  after  sponging.
The face may be coated with collodion  or dusted
with finely powdered boracic acid or zinc pow-
der.   When the scabs are hard, black, or offen-
sive, bread poultice may be applied  to loosen
them and allow the matter to escape.
  Measles.—The incubation  period  lasts from
twelve to fourteen days.  The invasion period is
marked by symptoms of a  cold in the  head and
some  feverishness.  There is sneezing, running
at the eyes and nose of watery mucus, a patchy 
ON FEVERS
167
redness of the mouth and  fauces, and  usually
an irritable cough.  On the fourth day the erup-
tion begins to appear about  the neck and behind
the ears, and on the forehead, and then on the
chest, gradually invading the rest of the body
and extremities.  It  attains its height in from
two to three days,  and then gradually declines.
The rash consists  of small red papules which
increase in size, and form crescents or irregular
circles.   There  is  some  branny  desquamation
for a week afterward.  The complications likely
to  occur  in  measles are  those affecting the
lungs, such as bronchitis  and inflammation  of
the lungs.  Inflammation  of the ear and ear-
ache, or conjunctivitis,  may supervene.  Diar-
rhoea is an ordinary complication, and  is trou-
blesome in some  cases.   In the  more severe
cases, delirium  and great  prostration  is pres-
ent, and gangrene of the cheek or vulva in deli-
cate,  feeble children  is sometimes a fatal event.
  Management.—The  contagion  of  measles  is
very  active  at  an early  period before  the  ap-
pearance  of the rash when the catarrh  is pres-
ent.  When measles is epidemic,  this  catarrh
should  create suspicion, and separation be en-
forced  at  once.  Children  should  be placed  in
bed at once,  and  care taken  to avoid  chilling
of  the  surface, or anything tending to aggra-
vate  the cough  or  produce  pulmonary complica-
tions.  If these occur, they will require special
management  (see Bronchitis).
   Attention should  be  paid to complaints  of
ear-ache in children, and any discharge  noticed.
Aperients should be avoided, as the subsequent
diarrhoea may  prove troublesome.
   During convalescence precautions against cold
are very necessary, as some delicacy of  lung, or
general debility, is often left in children, espe-
cially in those of tubercular taint. 
168  THE NURSE'S SERVICE DIGEST

  Botheln.  or German Measles.—The incuba-
tion period is sometimes very long,  nearly three
weeks.  The symptoms  are often less severe
than true  measles, and the rash is  papular, not
blotchy, and more  rosy  in tint  than measles.
The rash  is often preceded or accompanied by
swelling of the lymphatic glands behind the ears
and on the nape of  the neck.  There is less  ten-
dency to  catarrh or delicacy during  convales-
cence.
  Typhus.—Putrid   fever,  or  gaol fever,  are
other names for this fever,  which  is occasioned
mainly by overcrowding, destitution, and dirt.
  The  early  symptoms  are  characterized  by
great dulness and mental confusion, with qui'k
pulse  and fever.  After the fifth  or  sixth  day
the mulberry-colored rash  of  small  spots  ap-
pears, with petechia? (see Petechia*).
  The constitutional symptoms are grave,  and
delirium,  or coma with great prostration, ma.\
forebode a fatal result.  The urine is retained,
and must  be drawn by the nurse, and  the f:eces
passed  unconsciously, and  the  patient  sinks
from exhaustion, bed-sores, or pneumonia.   In
favorable  cases the symptoms abate, and  the
temperature subsides, perhaps suddenly, during
the third  week.
  Management.—In addition to the ordinary ob-
servances, constant stimulation will be required
in bad cases, and complete confinement to  bed.
Careful attention to the bladder and to the  pre-
vention of bed-sores is requisite, when there  is
much insensibility.  A  peculiar odor  has been
noticed in this disease, which is said to be char-
acteristic.  There is sometimes some difficulty
in the  early  stages in  distinguishing  typhus
from measles and haemorrhagic small-pox.  The
disease is most fatal in children and old people, 
ON FEVERS
lbl)
but epidemics are rare now in this country, and
a solitary case occurs only now and then.
  Typhoid,  or  Enteric  Fever.—This  disease
may  occur  at any period of the year, but  is
most  common in the autumn months, and though
attacking persons at all  ages,  is  essentially a
disease of early life.
  The specific contagion is contained abundant-
ly in the stools  and emanations from typhoid
patients, and it may be conveyed to others by
use of the same drinking cup,  drinking water,
milk, or by  the effluvia from infected drains, or
from  the different  excretions  of the patient.
Epidemics  of typhoid fever  are common,  and
may  often be traced to an  impure water  sup-
ply,  or  to  the  milk supply  from an  infected
dairy. Direct contagion from the patient or the
stools is not infrequent in the case of nurses or
attendants of a youthful age.
  The nature of the disease consists  essentially
in inflammation  and ulceration  of the Peyer's
glands of the intestines.  In the earlier period,
during the first week, there is  swelling of the
glands, and  these ulcerate  during the second
and  third  weeks, when  the slough  separates,
leaving the  bowel very thin at  this part,  until
healing has occurred during the fourth and fifth
weeks.
  Symptoms.—No two cases are  exactly alike,
but an instance of an ordinary  attack may be
given by way of example:—
  After a week or more of general indisposition
and increasing lassitude, the patient takes to
his bed.  He  has a heavy, dull  look; his face
pale,  with  slight flush on  the  cheeks.   The
tongue is moist, red at the tip and edges,  with
a light white fur in  the center.   The abdomen
may  be rather tumid and tender,  and  the mo-
tions  are usually loose.  The stools are  com- 
170   THE NURSE'S SERVICE DIGEST

monly of light  yellow  color, and of the con-
sistence  of pea-soup.  The  temperature is ele-
vated, being higher at night than in the morn-
ing.   The pulse  and respiration are  quickened,
and a bronchial cough is often present.   About
the tenth  day,  or  between  the  seventh  and
twelfth,  a rash appears  in the  majority  of
cases.  The rash consists of minute papules on
the abdomen, chest, or back.  They are rounded,
perhaps slightly  elevated, of rose color, and fade
on pressure, returning when the pressure is  re-
moved.   Each spot  lasts  about  two or three
days,  gradually  fading.  The general condition
of the patient is characterized by weakness and
prostration  with  stupor,   and wandering  at
night
  Toward the end of the third, or in the fourth
week, the tongue begins to  clean,  and the tem-
perature gradually falls, reaching the  normal
about the  end of the fourth week.  Convales-
cence is gradual and slow, and commonly with-
out serious drawbacks  (fig. 43).
  Relapse.—In a certain number of cases, after
a week or fourteen days from the  time the tem-
perature gained  the normal, the  temperature
again begins to ascend,  and fresh rose spots ap-
pear,  with a repetition of  the original  illness,
though  of  shorter duration; this is called  a
"relapse."  One  or  more  relapses may  occur,
and they are usually less severe than the first
attack (fig. 44).
  More severe cases are indicated by a higher
temperature,  of  105° or 106°, or by great pros-
tration, a dry brown tongue, or profound nerv-
ous symptoms of delirium and stupor.
  In typhoid fever, whether mild or severe, cer-
tain complications are usually apt to occur at
certain periods, with which the nurse should be
acquainted.  In  the  early stage,  or during the 
ON FEVERS
171
first ten days, serious complication is  uncom-
mon,  there is  sometimes slight bleeding  from
the bowel or nose.
  Death in the early  stage of typhoid fever is
rare.
  After the second week the complications are
more dangerous.
  Severe Diarrhoea, with eight or  ten  watery
evacuations during the twenty-four hours, may
cause great prostration.
  Hcemorrhage  from   the   bowel  should  be
watched for;  a few  ounces need  not cause
alarm, but half a pint or more repeated at in-
tervals  is dangerous.
  Peritonitis and Perforation.—The former  is
always  of grave import and sometimes fatal,
and the latter  almost  certainly  fatal.
  Bronchitis and Pneumonia.—Some branchitis
is commonly present,  and need not cause anx-
iety unless severe, or  accompanied by  lividity
and difficulty in  breathing.  Pneumonia is apt
to supervene very insidiously, and may be indi-
cated by short, rapid breathing, pain in the side,
or blood-stained sputum.
  Bed-sores are very easily produced from the
wasing  of the tissues, lying in one position, in-
voluntary  evacuations, and  other  causes,  and
should be guarded against (see  Bed-Sores).
  Management.—A successful issue in  typhoid
fever depends in great measure on careful nurs-
ing, to  a greater extent in  this than  in  any
other disease.  A knowledge of the nature of
the fever will assist  the nurse to  understand
the reason of the precautions observed in man-
aging these cases, and to be prepared  for the
complications which are likely  to occur in the
several  stages.
  The patient  should  be put to bed  after  re-
ceiving a warm bath, or, if too ill for a bath, he 
172   THE NURSE'S SERVICE DIGEST

may be sponged all  over with  warm water; at
this time any spots should  be noticed, and their
position observed.  It is advisable to  cut the
hair quite short after attending to the head.  A
water-bed should  be used from  the first.  In
most cases of typhoid, drug treatment is unnec-
essary,  but perfect  rest, careful feeding,  and
sleep  are  essential,  and the complications will
also require special management.
  Perfect  Rest.—Friends should be excluded as
far as possible, and  the patient must  be kept
absolutely quiet in bed, and lying  down.  Dur-
ing the middle  and later periods  of the disease,
moving in  the  bed  should be  accomplished
gently and gradually.  Fatal perforation  of the
bowel has occurred from sitting up, or  walking
about during the stage of ulceration.
  Diet and Feeding.—Exhaustion  and  emacia-
tion are prominent features in the disease, and
the  patient  requires  constant   nourishment
so that a patient suffering from typhoid  fever
should be  fed  at stated intervals during the
day, and also during the night, if the patient is"
having a fair amount of sleep. Those forms of
food should be given  which are digested with
the greatest ease.  Warm  milk,  that has been
previously sterilized and to which  a  small por-
tion of table salt has been added may be given
in the twenty-four hours,  diluted  with water,
barley water or soda water.  An adult will take
five or six ounces of milk every two hours, and
if given regularly a quart, or even two quarts,
can be  taken in this way in the twenty-four
hours  without  discomfort, to which  a small
amount of brandy may be added, if a stimulant
should be given.
  The stools of a patient on a strictly milk diet
should be examined  from time to time to see if
the milk is entirely digested and there are no 
ON FEVERS
173
curds present.  If well taken, nothing else need
be  given, but  if  very much disliked, veal  or
chicken broth or beef-tea may be substituted in
the place of one of the pints of milk.
  If the  milk  is  not  digested,  whey or pepto-
nized  milk   will  often  agree when the  plain
boiled  milk  fails.   The  patient  should  be al-
lowed to drink water freely when thirsty.
  In great prostration, nutrient  enemata of pep-
tonized milk, egg, and brandy may be required,
or  a saline  injection  of sterilized water,  salt,
and brandy.
  In severe  cases, with prostration or stupor, or
when there is  great loathing of milk or fluids,
and when the tongue is dry and brown, with
crusts  or sordes on the lips,  feeding is difficult;
but a successful result depends  on the adminis-
tration of nourishment.   The difficulty may  be
diminished by first cleansing the mouth,  tongue,
and lips with  glycerine,  borax, and  essence of
lemons, and then the nourishment, two or three
ounces, should be given  in  a feeder or spoon
every one or two hours.  Natural sleep should
not be heartlessly broken for the exact hours of
feeding, but a condition of stupor or prostration
must not be mistaken for* sleep,  and then  the
patient should  be  aroused to be fed.
  Stimulants are unnecessary in ordinary cases,
and where  nourishment  is well  taken,  but  in
the worse cases life may depend on them,  but
if  required  by the patient the  amount  will  be
prescribed by the medical attendant
  In the  fourth week, or when the patient is
beginning to feel  better,  there is often  a crav-
ing for solid food, and attempts  may be made
to persuade the nurse  to humor him  in this re-
spect,  especially  by the  friends,  who  are  not
aware  of the danger.  The walls of the bowel
are  very thin  where  the ulceration  has  oc- 
174   THE NURSE'S SERVICE DIGEST

curred, and if solids, or undigested hard bodies
are swallowed, a hole may be made In the bowel
and fatal peritonitis ensue.  The temperature is
the best  guide in  ordinary  cases as to the  ad-
ministration of solid food, and it is wise to wait
until the temperature has kept at or about nor-
mal for  a  week  or ten days before any  solid
food is allowed.   White fish is best in  the first
instance, followed after  a  while by  chicken,
sweetbread, light milk puddings, etc.
  Sleep.—It is important for the  nurse to be
careful to distinguish between a state of stupor
and natural sleep.  The latter  is  highly bene-
ficial,  and  should be undisturbed  for  four or
five hours if the nourishment has been previous-
ly well taken.  In stupor or prostration the  pa-
tient  must be aroused at intervals in order to
take nourishment.  If good sleep  is difficult to
obtain, a small  dose of stimulant at  night is
often  successful.   In other cases,  tepid spong-
ing, especially  if  the temperature  is  high, is
very comforting, and procures sleep.
  Diarrhoea.—Several  loose  motions  in   the
twenty-four hours are natural in typhoid fever,
and  require no  treatment.  When excessive,
such as eight or nine copious fluid watery evac-
uations, the patient's strength becomes  reduced.
Enemata of starch and opium is a safe remedy,
and is often prescribed, or the administration
by the mouth of  opium in  some form.  Beef-
tea should be avoided while the diarrhoea con-
tinues, and care should be taken that the  pa-
tient is not overfed.
  Constipation is common in the mild forms of
typhoid fever and during convalescence.  In  the
early  stage it is  safe to clear  the alimentary
tract  by  phosphate of soda  in warm water and
enemata.  Afterward the bowels should be  left
alone unless the  constipation lasts more than 
ON FEVERS
175
 two days, or there is evidence of lumpy faecal
 matter in the rectum, when an enema of oil in
 small  quantity may  be  slowly and gently ad-
 ministered.   Aperients  by  the  mouth  should
 never  be given, except under  orders from the
 medical attendant
   Motions.—The poison which  conveys the dis-
 ease is abundantly contained in the motions.  It
 is absolutely necessary to disinfect these imme-
 diately;  therefore,  on  removing  the  bed-pan
 from the patient, a strong solution of carbolic
 acid  (1-20)  or corrosive sublimate (1/1000)  or
 lysol (2 per cent.)  should be at once poured in
 before  emptying  and cleaning it in the usual
 way.  The cotton tow, or rag, should be used to
 cleanse the  patient, and  this  must be immedi-
 ately burnt.  The nurse  must always wash her
 hands in disinfectant solution after tending the
 patient or  touching the  bedding,  linen,  etc.
   When a motion has to  be reserved for inspec-
 tion,  a piece of tar paper or  glass, if  obtain-
 able, should be placed over the bed-pan and the
 handle stuffed  up with  lint wrung out  in the
 disinfectant.  The same applies to specimens of
 urine.
   All bed and  body linen should be put  in  a
 covered pail two-thirds full of disinfectant, and
 if the linen be soiled, a  covered  pail must  be
 taken to  the bedside to receive it.
   All vessels such as feeders, cups, speons, bed-
 pan, etc., to be marked  and kept entirely for
 that patient's  use.   They should be sterilized
 with  boiling water.   Special  marked  towels
 should be kept for cleansing and drying all such
 vessels.
  The  patient's clothes and bedding should  be
 thoroughly sterilized.
  Excessive  Fever.—A  high  temperature,   or
when the temperature is  constantly above 102° 
176   THE NURSE'S SERVICE DIGEST

or 103°,  is often treated  by cold  baths, or the
ice cradle (see Cold Baths and Ice Cradle).
  Haemorrhage.—This may take place from the
nostrils or bowel.  The former is often the re-
sult of picking the nostril, and is  usually insig-
nificant.   Haemorrhage  from the  bowel during
the first  fortnight is commonly  beneficial or
harmless, and  does not  need interference.  In
the third week and later, if copious, half a pint
or more, it is dangerous, and often  fatal if re-
peated.   The  medical attendant  should be at
once informed  in order that drugs  may be or-
dered, and ice applied to the abdomen (see Ice
Cradle).   In these cases opium is  useful, and
alcohol may have to be withheld.
  Peritonitis.—The onset may be insidious in
cases  associated with much stupor, in others
the symptoms and management would be  simi-
lar to cases previously  described  (see Perito-
nitis).  The peritonitis may be due  to perfora-
tion of  the bowel, when  there is  often sudden
fall of temperature to  sub-normal,  with symp-
toms  of collapse, such  as  great pallor,  cold
sweats, feeble pulse, syncope, etc. (see fig. 45).
  Pneumonia.—Inflammation of the  lung occurs
in a few cases in the course of the  disease. It
is often insidious,  and usually  dangerous,  espe-
cially  if  associated with great prostration, dry
tongue,  etc.  Stimulants are beneficial,  and at-
tention  to the temperature  and  ventilation is
specially required  (see Pneumonia).
  Plugged Veins.—Swelling of  the leg and pain
in the groin are symptoms of a clot  in the vein,
and are  sometimes attended with rigors.   The
patient should be kept lying down, with the leg
raised and wrapped in cotton batting, until the
symptoms have subsided.
  Convalescence.—The  temperature  should be
recorded morning and night for at least a fort- 
ON FEVERS
177
night after it has  reached the  normal,  and
longer if necessary.   A relapse occurs usually
from  seven to ten days after  the first illness,
and is indicated by a fresh gradual rise of tem-
perature, when the fluid diet must be  resumed.
The relapse lasts about fourteen days,  and in a
few cases a second relapse  occurs.  Slight rise
of temperature of a temporary nature may be
the result of excitement, or solid  food, or first
getting up.
  Great  hunger  is  common  during  convales-
cence,  and plenty of nourishment may be  al-
lowed after a while.  Mental imbecility, or deaf-
ness,  may  persist for a time,  but recovery  is
usual.
  Diphtheria.—A highly contagious  disease,  in
which the throat is sore and presents patches of
white membrane  in  parts,  and associated with
fever and  other constitutional symptoms.   It
affects children and adults at any  season of the
year,  but is far more common in children.   It
may be epidemic, and more often attacks damp
localities or insanitary houses; other  cases  of
ordinary sore throat are apt to prevail about
the same time.
  The period  of incubation  may be  very short,
only a few hours, or several days.
  Symptoms.—The general  symptoms   vary  In
intensity, and may be slight at the  commence-
ment.  The sore  throat is  often first  observed,
and  the tonsils  and uvula are  reddened  and
swollen, and a membrane of whitish or grayish
color  is seen on the  tonsils  and uvula,  or some
part of the pharynx.  There may be some dis-
charge  from  the  nostrils,   and the  membrane
may appear on wounds on the surface of the
body.  In  moderate  cases  the general symp-
toms are well  marked and accompanied by pros-
tration  and weakness.   Swallowing  is painful 
17S   THE NURSE'S SERVICE DIGEST

and difficult,  and the glands  of the neck  are
swollen.
  In  severe diphtheria,  death may occur in a
few days from extreme depression and prostra-
tion of strength.
  Laryngeal  Diphtheria.—This is  the most
dreaded  complication  in children,  and  is  one
cause of the great fatality  of  the disease.   At-
tendants  on  cases  of  diphtheria  in  children
should be acquainted with the symptoms which
indicate implication  of the larynx, as these  are
apt to occur  very suddenly, and in the night,
and rapidly become urgent.
  The child's  voiee  is  noticed  to  be  rather
hoarse on crying or  speaking;  there is a short,
dry cough, difficulty in  breathing, and  the  in-
spiration  becomes noisy and crowing.   As  the
difficulty in breathing increases,  the  child  be-
comes restless, and the lips and face bluish, and
then drowsiness supervenes.
  Management.—The nurse  should be prepared
to carry  out local treatment, if required.  This
consists either in painting  the throat with  lo-
tions of perehloride of iron,  or  antiseptics, or in
the use of the spray by the ball-spray appara-
tus.  During the application of these remedies
the tongue should be depressed by the spatula,
or gripped in a napkin and  drawn forward.
Coughing and expectoration  are very apt to be
produced  by  the application,  and  the nurse
should carefully  avoid receiving the particles
on her lips, as she may  easily  thereby contract
the disease.   A  respirator  or temporary  veil
may be used to cover the mouth at the time she
is making the application (see Throat Applica-
tions).
  Antitoxin Treatment.—The injection of Diph-
theria  Antitoxin is  frequently practiced,  and
has shown good results in early cases.   Recov- 
ON FEVERS
179
ery  has  most often been observed to  follow
when the treatment  has been begun not later
than the third or fourth day, and such patients
appear to be less liable to the Laryngeal form.
A special glass syringe is used for the injec-
tion, similar in kind to a hypodermic syringe,
but larger.  It is  so  constructed that all parts
can be rendered aseptic.
  In severe cases, constant nourishment is  nec-
essary to support  the general strength.  In all
cases it  is  highly  important  that the room
should  be well ventilated and  supplied with
plenty of fresh warm  air,  without  draught.
The temperature of the room should be about
60° F.
  Children should  be  carefully watched at night
for any  indication of the symptoms of impli-
cation of  the larynx,  such  as difficult breathing,
etc., and the surgeon  should be informed in case
tracheotomy may  be necessary  (see Trache-
otomy).
  Diphtheria  is very fatal in children,  either
from exhaustion or suffocation. In  a few cases
sudden  death  occurs unexpectedly  from syn-
cope.   If  there is much prostration, or  a  ten-
dency to  faintness, the patient should be kept
in bed and not allowed to get up.   The urine
must  be saved and examined for  albumen dur-
ing the disease.
  Paralysis.—During convalescence, and even
some months afterward, there is a liability to a
peculiar form  of paralysis.  This may be first
indicated  by a  return of fluids through the nose
during swallowing, or a nasal character  in the
voice, or  weakness in the muscles  of  the  legs
or back; or perhaps squinting and shortness of
sight  may be  first noticed.  The paralysis may
be slight  in  character  and limited,  or  it may
invade a  large number  of the muscles of the 
180  THE NURSE'S SERVICE DIGEST

body.  Recovery is commonly complete in a few
weeks  or months.  Massage,  warmth,  and at-
tention to the general health  will assist  recov-
ery.
  Mumps.—This  disease  affects children  and
young  adults at any season of the year.  There
is  inflammation  and swelling of the  salivary
glands, attended with  some  general  feverish-
ness.  The swelling produces a peculiar  rounded
look  about the face, in front of the ears,  and
under  the chin.  One side of  the face  is often
first  affected  and  then the  other, and swal-
lowing is usually painful.  In a few cases the
inflammation attacks the generative organs.
  Management.—The patient should be  confined
to the  room, and the face and  neck protected by
cotton-batting or soft flannel.   Pain may be re-
lieved  by hot fomentations, and care taken to
avoid cold or draughts.  Light liquid diet should
be given at first.  There is often general debil-
ity and feeble health for some time afterward.
  Asiatic Cholera.—A disease  known  by vom-
iting and purging, and  accompanied with rapid
collapse  of the vital powers.   Asiatic cholera is
rare in  this country, but epidemics have been
started by the importation of the disease from
foreign parts.
   Symptoms.—The disease comes on suddenly,
or is preceded by diarrhoea; the stools  are very
copious,  resembling rice-water.   Cramps of  a
violent kind attack the  muscles of the abdo-
men and extremities, and when collapse sets in
the  skin is  cold  and  covered  with  clammy
sweat; the  nails turn blue, the eyes are sunk,
and  the features look pinched,  while the pulse
fails,  the breathing becomes labored,  and the
urine is  diminished in quantity  or suppressed.
   The symptoms are sometimes  divisible  into
three  stages. 
ON FEVERS
181
  The first stage is marked by  "premonitory
diarrhoea," depression, and nausea.
  In the second stage,  the stools become  more
frequent, and the fluid ceases to be bile-stained,
becoming  colorless, and like rice-water; vomit-
ing ensues,  with cramps in the muscles of the
extremities  and abdomen; there is great thirst,
the voice  becomes husky,  and the face pinched.
  From this stage, which lasts from two to fif-
teen hours, the  patient passes gradually  into
the third,  algid,  or collapse stage, the purging
and vomiting diminish or cease, the tempera-
ture becomes subnormal, the  face and extremi-
ties acquire a leaden hue, the eyeballs are  sunk-
en, the face hollow, and the voice  sinks to a
whisper.  The urinary excretion becomes scanty
or  suppressed,  and  the skin  is covered with a
clammy perspiration.
  Death may ensue in  about  twenty-four hours
from the commencement.  A stage of reaction
may precede death,  or in favorable cases herald
the recovery.
  Management.—Rest  in  bed  and  abstinence
from all food are the first  directions in a case
of cholera.  Counter-irirtation to the pit of the
stomach by a  mustard-poultice helps to relieve
the depression.  Small quantities of  ice, iced
water, or lemonade may be  allowed to relieve
the thirst.  Cramp may  be  alleviated by hot-
water bag,  gentle rubbing with the hand,  or by
hot  bran-bag  applications.   In  the collapse
stage, hot  blankets and  hot bottles  should be
ready, brandy  or champagne  may be of use, or,
if  the diarrhoea has ceased, enemata of beef-
tea or brandy may be given.  Injection of fluids
into  the  veins is  sometimes practiced in this
stage with  good results.
  During reaction small quantities of nutritious
fluids may be constantly given  at short  inter- 
182   THE NURSE'S SERVICE  DIGEST

vals,  but  if suppression of urine continues,  the
patient may  be allowed to drink more freely.

  Precautions to be observed by  the Nurse in
                Cholera  Cases.
  1. To attend  to her own health, by insuring
regular meals,  sufficient sleep, and not too long-
continued attendance in the  sick-room.   Occa-
sional brisk  outdoor walks are helpful.
  2. To practice absolute cleanliness;  to wash
and disinfect her hands  after attending  to  the
patient, before her meals, and before leaving the
room; not to partake of meals or food  in  the
sick-room.
  3. To prevent the  spread of  disease  in  the
house  by  self-disinfection,  cleanliness,  and  dis-
infection of all discharges, excreta, utensils,  and
other  articles  from  the  sick-room.    (See also
Rules  for Disinfection, page----).
  4. Disinfection and  disposal of excreta,  etc.
For the purposes of the  sick-room, such  as  the
disinfection of soiled handkerchiefs, sheets,  and
the like, as well as for the swabbing of floors,
carbolic solution (1-20),  or preferably the per-
ehloride of  mercury solution,  may  be  used.*
The  latter may usually  be procured  from  the
Sanitary Authorities.
  In  places  provided  with proper  systems of
excrement disposal,  the excreta,  after  being
treated in detail with the disinfecting solution
in ample  quantity,  may  be safely put into  the
ordinary closet, but special care as to the flush-
ing of the  drains  and  sewers  is  necessary.
  * Perehloride of mercury, a cheap and efficient
disinfecting  fluid,  is  thus prepared:—Dissolve
half  an ounce  of  corrosive sublimate  and  five
grains of commercial aniline blue in three  gallons
of water,  and  add  thereto one  fluid  ounce of
hydrochloric  acid.  Preserve in earthenware  jars
or wooden tubs.  The aniline  blue  is intended
to color the solution, which  is highly poisonous. 
ON FEVERS
183
When the only closet is one that communicates
with  a cesspool or privy-pit, the best arrange-
ment that can be found practicable will have to
be  adopted,  but  advice should be  immediately
obtained from the Sanitary Authorities.
  5. Disinfection of the room  and  its contents.
After occupation by a cholera patient, the room
and its  contents should  be disinfected by  the
Sanitary  Authorities.
  1. As Cholera is  not in the ordinary sense of
the term  ''contagious," and is rarely,  if ever,
communicated  like  small-pox  or  scarlet  fever
directly from person to person;  as it is probable
that those in attendance  upon Cholera patients
are not more liable than others to  be attacked,
and as it is certain that physical and moral de-
pression favor the  liability to contract the dis-
ease,   apprehensions  should be allayed,  confi-
dence  encouraged,  and  that manner  of living
pursued  which experience has proved to be con-
ducive to the best state of  health.
  2. The  house should be clean,  dry,  and  well
ventilated.  Air-shafts, traps, and drains should
be in perfect working order.  Dust-bins should
be frequently emptied, and  no decaying matters
of any kind should be permitted to  remain  in
or near the house.
  3. As  water is one  of  the  chief  agents by
which choleraic infection is conveyed, all water
employed for personal  and domestic use in the
household should be scrupulously protected from
contamination of every kind; and if any doubts
of its  purity arise, the water should be boiled,
filtered,   and  consumed   within  twenty-four
hours.
  4. The dietary should consist of two or three
meals  daily.  The food  should  be fresh  and
thoroughly  cooked, the  vegetables  well boiled. 
1S4   THE NURSE'S  SERVICE DIGEST

Simply cooked,  wholesome fruit may be eaten.
Milk should be  boiled before use.
  Alcoholic  beverages  should  be taken in great
moderation, and only at meal-time.
  It is desirable to avoid soups, tinned or other-
wise  preserved  provisions, raw  or  stale  veg-
etables,  unripe,  over-ripe, or  decaying  fruits,
pastry, cheese, nuts or other indigestible things,
malt liquors turning  hard, ginger  beer,  coarse
oatmeal  gruel.  Too long  fasts, or too frequent
feeding should be avoided.
  Cooking utensils should be  scalded after use,
and kept carefully clean.
  6. Avoid the use of strong  aperients, and es-
pecially of strong saline aperients.   If there is
obstinate constipation, take at bedtime a vege-
table cathartic that will  not act on the liver and
kidneys,  or two teaspoonfuls of phosphate  of
soda in a cup  of hot water on  arising.
  7. Avoid excess and  irregularities of all kinds,
over-fatigue, prolonged watchings, emotional ex-
citements, undue mental strain, and  all  things
that exhaust  the nervous system.   Especially
avoid  the  frequent use of alcoholic or  other
stimulants to  cover sensations of sinking, ma-
laria,  or depression.
  8. If, notwithstanding a careful regulation of
the manner of  living, looseness of the bowels
should set in,  send immediately for medical as-
sistance; until  this arrives,  the following in-
structions may  be followed:—Retire at once to
bed in a warm  but well-ventilated room,  and if
troubled  with  cramps  or pains apply  hot appli-
cations to the  abdomen.  Take two teaspoonfuls
of phosphate of soda  in a cup of water as hot
as it can be swallowed.
  Should the diarrhoea continue after  the action
of the  bowels, relief may be obtained by taking
a few  doses of ordinary diarrhoea mixture, but 
ON FEVERS
185
any  further measures should  be  carried  out
under medical direction.
  Influenza.—Epidemics  of  influenza  occur
from  time to time  at  varying  intervals.   Pre-
vious to that of 1889, there was an interval of
fifty years, in which there had been no outbreak
in this  country.
  Spanish Influenza—Supposed to have started in
Spain and spread  throughout the world.   When it
attacks  a city or army camp, the proportion of in-
habitants stricken has not  been as large as  in the
epidemic of 1889.  This disease is classed by the
N. Y. Board of Health as  "infectious pneumonia,"
a streptococcic infection, producing active and viru-
lent pus germs.  The malady is highly infectious,
and  in  great  measure  conveyed  along  lines of
human intercourse.
  Symptoms.—The onset  of the disease is  usual-
ly sudden, and is marked by chilliness and shiv-
ering.   The temperature  is raised, the skin hot,
and the pulse quickened.
  Frontal  headache with  severe pain at the
back  of the eyeballs is  common,  and the eyes
have  often a pink  appearance  from increased
blood pressure in small congested vessels.   Pain
in the limbs, back, and chest may be very severe,
or present in a less degree of severity.
  Catarrhal  symptoms,  such  as  those accom-
panying an ordinary cold, may  be present or
entirely absent.   Prostration of  strength is  a
characteristic common  to the disease, whatever
form  it may take.
  Gastric symptoms may  be the most prominent
in some patients; in others, ordinary catarrhal
or bronchial affections predominate.
  Pneumonia  is a  dangerous complication,  and
responsible for a number of fatal  results.
  Mental symptoms are  not  uncommon in the
course of the disease. 
186   THE NURSE'S SERVICE DIGEST

  The majority of persons  attacked  by influ-
enza  recover  completely, though  in many the
convalescence is very  protracted.  In  others,
and especially in  those of delicate health, the
disease leaves permanent effects  behind, or  is
the starting-point  of tuberculosis  or other seri-
ous maladies.
  Management.—In ordinary cases,  rest in bed
for a few days,  until the fever and other symp-
toms  have  subsided,  and confinement  to  the
house  until  convalescence is complete, is  all-
sufficient.  Fluid  diet  during the  fever,  and
good nourishment  as soon as the patient is able
to take it, are requisite, as  on account of the
attendant prostration any lowering treatment  is
not well borne.
  Severe complications  have  often becn  the re-
sult in the case of persons who have not laid
up  in  the early stages of the malady, or who
have too soon exposed themselves  to the risk of
cold or overwork.

            Non-Infectious Fevers.
  Non-Infectious  Fevers.—There  is no  danger
of the  malady  being communicated to  others,
and the precautions with regard to disinfection
are unnecessary.  As examples may be given:
Rheumatic fever, and  Malarial fevers or Ague.
The latter are  frequently endemic in  certain
low-lying districts, or in tropical regions.
  Rheumatic Fever, or Acute Rheumatism, af-
fects the joints,  and is usually the  effect of cold,
damp,  or exposure,  in  those who have a ten-
dency  to rheumatism.
  Symptoms.—The joints, either  the ankles or
knees, wrists or  eblows, become  swollen  and
painful, and  the patient is unable to use them;
at the same  time  the  temperature of  the body
is elevated,  and the skin is  covered with pro- 
ON FEVERS
187
fuse perspiration of  acid  odor.   In addition,
there are other symptoms of constitutional dis-
turbance, and the urine is loaded with thick red
deposit.
  The  complications in  rheumatic fever are:
inflammation  of the valves  of the heart and
pericardium, pleurisy  and  pneumonia, and  ex-
cessively high temperature, or hyper-pyrexia.
  Management.—The patient should be clothed
in light  flannel, and may lie between the blan-
kets.   Owing to the  profuse perspiration,  all
exposure should be  avoided, and the room well
warmed.   The  joints  should be  moved with
great care and wrapped round in cotton-batting
or light flannel, and  the pressure  of  the bed-
clothes taken off, if necessary.  Getting  out  of
bed  must  be  entirely  forbidden.   The diet  al-
lowed  is usually milk, alone or with some fari-
naceous  food, while beef-tea and other nitroge-
nous diet  is strictly excluded.  In most  cases,
after  the administration of salicylic acid  In
some form the  temperature rapidly subsides,
and  the  pain  and swelling  of the joints  dimin-
ish,  so that in  a  few days  the disease is con-
trolled.
  Relapse is very common  if this  drug be left
off too soon, or if unsuitable diet is resumed,  or
if the  patient leave his bed at a too early  pe-
riod.   It is the practice of many physicians  to
commence the treatment of the disease with full
doses  of  salicylic acid  after the  bowels have
freely  acted;  and since patients differ in their
ability to tolerate this drug without unpleasant
symptoms, the  nurse  should be familiar with
 he symptoms of overdose.  These  are:  noises
'  ! the ears, deafness,  giddiness, headache, stu-
;  nr.  delirium; further, heavy, noisy breathing,
  :+h depression of strength, and possibly blood
1. ■. the  urine or haemorrhages from other regions. 
188   THE NURSE'S SERVICE DIGEST

The drug is generally administered until it pro-
duces some giddiness and deafness, with noises
in the head,  and is  then gradually diminished,
if the symptoms  of  overdose are prominent, or
when  the temperature falls,  as it often  does
rapidly.
  Pericarditis is a severe complication of rheu-
matic fever, and  notice should be taken of any
complaints of pain in the region of  the heart,
or  of shortness  of  breath, lividity,  etc.   (see
Pericarditis).
  High Temperature, or Hyper-pyrexia, is an
occasional complication of great  urgency.  In a
case of rheumatic fever,  the nurse should take
the temperature  constantly, every four hours,
or oftener if required.  Should the temperature
continue to  ascend  and  rise above 105°,  with
nervous  symptoms, such  as stupor and drowsi-
ness,  reaching perhaps 106°, 107°, or up to 110°
with  coma,  the patient will die unless the tem-
perature soon be reduced. The cold bath treat-
ment is the most rapid and efficient method, and
it will have to be given under the superintend-
ence  of the medical  attendant (see Baths).
   Convalescence  is sometimes rapid;  in others
there  is lasting debility, or  heart-disease, or
stiffness of the joints.   In all there is a ten-
dency to recurrence,  and flannel  garments or
Jaeger's underclothing should always be  worn
next  the skin.
   Malaria, Ague, or Intermittent Fevers.—In-
 dividuals  living  in marshy  districts in  this
 country, or who have  resided abroad  where
 these  fevers are common, are liable  to this af-
 fection,  which  may continue to  attack  them
 many years after they  have left the region in
 which they contracted the fever.
   Symptoms.—In the common form  of this fe-
 ver there  are three stages—the cold, the hot, 
ON FEVERS
189
and the sweating  stage—the whole attack last-
ing some hours.   Between the attacks there is
an  intermission of a varying duration of good
health.   The  patient is usually attacked sud-
denly with a  sense of chilliness and  increasing
feeling of cold.  The teeth chatter, and there is
general trembling of the limbs.   The extremi-
ties become blue and the face pinched, and the
urine is copious.  If the temperature is  taken,
it is found  to be  above the normal,  and going
up  rapidly.   After this  the  hot stage  com-
mences, and  the sense of chilliness diminishes.
The warmth  increases  until the heat becomes
intense, the face flushed, and the skin dry and
pungent.  This stage  may last  several hours,
and is succeeded  by the  sweating  stage,  in
which  the skin becomes bathed  with profuse
sweat,  the  temperature  falls,  and  the  other
symptoms of discomfort disappear.
  Management.—The nurse may  apply  warmth
during  the  cold stage  by different methods—
warm blankets, hot bottles, packing,  etc.; dur-
ing the hot  stage, tepid sponging  and light
clothing, and if there is  much thirst fluids may
be administered.  When  drugs, such as quinine,
opium, or antipyretics, are ordered, the temper-
ature should be taken regularly at short  inter-
vals before and after the drug is administered;
the observations being noted on  the chart  in
order that the effect  of the remedies on  the
temperature may be ascertained.
  Individuals  suffering  from ague should be
warned not  to go  out at night or in the early
morning in malarial regions, but should choose
the middle of the day.   They should also oc-
cupy a bedroom in the upper part of the house. 
CHAPTER  IX.
             DISEASE IN CHILDREN.

Observation of Children—The Cry—Attitude in
  Bed—Complexion—History of Illness—Disor-
  ders  of   Infancy—Wasting—Feeding—Artifi-
  cial Food—Teething—Convulsions.
Symptoms  and Management of Rickets—Laryn-
  gismus—Thrush—Sore  Throat—Gastric  Ca-
  tarrh— Constipation—Obstruction—Diarrhoea
  —Infantile  Cholera—Chronic Diarrhoea—Ty-
  phoid Fever—Worms—Tubercular Meningitis
  —Water  on the Brain.

    Introduction:  Observation of Children.
  Information  concerning  children's symptoms
or previous ailments has to be gathered  from
the mother or nurse, who only are constantly in
contact with  them both in health and  in dis-
ease, and  are thoroughly familiar with  their
methods  of  expressing  their wants and  feel-
ings.
  Observation of Children.—In the case of in-
fants, or children under  two years old, it is not
always an easy matter to comprehend the  signs
of suffering,  or  to  refer them  to their  real
cause,  but  a great deal  may be discovered by
careful attention.  An infant makes known its
wants,  and gives  expression to its feelings of
distress chiefly by crying.
  The  Cry, as described by Dr. Eustace Smith,
in his  work  on  Children's  Diseases, is  often
characteristic.  "A hungry infant in most  cases
                     190 
          DISEASE IN CHILDREN       191

clenches his hands and flexes his limbs as he ut-
ters his complaints,  and continues until satis-
fied.  If tortured by colicky  pain,  the cry is
violent,  paroxysmal, and  accompanied  by  un-
easy movements  of  the  body.   A shrill  scream
uttered at intervals, the child lying in a  drowsy
state with closed eyes,  is suggestive of tuber-
cular  meningitis.   A  constant  unappeasable
screaming is often the consequence of  ear-ache,
and the child frequently presses the  side of the
head against the mother's breast.  The pain of
pleurisy will also cause violent crying.  Any
alteration  in the quality  of the  cry  must be
noted.   It may be hoarse in a young infant from
inherited syphilis; and in an  older  child from
laryngitis."   Absence of crying is  often indica-
tive of  exhaustion or serious disease.
  Attitude in Bed.—The child's position in its
cot should be carefully observed.  Healthy chil-
dren usually lie partially on tne side,  with tne
cheek on the pillow.  In exhaustion or  serious
disease, the. infant often lies on its  back,  with
closed  eyes and  face directed  upward.  Lying
on   the side, with the head partially retracted
or thrown back on  the shoulders,  is suggestive
of brain affection, or, if associated with  diffi-
cult breathing, of laryngeal mischief. Lying on
the belly with the face pressed into  the pillow,
or the  thighs and legs flexed  on the abdomen,
may indicate abdominal discomfort.
  The Complexion of the healthy infant should
be clear and fresh,  and  any alteration, such as
sallowness,  pallor, lividity,  or a muddy color,
suggests derangement.  A  haggard  expression,
contracted brow,  or  sunken hollow eyes  are  also
the result  of disease.
  The frequency  of  the pulse  and respiration,
and the temperature should be noted; the latter
often rises with  very slight reason to a height 
192   THE NURSE'S SERVICE DIGEST

which, in an  adult, would probably be  associ-
ated with severe disorder.
  The state of the skin should also be noticed
as  an indication  of how  the  child has  been
cared for, whether dirty, or covered  with scabs,
parasites, or eruptions.
  History of  Illness.—In  hospital  practice,
when the nurse receives a sick child from the
mother or relatives, she should  make a point of
ascertaining  the  following particulars  before
they leave:—
  Name—Age—Birth : Fremature or full-time—
nursed or hand-fed—child's previous ailments:
specific  fevers,  eruptions,  etc.—History   and
symptoms of present  illness,  giving  dates:—
Family history: Father, mother, residence, num-
ber  of children  alive—miscarriages, still-born
children,  and ailments of living children—chil-
dren who have died, and cause of death.
  Information  of  this kind, and other particu-
lars relating to the cause or circumstances of
the illness are of great value, and cannot be ob-
tained in many cases  except  by the nurse,  who
has  the  opportunity  of seeing  the  child's  rela-
tives.
  For the convenience of the physician on his
visit the child may be stripped naked in a warm
room,  wrapped up in a blanket, and then placed
in the nurse's lap, if a complete examination is
desired,  and the child is not too ill.
  Disorders of Infancy.—Owing to  the extreme
excitability of the nervous system  in children,
slight functional disorders are apt  to give rise
to  signs  of considerable general distress.   For
instance, stomach  derangement, or  indigestible
food, may cause high fever, rapid breathing and
 cough, or perhaps a  convulsive  seizure.   In
 feeble children  some  functional  disturbance,
 apart from  any  actual disease, may  be  very 
          DISEASE IN CHILDREN       193

serious or even fatal.  In long-continued or ex-
hausting diseases there is often loss of this
nervous  susceptibility.   Sudden  death is  com-
mon in infancy,  especially  associated with ex-
haustion from diarrhoea and vomiting, or  from
laryngismus or convulsions.
  Wasting,  Inanition,  and  Bad  Feeding.—
Among the poorer classes a large number of  in-
fants, apart from actual disease, remain small,
thin, pale, and instead of increasing in size be-
come  more and more emaciated.  Want of air,
unhealthy  houses, and  deficient clothing are
among the common causes, but  bad  feeding is
the most common of all.
  Feeding.—A  healthy infant should be nursed
by the mother, if she is in  good  health, for the
first seven  or  eight months,  and requires  no
other  food.   During  the  first  month  or six
weeks it may receive the breast every two hours
during the day and less often at night. After-
ward it  should wait for longer intervals.  At
seven months one or two  meals a day may be
added,  consisting  of  Chapman's,  Mellin's,  or
Ridge's  food, or  Robb's biscuits,  mixed  with
milk.
  At ten months it may be weaned, and a little
broth, beef-tea, or milk added to its meals.  On
no  account should the baby be kept at the
breast after ten months, a custom with  some
mothers, but injurious both to the baby and to
herself.
  At  eighteen  months pounded meat  and light
puddings may be given, but a milk diet is usual-
ly preferable and gives all  the nourishment  re-
quired.
  If the mother's milk fail, or is not  available,
the infant will have to be brought up by hand.
  Artificial Feeding.—The milk should be  ob-
tained from a good dairy, or Van Camp's evapo- 
194   THE NURSE'S SERVICE DIGEST

rated milk reduced to the proper strength with
barley-water  or  lime-water is an excellent sub-
stitute for much of the fresh milk on the mar-
ket.   The mixed milk of several cows is often
better than  the milk  from  one special cow.
First month—The  bottle should be given every
two  hours, from 5 a.m. to  11 p.m.;  each feed
should consist of three teaspoonfuls of milk (or
two  teaspoonfuls of milk and one teaspoonful
of cream)  and six teaspoonfuls  of water.  In-
crease the milk and water  by one teaspoonful
each week of this  month.  Second month—Feed
every two and  one-half hours,  increasing the
amount to two tablespoonfuls of milk and two
of water.  End of third month—Feed every
three hours with equal  parts of milk  and water
—three to four  tablespoonfuls of each.   Warm
each  feed  to 95°  F.  One or two teaspoonfuls
of lime-water may  be  added, or  barley-water
may be used instead of water.  Boil the milk
and  water, or use a sterilizer.
  The best bottle  is boat-shaped, with a simple
india-rubber  teat on the end.  Wash the bottle
and  teat in hot water and soda after each feed,
and  then  rinse out in clean cold water.
  With the exception of the artificially prepared
foods mentioned above, farinaceous food should
hot  be  given to children under  six  months of
age.   It is a mistake to feed  babies too often, or
whenever they cry for it, just to stop their cry-
ing ;  or when they  grow older  to allow them
the same  diet as adults because  they enjoy it.
  Emaciated children,  otherwise healthy,  will
commonly improve  after their  diet  has been
carefully  regulated, and if one form of diet does
^ot agree with them some other should be sub-
stituted.  An emulsion  of cod-liver oil in small
quantities, twenty drops or  so, is an excellent
food, and agrees well with many infants. 
          DISEASE  IN CHILDREN       195

  Warmth.—Infants  are  very  susceptible to
cold,  and a  low temperature may produce in
them a variety of disorders.   The room they
occupy should  be well ventilated, warmed, and
kept at an equable temperature.  Their clothing
should be of flannel,  light, and not too tightly
applied.  The legs and  arms should be covered
and protected  from exposure out  of  doors.
When  indoors,  they  may,  with advantage, be
allowed to kick about and exercise their limbs,
sometimes on a heavy rug or a blanket spread
on the floor.
  Teething  Derangements.—The first  denti-
tion,  or  cutting  the milk teeth,  commences
usually at the seventh month and terminates at
the end of the second year.
  The teeth  should appear in the following or-
der :—Lower central  incisors, upper central in-
cisors, upper lateral  incisors, lower lateral in-
cisors, fist molars, canines, back  molars.   At
twelve months  the infant should have cut eight
teeth.  The order given above is  not, however,
constantly followed in all healthy children, and
the time  may  be anticipated  or  delayed.  In-
fants are  liable to be feverish during  dentition,
and there is  a  tendency to irritability and rest-
lessness ; chills  are more easily taken, and the
food is more likely  to  disagree, giving rise to
pulmonary  troubles,  gastric derangement,  or
convulsions.  Greater care is therefore  neces-
sary at this period  to  avoid cold, or  sudden
change of  diet.  If  the  gums are swollen and
painful, they may  be gently rubbed  with the
finger moistened with lemon juice, but in a few
cases it may  be necessary to use the lancet.
  Convulsions.—Apart   from  disease  of  the
brain and epilepsy, convulsive seizures are com-
mon in infants under two years  old.  Rickety
children, or  the offspring of nervous parents, 
196   THE NURSE'S SERVICE DIGEST

are more liable to suffer.  The exciting cause is
usually some distant irritation which should be
sought for.   Commonly some gastric irritation
in the form of curdled milk, or undigested food,
constipation,  or intestinal worms, will account
for it. Irritation of the ear from wax or other
foreign bodies, or the cutting  of a tooth,  are
often causes  of fits.  In a few instances a con-
vulsion denotes the onset of a specific fever, and
corresponds to a rigor in the adult; fits are also
common in whooping-cough.
  A convulsive seizure is usually sudden, though
sometimes preceded by restless excitability, ac-
companied  by  starting  and twitching  during
sleep; the  eyes have  a staring  look  and  are
directed upward, and the thumbs  are  turned
toward the palms of  the hands.  When  the  fit
begins the  child  becomes  stiff,  the  head  is
thrown back, the limbs straightened and fixed,
and the breathing ceases.  Soon  afterward  the
face becomes flushed,  the  eyeballs  move from
side to side,  and the muscles of the  face and
body  constantly twitch.  There  is loss of con-
sciousness during the fit which lasts commonly
for several minutes, and may recur.  The face
becomes pale and moist with sweat, the infant
falls asleep, and on awaking seems  to have re-
covered and to be in  its usual health.
  Management.—For  the convulsive attack  a
warm bath and the application of cold to  the
head  is  frequently ordered.
  An infant may be immersed in a bath of the
temperature of 90° F., cold sponges being placed
on  the head, and constantly changed.  Ten to
twenty minutes,  according  to  the  age  of  the
child, is a sufficient length of time  to continue
the bath, unless there has been previously great
exhaustion, when five minutes or less is suffi-
cient.  Afterward the room  should  not  be too 
          DISEASE IN CHILDREN       197

hot,  and the child should lie lightly covered in
the cot.   An  enema  of  sweet  oil or soap  and
water  may  be given if the bowels have been
confined.
  In children  who are liable to convulsions, or
who  have previously been attacked, the symp-
toms before  the  onset  should  be noticed,  and
care  taken to avoid those sources of irritation
which  seem to induce an attack.  The bowels
should be kept open, the food  carefully chosen,
chills avoided, and during dentition extra  pre-
cautions in these various ways should be taken.
The  majority  of  infants  survive an  ordinary
convulsion, but in some cases the fit terminates
fatally, especially if there is  a succession of
them.
             Diseases of Children.
  Rickets.—This disease essentially one which
attacks infants belonging to the poorer classes
in large towns, though it occasionally  appears
among the well-to-do.  Bad  feeding and a de-
fective  supply of fresh  air  are the two main
causes of rickets.
  Symptoms.—It  is unusual for these to appear
before the sixth month or after the second year,
but once begun, they may continue in one form
or another for  several  years.  The  time of
weaning  seems  to  determine  the  commence-
ment in  many infants, and symptoms  of  di-
gestive derangement appear and continue.  The
motions  are  more frequent,  offensive from un-
digested food, and pasty looking, or of green-
ish color.  The  child is irritable  and  fretful,
and  dislikes  to be handled on account of  ten-
derness of the body and limbs; the color of the
skin  is  sallow   and   unhealthy-looking,  the
cheeks pinched, and there is a tendency to co-
pious perspiration about the head at night.  The 
198  THE NURSE'S SERVICE DIGEST

coverings  of  the  bed are thrown off, and  the
infant  may be found asleep resting  on its  el-
bows  and  knees,  on  account of flatulent dis-
turbance and  pain  in the belly.  The  head is
enlarged and the  abdomen distended; the teeth
are late in appearing, and the fontanelle  is
wide open  after  the  second  year, the  time  at
which  it should  have closed.   The  bones  too
are found  to  be  misshapen, especially  the ex-
tremities of  the  wrists  and  lower  leg bones,
which appear swollen; and small rounded swell-
ings are liable to occur in the ribs near to the
breastbone.  As the child  grows older, these de-
formities may increase,  and the shape of  the
chest  be distorted, especially if the infant is
attacked by pulmonary disorders, to  which they
are  unusually liable,  causing  the  condition
known  as  pidgeon-breast.  The shape  of  the
long bones of  the legs is influenced by standing
and walking,  and  the bones  being  weak  are
bent and curved in various ways by the weight
of the body.
  Tetany  is a not  uncommon  complication of
rickets.  It is due to a  spasm of the  muscles
of the extremities, by which a peculiar  position
of the hands and feet is produced.   The thumb
is drawn  into the palm, and  the back of the
hand is arched;  the top of the foot  is also
arched, and the extremities become swollen and
painful.  This  condition  may last for  some
days.
  Rickets  is  not usually fatal in  itself,  but
death  may occur from  complications,  such as
pulmonary  complaints,  convulsions,  water  on
the brain, laryngismus or spasm of the glottis,
or  gastric  derangements and diarrhoea.
  Management.—It is necessary first to inquire
how the infant has been fed, the kind  of food,
and the number  of meals given at  the present 
          DISEASE IN CHILDREN       199

date.   The clothing should be noticed, and  in-
quiries made about the ventilation of the room,
and  whether  the child is ever  taken out of
doors. Among a large number of the poor and
working  classes,  attention to these particulars
is not possible, nevertheless  a good deal may
be done in many instances toward improvement
in the  manner  of  feeding.  On  inquiring,  it
will  often be  found that the  mother is keeping
the infant at  the breast up to two years old or
longer, or else has  been feeding  the infant on
cheese, beer, spirits, or anything  that  she may
be having herself,  saying  that the child  craves
for it and is  not satisfied. When the diet has
been  corrected and arranged  (see Feeding), and
directions given for cleanliness  and fresh air,
the state of the stomach and bowels should be
ascertained,  whether  there  is sickness,  flatu-
lence, or  diarrhoea.
  It  is a good plan  to apply a  warm  flannel
binder round  the abdomen, which is often suffi-
cient to remedy the intestinal derangement, but
in long-standing or obstinate cases drugs will
be required.  When the bowels are brought  to
a natural state,  great improvement in the gen-
eral  condition will  follow, and an emulsion  of
cod-liver   oil  may  be  given with  advantage.
From ten to twenty drops to  half a teaspoonful
is sufficient, according to  the age.
  When the child arrives at  the age for stand-
ing or walking, it should not  be allowed to bear
its full weight  on  the legs, as the bones, being
weak, will become  bent  and  curved, producing
deformity of  a more or less permanent kind.
  The pulmonary  complications  of rickets re-
quire the ordinary  measures and precautions
necessary in  these cases (see Bronchitis).
  Congenital Syphilis may  show  itself in the
 child in  various  ways.  Among the common 
200   THE NURSE'S SERVICE DIGEST

manifestations  are the following:  red or cop-
pery-colored rashes on the  body and  buttocks,
"snuffles," fissures about the mouth or anus, a
hoarse cry,  enlargements of the bones, an old-
wizened look, and a tendency to wasting.
  Laryngismus, or False Croup, is a spasmodic
attack of difficult breathing,  and is  fatal  in
some instances.  It may be preceded by a crow-
ing  sound  with breathing,  and then  suddenly
the  breathing ceases,  and  the  infant becomes
stiff, and the face dark and livid;  this lasts for
a few seconds,  and then the spasm relaxes and
the breath is  drawn  in with a crowing noise;
vomiting,  perhaps, occurs  afterward.  The at-
tack may  produce or be associated with a con-
vulsion, or  the  attack  of laryngismus may  be
repeated.
  Management.—When  there  is  time,  a  hot
sponge should be placed against the outside of
the  throat,  or  the back of the fauces may  be
tickled with the finger to produce  vomiting.  In
some instances the attack may be  controlled  by
holding a bottle of smelling-salts to the  child's
nose. The return of the paroxysm may be pre-
vented by  regular cold bathing three times  a
day,  the  body  being  rapidly  and  thoroughly
sponged with cold water.
  Disorders of the Alimentary Canal.—Apthw
Thrush.—Infants and young children are liable
to disorders of the mucous membrane  of  the
mouth, especially when teething, or when there
is  some digestive disturbance.  White patches
of thrush are apt to form on the inner surface
of the lips,  gums, and palate, or else  small
vesicles form and break, leaving circular, shal-
low  ulcers, with  a whitish  surface on the mu-
cous  membrane.   In  either case,  they are as-
sociated with stomach derangement, and are of
no great consequence in strong children,  but in 
          DISEASE IN CHILDREN       201

those who are suffering from chronic diseases,
or exhaustion,  they are of serious import.
  Management.—The  most suitable local treat-
ment is to cleanse the affected part with warm
water,  afterward applying a solution, consisting
of half a drachm  of pulverized borax  to  an
ounce of glycerine, with a camel's-hair brush.
  Gangrenous  Inflammation. — More  serious
forms  of  ulceration and  gangrenous  inflamma-
tion  of the cheek or mouth occur sometimes in
children after specific fevers, or in those of un-
healthy or debilitated constitution.
  Management.—In  these  cases nourishment
and  stimulants have  to  be freely  given,  and
the  surgeon  may  find  it necessary  to destroy
the gangrenous parts with caustics.  The local
after-treatment, consisting mainly in the con-
stant  application  of  antiseptic solutions, may
have to be carried out by the nurse.
  Sore Throat—Enlarged  Tonsils—Adenoid
Growths.—Children of all ages are liable to "af-
fections of the throat,  and complaints of pain,
soreness,  or  difficulty  in  swallowing  should be
attended to.   The throat may be inspected by
gently  pinching the nostrils together while the
mouth  is held open and a deep breath drawn in.
Redness of the fauces, tonsils, and uvula should
be noticed, and it should be  observed whether
there is a patch of white  membrane, as in diph-
theria,  or if the tonsils are  red, swollen, or
project unusually into the throat, as  in  quinsy.
A red  mottling of the throat is sometimes seen
early in scarlatina.
  Management.—Throat  affections  should  be
seen early by the medical attendant, and in any
case it is advisable that the child be immedi-
ately separated from  other  children until his 
202   THE NURSE'S SERVICE DIGEST

visit,  in case the throat should betoken the on-
set of an infectious fever.
  In  chronic enlargement of the  tonsils, and
when the  back  of the nostrils is  blocked  up  by
adenoid growths,  the  breathing  is apt  to  be
heavy and labored, snoring at night is common,
and some deafness is likely to supervene as the
child  grows older.  In young  children, if the
enlargement is  great,  deformity  of the chest
may  be induced by  the difficulty  in breathing.
The surgeon usually removes the  enlarged ton-
sils and scrapes away the adenoid growths at a
suitable time.
  Gastric Catarrh.—Symptoms.—This ailment
has been mentioned  in connection with infants,
but it also affects older children  as the  result
of a  chill, an  error in  diet,  or a scrofulous
habit.  The onset may be sudden,  with  fever-
ishness, cough,  and rapid breathing, the tongue
is coated  with  white  fur,  and  there  may  be
sickness and  constipation. There is sometimes
a watery discharge from the  eyes and nose, and
the fauces may  be reddened.  In some children
there is slight  delirium at night.  The  urine is
usually turbid and high-colored, and there may
be slight jaundice of the skin. The temperature
may rise to 104°  or 105° in the  evenings, but?
descends in the  morning. These attacks may
occur without fever  or with only slight febrile
symptoms, and they have a  tendency  to  recur.
The febrile form  bears a close resemblance to
enteric fever in young children.
  Management.—Children who  suffer from this
disorder, and  show  a tendency  to recurrence,
should wear a broad flannel  bandage, extending
from  the arm-pits to the hips, and applied firm-
ly as a protection from cold, but it should be
taken off  at bedtime.   During  the attack the
character  of  the excretions  should  be  noticed, 
          DISEASE IN CHILDREN       2CS

and  whether there is  a tendency to acidity of
the stomach  or sour-smelling  breath.
  Diet.—The diet  is all-important;  sweets  and
starches in any quantity should be avoided,  also
fruits,  cakes,  potatoes;  while  freshly  made
broths,  milk  and  lime-water,  and unsweetened
barley-water  should be allowed.  Purgatives are
best  avoided, and  the  action of the  bowels  reg-
ulated by  mild aperients, such as liquorice pow-
der  or  castor oil.  During convalescence, fish,
fowl, and  mutton may  be taken, and  farinaceous
food only in small quantity.   Cold bathing in
the morning  will strengthen the system against
recurrence.
  Constipation  is a  common trouble in chil-
dren and  infants of all ages.   In young infants
it  is natural for the bowel to be relieved  sev-
eral  times in the twenty-four hours, so that
one  motion a day would indicate constipation.
In older children  the  bowel may not act more
than once every two  days without any  symp-
toms of further disorder; but evidence of head-
ache, languor, loss of  appetite, and sallow com-
plexion  would indicate that  the  constipation
was  harmful, and  should always be relieved by
the use  of a  mild  aperient.
  Flatulence  and colic are  often associated with
constipation  in infants, as shown by constant
crying and flexing the thighs on the abdomen;
the  motions  are  hard and lumpy,  and voided
with pain.  In many  cases the child restrains
efforts  at evacuation  on  account of the pain
produced  by  the  passage of the  lumps.   In
some the  hard faecal matter irritates the bowel
and  causes partial diarrhoea,  which is only re-
lieved by  remedying  the  constipation and irri-
tation;  obstruction  of the bowel  may  result
from long-continued constipation, which should
never be permitted. 
 204  THE  NURSE'S SERVICE  DIGEST

   Management.—The child should be trained at
 an early period  to  go  punctually  to the  stool
 every morning, and  regularity enforced  until a
 habit is  formed;  when the bowels  cannot be
 evacuated naturally, an enema of sweet-oil soap
 and water  may be used.
   In younger children and infants the diet,  con-
 sisting  in a large degree of farinaceous food,
 has a tendency to  produce dry fa?cal matter.
 The amount of this food will have to  be  les-
 sened  where  constipation  exists.   Extract of
 malt, one or two teaspoonfuls a day, added to
 the food, are  useful. Friction of the abdomen
 with the hand is found  to  be effective in some
 cases.   When  accumulation is  present, a small
 enema,  or a dose of  castor oil, may be given, or
 a  small teaspoonful  of  glycerine may be intro-
 duced into the rectum with a syringe.
   Nurses  should not  take upon themselves  the
 responsibility of constantly dosing children with
 aperients without medical sanction,  as much
 harm may be  done to weakly infants by aperi-
 ents injudiciously administered.
   Obstruction of the Bowel in infants may be
 caused by "intussusception" or by a rupture.
   Symptoms.—In the former, the symptoms may
 commence with  sudden  pain in  the abdomen,
 screaming, vomiting more or less persistent, and
 obstinate  constipation,  though  there may   be
 some  action of  the  bowels at  first.  After a
 while there  is commonly a discharge of blood
 and mucus from the bowel, with much strain-
ing, and the other symptoms continue. The in-
fant appears  exhausted  and the countenance
pinched  and haggard, and there may be  a pro-
trusion  of the bowel from the anus.   Coldness
of the extremities and collapse supervenes, and
the child dies if the bowel is not relieved.
  Management.—Unless  these cases  are  recog- 
          DISEASE IN CHILDREN       205

nized in  the  early  stage,  there  is  not  much
chance of recovery, and the nurse should imme-
diately summon medical aid instead of waiting,
perhaps,  until after the mother has given  fre-
quent aperients, and collapse is imminent.
  The treatment will have to be carried out by
the surgeon, and consists in endeavoring  to re-
place the bowel by giving enemata, or injecting
air into the bowel.
  For rupture, see Hernia.
  Diarrhqsa.—The mortality from severe dior-
rhoea in infants is very large, but  slight attacks
are frequently prevalent.
  Symptoms.—In  its  simplest form,  resulting
from improper feeding, teething, or a chill in a
healthy child, it is a mild disorder, and ceases
when the exciting cause has been removed.  It
is attended  with  griping  pains,  restlessness,
vomiting, and slight fever.  The motions are at
first loose and lumpy, with undigested material,
of sour odor, and perhaps frothy  from fermen-
tation;  subsequently  they become thinner,  wa-
tery, and mixed with greenish mucus.
  Management.—The child should be kept warm,
and  at the commencement, especially if the  mo-
tions contain undigested material and there is
griping  pain, a  small dose of castor oil should
be given.
  Diet.—In a hand-fed  baby the milk should be
well diluted  with barley-water or  lime-water,
and  starchy material  or other unsuitable food
withheld for a time.
  Summer Diarrhcsa  and Infantile Cholera.
—Acute  and  severe  forms of diarrhoea are apt
to attack infants and young children residing in
large towns,  and these may be especially fatal
and  dangerous  during  the late  summer  and
early autumn months,  so that the term summer
or  autumnal  diarrhoea  has  been  applied to 
206  THE NURSE'S SERVICE DIGEST

them.  The exciting causes may be similar to
those inducing  the  simpler forms of  diarrhoea,
such as indigestible food,  or  chills;  but there
would seem in  many instances to be some  epi-
demic influence from  soil or  sewer drainage.
Epidemics occur more often after or during  hot,
dry summer weather, and  an immense number
of cases of simpler  and milder forms of diar-
rhoea may  precede  the epidemic.   Infants  and
children of the poor classes are more liable to
be attacked than others.
  Symptoms.—The early symptoms resemble in
the main  those of  simple diarrhoea, but soon
become intensified;   the vomiting  is more con-
stant, or sour and  acid fluid.  The purging is
more violent, the stools numbering from six or
seven to fifteen or  twenty in the twenty-four
hours.   Their color varies, but is often dark-
colored, or  green, frothy, and very offensive,  and
there may be  some slimy mucus  tinged with
blood.  The general symptoms are severe; there
is rapid wasting, and the  face changes  its as-
pect, the eyes become hollow, the skin pale  and
wrinkled,   and   there  is  great  depression  of
strength.  The  temperature may  be elevated to
102°  or  103°.   If   the disease  continue,  the
tongue becomes dry  and brown; the pallor  and
pinched look about  the face increase, and  the
eyelids droop but remain partially open  during
sleep; the  fontanelle is found  to  be depressed,
and  the extremities cold.  The infant may  die
either  suddenly  from  syncope,  or  gradually
from exhaustion.
  Older children are better  able  to  withstand
the exhausting effects of the vomiting and purg-
ing,  and there  is less danger.  The  young in-
fants or weakly children are very soon brought
into a critical state by the  exhausting effects of
purging. 
          DISEASE IN CHILDREN       207

  Management.—When an epidemic of autumnal
diarrhoea prevails in the neighborhood, some ex-
tra care should be exercised in the management
of  infants and  young children, and attention
paid at once to symptoms of gastric disorders or
looseness of  the  bowels.  Aperients  or  purga-
tives  should  be  given with great care.   Purity
of air in the nurseries should be insured,  excite-
ment  should be avoided, and early hours insist-
ed on.
  Diet.—In infants  at  the breast and hand-fed
babies,  the diarrhoea is apt to be increased  or
kept up by the use of milk,  and  it will have to
be  diminished, or altogether suspended for a
time.   Barley-water, or whey,  in equal parts,
or weak chicken  broth, given cold, will have to
be  substituted.    Koumiss  has  been  found  to
agree in some  instances, and  when given  to
young children the  gas should be first got  rid
of.  When the exhaustion is great,  or  if col-
lapse  seem to be imminent, four or five drops of
brandy  may be given at once, or two or three
drops every  three or four hours according  to
the age.  In older children the diet should con-
sist of  plain whey,  barley-water,  weak veal  or
chicken-broth, or if  necessary brandy and milk
with yolk of egg.   When milk is given, it  should
be boiled and mixed with  lime-water or barley-
water.   In  all  cases the abdomen  should   be
kept  warm  with  flannel,  and hot applications
placed on the extremities  if necessary.
  In  chronic diarrhoea the  symptoms are less
urgent,  but there may  be very  great wasting
and weakness.  In addition to the general rules
with  regard to  diet  in  diarrhoea  previously
given, the milk and starchy foods must  be  re-
stricted,  and  their  place taken by  stronger
meat-essences, broths,  or meat-juice in  some 
208   THE NURSE'S SERVICE DIGEST

form.  In  older  children, raw meat  specially
prepared is of great service (see Chapter XVII).
  Typhoid  Fever and Ulceration of the Bow-
els.—Typhoid fever is less common in infants
and young  children than in adults, and it has a
tendency to run a milder course.
  Symptoms.—The  early  symptoms  are vague,
but there is  usually headache, listlessness,  and
loss of appetite, with some fever.  In the second
week  there is usually some tenderness and  dis-
tension of the abdomen, and the bowels may be
relaxed.  The fever  increases, and there is thirst
and nocturnal delirium,  with some drowsiness.
The spots characteristic of typhoid may appear
in crops, or may be entirely absent.  The course
of the fever differs from that  in the  adult,
chiefly in its milder character, a  rather shorter
course, and fequent absence of spots.  Bed-sores
are less common than in the adult, but boils  and
abscesses may occur, and debility and mental
weakness may persist for some time after  the
fever.
  Management.—The same careful nursing  and
feeding  as described  under  typhoid  fever in
adults is requisite (see Typhoid Fever).
  Diet.—For young children  milk, broths,  and
water may be  allowed in fair quantities when
there is great thirst.  In giving drink to thirsty
children, not only in typhoid,  but in any other
case,  the nurse should be particular to put the
whole amount intended for them to drink at
one time into the glass, and allow them to drink
it all.  Young children do not understand  that
they must not have more than a certain amount,
and if a full glass is given, and they are  only
permitted  a few  sips,  they  cry at  once  for
more.
   In  typhoid and  other cases of ulceration of
the bowels, tubercular  or dysenteric,  a flannel 
          DISEASE IN CHILDREN       209

bandage may be worn with advantage round the
abdomen.  The motions should, in all cases, be
examined  and saved for inspection if  there is
anything unusual.
  Intestinal Worms.—These parasites  are very
common in children, and are caused by  drinking
impure water, or eating imperfectly cooked or
spoiled food.
  There  are  three  common  forms:  thread
worms, round worms, and tape worms.
  Thread  Worms.—These  small  white worms
are like fine threads; they measure  from  a
sixth  to half an inch long,  and  reside in the
large  bowel just  inside  the external orifice,
where they  cause  great irritation and itching.
They  may be observed in the motions.
  Management.—The most  effective method of
removing  thread worms  is by  the use of ene-
mata.  The  bowel  should be first  cleared by a
copious injection of warm water, and afterward
five or six ounces of a solution of  common table
salt,  in the  proportion of one teaspoonful to
four  ounces  of water, should be  injected  and
retained for a few minutes;  or the same quan-
tity of an infusion of quassia may be employed
instead.  Great cleanliness  of the  parts should
be insisted upon, especially  after action of the
bowel, warm soap  and water being used if nec-
essary.  An  ointment, composed of one drachm
of powdered camphor  to an ounce of lard, is
useful to allay the itching inside the orifice.
  Round Worms.—These long worms  resemble
in shape and appearance an earth worm, only
they  are  white  or yellowish-white, instead of
red in color.   They inhabit the stomach  or small
bowel, and are a common  source  of symptoms
of  gastric irritation in children.   The  child
seems never satisfied after  food, and is fidgety,
picking  the   nose  and  rubbing its  eyes;  the 
210  THE NURSE'S SERVICE DIGEST

tongue and mucous membranes  look  red, and
the nutrition of the body suffers.  In some cases
severe  symptoms of  nervous disturbance,  or
bowel derangement, may be created in infants
and  young children by the presence  of these
worms.  They may be solitary, or many in num-
ber,  and may  be passed spontaneously  by  the
bowel, or be vomited from the stomach, or they
may crawl out  of the mouth or nose while the
child is  asleep.
  Tape  Worms.—Segments or joints of white,
flat tape-like appearance, of about half ah inch
in length, and a quarter of  an inch across, are
sometimes voided with the motions. These are
portions of the tape worm, which is many feet
in length when complete (fig. 46).
  The segments are broader at the center, and
become  smaller and finer as they approach the
head, which is globular in form and of the size
of a pin's head, so that it commonly escapes de-
tection.   The worm gives rise to intestinal de-
rangement and diarrhoea, but produces no very
special symptoms, and can only  be detected  by
the presence of the segments in the stools.
  Management.—The nurse should make herself
acquainted with the common forms of worms
that infest the alimentary canal, In order that
she  may  recognize  them.  Specimens  of  the
round worm, or ascaris, and of the tape worm,
or taenia,  may be found on the shelves of most
museums.  Once known, they are unmistakable,
but otherwise an error might be made in con-
fusing  quite different  substances with them.
Casts of  white membrane are  sometimes shed
from the  bowel in large quantities, of irregular
shape,  which might be mistaken for worms by
the inexperienced.
   Worm  powders  of  various  kinds  are  pre-
scribed, usually consisting of santonin,  for the 
          DISEASE IN CHILDREN       211

expulsion of  worms.  To be effective, it is nec-
essary that these  remedies should be given  on
an empty stomach; they are best taken in the
early morning,  and should  be followed by  a
brisk aperient; the remedy being  repeated in a
day  or two if not successful.  If  the last meal
is taken early, they may be given at bed-time,
an aperient being taken in the morning.  The
excreta should be carefully examined afterward
to see if the worm or  worms have been passed.
  Tubercular  Meningitis.—Infants  and  chil-
dren of all ages suffer from this very fatal dis-
ease, and the offspring of  delicate or consump-
tive  patients are especially liable to be attacked.
  Symptoms.—The premonitory  symptoms  in
children may be of some duration, consisting of
listlessness, languor,  loss  of flesh, pallor, and
alteration  in temper and  manner.   The onset
may be gradual or sudden, with headache, vom-
iting, feverishness,  flushed  face,  constipation,
drowsiness, and irritability when awake.  The
headache is usually constant, with paroxysms of
great severity, causing the  child to shriek  or
cry  out  suddenly; the senses  are very acute,
strong  light or  loud noises causing  distress.
After  a varying  period,  the  so-called second
stage sets in.  The headache is  more severe, and
the  brows are contracted; there  is  great irri-
tation on being disturbed,  but  there  is increas-
ing drowsiness and stupor, and delirium is fre-
quent; the pupils may be dilated, or a squint
may be noticed. The urine is often retained, or
there is  incontinence.  The face is pale with a
tendency to  flush, and the pulse  and tempera-
ture descend. The third stage supervenes with
increasing stupor or complete coma, and in ad-
dition there  may be twitching of the limbs, or
a  general  convulsion.   The temperature may
rise  considerably  before  death,  which occurs 
 212  THE NURSE'S  SERVICE DIGEST

 usually  under  a  fortnight  from  the  onset,
 thought the length of the illness is very variable.
 In a few cases there is a return of conscious-
 ness, more  or  less complete,  shortly  preceding
 the fatal termination, but coma again returns.
 There  are few diseases which  may present so
 variable  a course and uncertain symptoms as
 tubercular meningitis, but constant severe head-
 ache, vomiting, and  constipation are prominent
 symptoms which should rouse suspicion of head
 mischief.  Other  acute brain •affections in chil-
 dren, such as abscess, or simple-meningitis, pre-
 sent  symptoms of the same character  as tuber-
 cular meningitis, but the chance of recovery is
 rather  more favorable.
  Management.—The nurse may be able  to do
 a great deal toward  the alleviation of the  suf-
 ferings of the child; and although a  fatal ter-
 mination is  almost a certainty in an undoubted
 case  of tubercular meningitis, there are  many
 others  in which the  exact nature of the affec-
 tion  must remain uncertain,  and in which an
 unexpected  improvement   in   the  symptoms
 changes  the aspect,  and  a favorable termina-
 tion  ensues.
  On receiving  a child in  hospital  suffering
 from head symptoms, the nurse will do well to
 inquire for any strumous or consumptive taint
 in the parents, family, or other children.  Blows
 on the head, discharge from the ear,  overpres-
 sure  at school are also points concerning which
 information  may be obtained.  The child should
 be placed in a quiet room, cool and well venti-
lated; the light must be shaded by a dark  cur-
tain, the hair may be cut short or shaved, if
ordered,  and cool applications kept in contact
with the  scalp.   The feet should  be  warmed,
and the bowels relieved by an aperient or  ene-
ma.  Liquid food in small  quantities should be 
          DISEASE IN CHILDREN       213

given at intervals, and ice if there is  vomiting.
Nursing or  moving  the child  about  should be
avoided, tending  to  increase the headache  and
liability to  sickness.  When coma supervenes,
the usual precautions  as to the excretions  will
have to be taken.
  Water on the  Brain—Hydrocephalus.—This
chronic affection  is  due to an accumulation of
the natural  fluid in  the interior of the cavities
of the  brain, and shows  itself soon  after in-
fancy.   The infant's  head is noticed to be larger
than usual,  and continues to enlarge; the fore-
head and sides seem especially prominent,  and
the fontanelles show  no sign  of closing  in, so
that soft places  are  felt extending  along the
top and sides of the  skull.  The face appears
unnaturally  small in  size, and  the  eyes  look
prominent and staring; nervous symptoms are
usually present.  The  majority of children  thus
affected die during infancy or  quite young, and
those who live are defective in intelligence and
terminate their lives in a lunatic asylum, 
CHAPTER  X.
  WOUNDS AND THEIR COMPLICATIONS.—ULCERS,
             BURNS, AND SCALDS.

Incised and Lacerated Wounds—Healing by first
  Intention, by  Granulation—Dressings—Scalp
  and  Face  Wounds — Cut Throat — Haemor-
  rhage:  Capillary,  Venous, and Arterial—Ar-
  rest of Bleeding—Inflammation and Abscess—
  Pus or Matter.
Symptoms and Management of Cellulitis—Ery-
  sipelas—Poisoned Wounds—Pyaemia or Blood-
  Poisoning—Tetanus—Ulcers and Ulceration—
  Burns and Scalds.

   Introduction:  Different kinds  of Wounds.
  Wounds may  occur from various causes, and
present endless  variety of  shape  and position.
They may conveniently be divided into Incised,
Contused, and Lacerated Wounds.
  Incised Wounds.—Simple cuts  of  superficial
extent are of slight  consequence if properly at-
tended to, and will often heal readily of them-
selves.  Any dirt should be washed off,  a strip
of  plaster applied to bring  the  edges  of the
wound  together, a pad of  lint bandaged over,
and the wound will usually heal quickly and
without trouble.
  Healing by First Intention.—In these cases
the edges of the wound  are rapidly  glued to-
gether,  and there is a very slight scar or cica-
                     214 
      WOUNDS AND  COMPLICATIONS   215

trix  left.  This  method  of healing is called
union by first intention, and is the quickest and
most favorable that can be desired.
  Extensive and deeply incised wounds are ac-
companied with severe haemorrhage (see Haem-
orrhage).  After the bleeding has been stopped,
the surgeon often has to insert some stitches or
sutures of wire or  silk to keep the  edges in
position, and to enable the wound to heal, as
far as possible, by the first intention.
  Contused and Lacerated Wounds are accom-
panied  by some damage  to  the  skin  and soft
parts, and the  skin may be partially destroyed,
and the tissues bruised and torn.  These wounds
are usually produced by blows or blunt instru-
ments,  or by gunshot accidents  or explosions.
They sometimes contain a considerable quantity
of dirt or foreign bodies of various kinds.
  Healing  by  Granulation.—There  is little
chance of their healing by the first  intention, as
new skin has to be formed where the skin has
been  destroyed, and the deeper  parts  of  the
wound must first unite together before the sur-
face heals over.  In cases where wounds do not
heal by first intention there is more inflamma-
tory action,  and matter is  formed on the sur-
face of the wounded parts.  After a time small
red  spots appear in  the deeper  parts  of  the
wound which bleed easily, and are called gran-
ulations; these sprout up and gradually fill the
gaps, while the edges  of the wound uniting by
degrees the skin grows over the surface and the
wound  is healed.  This method of healing is
much slower than union by  first intention,  and
the cicatrix is more distinct and permanent.
  The  Management and  Dressing of  wounds,
either the result  of accidents or  after opera-
tions,  has frequently  to be undertaken by the
nurse.  In severe cases the wound is treated by 
216   THE NURSE'S SERVICE DIGEST

the surgeon, and usually dressed antiseptically;
the after-dressing is often handed  over  to a
nurse to continue  the antiseptic treatment.   It
is usual to treat all wounds antiseptically (see
Antiseptic Method), but where this cannot be
carried out the nurse should observe the follow-
ing details:—
  In the case of incised wounds of small extent,
a piece  of  strapping  of  sufficient size to cover
the whole  wound  should be  applied, the part
having been previously dried, and the edges of
the wound brought neatly  together,  and band-
aged  if further  support   is  necessary.  The
wound will frequently heal perfectly by the first
intention and no further dressing be required;
in fact, the less disturbed  it is the  better, un-
less there is evidence of inflammation.  If the
plaster is well heated by wetting in boiling wa-
ter, it will remain  secure  until the wound  is
healed.
  If the wound is of considerable  length, the
plaster is best applied in strips, about one inch
broad, and  of sufficient length to extend  some
distance on either side  of  the wound.  In  ap-
plying each strip,  one end  should be first fixed
down, and then the edges  of the wound drawn
together by the thumb and finger of the  other
hand, the plaster  can be then brought  over  the
wound  and finally fixed on  the other  side; a
small space should be left  between the several
strips of plaster, and a bandage may be advan-
tageously used to assist in  keeping the  parts
together.
   In  dressing lacerated  wounds,  discharging
wounds, or those containing dirt, it is of  the
greatest importance to cleanse them thoroughly
first  This is best done by directing a stream
of warm water  either  with a  syringe, or  by
other means,  into the wound until all  particles 
WOUNDS AND COMPLICATIONS   217
of dirt  and discharge have been removed.  In-
stead of simple water, a lotion composed of one
part of carbolic  acid to sixty  of  water,  or a
weak solution of  Condy's fluid, may be  em-
ployed.  If dirt or gravel or other material  still
remain  fixed in the wound, a hot bread or lin-
seed-meal poultice may be used for three or four
hours before the dressings are  applied.  If the
surgeon does not advise some particular dress-
ing, strips of lint covered with eucalyptus vase-
line,  or carbolized  oil,  may  be laid over the
wound,  a pad  of  cotton-batting over this,  and
then a  bandage used to secure  the dressings in
position.
  In dressing or  re-dressing wounds, the nurse
should  endeavor  to give as  little pain as  pos-
sible.  The dressings required should all be pre-
pared beforehand,  and  in  addition,  scissors,
dressing forceps, syringe, basins and  dishes, and
boiling  water should be in readiness.
  In  removing strapping, it should be  done
gently,  the  two ends being unfixed  and  raised
toward the wound,  and the edges kept together
by  the  thumb  and  the finger while  the plaster
is being peeled off.   If it adheres  to the hairs,
the process is painful  and the hairs should be
cut, but  it is better to  shave the spot  before
applying  the plaster.
  In re-dressing extensive wounds, the old plas-
ter should  not all be removed until the  new
strips have replaced some of  the old ones,  thus
preventing  any undue  strain on the wound.
  Where sutures  have been  applied, the nurse
should  be careful  not  to  pull on them, and to
notice  especially  whether there is  much  red-
ness or inflammation round them, which is fre-
quently the case if they have been in too long,
and should report  to  the surgeon.   In  severe
wounds of  the extremities, a splint  is required 
21S   THE NURSE'S SERVICE DIGEST

to keep the parts completely at rest.  The pad-
ding in the neighborhood of the wound should
be covered with oiled silk  or  some other pro-
tective, to prevent  the  necessity of changing
the padding every  time, which  would otherwise
become soaked with the discharges from  the
wound.
  Wounds of the  Scalp are of very  common
occurrence, as the  result of a blow or a fall on
the head.  Owing  to the looseness with which
the scalp is attached to the parts beneath, large
flaps are sometimes separated and torn, so that
a very extensive wound  is produced,  and  the
consequent haemorrhage is often severe.
  Management.—After  the  wound  has  been
thoroughly  cleansed, the  flaps should be  re-
placed in position, and  the hair  cut short or
shaved for a  considerable  extent  round  the
wound.  A pad of  dry lint can be retained in
position by a capeline bandage,  handkerchief, or
calico  cap.   In  many cases the  wound heals
readily, but  in persons  addicted  to intemper-
ance,  inflammatory  action  often  sets  in with
suppuration, and perhaps erysilepas.  The parts
around a scalp wound should  be  carefully  ex-
amined at the time of dressing, and the nurse
should notice if there is any swelling or bagging
under  the adjacent parts, indicating the forma-
tion of matter, or  if there is any flush or red-
ness about the part, and should report at once
to the surgeon.
  In Wounds of the Face,  the edges should be
very  carefully adjusted  in  order to  promote
healing by first intention and secure as slight a
scar as possible.  If they are extensive,  the sur-
geon will probably insert sutures, which have
to be removed after about forty-eight  hours if
wire has  been used.  They  heal  very  readily,
but occasionally erysipelas supervenes. 
      WOUNDS AND COMPLICATIONS   219

  Cut Throats.—In desperate cases, the haemor-
rhage from the large vessels in the throat may
be so severe as to destroy life rapidly.  In some
patients there is the danger of suffocation if the
windpipe has been laid open; the blood flowing
into the opening  blocks up  the  passage.   If
there is evidence of this, the patient should be
placed on  his side or  face, and the  wound
should on no account be covered up.
  After the immediate dangers have been passed
the position of the patient in bed  is important.
The shoulders should be raised by pillows, and
the  head bent forward,  and, if necessary,  in
unruly cases, a bandage should be carried round
the  forehead, and  the  ends brought from the
temples down to a waistband in front.
  There  is  risk of inflammation  of  the lungs
from the access of cold  air through the wound
in the windpipe, which  may  be obviated by the
application  of hot, moist flannels, laid  lightly
over the wound.  If the epiglottis or the oesoph-
agus be wounded, there may be difficulty  in
feeding the patient, and the administration of
food or stimulants by the rectum rendered nec-
essary for a time.
  Wounds  of the  Trunk which penetrate the
cavities of the chest or abdomen are dangerous
according to their  extent, and to the complica-
tions which may ensue  from damage to  the  or-
 gans contained  within them.   They  require
early attention by the surgeon.  In severe cases
death may be immediate from shock or internal
haemorrhage.

          Complications of  Wounds.
   The complications of wounds  are  Haemor-
rhage,  Inflammation  and  Abscess,  Cellulitis,
I ry sipelas,  Blood-Poisoning, and Tetanus.
  Hemorrhage,  or Bleeding.—Loss  of blood 
 220   THE  NURSE'S SERVICE DIGEST

 may  occur  from a  wound of an  artery, of a
 vein, or of capillaries.  It is important to be
 able  to  distinguish  them, as  bleeding  from a
 large artery is  rapidly fatal if  not  controlled.
 In bleeding from wounded capillaries, the blood
 is of bright color,  oozes  into the wound  and
 flows over, perhaps very briskly.   When  the
 blood flows  in a steady stream, and wells up in
 the  wound, of  a  dark or blue-black color, it
 comes from a wounded vein.  But when an ar-
 tery is wounded the blood is spirted  out in jets
 with great force to a considerable distance, and
 is of a bright red color, so that the  amount of
 blood lost from a large vessel in  a short time is
 very great.
  In the majority of wounds  in  which the  cap-
 illaries are  cut  across, and even in  some acci-
 dents where the artery is damaged  by  violent
 crushing or tearing, nature arrests  the bleed-
 ing.   In  the case of  wounded capillaries,  the
 blood forms a clot,  which blocks up the open
 channels,  and  no  further  bleeding  occurs.
 Where an  artery  is torn across or  lacerated,
 the muscular  and elastic coats will  often  con-
 tract and diminish the  size of the orifice.  The
 flow of blood is thus lessened or stopped,  and
 this  gives time for  a clot to be formed which
 closes up the mouth of the artery  sufficiently
 for the time,  and if left  undisturbed changes
 take place  which permanently seal the  wounds
in the vessel.
  Methods of Arresting  Haemorrhage.—If  na-
 ture does not arrest the bleeding, it is neces-
sary to check it artificially.  The means which
 a nurse  can best employ in an emergency is
pressure  applied in various ways;  at the same
 time attention must  be given  to  the position of
the wounded limb.
  Bleeding from Capillaries.—In a wound where 
      WOUNDS AND COMPLICATIONS   221

there is free  bleeding from capillaries, which
does not cease when exposed to the air or after
bathing with cold water, pressure may be ap-
plied in the form of a pad of several folds of
lint, soaked in cold water, and firmly  bandaged
over. If the wound is on an extremity, the limb
should be raised on a pillow and not allowed to
hang down.
  Bleeding  from  a Vein,  as for instance  a
wounded  varicose vein  in the leg, may be ar-
rested by a pad placed on the bleeding-spot, and
tied on by a handkerchief or bandage, and the
patient placed on a sofa with  the  leg  well
raised.   If this  is not  sufficient, a  bandage
should  be applied firmly round the limb on the
side of the wound away  from the heart.
  Bleeding  from  Arteries.—To arrest arterial
bleeding the finger or a pad  should be applied
to the bleeding spot, and  pressure kept up  until
assistance can be obtained.   The exact source
of  the  bleeding may sometimes be ascertained
by  sponging away the blood out of the wound,
and watching for  the point  where the jet of
blood issues.  If  this fail, and the wound  is of
a limb, the extremity should be well  raised up
and a bandage firmly applied for  some distance
above the wound;  and  if the wound  is near a
joint,  a pad may  be placed  in the  flexure of
the joint next above the wound,  and the  joint
firmly bent.
  If the bleeding continue, pressure  should be
applied in the course of the main artery of the
limb, but this is only possible for the nurse if
she is  acquainted with  its  situation, and the
spot at which pressure can be applied with ef-
fect.  The finger or thumb  may be  used for
this purpose,  or  some form  of extempore  tour-
niquet, such as a handkerchief with  a knot or
some solid substance tied in;  the knot  being 
 222  THE NURSE'S  SERVICE DIGEST

 applied over the artery and the ends tied tight-
 ly  round.   If the position of the vessel is  not
 known, a  handkerchief may be tied round  the
 limb above the wound, and a stick inserted and
 then twisted round  until sufficiently  tight  to
 stop the  bleeding  (fig. 47).  An elastic  band-
 age or  india-rubber tube  tightly  wound round
 the limb is often effectual (fig. 48).
  In wounds of the  arteries of the upper  ex-
 tremity the  main artery  may  be pressed upon
 in  the groove  on the inner side  of the upper
 side of the  sleeve of a  man's coat;  pressure
 must of course be made above the wound.
  In bleeding from an artery in the lower  ex-
 tremity,  pressure may be applied to the main
 vessel, the femoral artery.   The  spot chosen
 should be in the middle of the groin at the  top
 of the thigh (fig. 49).
  After the bleeding has ceased, care should be
 taken,  if  the patient  has to be  moved to any
 distance, to keep the limb steady and raised on
 a pillow,  but it should not  be covered up, so
 that if  the bleeding occurs it  may  at  once be
 visible.
  Constitutional Symptoms.—Considerable loss
 of  blood usually produces faintness, indicated
 by  pallor and temporary  loss of consciousness,
 accompanied by a feeble pulse.  The mere fright
 caused by the sight of blood is sufficient to pro-
 duce faintness in some people, but the condi-
 tion is one favorable  to  the arrest of  haemor-
 rhage,  because  it  reduces the power  of the
heart, and consequently diminishes the  force of
the blood stream.  Immediate  resort to stimu-
lants is therefore unnecessary,  or even harm-
ful, and all that is requisite is to put the head
low.
  If the  faintness  proceed from  the actual
amount  of blood  lost, the pallor increases until 
      WOUNDS AND COMPLICATIONS   223

the face is blanched, the breathing is  sighing,
and  there is much restlessness;  the pupils di-
late, and the extremities feel cold,  a  profuse
perspiration  breaks  out, and the patient may
be in danger of  dying from  syncope.  The head
should be kept  lower  than the body,  and  the
extremities raised and kept warm..  Stimulants
should be given  (30 drops of aromatic spirits of
ammonia in a wineglass of  water), and it may
be necessary to inject  stimulants, or  even to
use tranfusion,  a method by which  fluid of  a
suitable  kind can  be  introduced into  a vein,
thus  supplying  the  place  of the blood  which
has been lost (see Transfusion).
  After  the  immediate  effects  of the  haemor-
rhage  or shock  have passed away, the patient
sometimes becomes  hot  and  flushed,  with  a
quicker  and  stronger  pulse,—a  condition  to
which the term "reaction"  is applied, and this
stage  will  probably  be intensified if  much
brandy has  been given  during the former pe-
riod.
  Inflammation and  Abscess.—Some  wounds,
especially if much lacerated and contused, or
from the presence of some foreign  bodies, or
from  other  causes, do  not heal readily;  the
edges  become red and swollen, the wound feels
hot  and painful, and these signs increase  and
spread into the  surrounding parts.
  These four signs—redness, swelling, heat,  and
pain—denote inflammation, and  they are pres-
ent in a greater or less degree in inflammation,
wherever occurring, either  in  the external tis-
sues or  in the  internal organs.
  Constitutional Disturbance.—In addition to
the  local signs in the wound there are often
symptoms of affection  of  the general health.
The patient  complains  of a sense of chilliness,
headache, and pain in the limbs.  The  tempera- 
224   THE NURSE'S SERVICE  DIGEST

ture  is raised,  the  pulse  quick, the skin  dry,
and the tongue coated.  There is loss of appe-
tite,  thirst, turbid urine,  and constipation; in
short, there is feverishness.  After a time the
constitutional disturbance  subsides, and  the ap-
pearance of the wound alters, the redness, swell-
ing, and discomfort decrease, the inflammation
terminates in  "resolution," and the wound heals
or  becomes healthy;  or  the inflammation  in-
creases,  giving  rise to the further process of
suppuration or the formation of pus or matter
in the wound.  The swelling and redness then
increase,  and the wound throbs and is  very
painful,  and the  constitutional symptoms may
be  considerable.   The pus formation and  dis-
charge of matter  is often accompanied  by  ces-
sation  of  the  acute  pain,  and the swelling
diminishes.   When  matter  is  pent  up in  a
wound  or  in  the  tissues,  it causes very great
suffering from the swelling and tension of the
parts, and this is apt  to occur in deep wounds
which heal at  the  surface  by  first intention,
while inflammation  and suppuration are going
on  in the deeper  parts.  The matter is unable
to find its way out,  and collects in the interior,
great pain being  experienced until the wound
is re-opened,  and the matter allowed to escape.
Deep wounds  should be made to heal from, the
bottom upward.
  Abscess.—When a collection of matter, or  pus,
forms in  the  tissues or organs, either  as  the
result of wounds  or spontaneously, it is called
an  abscess.  This  gives rise to the usual signs
and symptoms of inflammation.  The  abscess
may point or protrude at one  spot, and  then
break through the tissues,  or it may  require to
be opened  by the surgeon;  the  symptoms  are
commonly relieved as the matter is discharged.
  The character of pus or matter from  an ab1 
      WOUNDS AND COMPLICATIONS   225

scess or from an inflamed wound should be no-
ticed by the nurse.  Healthy or laudable pus is
of yellowish  color  and of a sweet, faint odor,
and  may  contain streaks of bright blood from
the  healthy  granulations, which  easily  bleed.
The  discharge from an unhealthy wound or ab-
scess is greenish yellow or green, or dark brown
or red, from decomposing blood, and the smell
is unpleasant, offensive, or even putrid.
  Management.—A nurse  should make herself
familiar with the appearance of a wound which
is becoming  inflamed,  or  not  doing well, and
report to the  surgeon.   Such wounds require
constant dressing  and  attention, treating with
an antiseptic, and care must be taken to prevent
the matter being confined by too close strapping.
"A bread or linseed-meal poultice will often suf-
fice to relieve the  tension and allow the matter
to escape.  The discharge should  be carefully
washed from  the wound, and drainage secured
by various means, such as insertion of  strips
of gutta-percha tissue, oiled  silk,  or drainage
tubes."
  "Antiseptic  dressings may  be required, and
Iodoform  powder  sprinkled over the wound is
often very effective.  Strips of lint soaked in
carbolic lotion, or some  other  antiseptic solu-
tion, may be laid over the wound, and the parts
kept at rest."   .£oderate diet and aperients will
help to control the feverishness.
  Cellulitis is a form of inflammation which
may attack the cellular tissue in the neighbor-
hood of a wound, and extends for some distance
into  the surrounding parts.  The tissues affected
become swollen and red,  and the  wound has
generally  an unhealthy appearance.  The tem-
perature usually ascends above the normal, ac-
companied by  the  customary symptoms of fe-
verishness. 
226   THE  NURSE'S  SERVICE DIGEST

  Erysipelas occurs in two forms.  In each case
there is an  excess of uric acid in the system,
and this must be eliminated as speedily as pos-
sible, which will assist greatly in  treatment of
the malady.   There is a  superficial kind which
only attacks the skin; a  rash of bright red  col-
or appears  around or  near the wound, having
a distinct margin.   It spreads rapidly, and there
is usually some swelling  underneath.  There is
no limit to the extension of the rash, and it may
disappear,  and  reappear  suddenly  in another
part.   Its  natural term  is generally  eight  or
ten days.
  The other form of erysipelas is  more severe;
it attacks the deeper parts as well as  the skin,
and is closely  allied  to cellulitis.  There is
more swelling and  pain, and vesicles or blisters
often appear on the skin containing clear fluid
which  soon  becomes  turbid.   In erysipelas
the constitutional  symptoms are  usually  well
marked.  There is often  a chill or  rigor, with
rise of  temperature and  fever symptoms.  The
condition of the wound probably  changes, and
an  unhealthy appearance is  visible before  the
attack,  or a blush may be seen at  or round  the
edges of the wound, and the discharges cease or
change  color.
  Management.—The  nurse should  be on  the
lookout for rigors  or  rise of temperature, and
watch the wound carefully, especially if the  pa-
tient is  in the wards of a hospital,  in order that
the first sign of erysipelas  may be detected,  as
the disease  is highly contagious to others suf-
fering from open wounds.
  It is usual  to remove cases of erysipelas and
cellulitis at  once  into  separate  wards to  pre-
vent the spread of the disease.
  Good  ventilation  and absolute cleanliness are
essential. 
       WOUNDS AND COMPLICATIONS   227

   In cases of a low type, nourishing  diet and
 stimulants—milk  punch  or  egg-nog—are  re-
 quired.
   There are many applications in ordinary use;
 among the best being the application  of collo:
 dion,  or dredging the parts with flour.  The
 greater  number of  cases get  well, but  among
 the intemperate, those of feeble constitution, or
 those  suffering from kidney disease, the malady
 often  proves formidable.   Delirium, inability to
 take food, and  a brown  tongue, joined with
 great  feebleness,  are bad symptoms, and fore-
 bode a fatal termination.
   The disease is sometimes epidemic at certain
 seasons  of the year, but it may break  out in a
 ward  and spread  without any apparent reason.
 The nurse should notice if it makes its appear-
 ance first at  any particular spot, or clings  to
 any part of the building, since dirt, bad  drains
 or decomposing  materials  are  common  causes
 of an  outbreak.  She should also remember its
 infectious qualities, and  be careful to destroy
 dressings from  these wounds, and not to em-
 ploy splints  or instruments for other  patients'
 which  have been  used in  these cases.  On the
 termination  of  the illness,  all  instruments
 should be thoroughly boiled and disinfected in
 strong carbolic  solution, and the  bed and bed-
 ding sent away to be disinfected (see Disinfec-
 tion).
  Poisoned Wounds.—Slight cuts, abrasions, or
 wounds  of any kind may become poisoned  by
 the introduction of decomposing matter,  or by
 the decomposition or foulness of their own dis-
 charges.
  A common  instance  is an  ordinary  "whit-
 low."  The poisonous material enters at a small
crack,  or hang-nail, on the finger and inflamma-
 tion is set up  in the deeper  parts.  Matter 
228   THE NURSE'S SERVICE DIGEST

forms and perhaps can be seen  as a yellowish-
white speck deep under the skin. The affection
is very painful, and unless the  matter escapes
or is relieved by an incision,  the inflammation
may spread and affect the nail and  the bone,
destroying part of the finger.
  Inflamed Lymphatics.—As  a result of whit-
low or other poisoned  wounds, inflammation of
the lymphatic vessels and glands in the neigh-
borhood  or  above the wound is always  to  be
suspected.   The  first  sign  of this is  a faint
blush running up the limb in  the course of the
vessels, with a feeling of pain  and stiffness, and
usually some constitutional disturbance.  In the
case of a whitlow the  flush will be visible  on
the front of the  fore-arm to the elbow, and
along the inner side of the upper arm to  the
arm-pit.   Here there is often some  tenderness
and  pain, and  the lymphatic  glands  may per-
haps be felt to be swollen, or the glands may be
tender without any preceding  blush.
  Management.—If the nurse is in charge  of
poisoned wounds of the extremities, she should
be on her guard  against  inflammation  of  the
neighboring lymphatics, and report at  once to
the surgeon.  She should also be very careful of
her own  fingers, and touch the wound and dis-
charges as little as possible, washing her hands
in carbolic or some antiseptic  afterward. These
precautions may prevent her suffering herself.
  Blood-Poisoning — Pyaemia.—In pyaemia  the
morbid material in the wound not only affects
the lymphatics,  but also enters  the blood, pro-
ducing a serious and often fatal disorder.
  Symptoms.—The onset is marked by a sudden
and severe rigor, often lasting some time.  The
patient's  teeth chatter,  the bed  shakes, and  he"
becomes blue.   His temperature is found to  be
above normal, and rapidly rises to 104°, 106°, or 
      WOUNDS AND COMPLICATIONS   229

higher.   After  the shivering,  profuse  perspira-
tion sets in, lasting some time, and the temper-
ature subsides.  These  rigors are a great fea-
ture in  the disease, and usually recur at inter-
vals, often of twenty-four  hours.  The general
condition of the patient rapidly becomes worse,
and he  gets pale  and  thin.  During this time,
or perhaps before, the wound has become un:
healthy  and  offensive,  and abscesses  may ap-
pear in  different parts of the body, either in the
external tissues, in the joints, or in the inter-
nal  organs.  In  acute  cases,  death  occurs in
from two or  three days to a fortnight.  The
more chronic last from two to six weeks or
longer,  and there is  greater chance of recov-
ery.
  Management.—The  main  predisposing causes
to pyaemia are overcrowding,  dirt, bad ventila-
tion, and insecure drainage, some of which may
be guarded against by  the  nurse; and especial
attention to these points is necessary in a ward
where there are many discharging wounds. The
nurse should comprehend the  importance  of a
rigor, and  take the temperature, administering
some warm drink, and  applying additional cov-
eings.   Later on  her   attention  should be  di-
rected to complaint of pain in any region as
perhaps indicating the appearance of  an ab-
scess.   In  chronic cases, a water-bed is  very
desirable. The freest possible ventilation should
always  be secured.
  Tetanus, or Lockjaw.—This formidable mal-
ady is  liable  to  attack patiens suffering  from
wounds  of any description,  the slightest or the
most severe, though it is perhaps more common
after lacerated wounds. It is  characterized by
spasm and cramp in the muscles of  the  body
of a most painful kind.
  Symptoms.—The early symptoms  are impor- 
230   THE NURSE'S SERVICE DIGEST

tant, and often slight in character.  The first
complaint is usually of a  feeling of stiffness
about  the jaws and throat, so that eating is
difficult,  and the patients finds he is unable to
open his mouth.  Other  muscles become affect-
ed, and a spasm comes  on, in which the  mus-
cles, often the  muscles  of the trunk, become
firmly  contracted, and the face is drawn into a
grinning expression.   As the spasms increase, a
larger  number  of muscles  become affected, the
head is bent back, the body  arched with the ab-
domen forward, and if the  spasm continue the
breathing ceases, and the countenance becomes
livid.  If the spasm  does not relax, the patient
may die of  suffocation.   In acute  cases  the
spasms increase in  severity and the intervals
become less  frequent, and death takes place  by
suffocation or exhaustion; but the more chronic
and  less severe cases sometimes recover.
  Management.—Recovery in cases of tetanus is
obtained by  very careful supervision, nursing,
and  feeding.   It is important that the disease
should be recognized at an early stage, and it is"
highly probable that the nurse will be the first
to hear of the early symptoms.  Sometimes gas-
tric  derangement and constipation  precede the
first stiffness about the muscles of the jaw,  or
the drawn expression of the mouth may  be the
first  indication.  The bowels should be thor-
oughly acted on with a  reliable purgative, the
patient should at once be isolated and kept per-
fectly quiet,  as  the spasms are frequently start-
ed by the least noise, or even by a draught  of
air,  touching the bed.   Feeding  is  of  next
importance, and should be carried  on between
the spasms frequently and gently.  It is some-
times difficult on account of the closure  of the
mouth, but the fluid must be introduced through
gaps between the teeth, or by enema, if feeding 
      WOUNDS AND COMPLICATIONS   231

by the mouth is not  possible.  Sleep should be
encouraged as much  as possible.
  Ulcers  and  Ulceration.—An open sore is
sometimes  left as the result of injury, or  in-
flammation of the skin or mucous membranes,
or the loss  of vitality in the affected part is due
to some constitutional or local  weakness.  The
sore or ulcer presents various appearances, and
discharge  of matter usually occurs  from the
surface.
  A  healthy  or healing ulcer is covered  with
small, red  granulations,  discharging  yellowish
pus, and is  surrounded by  healthy  skin, pre-
senting a bluish line  at the circumference. The
size  of the ulcer diminishes  day by day as the
skin heals  over.
  No further treatment than rest and simple
dressing is required.
  Unhealthy  ulcers  are  accompanied  by a dis-
charge of  unhealthy pus, the  skin  round the
margin appears inflamed, and the base is  occu-
pied  by swollen granulations,  or covered  by a
slough; and  the  ulceration invades the sur-
rounding parts.
  Special treatment is required for these ulcers,
and  under  medical advice.
  Cold or  callous ulcers are characterized  by
slow healing, and the margin is hard  and white,
and the  surrounding skin brawny; the granu-
lations are pale and flabby, and there is but
little secretion from the surface.  Stimulating
applications are necessary, and  attention to the
general health.
  In the management of all ulcers, support by
strapping  and bandaging is required, and  wnen
the  ulcer is situated in  the  lower  extremity, a
few  days' rest in bed will often produce marked
benefit; if  in the lower limbs, that part should
be raised above the level of the body. 
232   THE NURSE'S SERVICE DIGEST

  Malignant ulcers are of a cancerous nature.
such  as  epithelioma,  and rodent ulcers of th^
face.   These attack  persons  in  the more ad-
vanced periods of life, and can  only be dealt
with by operation.
  Burns and Scalds.—Destruction of the skin
and  soft parts of the body is caused by  dry
heat in burns, and by moist heat in scalds. The
extent of this destruction indicates the severity
of the burn, and  in  severe cases  there is great
nervous  shock,  with  depression  of the  vital
powers.  The face is pale and drawn, the skin
cold  and clammy, the pulse fails, and  there is
immediate danger to  life.
  Management.—When the  patient is suffering
from  shock, the treatment must  be directed to
this before the  local injury is attended to.  He
should be wrapped in warm blankets and placed
near  the fire, or  covered up in bed, and hot
bottles applied  to the feet  and surface of the
body.  Stimulants, hot beef-tea, or hot fluid of
some kind  should  be administered.  In  the
meantime a warm bath should be  prepared, of
sufficient size to  enable the patient to  be com-
pletely immersed.  The  water should  be of  a
temperature comfortable to his sensations, and
he may remain continuously in the  bath  until
all  severe  symptoms  have passed  away (see*
Baths).
  In the local treatment, after the charred re-
mains  of clothing have  been  gently removed,
the burns may be dressed. One limb or part of
the body should  be dealt with  first, the rest
being covered up.  If there  are vesicles or blis-
ters of large extent, they should be snipped, and
the fluid evacuated or soaked  up with absorb-
ent cotton, but the skin should not be removed;
small vesicles may remain uncut and  be pro-
tected with  absorbent cotton.  The burnt sur- 
      WOUNDS AND COMPLICATIONS   233

face may then be freely painted over with the
flexile collodion of the Pharmacopoeia,  two or
three times, or Carron oil  (equal parts of lime-
water and linseed oil) may be applied on lint.
  If  these applications  are not at  hand, the
surface may  be freely dusted  over with bicar-
bonate of soda or pulverized borax, or if these
cannot be had quickly, by wheat flour, and en-
veloped in a thick  layer  of  absorbent cotton,
retained in position by a flannel bandage.
  In  slighter  cases,  simple dressings of  zinc
ointment  or  lead lotion will  suffice, and since
the  removal  of  dressings  is  always attended
with  severe suffering, they should be changed as
seldom as possible.   In the case of children or
others of sensitive disposition, it is  no uncom-
mon practice for the surgeon to administer chlo-
roform during the removal of the  dressings.
  The scars  left from burns  are very disfigur-
ing, and great contraction of the skin is apt to
follow, producing various deformities.   Long
after-treatment is required,  and  extension by
means of splints of different kinds.
   Scalds of the Throat in  children  require
especial  notice,  as  they  are not  infrequent
among the children of the poor. They are com-
monly produced  by  attempting to  drink boiling
water from the spout of the tea-kettle.  A scald
of  the mouth, fauces, and larynx results, giv-
ing rise to  dangerous symptoms of difficulty of
breathing from injury to  the  larynx.
   Management.—The child should be placed in
 a warm, moist atmosphere, by means of a cov-
ered cot, or  surgical cradle, with a steam kettle
near by, as for tracheotomy  cases.  In severe
cases, when  the dyspnoea is urgent, tracheotomy
may be required (see Tracheotomy). 
CHAPTER XI.
                 fractures.

Fracture  by Direct  and  Indirect  Violence—
  Simple,  Compound,  and  Comminuted  Frac-
  tures—Signs  of Fracture—Union  of Bone—
  Setting  Fractures—First Aid in Fracture.
Management of Fractured  Skull — Concussion
  and  Compression  of the Brain — Fractured
  Lower Jaw — Spine — Pelvis — Collar-Bone —
  Splints  for Fractured Arm—Colles' Fracture
  —Thigh Bone—Bones of  Leg—Patella—Plas-
  ter of Paris Case—Crutches—Compound Frac-
  tures—Sprains  and Strains—Dislocations.

        Nature and Signs of  Fracture.
  A bone  may  be broken by direct violence, as
when the blow falls directly  on the bone  and
fractures  it at that point; or by indirect  vio-
lence, in which case it gives way at some spot
in between,  the force being applied at one end,
while the other  is fixed.   An example of the
latter would be  a  fracture of  the  clavicle or
collar-bone by  a fall on the shoulder.
  A less common method of fracture  is by mus-
cular action, a  powerful and sudden  contraction
of a muscle causing the bone into which it is
inserted to  break;  for instance, a not uncom-
mon example is fracture of the patella or knee-
pan, by  sudden  contraction of the powerful mus-
cles in front of the thigh bone.
  When a bone is broken by indirect violence, it
commonly gives way at the thinnest  and  weak-
                     234 
FRACTURES
235
est  part.  In jumping  from a height, the tibia
is usually fractured at its weakest part, a point
a few inches above the ankle joint.
  There are  three kinds of fractures:  Simple,
Compound, and Comminuted.
  Simple.—When the bone only is broken, and*
in one place.
  Compound.—When  the bone is broken, and
there is in  addition a wound of  the skin and
soft parts  communicating  with  the fracture.
The wound may be caused by the same violence
that produced the fracture, or the sharp end of
the  broken  bone  may  be subsequently  forced
through the  skin by the movements of the pa-
tient, or by the careless handling of those who
endeavor  to  assist him.
  Comminuted.—Where  the bone is broken in
more than one place.
  Signs of Fracture.—These are:—
     Loss of power in the limb.
     Distortion and swelling.
     Pain; tenderness,  and increased  mobility
      when handled.
     Inequality in length between the  injured
      and the sound limb when their measure-
      ments are taken.
     The hand placed on  the bone at the injured
      part  may  detect  some  irregularity,  and
      perhaps feel a  grating  sensation  (crepi-
      tus),  caused by the rubbing together of
      the fractured ends.
  Union of Bone.—A  fractured bone is mended
by  nature on the same principles as an ordinary
wound  of the soft parts is  healed,  only the
time required is considerably  longer.  To favor
this process, the ends  of  the  bone  must be
brought  close together and kept at  rest.   The
blood which has been  effused about the ends of
the bones is gradually absorbed, and after about 
236   THE NURSE'S SERVICE DIGEST

a week a soft material  is formed around  and
between  the  ends of  the broken  fragments,
which holds them  together like splints, while
the ends  become  glued  together  by the same
material.  This soft material is called "callus,"
and after the third or fourth week is hardened
by the formation in it  of bony  substance, so
that  by the  sixth or eighth week the fracture is
united by bone and  becomes solid.  The time'
required  for firm union varies  according to the
thickness  of the  bone, the larger bones taking
longer than the slighter.   Lumps  of hard "cal-
lus"  may  often be felt about the seat  of frac-
ture  when union is going on; these are removed
or smoothed down after a variable time, when
the bones are united  in a good  position.
  Setting  a  Fracture.—In the  treatment of
fracture,  the  surgeon's  first  endeavor  is  to
bring the ends of the bone as nearly as possible
into  their natural position, and then by means
of splints and other mechanism to keep them
so, and perfectly  quiet.  This having been done,
nothing remains  than to  wait  and let nature
complete the  cure.  In the greater number of
cases,  after union has  taken  place, the  bone
gradually regains its strength, so that finally it
is as  strong as before.  In some few, especially
debilitated subjects, the bones do not unite,  and
an "ununited" fracture is the result.  This may
also  occur when  the ends of the bone have not
been brought sufficiently close together, or kept
at rest; but in these cases the  bones more com-
monly unite at an angle, or in  some other  bad
position,  and deformity is the result,  with im-
paired power of movement.

            First Aid  in Fractures.
  A  person  with  a fracture,  especially of the
lower  extremity,  should  remain,  if  possible, 
FRACTURES
237
where he  is until medical  assistance can  be
obtained, the limb meanwhile being kept at rest.
If it is  necessary for him  to be moved, the
greatest  gentleness and care  should  be  exer-
cised, and the fractured limb kept from further
injury by firm support.  If the upper limb  be
injured, it should be  well supported by a  sling
in a  comfortable position, and the patient should
walk or be moved home.
  In  the case of fracture of the lower extrem-
ity, some form  of extemporized splint should be
used  to prevent  movement of  the broken  ends
and  the possibility of a simple fracture  becom-
ing a compound fracture.  For this purpose a
stick, umbrella, or thin firm  board tied on to
the side of the leg by pocket-handkerchiefs will
suffice.  The injured  and  sound limb may  then
be tied together, and the patient removed  on a
stretcher  or  shutter.
   Management.—In cases  of  fracture  of the
lower extremities,  the bed should be specially
prepared for the patient, four or five deal boards
about a foot wide being placed across the bed
under the mattress, in order to prevent it  from
sinking in the  middle.
  A  soft  mattress  or feather bed  must  not be
used, but one  of good, firm horse-hair or  well-
stretched  sacking.
   It will  be  necessary for the nurse to undress
the  patient,  and she  should be practically  ac-
quainted with  the right method.
  The boots  must be  removed  with great  care,
and  while withdrawing the boot with one hand,
the other should be employed to steady the limb
at the ankle.  If there is any difficulty, the boot
should be cut down one side.  Before removing
stockings, the garters must be loosened; braces
should be unbuttoned in front and behind.
   If  there  is  any difficulty  in  removing the 
238   THE NURSE'S SERVICE DIGEST

trousers, or if the thigh bone is fractured, it
is  better to cut down the outside seam, which
can be easily repaired.
  On taking off the coat, it is better to remove
the sleeve from the  sound limb first.
  The patient may be undressed either  on the
bed or on the  stretcher on which he was car-
ried; before placing  him in bed, the bed-clothes
should be well turned down, and then he should
be lifted on, a  person  standing on  either side
of the bed  to do so.   If it is necessary to wait
any  time for the setting of a fracture, the leg
may be supported at the sides by sand-bags or
some substitute,  the  bed-clothes being kept off
by a  cradle.

              Special Fractures.
  Fracture of the  Skull.—A blow  or fall on
the head may fracture  the roof of the skull by
direct, or  the  base   by indirect,  violence.   If
the roof  is fractured, the scalp will probably be
wounded and  the fracture  be  compound.  The
fracture  may take the form of a silt or fissure,
or the bone may be forced in,  causing a depres-
sion.
  In  fracture of the base  of  the  skull, there
may be merely signs of a blow on some part of
the head.
  Symptoms—Concussion of the Brain.—In some
cases of  severe blows on the head, whether the
skull be  fractured or not, there is evidence of
concussion  of  the brain.  This may be slight,
and  is accompanied  by pallor  of the face and
feeble breathing. There is more or  less uncon-
sciousness,  but  the  patient will often answer
questions, though with  difficulty and in mono-
syllables.  The symptoms are  immediate; vom-
iting  is very common, and there is confusion of
thought for some time after, with perhaps loss 
FRACTURES
239
of memory for events  occurring at the time of
the accident.  Headache is usually severe and
persistent, and there is often subsequent drow-
siness.   After  a good sleep  the patient  fre-
quently awakes  much better.
  Management.—Absolute quiet and rest in bed
for some time.   The feet and legs should  be
kept warm, and cold  may be applied to the
head.  Afterward the diet should be  light and
unstimulating, and  the bowels relieved by  ape-
rients.
  Fracture  of the Base of the Skull.—The
symptoms of compression  are usually present,
and in addition there may  be bleeding  from the
mouth, nose, or  ears, or  a discharge of watery
fluid from the ear.
  Compression and Injury of  the   Brain.—
When  the roof  of the skull is broken in  and
depressed, the brain and membranes underneath
are injured and  the symptoms are more severe,
or blood may be effused within the skull, caus-
ing pressure on  the brain.
  Symptoms.—The symptoms are  those of com-
pression, of which the following  are  the most
important.  There is complete loss of conscious-
ness, the breathing  is slow and labored  and
perhaps stertorous,  the pulse is slow,  the blad-
der paralyzed, the pupils  dilated  or unequal,—■
in short, a condition of  "coma."   These symp-
toms may come  on at the time of the  accident,
or may supervene after an interval of conscious-
ness.  In any  case,  they  are of very grave im-
port.  When the bone is depressed, an  opera-
tion  is performed by the surgeon to  raise the
bone and remove the fragments, which may be
pressing on and irritating the brain, or "trepan-
ning" may  be necessary, a process by  which a
hole  is made through  the  roof of the skull  to
facilitate the  operation. 
 240   THE  NURSE'S  SERVICE DIGEST

   Management.—The  patient should be  put in
 a darkened room and  kept quiet; if  uncon-
 scious,  all the attention required in such cases
 will be necessary (see Coma). The nurse should
 be watchful for anything in the form of a con-
 vulsive seizure,  for returning consciousness, or
 for any evidence of local paralysis.  When frac-
 ture of the  base is suspected, the pillow should
 be examined for evidence of discharge from  the
 ears.  If any operation has to be  performed,
 the head will probably require  shaving.
   After the immediate effects have  passed  off,
 the temperature should be noticed, or if there
 is other signs of fever, indicating the  onset of
 meningitis (see  Meningitis).
   Fracture of  the  Lower Jaw.—The  person
 will  have difficulty in opening  his mouth and
 speaking. There may be  bleeding  in the gums,
 or looseness of the teeth, near  the fracture.
   Management.—A special  form of bandage is
 convenient  for  this  fracture,  and  the nurse
 should  be able  to make it.  It  is  called  the
 four-tail chin bandage, and consists of  a yard
 and  a  half  of calico three or four inches wide,
 with the ends slit down  the middle to within
 three inches of the center.  A hole or slit should
 be made in  the  center about an inch from the
 border,  just large  enough to receive the chin.
 To apply the  bandage, the chin is  first  placed
 in the  central slit with the narrower side in
 front, the two upper tails are carried back and
 fastened round the neck,  while the lower ones
 are tied on the top of the head  (fig. 50).
  Fluid nourishment  should be  given for some
 time after fractured jaw,  as mastication  is dif-
 ficult.
  Fracture  of the Spine.—The  symptoms of
 fracture of the  vertebrae,  with  displacement,
depend  on the amount of  injury to  the  spinal 
FRACTURES
241
cord.  Injury to the cord high up in the neck is
often  immediately fatal; if lower  down, the
symptoms are those of paraplegia, and the com-
plications and management will be similar  (see
Paraplegia).
  When the vertebrae in the neck are fractured,
the  greatest care should be exercised to keep
the head from any sudden  movement; it is ad-
visable to place the patient at once on a water-
bed.
  Fracture of the Ribs.—Pain is  felt at the
seat of the fracture, especially on movement or
taking a deep breath, and coughing  or sneezing
are particularly painful.   Great relief  is expe-
rienced from firm pressure, which helps to con-
trol the movements of  respiration.
  Management.—A flannel  roller eight  or ten
inches wide  should  be  firmly bound  round the
chest  once  or twice, and  then  stitched,  or  a
broad  piece  of strapping may be first applied
half round the chest on  the injured side.
  Complications.—Injury  to the pleura and lung
by  the broken  ends of  the bone may  occur,
causing difficult and rapid breathing, with much
pain,  owing  to  inflammation   of  the  pleura.
Pneumonia  or inflammation of  the  lung may
set  in, in which case there is troublesome cough
with   expectoration,   often of  blood-stained
phlegm, rapid  breathing, and general signs of
fever (see Pneumonia).
  Fractured  Pelvis  is  usually  the result  of
very severe  violence or  crushing, so that the
internal organs often suffer damage, especially
the bladder.   The nurse should be careful to
notice  if any urine is passed after the accident,
and should save it in order  that it may be ex-
amined to see if it contains any blood.
  Fractured Collar-Bone is a common accident
from  falls  on the  shoulder.  The patient is 
242   THE NURSE'S SERVICE  DIGEST

usually inclined to support the elbow of the in-
jured side with the  other hand,  and bends the
head  to  the injured side.
  Management.—There  are  many methods for
setting  a  broken collar-bone but  the  nurse
should  prepare the following apparatus:  A
wedge-shaped  pad  of  some  firm material,  of
moderate size,  to place in the arm-pit.  Band-
ages to confine  the arm to the side, and a  sling
to support the fore-arm. The bandages may be
best kept in position  by stitching  them together.
      Fractures of the  Upper Extremity
  Fractured Humerus.—Short splints or well-
padded Gooch  splints are sometimes used,  or a
short external  with  an angular  internal splint
may be applied so as  to fix  the fore-arm, the
arm being put  in a sling.
  Fractured  Ulna  and  Radius.—Two  side
splints of sufficient length to extend from the
elbow to the fingers are required; the inner one
should be shortened so as not to press at the
bend of the elbow when the  limb is flexed.
  Colles' Fracture,  or a fracture of the lower
end of the radius, is very common, and may be
treated  with  two side  splints, or by a  special
internal splint, of the  pistol-shape, or one pro-
vided with a hand-piece.
  Management'.—In   attending  to fractures  of
the upper extremity, the nurse should be care-
ful to notice if there is any  undue swelling or
blueness of the  hand, or if great pain and numb-
ness is  complained of  by  the patient,  as  the
bandages  may require  loosening.   If unable to
consult the surgeon at the time, it would be bet-
ter to loosen  or cut up part of the bandage
than risk gangrene from tight pressure.
  Strapping or  bandages underneath the splints
are to be avoided, as liable to create undue pres- 
FRACTURES
243
ure  and interference  with the circulation, or
pressure of the splint  at the bend of the elbow
may cause the same discomfort
  The time required  for  a fracture to  remain
in splints  varies  from three  to  six or  more
weeks, according to the size of the  bone or the
severity of  the accident.  It is often necessary
to remove the splints during the treatment, and
gently move the joints in  order to prevent stiff-
ness.  In many cases of fracture, if this  precau-
tion  is not  taken, and the splints are kept ap-
plied for a long time, a troublesomely stiff joint
ensues, which may take as long to remedy as
the fracture itself.  In fracture of  the  clavicle
or injury to the upper arm, the shoulder joint,
and in fractures of the arm the elbow and wrist
joints, require to  be moved.  After removal of
splints, it  is safer to keep  some  support  on
the limb, and the arm should still be kept in a
sling; gentle and gradual movement being  prac-
ticed until the bone is firmly  consolidated and
strength restored.

      Fractures of the Lower  Extremity.
  Fracture of the Thigh-Bone.—From  the ac-
tion  or contraction of the powerful muscles of
the thigh there is often considerable shortening
of the limb in this fracture, and in addition to
splints an  apparatus for pulling down the low-
er fragment  is useful.   This is managed  by
hanging a  weight on to the lower leg, to which
method the term  "extension" is applied.
  Apparatus Required.—A long,  padded splint,
Liston's or  other, of sufficient  length to extend
from the arm-pit  to a few inches below the foot.
There should  be a hole cut for the outer ankle,
and  the splint should  be provided with  a  cross
foot-piece.   Strapping, broad bandages,  flannel,
and  calico,  a  broad binder to  fix the splint to 
244  THE NURSE'S SERVICE DIGEST

the body, and several pads of different sizes are
necessary.
  The  extension apparatus is fixed  on the leg
by means of a "stirrup."   This consists of a flat
piece of wood, two to three inches square, with
a hole bored through the center, and a strong
piece of strapping one and a half inches wide,
and about a yard long.   The wood is placed in
the middle of the strapping, which is fixed to it
by another strip of plaster bound round it, and
a hole is bored through the middle.  A piece of
card is passed  through  the hole, and to this  a
weight of several pounds is attached (fig. 51).
  The  fracture is  put   up  as  folloivs:—The
strapping  is heated  and applied on either  side
of the leg as high  as  the  knee,  avoiding the
ankle,  around  which  some  wadding  may  be
wrapped.  A flannel bandage is then carried up
from the foot,  over  the  strapping,  to the knee.
Firm, steady traction is then used to draw down
the lower fragment into position, and while this
is kept up by  an assistant, the surgeon applies
the long splint to the  outer side  of  the leg.
The cord  can  then be passed through the hole
in the stirrup,  and as heavy  a weight as neces-
sary fixed on, and hung over a pulley or bar at
the foot of the bed.  Extension is by this means
constantly  kept up on the lower fragment, and
the bones maintained in  position.
  Another method of extension, but not so com-
monly  used now,  as being far less comfortable,
is by means of the "perineal  band."  The upper
end of the long  splint  is provided with  two
holes.  A  soft handkerchief or padded  band of
lint, the perineal  band,  is passed between the
thighs,  and the two ends passed through the
holes in the top of the splint.  After the splint
has been bandaged to the leg, extension is put
on the lower fragment,  and  at  the same time 
FRACTURES
245
the perineal  band is  tightened, and firmly  tied
at the  top  of the splint.   It  is advisable to
cover the perineal band with oiled silk, as it is
liable to  get soiled with the excretions.   The
splint may be kept straight by  sand-bags, and a
cradle should be placed over the broken bone.
  In the  treatment of  fractured  thigh-bone in
children, it is often necessary to put the sound
limb in  a long splint  also,  to prevent them roll-
ing over and moving about; they may also re-
quire to be tied up to  the head of  the  bed by
a band  round the waist, to prevent their slip-
ping down toward the foot, and so  removing
the extension.
  Fracture  of the  Leg.—Either one or both
bones may be broken, the most  important being
the tibia, the larger of the two.  When the bone
is broken just above  the ankle-joint there may
be considerable displacement of the  foot to one"
or other side.
  Splints.—Fractures of the leg-bones may be
put  up  in a back-splint and  two  side-splints.
The back-splint should extend  from above  the
knee to the foot, where there should be a foot-
piece.  The leg is first  bandaged into the back-
splint, with a good pad under the Tendo Achillis
above the heel, to keep pressure off the heel.
The foot  is bandaged to the foot-piece, and  the
bandage carried all the way up, or a space may
be left  free  at the seat of fracture.  The  two
side-splints  may  be  fixed on  by a band  and
buckle above and below,  the  whole  leg being
suspended by straps or bandages to a cradle
and  allowed to swing,  in which  position it is
most comfortable (fig. 52).
  Management.—Great discomfort is felt by  the
patient  when the heel rests on the splint;  the
constant  pressure interferes with the circula-
tion,  and an ulcer  or sore  place  frequently 
246  THE NURSE'S SERVICE DIGEST

forms which interferes with the treatment; the
same trouble  may  be produced by  too  great
pressure on the prominent  ankle bones.   This
is  avoided by  careful adjustment of pads in
suitable positions.
  After  applying  neatly to  the lower  limbs
bandages  which have to remain  on for some
time, it is a good plan to starch them over  and
let them dry, by which means they are kept tidy
and  in position.  The leg  is  usually  kept in
splints from  four to  six weeks.
  Fractured Patedda.—The knee-pan is often
broken by the sudden contraction  of the power-
ful muscles in front of the thigh.  This accident
is  generally accompanied by swelling and effu-
sion into the  knee-joint  at the time,  or soon
after,  and it  is often necessary to wait for a
while, and  apply cold  lotions to  reduce the
swelling, before the  bandages can be applied.
  Management.—The patient may  be propped up
in bed with the leg  raised on pillows or a rest,
in order to relax the front muscles.
  There are many methods of treating this frac-
ture.  In many instances the surgeon performs
an operation immediately,  by  wiring  the  two
fragments together.   The older method was  to
apply  a back-splint,  with two  pieces of strap-
ping or an elastic bandage above  and below the
fragments,  to  bring them  together.  After re-
maining on  the splint for  six  or more  weeks,
the  limb has to be encased in some firm support
before the fracture is sufficiently  united to bear
any strain, and resist stretching.
   After-treatment of fractures of the lower ex-
tremity.  It is a common and convenient prac-
 tice to remove the  splints  in cases of fracture
 before the bone is actually consolidated, and to
 gut them up in some firm  support, so that the 
FRACTURES
247
patient  can go about  with crutches or sticks
until the cure is complete.
  The  substances  in common  use are starch,
gum and chalk, and plaster of Paris.  The lat-
ter has many advantages,  and may be applied
as follows:
  Plaster  of  Paris  Bandage.—The  plaster
should be the fine white powder used by mod-
ellers; the bandages of very loosely woven lint
The dry  powder  should  be  rubbed into the
meshes  of the bandage on  both sides, with the
palm  of the  hand,  and the bandage rolled up.
The limb may be first evenly  bandaged with a
flannel  bandage.  The  plaster bandages should
be placed in  a basin of water  containing some
of the powder for a few minutes before using,
and when thoroughly  wetted  may  be  applied
over the flannel bandage evenly,  as far as pos-
sible without "reversed turns," each fold over-
lapping the one below.  Some of the wet powder
may be rubbed in between each layer, and two
or  three  or  more  layers  of  bandage may  be
used,  according to  the  desired strength and
thickness of the case.
  The plaster will have set in five or ten min-
utes, and should then  be allowed to dry.
  The plaster bandage can be removed  when
desired  by unwinding  the  bandages, or if too
thick  for this, the dilute hydrochloric acid may
be  rubbed along one  side  for a few  minutes,
after  which the bandage may  be cut down by
scissors.
  Crutches.—After a  fracture  of the lower ex-
tremity, on first  getting up the  patient is too
weak  to move about, and  in his first attempts
to walk he will require the use of crutches, or
two sticks.  The leg should be supported in a
sling passing  under the foot and round the neck,
the crutches being only just of sufficient length 
24$   THE NURSE'S SERVICE DIGEST

to enable  the  patient,  standing on  the sound
leg,  to  raise  the  injured  one  off the  ground.
The cross-bar  for  the  arm pit  should  be  well
padded  with  soft  material, to prevent undue
pressure on the nerves  of the arm.  The end is
then covered with a cap of leather or cloth, to
prevent it from slipping on  the  ground,  and the
person should be warned against using them on
a  slippery floor.  Great  care  should  be exer-
cised when a  patient in a weak condition  first
uses crutches.

            Compound Fractures.
  Compound  Fractures.—It is  very important
that these should be converted into simple frac-
tures as soon as possible by the  rapid healing
of the wound.   If the wound is slight, a piece
of lint,  soaked in  carbolic oil,  or covered with
collodion, is a good application.
  Where there is more damage and much effu-
sion of  blood into the tissues, a water-dressing
or poultice should be  applied, or  the  wound
may be  dressed antiseptically  (see  Antiseptic
Dressings).  Where the  wound heals  readily,
the fracture will unite as well  as simple frac-
tures.
  Splints.—The surface wound often  prevents
the use of  ordinary splints, and an interrupted
splint is useful.  In splints of this kind a gap
is  left at the  part required, the place  of the
wood being taken  by  a curved piece of iron.
The interruption can be made at any place, and
the wound  can  then be dressed without disturb-
ing the splints.
  In very  severe accidents,  where there is so
much damage  to  the  limb that  there is no
chance of saving it, and gangrene would be like-
ly  to supervene, amputation is necessary  (see
Amputations). 
FRACTURES
249
          Sprains  and Dislocations.
  Sprains  and  Strains are the result of the
forcible overstretching of the muscular and liga-
mentous tissues.  This very commonly occurs in
the neighborhood of a joint such as the ankle of
wrist, from the effect of  a wrench or a twist.
Acute pain  is  then felt at  the  moment,  suffi-
cient  to produce temporary faintness  or  sick-
ness, and the part becomes rapidly  swollen, and
hot.  In a few  days the swelling  gradually sub-
sides, and  usually  some  discoloration appears
under the skin, due to effusion  of blood  from
the rupture  of small  blood-vessels,  the  color
changing  after a  time from  red to various
shades  of greenish blue and black.   In many
cases of strains and  sprains in  which the im-
mediate swelling and pain soon subside, a long
time elapses before the patient is able to move
the parts freely.
  Management.—Injuries  to joints  should  be
examined as soon  as  possible  by  the surgeon,
in order that he may determine  whether there
is any  further damage than a  strain of the
soft parts,  since the subsequent swelling makes
it difficult to be certain in some cases as to the
extent of the injury.
  In severe cases a splint  may be  applied with
advantage, and in any case perfect rest is nec-
essary for a time.
  Hot fomentation, or bathing with hot water,
may be  employed, or cold applications and evap-
orating  lotions may allay the pain.  A bandage
exercising  moderate  pressure  will  sometimes
prevent excessive swelling, and the parts may
be  subsequently  rubbed   with   liniment,  or
douched with cold  water, with advantage.
  A  bandage should be  worn  for some  time
after the patient has begun to use  the joint.
  Dislocations occur as the result of violence 
250  THE NURSE'S SERVICE  DIGEST

by which  there is a displacement of the bones
at a joint: they  are  usually  accompanied  by
some tearing of the ligaments or  muscles which
surround the joint.
  There  is  more  or less deformity, and the
movements of the  joint  are impossible, or much
interfered with,  and are accompanied by great
pain.
  Dislocation  may occur at  almost  any of the
joints,  but some are more easily  displaced than
others, owing  to the shape of the articular sur-
faces.
  A considerable amount of technical knowledge
is required to recognize the nature of these  in-
juries,  and they should be seen by the surgeon
as soon as possible,  in  order that they may be
rectified or "reduced" at an early stage.  Swell-
ing commonly succeeds  these accidents, and  af-
ter reduction  it is necessary to  keep the  parts
at rest by bandages  and splints.
  Management.—The nurse should be prepared
with splints, and  may  have ready in addition,
for the operation  of reduction, bandages,  jack-
towel,  and starch  powder to dust over the part
where  pressure will  have to  be applied.
  In dislocation of the hip, or old dislocations,
or other cases where there  is difficulty  in  re-
duction,  it is usual to administer some anaes-
thetic  to relax the muscles and prevent pain. 
CHAPTER  XII.
   OPERATIONS AND SPECIAL SURGICAL CASES.

Preparing Patient for Operation—Aseptic Prep-
  arations—Operation  Room  and Table—Man-
  agement  of Patient after Operation—Haemor-
  rhage after Operation.
Management  of  Hare-Lip—Cleft Palate—Tra-
  cheotomy Cases—Gangrene—Amputations—
  Retention of Urine—Catheters—Stone in the
  Bladder— Lithotrity— Lithotomy— Fistula—
  Piles—Hernia—Strangulated Hernia—Ovari-
  otomy.
                  Operations.
  Preparing  Patient  for Operation.—Before
operation,  the  urine of  the patient should be
saved in order that it may be examined, and in
the  morning a  free evacuation  of  the bowels
should be  obtained, if necessary by an enema,
and an aperient given  over night.   The nurse
should see that the patient's clothes are prop-
erly arranged beforehand,  and he should be
dressed as lightly and loosely as possible, with
due regard to warmth.   The patient must  not
be  allowed to get cold,  and should wear a flan-
nel  dressing-gown over the  night shirt, and a
pair of  warm stockings and slippers. The loose
garments can then be easily turned back  from
the part to be operated on,  which may be sur-
rounded with carbolized  towels,  and a mackin-
tosh arranged  to prevent  the  blood soaking
through and soiling the  clothes, or a  sheet of
rubber  will be found preferable.
                     251 
252   THE NURSE'S SERVICE DIGEST

   Aseptic  Preparations.—In  preparing  a  pa-
tient for operation, the parts round the seat of
operation require very thorough cleansing  be-
fore they are made aseptic.  All hair  about it
must be carefully  shaved;  the  skin  over and
around it should be scrubbed with a clean nail
brush  and  soap, or hand sapolio,  and  the parts
rubbed well  with ether or alcohol to remove
grease, as  the  antiseptics  will not soak  into a
greasy  surface.   The cleansed parts should  be
covered with a sterilized towel, which  has been
soaking for 24  hours in carbolic lotion, 1 in 20.
This should be  bandaged  on 12 hours at least
before  the operation.   A  nurse cannot be  too
particular about cleaning her hands. She  should
turn up her sleeves to the elbow, cut her nails
as short as  possible,  take a  clean nail-brush,
with hand  sapolio, or soap  and water, and scrub
all the visible  dirt  away,  then rub them with
alcohol or ether.  She must also remember that,
having thoroughly  disinfected  her hands,  she
must  not  touch anything that  has  not been
made aseptic without disinfecting them again.
  When chloroform or ether has to b   adminis-
tered,  it is important that the patient  should
not take any solid  food for at least four hours
beforehand.  The last meal should be a light
one of meat-soup or beef-tea, with a little stim-
ulant if necessary.   A full stomach at  the time
of receiving the anaesthetic is a source of danger
to the  patient, and will result in troublesome
vomiting and discomfort.  False teeth  must  be
removed prior to operation.
  Operation-Room  and Operation-Table.—The
temperature of the room should be from  65° to
70°; there  should be a fire and a large kettle
containing  boiling water.   The operation-table
should have a folded blanket upon it, and a pil-
low or two; a mackintosh-sheet of rubber being 
    OPERATIONS AND SURGICAL CASES 253

 placed over the part of  the table at which the
 haemorrhage will occur,  and a  moist towel on
 the ground to  catch the blood (see Operation in
 Private Houses).
   The  nurse should have  the  following  requi-
 sites always in readiness:—
    1. Extra blankets  and mackintosh-sheets.
    2. Towels.
    3. Hot and cold water.
    4. Bandages and strapping plaster.
    5. Lint and absorbent cotton.
    6. Oiled silk.
    7. Basins, large and small.
    8. Bucket.
    9. Sponges  or mops.
   10. Oil and vaseline.
   11. Scissors  and dressing-forceps.
   12. Pins and safety-pins.
   13. Syringe.
   14. Brandy and aromatic spirits of ammonia.
   15. Dressings.
   The duties of the nurse in the operation the-
ater are various; she may be single-handed, but
more often there are  others assisting, and to
each  is allotted her special task.  In any case,
she must  be attentively  on the  lookout  to be
ready with anything  that may  possibly be re-
quired.  She should arrange the patient on the
operating table in such a manner  as to  make
everything as easy as possible for the surgeon.
She should remove the compress, and the part
to be operated  on should again be cleansed with
soap  and water, alcohol, or ether.   Sterilized
towels must then be arranged around the site
of operation, and the patient will be ready.
  The nurse should have  ready  a plentiful sup-
ply of swabs of different  sizes, which  are burnt
after  use.  If  sponges are  used,  each sponge
should  be washed in warm  carbolic  solution, 
254   THE NURSE'S SERVICE  DIGEST

and  wrung very dry before it is handed to the
surgeon, or  the  wound  becomes filled  with  wa-
ter.  The nurse  should have sterilized  dressings
and  suitable bandages ready at hand.   A basin
and  towel should  be  kept  in readiness in case
the patient is sick on beginning to revive from
the anaesthetic.
  Before  the  dressings are applied,  the  nurse
should be prepared  with clean warm carbolic
lotion, and  a fresh  sponge, to wipe away  the
blood, clean the surrounding parts which have
been soiled,  and then  dry  them.  In  sponging,
the wound is covered over  and the parts round
sponged.  While the  operation  is  being per-
formed,  the  patient's bed  must  be  prepared,
and  if  he should  have  to  remain there some
time a  "draw-sheet"  must  be  placed  over  the
ordinary sheet where  the  pelvis will  lie.   An-
other draw-sheet and a  mackintosh-sheet must
be placed ready for the patient,  so  that  they
may rest beneath  the wound and  soak up all
discharges.  In  cold weather  the bed must be
warmed with  a  hot bottle.
  Sterilizing of Instruments and Dressings.
—If the  preparation of the  surgeon's instru-
ments falls to the  care of the nurse, she should
see that they are all thoroughly washed, and
afterward boiled  in a sterilizing  apparatus,
which consists of a tray of wire network with
wooden  handles, in which  the  instruments  are
placed.  This  tray is then put into a receiver
containing boiling  water  and  bicarbonate  of
soda. The  receiver  has a  spirit lamp or  gas
burner  underneath,  and  the instruments  are
boiled from  three to five minutes.  The trays
containing the instruments are then placed in
carbolic lotion and they are ready for use.
  The dressings, swabs and bandages  are ster-
ilized by the dry method. 
    OPERATIONS AND SURGICAL CASES  255

  The dressings of gauze are cut up into a con-
venient size and  packed  carefully into a  tin
box.
  The swabs, which are used instead of sponges,
are made of pledgets of  absorbent cotton, cov-
ered with gauze, which is tied over the cotton.
These are also packed into a tin box.
  These boxes are then put into the sterilizer
with  the lids  off (the lids are also sterilized),
and kept there for half an hour at a tempera-
ture of 260° F.
  The lids are put on by the nurse, who wears
sterilized gloves.
  Management of the Patient after Operation.—■
In moving the patient from the operation-table,
especially if not quite recovered from the anaes-
thetic, he should not be suddenly raised into a
sitting posture, lest faintness  be induced.   He
should be  carried  out in  a horizontal position
and placed in bed, and it is then the nurse's
duty to watch him carefully, and see that he  has
plenty of  fresh air; if he is sick, the head and
body  should  be  slightly  raised  or turned on
one side.  If there is unusual depression, faint-
ness,  or difficulty in breathing, the attention of
the surgeon should be requested.
  When the immediate effects of the operation
have  passed off,  the patient should be kept as
quiet as possible, and as a rule nothing should
be given by the mouth except one or two tea-
spoonfuls of hot water  for some  hours;  after
that,  if there  is no nausea or sickness, a small
quantity of milk  or beef-tea may  be adminis-
tered. If there is  troublesome sickness, only a
very  small quantity of fluid should be  given at
one  time,  either  iced  soda-water,  effervescing
drink, or iced champagne; a mustard plaster
may be applied to  the pit of the stomach.   Ice
should be given in moderation, not too frequent- 
^256   THE NURSE'S SERVICE DIGEST

ly,  nor for  too long a  time.   When there has
been  much haemorrhage, or when the operation
is followed  by great faintness  or collapse, the
nurse should ask for instructions as to  the ad-
ministration  of stimulants.
  Hemorrhage after Operation.—Intermediate
or  Reactionary haemorrhage  is  that occurring
soon  after an  operation.  Small vessels which
did not bleed at the time of the operation some-
times begin to do so when the  patient  becomes
warm in bed, and  as he recovers from  the de-
pressing effects of  the  chloroform or the oper-
ation.  In order that the nurse may watch the
part that has been  operated on,  it should be left
partially uncovered, or  if this is not possible,
the dressings and  parts around should be ex-
amined every now and then.  After the amputa-
tion of a limb, a cradle should be  placed over
the stump, and the bed-clothes  partiaUy turned
aside.
  The  nurse should learn to  distinguish the
oozing  of   blood-stained   discharges   soaking
through the  dressings and bandages from  fresh
blood.
  In  the former, the discharge is thin, and dull
in color, and extending beyond  this  is a margin
of a still fainter tint.
  Fresh blood is bright red  and extends more
quickly, and the stain  is throughout of a bril-
liant  color.   This reactionary haemorrhage may
come on soon  after the operation, but perhaps
not for some hours, or  during  the  night.  The
patient may become aware of  the haemorrhage
by  feeling something warm trickling  down, or
he may notice  that the  bed is getting wet, or he
may  suddenly feel faint.   Patients who have
just  been operated on  must  be very  carefully
attended during the night, and if there is any
suspicion of bleeding, the  dressings, grooves of 
    OPERATIONS AND SURGICAL CASES  257

the splint, and the surrounding parts should be
examined, and left exposed or very lightly cov-
ered.  If there  is bleeding, the surgeon  should
be  summoned,  and if this becomes alarming
before his arrival, the part should be well raised
and exposed to the air.
  If this is insufficient,  pressure must be applied
with  the  fingers or thumbs to the  main vessel
until help arrives, or other means for arresting
haemorrhage  must  be  adopted   (see Haemor-
rhage).
  Secondary or  Recurrent haemorrhage  is  the
term  applied when bleeding occurs subsequently
to the separation of the ligature  that has been
used  to  secure  a vessel,  or it  may be due to
sloughing of  the wound and consequent opening
up  of vessels.  In such cases the bleeding may
be very rapid and severe, and place the patient's
life in jeopardy.  Tourniquets, pressure on  the
bleeding spot,  or any  of  the  means described
under "Haemorrhage,"  must be  used until  as-
sistance can  be  obtained (see Haemorrhage).
  In  cases where secondary haemorrhage is  ex-
pected, it  is a  useful  precaution for the  sur-
geon  to mark with ink the spot  at  which pres-
sure should be applied,  and the nurse should re-
ceive directions as to the  best means of  apply-
ing it.
  A tourniquet  may be kept loosely adjusted,
which can be tightened up at once if necessary.

            Special Surgical Cases.
  Hare-Lip and Cleft  Palate.—These deform-
ities date from  birth, and  may exist separately
or together.  In simple hare-lip there is a cleft
in the upper lip on one side of the middle line.
When double, there is a fissure on each side of
the middle line, and one often  extends into  the
nostril.  Cleft  palate  may be associated with 
27>8   THE NURSE'S SERVICE DIGEST

hare-lip or exist independently.  On looking Into
the mouth, a fissure or cleft is seen in the palate
at  the  back part,  so that  the cavity  of the
nose and mouth are placed in communication.
  The operation for hare-lip  is usually  per-
formed  during  infancy  or  in childhood, the
edges of  the  cleft  being  united  and held  to-
gether with a pin;  a piece of strapping, broad
at either end and narrow in  the middle,  is next
adjusted, while the cheeks are pinched together
with  the thumb and  finger,  so that the broad
part  adheres  to either cheek  and the  narrow
portion  covers  the upper lip.  The object is to
prevent traction on  the  wound, and allow the
edges to heal.  The  baby should be fed with
the spoon  for  a  time.   At the end  of  two or
three days the pin will be  removed and the
strapping  re-applied.
  The operation for cleft palate is performed at
a later  date.  It is difficult  to obtain a favor-
able result, and the patient requires  great care
afterward.  No speaking should be allowed, the
mouth being kept shut as far as possible, and
fluid  nourishment administered for  a time.
  Tracheotomy, or  the operation of opening the
windpipe  and  inserting  a  tube,  is  performed
when there is obstruction to the passage of air
through the larynx, and when the patient is in
danger of suffocation.
  Management of the patient after tracheotomy
is usually intrusted to a  thoroughly experienced
and trustworthy nurse,  and  a favorable result
can only be obtained  when this after-treatment
is well carried out, particularly in  the  case of
children, in whom  the  operation is  far  more
often required.
  There  are three main  points  in  the after-
treatment which require special notice:—
     (1)  To keep the tube clear. 
    OPERATIONS AND SURGICAL CASES 259

     (2)  To prevent the access of cold air.
     (3)  To feed carefully.
   1. To Keep the Tube Clear.—The nurse should
 be familiar with  the ordinary form of trache-
 otomy tube in  use—the silver  double tube.  The
 outer tube  (a) is provided with a slit on each
 side of  the guard, through which a piece of tape
 is passed long enough to go  twice round the
 neck.   The outer tube is thus secured in the
 wound, the inner  tube (6) being taken out and
 cleaned as often as is necessary (fig. 53).
   When removing the inner tube, the finger and
 thumb of the other hand should hold the outer
 tube by the guard  and gently press it  toward
 the wound; the surfaces of the inner tube may
 be oiled with  advantage.
   In case  of  diphtheria, the sticky mucus, or
 portions of  membrane, are apt to block up the
 tube,  and constant  cleaning  is required or the
 patient  will suffocate.  The process  of  clean-
 ing may  be managed by  means  of a feather
 dipped  in solution of bicarbonate of soda  (fif-
 teen grains to the ounce),  the feather being
 turned  round  as  it  is withdrawn.   If  this is
 insufficient,  the inner tube  must  be removed
 and soaked  in  the solution, or  in boiling water,
 until the tenacious material is  got rid of.
   If there is  any difficulty,  and the breathing
 does not seem to be  satisfactory,  the surgeon
 should be immediately summoned.  If pieces of
 membrane  be  detruded, they  should  be  saved
 for inspection.
  2. To Prevent  the  Access  of Cold Air.—A
 good method is to make a tent outside the  bed
 with curtains,  enclosing its  three sides.  The
 open side may face  the fire,  and a bronchitis
 kettle should  be kept boiling  on the stove  or
gas jet.
  The temperature inside the cot must be regis- 
 260   THE NURSE'S SERVICE DIGEST

 tered by a thermometer, and not allowed to be-
 come unduly heated.  Failing this  arrangement,
 flannels wrung out in hot  water  should be ap-
 plied over the tube, and constantly changed.
  3.  The Feeding  of  young children who have
 had  tracheotomy performed  for diphtheria re-
 quires great  care and attention.  Their powers
 are much exhausted  by the disease,  and it is
 difficult to  persuade them to take  nourishment,
 as swallowing is often  painful; or the amount
 taken at a time is so small  that  they  have to
 be constantly disturbed in  order that  they  may
 receive sufficient food  to keep up their  strength.
 An infant's power of swallowing is  generally
 interfered with  by the tracheotomy tube,  and
 the milk sometimes finds it way down  the tra-
 chea into the lung, and sets up pneumonia.
  In cases where there is great exhaustion, and
 sufficient nourishment cannot be  administered
 by the mouth, feeding may  be managed through
 the nose.  For this purpose a soft india-rubber
 catheter, No. 4  or  No. 6,  should be passed
 through the nostril, and on to the back of  the
pharynx; it should then be pushed on  and  will
 find its way  into the  gullet without much diffi-
culty.  The milk or fluid can be  administered
by a  syringe or funnel through the tube.   By
this means four to six  ounces can be  given at
a time, and  the  child allowed to sleep longer
without disturbance.
  Gangrene,  or mortification of a part, may su-
pervene as the result of inflammation, or may
be produced by cold, as in  frost-bite, or by  the
effect of pressure and  consequent stopping of
the circulation in the part,  as is the  case in
bed-sores.
  There are  two  forms:  the moist gangrene,
and the senile or dry gangrene.
  Moist Gangrine.—After  severe   accidents, in 
   OPERATIONS AND SURGICAL CASES  261

which  the damage to the soft  parts is exten-
sive, the inflammation may be violent and result
in moist gangrene.  The appearance of  the in-
flamed part alters, the red color becomes livid,
mottled, or greenish black;  the skin blisters,
and a thin, discolored, watery discharge exudes,
and  a  foetid  odor is perceptible. The sense of
pain and  touch becomes lost when  the  part is
dead or  mortified.   Under  favorable  circum-
stances the mortification or  gangrenous  inflam-
mation ceases to spread, and the dead part be-
comes  marked  off from the  living by a  line of
healthy inflammation called  the line of  demar-
cation.  The dead part subsequently separates
itself naturally from the living, or  is removed
by the  surgeon.
  During the process of  gangrene  the  patient
exhibits general symptoms of constitutional dis-
turbance, and  in  severe and unfavorable cases
loses  appetite  and strength;  the  tongue be-
comes dry and brown, and the features shrunk-
en  and pale.  He wanders  at  night, and does
not  sleep, or he becomes unconscious, and grad-
ually sinks from the effects  of exhaustion.
  Senile, or Dry Gangrene, attacks old people in
whom  the blood-vessels have become diseased,
so that the blood-supply is impaired.  It  is more
liable  to  occur in parts  that are far removed
from  the  heart and  where the circulation is
sluggish,  as in the feet,  fingers, or ears.   One
of the toes is the part  most  commonly affected;
it becomes numb, cold, pale, and shrunken, and
then gradually turns black, dies, and shrivels.
The process  is often very painful, and the pow-
ers  of  the patient may be unable to withstand
the  accompanying exhaustion.
  Management.—The nurse should direct her at-
tention to the dressing or local  treatment of the
gangrenous part, and  maintain the powers of 
 2f2  THE NURSES SERVICE DIGEST

 the patient by giving nourishment or stimulants
 constantly, as directed by the medical attendant.
 In the  moist form of gangrene, where there is
 much sloughing  and consequently great feet or,
 poultices  or  hot moist  applications are  best
 avoided, and some antiseptic,  such as carbolic
 lotions  or  lint, used, or iodoform, or powdered
 charcoal  may  be dusted  on,  and  the  part
 swathed in oakum or absorbent cotton.
   In  senile or dry gangrene, a small poultice,
 charcoal or yeast, may be applied, or an opiate
 lotion used, or the part painted over with bal-
 sam of  Peru, and the limb well surrounded with
 absorbent cotton.  In all cases  the temperature
 of the limb should be kept up during the process
 of separation and afterward.
  The enfeebled  condition of many of the suf-
 ferers from gangrene, and the exhaustion from
 the pain and sloughing, require the frequent ad-
 ministration  of  nourishment  and  stimulants,
 which are  best given in a fluid  form, especially
 when the tongue and mouth  are dry.  Opium is
 often given  to  soothe the  pain and  promote
 sleep, and  if it is well  borne, and does not dis-
 turb the stomach and head, greatly adds  to the
 comfort of the patient.
  Amputations.—A  limb may  be removed by
 the surgeon when it is useless to the patient, or
 where the  presence of disease renders it  neces-
sary for the prservation of  his health or  life.
The severity of  the operation  is increased the
higher up in the limb the amputation has to be
performed; thus, amputation in the thigh is  a
far more severe operation than amputation of
the foot.
  In addition to the usual  necessaries of the
operation-theater, a small padded splint  is re-
quisite  on  which to  bandage the stump; also
broad pieces of strapping, for keeping the flaps 
    OPERATIONS AND SURGICAL CASES 263

together, should be cut beforehand, and the par-
ticular dressings required should be ascertained
and prepared.
  When the patient is placed in bed the stump
should be slightly raised on a  pillow and left
exposed for a time (see Haemorrhage).  Wheri
covered, a cradle must be used  to keep off the
pressure of the bed-clothes.  If  there is sudden
starting in the  stump, it  must  be confined on
the pillow by a bandage passed  round  or across
the bed.
  When dressing the  stump,  the nurse should
not take hold of it by the end, but should gently
insinuate her fingers between the part above the
pillow on  which it rests,  the back of  the  hand
being toward the bed, and then sliding  both
hands down toward the end she should raise it
from  the  pillow and support  it steadily the
whole time it is being dressed.
  Retention  of Urine.—Inability to pass water
in the female may be due to hysteria, or nerv-
ous conditions after  operations  on the rectum
or neighboring parts.  There  is no obstruction
to the urethral passage, and the application of
a hot fomentation to the pubic  region in these
cases  is often sufficient.  When the bladder is
much distended, forming a swelling at the low-
er part of the abdomen, or if there is obstruc-
tion to the  passage  of urine through the ure-
thra,  or for other reasons, it will be necessary
to  use the  catheter.  Every  qualified nurse
should be able  to pass a  catheter in the fe-
male.
  Passing  Catheter  for  Female Patients.—
The patient may lie on her back with her knees
drawn slightly up.  The nurse should  stand on
the right  of  the patient, and passing  the left
hand  between  the thighs  place the  forefinger
between the labia at the orifice of the vagina. 
204  THE NURSE'S SERVICE  DIGEST

  The  catheter after being oiled should  be in-
troduced with the right hand and made to glide
over the forefinger of the left until it slips into
the orifice of the urethra;  it should then be
passed upward and  backward till it  enters the
bladder.  The forefinger of the right hand should
close the orifice of the catheter before it reaches
the bladder, and the left hand disengaged carry
the bowl to receive  the urine.  In withdrawing
the instrument, the orifice of the catheter should
again be closed to prevent wetting the bed.
  The best instrument is a flexible elastic cathe-
ter (No. 8),  such as is used  for the male sex,
but the silver female catheter may be used for
ordinary cases.
  Retention of urine in the male is very com-
mon as the result of stricture  of  the urethra,
enlarged prostate,  and  other causes, and the
use of instruments of various kinds and sizes is
employed by  the surgeon.
  Management.—The nurse must know that se-
rious consequences may result from retention if
left  too  long, such  as  rupture  of  the urethra,
and  extravasation or escape of urine, or over-
distension of the bladder, and assistance should
be summoned as soon as possible.   She should
also be acquainted  with the various kinds of
instruments,  the silver,  the  gum elastic, the
French "catheter a  boule," and  the  soft india-
rubber catheters, all  of  which  are  numbered,
according to their different sizes.  The female
catheter  may be of  glass, which can be boiled
after using.  She should have in readiness oil,
vaseline, bowls,  and hot water.
  Catheter Fever, or constitutional disturbance
following the introduction of  a catheter,  occurs
in some cases.  The patient is seized with  chil-
liness and  a  rigor, and his temperature rapidly
rises.  This may subside with a  profuse  sweat, 
    OPERATIONS AND SURGICAL CASES 265

or  prolonged  feverishness may ensue.  A mild
attack quickly yields to brandy and water, or a
dose of opium.  When there is any sign of dis-
turbance after the passage of a catheter, or in
any case where a catheter is tied into  the ure-
thra and left, the nurse should watch the tem-
perature, and report if there is any fever.
  Washing Catheters.—Inflammation of  the
bladder may be produced by the use of instru-
ments that are dirty, and the nurse will be ex-
pected to see  that they are clean.
  The catheter should be allowed to  remain in
a solution of Mercury Bichloride (1-4000), hav-
ing been previously scrubbed with soft soap and
syringed with Mercury solution (1-2000).
  Stone in  the Bladder produces  a  variety of
symptoms,  among which  are:  pain on passing
the urine, a constant desire to pass urine, with
perhaps some changes in the urine,  such  as  a
sediment  or  blood.   Children  suffering  from
stone are apt  to wet the bed at night, and pull
themselves about, owing  to pain in  the  penis.
The urine  should always  be saved in  case of
suspected stone or bladder disorder.
Lithotomy and Lithotrity.—The  operation of
cutting into  the  bladder for  stone is called
Lithotomy, and that of crushing the stone  by an
instrument passed into the bladder, Lithotrity.
  Management.—For Lithotomy cases the bowel
should be carefully  emptied by an  enema early
in the morning of the operation, and the patient
should be directed  not to pass water for some
hours before the operation, as it is convenient
that the bladder should  be partially  distended.
Some surgeons prefer the bladder emptied and
then injected  with  boracic solution, with  a sy-
ringe  to measure the amount.
  The  bed should  be arranged with a draw-
sheet  and mackintosh or  rubber sheet under- 
260  THE NURSE'S SERVICE DIGEST

neath,  and will  require much attention, as the
water is constantly dribbling through the wound
in the perinaeum.  The  patient must  be  kept
warm and dry, and  the  back  should be bathed
and dried.  The nurse must be on the watch for
haemorrhage, especially  in children,  and  she
should keep herself informed whether the water
is passed through the wound, or whether any is
passed naturally,  and if  it   contain  blood  or
clots.   When the supra-pubic  operation is per-
formed,  a catheter  is  usually tied  into  the
wound and connected with a  long  tube with  a
bowl  of  boracic lotion  under  the bed.  The
nurse has  to  see that the tube does not get
blocked.
  After the operation of  lithotrity everything
passed from the bladder  should be  scrupulously
saved,  in order that any  crushed remains  of
the calculus may be  inspected.
  Vesico-Vaginal Fistula.—After  difficult con-
finements or other causes, a communication may
be  formed  between  the  bladder  and  vagina
called a  "fistula," through which urine is able
to pass from the bladder  into the  vagina, and
incontinence of urine is  the result.   To remedy
this miserable condition,  an operation is devised
for uniting together  the  edges of the fistula.  A
successful result is difficult to obtain, and much
depends  on careful  after-treatment and man-
agement.
  Management.—Before the operation, the bow-
els must be thoroughly opened with a  vegetable
compound cathartic  at night  and a liberal dose
of phosphate  of soda in  warm water in the
morning.  It is  essential that after the opera-
tion no urine should find  its way  through the
wound and irritate  the  edges,  and so prevent
the fistula healing.
  To  secure this, a  catheter is  introduced into 
    OPERATIONS AND SURGICAL CASES  267

the bladder at the time of the operation, and
tied in.  This  may be worn constantly until the
wound  has healed,  being  only removed occa-
sionally for cleaning purposes.
  Rectal Cases.—Fistula of  the bowel is often
caused by an  abscess forming near the rectum,
and opening both externally close  to  the orifice
and internally into the bowel.   A  tract is thus
made and kept open by the faecal matter pass-
ing through.  There is  often a discharge of mat-
ter and  blood, and pain may be intense when
the bowels act.
  An  operation is usually  required to cure the
fistula.
  Piles  or Hemorrhoids are small tumors
formed  by dilated veins  at  the  verge of  the
rectum. They  may arise within the  bowel, in-
ternal, or just without, external.
  They may be caused by  constipation, conges-
tion of the liver, straining at stool, pregnancy,
or other causes, and they have often a tendency
to bleed.  When inflamed, they give rise to great
pain,  especially when the bowels act.  A  bread
poultice may give much relief when they are in-
flamed ; a  low diet, without stimulant and an
aperient or enema to  unload  the bowels,  are
advisable.
  Removal of the piles with  the ecraseur  or
clamp is often necessary.
  Management.—Previous to  operation in cases
of disease of the rectum of any kind, the nurse
should make sure that the bowel  is empty.  A
vegetable compound cathartic  given  at  night
and a dose of  phosphate of soda in the morning.
The latter should be administered quite  early,
so that there  is plenty of  time for a thorough
evacuation before the  operation, as nothing is
more  annoying to  the surgeon than to have the
bowels acting  at the time of the operation. 
268  THE NURSES SERVICE DIGEST

  The  nurse  should prepare  beforehand  the
dressings, and also the T-bandage, which is re-
quired  in all operations on the rectum or  peri-
naeum  where dressings  are used  (see T-band-
age).
  It is comfortable for  the patient after the
operation that  the bowels should not act for
some days, and a light diet is advisable. There
is  sometimes difficulty  in  passing  urine  after
these operations, especially in  females, and if
not relieved by the application  of a  hot fomen-
tation  the catheter may be required.
  Hernia.—A rupture is formed by a protrusion
of some portion  of  the bowels through the wall
of the  abdomen.  The protrusion occurs usually
in one  of three situations:—at the navel, in the
groin, or at the upper part of the thigh, and the
hernia  is termed accordingly either an  umbilical
hernia, an inguinal hernia,  or a femoral hernia.
In all  three instances the  bowel finds its way
through  an opening or canal  which  naturally
should  be sufficiently closed to prevent  it; but it
remains  covered by the integuments  and the
soft parts, forming a soft,  doughy  swelling in
the  region of the canal which it  has passed
through. In the majority of cases the  hernia is
what is called "reducible," and the bowel can be
returned inside  the abdominal cavity  by  pres-
sure, or  it returns of its own accord  when the
individual  lies  down.   When  he gets  up,  or
makes  any  exertion  or  coughs,  it  again pro-
trudes.
  It is important  that a person suffering  from
hernia  should wear a "truss" to keep the bowel
from coming down.  The truss  has to  be adapt-
ed to the particular form  of hernia,  and  it is
essential that it should be efficient  in keeping
the  bowel  back without exercising  any undue
pressure or other  discomfort (fig. 54). 
    OPERATIONS AND SURGICAL CASES 269

   Umbilical Hernia is not uncommon in young
 babies.  The protrusion  is  at  the navel,  and
 when  the child cries it is often much increased
 in size,  and causes pain.   A firm pad  can be
 easily adapted after the bowel has been pressed
 back through the canal, and then a broad flan-
 nel binder rolled twice or three times round the
 abdomen will keep  it in position, and support
 the  walls.  The canal usually closes up as the
 child  grows older,  and the rupture ceases to
 come through if the pad is well and constantly
 applied.
   Inguinal  Hernia is more common  in men
 than women, and may  protrude, forming a swell-
 ing  in the groin, or the rupture may travel on
 down  the canal into  the scrotum, forming  a
 swelling perhaps  of considerable  size.   There
 may be a rupture on both sides.
   Femoral  Hernia is  more  common in  women
 than men, and gives rise to a swelling, often of
 small  size,  in the upper part of  the thigh, at
 the inner side just below the groin.
   In any form of reducible hernia a truss should
 be fitted by the surgical instrument maker, and
 if there is any doubt as to its efficiency, the sur-
 geon should be consulted.
   Strangulated  Hernia.—Sometimes  there is
 difficulty in returning the hernia, and the swell-
 ing becomes painful, the bowels do not act, and
 gas is  not passed,  and  after a time other  symp-
 toms of  obstruction set in,  such  as vomiting.
This condition is due to obstruction of the pas-
sage of the  bowel in  the  hernia,  by  the con-
 striction  of  the  ring  through which  it has
passed, and the bowel is said to  be "strangu-
lated."  If this condition is  not relieved, fatal
consequences will  ensue.  The surgeon  should
be immediately  informed, so that  he may  en-
deavor at once to reduce the hernia by a process 
270   THE NURSES SERVICE  DIGEST

called "taxis,'' or manipulation with the fingers.
Failing  this or the use of the warm bath, the
patient  will be placed under an anesthetic, and
if then  the bowel cannot be  returned, an  oper-
ation has to be performed.
  Management.—In watching a case of strangu-
lated hernia before operation, the nurse should
only  administer  a teaspoonful or two  of hot
water or a very  small  quantity  of  fluid; she
must be  careful  to save everything vomited,
and the temperature and pulse should be taken.
  After  the operation a pad  is  applied  by  a
spica bandage  to the wound.  The patient should
not be allowed to move; if sickness, coughing,
or retching occur, the wound may be supported
by gentle pressure with  the  hand, to  prevent
strain.  The diet allowed is  only  small quanti-
ties of milk or fluid of some  kind.  No aperient
should be  given,  but opium  is frequently  pre-
scribed.  Any  complaint of pain in the abdomen
should be attended to, and the temperature  care-
fully  noted.
  Recovery is usual after operation  for stran-
gulated  hernia,  unless  the  strangulation  has
been allowed to remain unrelieved too long, and
the bowel has suffered damage.
  A suitable truss should be  worn afterward.
  Ovariotomy.—In ovariotomy  and  other ab-
dominal  operations, each surgeon has his own
particular  plans  for nursing, and  usually  pre-
fers  to  employ nurses specially  trained under
him,  that  they  may be acquainted with his
methods, and  pay attention to those details in
the after-treatment which he  considers of the
greatest  importance.  It is  only  necessary,
therefore, to mention the more general points
in the management and after treatment of ova-
riotomy, those in fact which  a nurse who has
received  an ordinary training would be expected 
    OPERATIONS AND SURGICAL CASES  271

 to know,  should  she  be called  upon to take
 charge of a case of this kind. At the same time,
 for the successful  management of all abdominal
 cases, the extreme importance  of practical  ac-
 quaintance with small  details  cannot be  too
 strongly insisted on.
   Before Operation.—In addition to the ordi-
 nary rules to be observed,  the catheter may be
 passed for a few days previously, and the blad-
 der must  always  be emptied just before the
 operation.   The bowels should act freely  in the
 morning,  and  an  enema be given about four
 hours before the operation.  In patients suffer-
 ing from debility, two or three ounces of brandy
 may  be  injected by  the rectum shortly before
 the anaesthetic is given.
   The cleanliness of the body must be secured
 by a  bath, and the abdomen  should  be well
 sponged  over with  carbolic  solution.
   The patient must be warmly clad, and should
 wear a flannel dressing-gown and warm  stock-
 ings.
   The room in which the operation is to be per-
 formed  must   be  previously  scrubbed  and
 cleaned, and kept at a temperature of about 70°
 Fahrenheit.
   The ordinary  requisites  for the  operation-
 room must be prepared, and in addition two or
 three empty buckets, sponges, and  sponge hold-
 ers, flannel bandage, antiseptic dressings, long
 glass  drainage tubes  (fig.  55),  and a special
 mackintosh  sheet, or rubber sheet.
  The buckets are required to hold the  fluid
 which is contained  inside the ovarian tumor  or
cyst, often  in considerable quantities.
  The sponges must be of medium size, soft, ab-
solutely clean or new,  and  well wrung out  in
warm  antiseptic  solution.  There should  be a
dozen or more, and the number in use at the 
272  THE NURSE'S SERVICE DIGEST

time of the  operation should  be  counted and
noted down, in order that it may be ascertained
before the wound is  closed that all the sponges
have been removed from  the interior of the ab-
domen.
  The  flannel bandage  must  be  of  sufficient
width to reach from the lower end of the breast-
bone to the pubes, and the "many-tailed  band-
age" is the form in common  use  (see Many-
tailed Bandage).  The mackintosh sheet is pre-
viously prepared by cutting out a portion in the
center  to form an oval aperture, the length of
the proposed  incision in  the  abdomen.   The
sheet round the aperture is covered with a  broad
band of adhesive plaster to fix it down to the
abdomen.
  After Operation.—The  room in which the pa-
tient is placed after the operation should  be
kept at about 65° to  70°  Fahrenheit.
  The  bed  may be made with  a new  or  fresh
mattress, and should be arranged with a mack-
intosh  under the draw-sheet.   The upper bed-
clothes may be folded so as to open in  the mid-
dle and facilitate passing the catheter,  or dress-
ing the abdomen; and a pillow may be placed
as a support underneath  the knees.  Warm bot-
tles should be placed in  the bed before the pa-
tient leaves the operation-table.   The patient
must lie on her back, no  movement being al-
lowed,  and the urine should be drawn off with
the catheter every four or  six hours.
  Complications  after  Ovariotomy.—Second-
ary haemorrhage  may occur from the giving
way of a vessel internally, and might arise soon
or several hours after the operation. The main
indications would be  faintness,  blanching of the
face, sighing, with perhaps pain in the abdomen,
and low temperature.
  Peritonitis is the usual cause of death in the 
   OPERATIONS AND SURGICAL CASES 273

unsuccessful cases,  and may supervene  at al-
most  any time  during the earlier periods.  A
careful watch should always be  kept  on the
pulse and temperature,  and if  there  be  access
of abdominal pain,  with  vomiting, shivering, as-
sociated  with  fever,  the  onset of  peritonitis
should be suspected (see Peritonitis).
  The nurse  will  receive definite instructions
from  the surgeon  as  to the management and
diet of each particular case, also whether opium
or aperients have to be given.
  During convalescence, the  abdomen will re-
quire  some support,  either a  broad  flannel
binder, or a  well-fitting flannel belt, strength-
ened, and furnished with buckles.
  Skin-grafting.—In  the  case of large wounds
with  much  loss of  tissue,  extensive ulcers, and
severe burns,  this method  is often employed by
the surgeon.  The graft is  implanted directly
on to  the raw surface, which may have previ-
ously to be scraped, and  is then purified with
antiseptic lotion, covered  with  a sheet  of pro-
tective, and bound  firmly  up  until the bleeding
has ceased.  The graft is then cut with a sharp
razor  from the thigh  or  some other suitable
spot,  and transferred  to the raw surface and
dressed antiseptically.  The  thigh  will also re-
quire dressing. 
CHAPTER XIII.
        the management of child-bed.

Before Labor—Lying-in  Room—Preparation  of
  the Bed—Precautions against Infectious Dis-
  eases— Indications of Commencing Labor —
  Pains—Stages  of Labor—Management of Nat-
  ural Labor — Antiseptic Rules  for  Monthly
  Nurses—Management after  Labor—Lochia—
  Lactation—Prevention  of Puerperal Fever—
  Antiseptic Solutions.
Management of  the Infant—Separation—Wash-
  ing and  Dressing—Rashes—Navel—Eyes—
  Rupture—Snuffles.

         Preliminary  Arrangements.
  There are certain preliminaries  before the on-
set  of labor  concerning which the nurse has
usually an opportunity of informing her charge,
and this is especially desirable in  first labors or
primiparous women toward the termination  of
pregnancy.
  If  the health be tolerably good, moderate ex-
ercise should  be  recommended, and invalid hab-
its discouraged.  It is often possible during the
last  weeks of pregnancy for  walking exercise
to be taken easily, when previously accompanied
by much discomfort.   The diet should be gener-
ous  and sufficient,  but  not  stimulating.  The
state of the bowels should be carefully regulat-
ed by  laxatives if necessary,  and at the ap-
proach  of  labor the  large bowel  should  be
emptied by the administration of  an enema.  A
                    274 
     THE MANAGEMENT OF CHILD-BED  275

tedious labor may be the result  of  neglect in
this particular.
  The Lying-in Room.—The temperature should
average from 60° to 65° F., and the room should
be well ventilated. In warm weather the win-
dows may be opened, and the patient protected
from draughts by a  screen.  In  winter  a  fire
should be kept burning in the grate, and  the
windows  opened according to the state of  the
weather.  The  room should not contain  an  un-
necessary  amount of  furniture,   and  curtairt
hangings  about the bed are undesirable.  Abso-
lute cleanliness in every respect is imperative.
  The wash-hand  stand must be prepared when
labor commences,  and should contain three ba-
sins, one for washing with soap and water,  and
the other two for antiseptic solutions.  One of
these may be used for the hands and the other
kept for cleaning  the different instruments.
  Preparation  of the Bed.—After the bed  has
been  made in the ordinary way,  a mackintosh
is placed  upon the lower  sheet,  of sufficient
width to  tuck  in on either side,  and deep
enough to extend from the small of the patient's
back to the knees; over this a draw-sheet should
be doubled and placed crossways to the bed, so
as to overlap the mackintosh a  few inches in
each direction.   A sanitary sheet  may with ad-
vantage be placed immediately beneath the pa-
tient  during  labor.  The bed  can  thus  be kept
constantly dry, and the draw-sheet changed by
rolling up, and moving the  patient  while  an-
other is substituted (see Draw-Sheet).

             Special Precautions.
  Infectious Diseases.—The lyingin- patient is
very susceptible to diseases of an infectious na-
ture,  and the nurse should be careful to avoid
contact with any  one suffering from fever of 
276   THE NURSE'S SERVICE DIGEST

any kind, or the neighborhood of any infectious
malady.  Such diseases as erysipelas, small-pox,
scarlatina, and especially puerperal or child-bed
fever, are dangerous.   A nurse who is  aware
that she has been exposed to infectious  illness
should,  before undertaking a  monthly case, in-
form  the medical attendant,  and  ascertain  if
she is justified in doing so after the adoption of
the  proper  precautions for  disinfection  (see
Disinfection).

        Management of Natural Labor.
  The indications of commencing labor are the
presence of  uterine  pains, and a discharge of
mucus tinged with blood.
  The Pains felt at an early period of labor are
situated over the front of the lower part of the
abdomen, and are tolerably regular, cutting in
character, reaching a certain pitch of intensity,
and gradually  subsiding; there may be intervals
during  which  the pains  are  absent for  several
hours.
  False  pains are  due to  flatulence, or some
bowel disturbance, and do not accelerate labor;
they are short and irregular in character.
  The Stages of Labor are three, during which
certain  events take place:—
  In the first  stage, the orifice of  the womb  is
dilated  to permit of the passage of the child,
and the membranes  covering the child are  rup-
tured.   The pains which occur  during the  first
stage, are such  as have been described  above,
and are caused by the dilatation of the neck of
the womb by  the bag of membranes.   Several
hours, to a  day  or  more,  are occupied by the
process, and it is often accompanied  by  a sense
of nausea, vomiting, or attacks of shivering.
  When, at the  end of this stage, the mem- 
    THE MANAGEMENT OF CHILD-BED 277

branes have ruptured and the waters have es-
caped, the  next stage follows.
  In  the second stage of labor,  the  pains in-
crease in intensity, and are felt in the  sacrum
or lower part  of the back; they gradually be-
come  more violent and expulsive in  character
until  the child  is born.  Toward the termination
of the first stage and the commencement of the
second, the patient feels constant desire to pass
water.
  The third stage is occupied by the expulsion
of  the placenta or  after-birth,  and there is
usually an interval of  fifteen to thirty minutes
after the second stage  before the pains  succeed
which expel the after-birth.
  Management. — In   first   labors  the  early
stages are apt to be  of long duration, and con-
siderably  exceed those  of women who  have
borne children.  False hopes should never  be
held  out that  the labor will be a quick one, or
that  it will soon be all over, as the patient rap-
idly loses  confidence  when  she finds that she is
disappointed.
  When the first stage is protracted, the patient
should be advised to  occupy  herself and  keep
about as far as possible during the daytime, and
sleep when  she feels inclined.  The  feeding
should not  be  neglected,  and  milk, beef-tea,
soups, or  other nourishment may be  given reg-
ularly ; exhaustion renders the pains less  effec-
tive,  and often prolongs the final stages.  Stim-
ulants are unnecessary when food is well taken.
An enema may often prove of advantage in slow
cases during the first stage.
   During  the second stage the patient should lie
 on the bed, and may aid the expulsive pains by
holding her breath, and bearing down or strain-
 ing,  unless they are  too violent.  Great relief is
 often given  by the  nurse supporting the lower 
278   THE NURSES SERVICE  DIGEST

part of the back by firm pressure  with the hand.
As soon as the child is born, the  cord should be
noticed in case it be twisted tightly round the
child's neck,  and,  if  so, it should be gently
drawn down,  and  slipped over  the  head (see
Child, Separation of).
  The mother should  remain perfectly quiet
after the birth  of the child.   A  short  time
elapses before  the  after-birth is  expelled by a
few  sharp  pains, a process  which nay be  as-
sisted by the  patient  coughing  a  few times.
Traction  or pulling on the  cord  should not be
practiced, being not without danger.   It is at
this  period  that  flooding is apt  to occur,  and
the nurse should be on the  watch for excessive
haemorrhage.  After  the  third stage of  labor,
the binder may be applied (see Binder).
  Vaginal Examinations.—To place a patient
in the so-called obstetric  position for an exam-
ination, the clothes around  the waist should be
unloosened,  so that the  abdomen  can  also be
examined, and the  diaper or pad removed. The
patient must be turned well on to the left side,
with  the head low on a pillow  placed at the
left side of the bed,  and the trunk lying right
across the bed.  The buttocks should overlap
the edge  on the right-hand side, the legs should
be drawn up  so  that the thighs form  a sharp
angle with the trunk, and the knees should be
as close  as  possible to the  chin.  It is a good
plan  to turn the upper sheet over the  counter-
pane  on the right-hand side of the bed, and se-
cure  it  there  with  nursing pins.   A napkin
folded diagonally should  always  be at  hand to
guard the doctor's arm during  the examination.
  Antiseptic  Rules for Monthly Nurses.—
Every nurse should practice systematically  the
following rules unless otherwise  directed, or
modified  by the medical attendant:— 
    THE MANAGEMENT OF CHILD-BED 279

  1. The  hands must be kept  clean,  and the
nails cut  short, the nail-brush being constantly
in use with soap and water.
  2. During and after labor, a small basin con-
taining an  antiseptic solution  must  always
stand  by  the bedside of the patient,  and the
nurse  must  thoroughly  rinse her hands  in  it
every time she touches the patient in the neigh-
borhood of the genital organs for any purpose
whatever, either of douching, washing, etc.
  3. Vaginal  pipes,  enema  tubes,  catheters,
sponges, etc., should be kept permanently in the
antiseptic solution, except when  in use, and
cleaned in a  similar solution before and after
using.
  The surfaces of  slippers and  bed-pans should
also be sponged with it.
   4. Vaginal   pipes,  tubes,  etc.,  should  be
smeared with carbolized vaseline before use.
  5. Unless express directions are given to the
contrary,  the  vagina  should  be douched  night
and morning with  antiseptic solution.  The hot
douche, if ordered, should be given at a tem-
perature  of 115°.   Care must be taken to have
the pipe  and tube  filled with the solution, and
devoid of air-bubbles before insertion, and suffi-
cient  should  be allowed to pass  through  to
warm the apparatus.  During  the administra-
tion of the douche, pressure may be maintained
on the womb  by the hand placed on the abdo-
men.
   6. All  soiled linen,  diapers,  etc., should  be
immediately removed from the  bed-room; soiled
pads  should  be  burnt.   All  bed-pans,  urine-
boats, and bed-baths should also be removed as
 soon  as  possible,   and after  they  have been
 emptied,   they should  be washed  and  disin-
fected.
   7. The nurse is recommended  to wear a light- 
2S0   THE NURSE'S SERVICE  DIGEST

colored dress  of  washing material,  with apron
and  sleeves,  which  easily show  the dirt,  and
the skirts  should be sufficient short to  escape
sweeping the  floor.
  Application  of  the  Binder.—This  should
consist of huckaback towelling, thirty-six inches
wide, and  one and a quarter yards long, dou-
bled lengthways.   Its lower  edge should reach
four  inches below the  top  of the  thigh-bone.
The  free end of  the binder should be  upper-
most  on the right side.   Starting from the left
flank, the binder  should pass over the abdomen,
ending on  the right flank, where, after  it has
been tightened, and all creases smoothed out, it
should be securely fastened by four  strong pins.
The  patient's skin should be guarded  by the
left hand beneath, while  the pins are inserted.
Straight  pins, two inches long, are the best.*

          Management  After Labor.
  For the first three days after labor the hori-
zontal position must be maintained, and exer-
tion  and sudden  movements  should  be  avoided.
After this  the head  may be  raised by a pillow,
and  the  patient  propped  up  to take food, but
she should  not be allowed to sit upright in bed.
On the eighth or tenth day,  if doing well, most
patients may be  allowed to  be outside  the  bed-
clothes, in a  dressing-gown,  and in a  day or
two more they may sit in a chair, or lie on the
sofa  for an  hour at a  time.  The  progress
varies greatly in  different cases, some requiring
much longer rest than others.  In delicate per-
sons,  or where there is  much anaemia, or debil-
ity  after flooding, the horizontal position has
to be enforced for a much  longer  period,  and

  * A more  convenient form of binder is  made by
shaping the towelling to the  body and fastening
with buckles and straps. 
    THE MANAGEMENT OF CHILD-BED  281

the erect position should not be assumed quick-
ly or suddenly.
  If the lochia become red  or free, or there be
marked rise of temperature when the  patient
begins  to get  up or to move about, she should
be kept quiet  on the sofa.
  Temperature.—After delivery,  the tempera-
ture should be taken  at regular times twice a
day, or more often if desired.  If there is a
sense of chilliness, the temperature  should be
ascertained, and if a  rigor occurs, the temper-
ature should  be taken every  half  hour, and a
hot bottle applied  to the feet, while warm milk
or beef-tea should be given.
  Constant  feverishness, rigor,  or  sudden high
temperature should always  be reported as early
as possible.
  Lochia.—Three  points should be noted:  the
amount, the color, and whether  offensive or not.
If any clots or shreds are passed, they must be
removed and  kept for inspection.  At first, the
lochia  should  be of pure  blood  and fairly free,
being  increased  by relief  of  the  bladder or
bowels, and during the presence of after-pains.
In a few days the quantity of  the flow dimin-
ishes,  and  the color becomes  lighter and  less
tinged,  and then turns to a greenish color  be-
fore ceasing in two or three  weeks'  time.
  Suppression of the lochia at  an early period,
associated  with  other signs,  or an offensive
odor, any decomposing clots or  shreds, are bad
symptoms, and should be immediately reported.
  Bowels.—It is a  good plan  to administer a
dose of  aperient medicine  on  the morning of
the third day, and an enema  may be given the
same evening.
  Bladder.—Unless   otherwise   ordered,   the
urine should  be passed in the knee-and-elbow
position, with the assistance of the nurse,  and 
282   THE NURSE'S SERVICE DIGEST

the bladder  should be emptied two  or three
times in the twenty-four  hours without strain-
ing.  If there is any difficulty, this may be rem-
edied by  the application  of a  warm  fomenta-
tion  to  the  vulva, or,  if  necessary,  by the use
of the catheter. The latter should be preceded
and  followed  by  antiseptic  ablutions.   The
urine may be required for examination  a  few
days after delivery, and in that case will have
to be drawn  off with the catheter.
  After-Pains.—These  are  most  common in
women who  have had several children, and  may
continue  for three  or four  days,  preventing
sleep, if severe.  There may be no cause ap-
parent,  or else they may be attended  by  the
passage  of   clots.   The  douche may  remove
these and the  pains subside, or they may re-
quire some opiate medicine.
  Lactation.—There is not, usually,  sufficient
milk secreted by the breasts for the infant be-
fore  the  third or fourth day, and this incident
may  be  attended with some feverishness  and
slight  constitutional disturbance,  called  milk
fever.
  The child  should  be put  to the breast for a
few  minutes only,  three  times in  the  first
twenty-four  hours, until the milk is  established,
and after that  for  ten minutes regularly every
two or three hours  unless it be asleep, to  one
breast only  at  each meal.  The breasts should
be used alternately.
  If  the  nipple does not stand out well, or the
child  has difficulty in sucking, it should be
drawn out with a  shield, this  being  carefully
cleansed.  The  nipples before the first confine-
ment  should be hardened with  spirit, or  eau-
de-Cologne, and, if necessary, drawn  out.  Af-
ter the child is taken from the breast, the  nip-
ples  must be washed and carefully  dried with 
     THE MANAGEMENT OF CHILD-BED 283

a soft napkin.  If the nipples  are carefully  at-
tended to, they rarely become sore, but if this
happens  they may be moistened with glycerine
of  borax.   If  the  breasts  become  hard and
painful from  the flow of milk, they  may  be
rubbed with the  hand lubricated with oil in a
direction from the circumference to the nipple.
If the breasts hang down and  feel heavy, relief
may be obtained by the support of a folded nap-
kin passing under each and  round  the opposite
shoulder.
  If it is necessary to apply  camphorated oil to
the breasts to dry  up the milk, it is very im-
portant  to  avoid the  nipple.   The application
should be smeared  on lint  and covered  with
protective; the latter should  overlap the lint an
inch in  every direction, and a hole should  be
cut in both for the  nipple, the hole in the lint
being considerably  larger than the one in the
protective.  The  whole should be then covered
with  a  pad of  absorbent cotton and kept  in
place by a napkin.  The cotton may be replaced
when it  has been saturated by the  milk.  While
the milk is being dried up, the supply of liquid
food to  the patient  should  be diminished.   On
no  account must  the child be put to the breast
after the camphorated oil has  been applied, but
if the secretion  is  too copious, the excess of
milk  may  be drawn off with the breast pump.
The flow  will commonly subside  without  the
application, if  the  breast is rubbed well with
the hand lubricated  with  camphorated  oil.
  The mother should  not be  allowed  to  sleep
while  the  child is  taking the breast.
  Nipple-shields may be employed if the nipple
is too sore to allow the child to suck directly.
  Lacerations of Perineum.—Tearing of some
or  other part of the external genitals occurs
most commonly in first labors, and in some cases 
2S4   THE NURSE'S SERVICE DIGEST

the  parts  have  to  be  sutured.   The  patient
should be kept on her side with the knees bound
together, and it is  important  that  the lacer-
ated surface should  be wetted as little  as  pos-
sible.  It may be kept  dry and  clean  by the
absorbent cotton.  In cases of lacerated peri-
naeum, the catheter  may be used, or else the
patient should be directed  to pass water in the
hand-and-knee  position  before  using the  bed-
pan, or before the douche is given.  Straining
should also be scrupulously avoided.
  Inflammatory Disorders and Puerperal Fe-
ver.—Inflammation connected with some part of
the  womb  or  its appendages  may  supervene
after delivery, accompanied with  feverishness
and  local pain in the abdomen.
  Inflammation  of any  kind  is a  symptom of
importance after delivery,  and should be imme-
diately reported.  A hot fomentation may be ap-
plied to the abdomen, which commonly gives re-
lief  (see Peritonitis).
  Puerperal  fever is  the  most dreaded after-
complication of  child-bed,  and is often  marked
at its onset by one or more severe rigors with
speedy elevation of  temperature;  the face be-
comes flushed, and there are other constitution-
al symptoms of greater or less severity.   The
special symptoms connected with it  are:  sup-
pression  or offensiveness of the lochia,  failure
of the milk supply, abdominal pain and disten-
sion, with tenderness over the uterus.  In fatal
or severe cases, the course taken by the fever
is similar to  cases  of septicaemia  or blood-
poisoning.
  Prevention.—The prevention of this very fa-
tal disease is in great measure  in the hands of
the  nurse.   By  the  most  careful and  absolute
cleanliness on her own part, by close attention
to the hygienic  condition of the lying-in cham- 
     THE MANAGEMENT OF CHILD-BED 285

ber,  and to the details of  antiseptic midwifery,
the number of cases  will be reduced to a mini-
mum, and the nurse will feel that she has exer-
cised every precaution in her power.   If such
a  case should occur  under  her  charge, she
should make every effort  to ascertain whether
it  might be due to any preventible cause.
  The condition of the lavatory, or closet, any
defect in  the drainage, or unsanitary  surround-
ings  which  may have been  previously  over-
looked, should  be searched for, and  the pres-
ence in the house of  any one carrying infection
from the outside should  also be the subject  of
inquiry.
             Antiseptic Solutions.
  Antiseptic  Solutions for use in the lying-in
room are:—
  Perehloride of Mercury—Corrosive Sublimate.
—A standard  solution should  be kept ready  of
the strength of 1 in  200, and diluted for use to
1 in 2000 by adding  9 parts of water  to 1 part
of the standard solution.   The antiseptic prop-
erties of  the solution are  destroyed by soap; in
consequence of  this, it  is necessary  to thor-
oughly rinse the hands of soap before they are
soaked in the  antiseptic solution.
  Carbolic Acid.—A standard concentrated solu-
tion of 1 in 20 should be kept ready, and corre-
sponds in strength  to a  1  in 1000 solution  of
perehloride of mercury.
   Condy's  Fluid—Permanganate  of  Potash.—
This should  be employed  in  solution  of  the
strength  of one teaspoonful to a pint  of water.
It is useful in  indicating  the presence of septic
matter in the part to which it is  applied, by a
change of color from purple to brown, and  its
use  must  be  continued until the color remains
unchanged.  An objection to  Condy's Fluid  is
the  stain that is left on the linen.   It should 
 286   THE NURSE'S SERVICE DIGEST

 not  be used with  soap,  carbolic acid,  oil, or
 glycerine, all of which  decompose it.
     Management of the New-Born  Infant.

   Separating   the  Child.—Immediately  the
 child is born, the eyes,  nose, mouth, and throat
 should be carefully wiped  with a clean  napkin
 dipped  in  boracic  lotion.   The ligatures  and
 scissors should  be placed ready before delivery.
 The  ligatures consist of five or six strands of
 floss silk, or silk twist,  eight inches long, knot-
 ted together at either  end and rendered  anti-
 septic ; the scissors should have rounded ends.
 When pulsation has ceased  in the cord, it should
 be tied in two  places—one at  least  two and  a
 half  inches from the navel,  and the  other an
 inch farther off. The first knot should be firmly
 and tightly pulled  until the resistance  of the
 cord  is felt to  give way,  before being secured
 with a  reef-knot.   When  both ligatures have
 been applied,  the intervening cord may  be di-
 vided midway  with the  scissors.   The  navel
 should not be dragged upon when the knots are
 being tied or the cord divided.  The end  of the
 cord  attached to the child  should  be examined
 after it has been wiped dry to ascertain  that
 there is no oozing of blood, and that  the liga-
 ture is secure, otherwise it will be necessary to
 make it so by a  second ligature.  The baby may
 be placed in a flannel receiver, and removed.
  Washing and  Dressing  the  Baby.—After
 labor,  the nurse must not leave the mother to
 attend to the baby  until  everything has beeri
 done for her that is required;  the baby in the
 meantime being  placed in a warm and safe po-
sition.  Everything  should  be  prepared  ready
beforehand for  washing and dressing the  in-
fant.
  Infants must  be bathed at  a  temperature of 
     THE MANAGEMENT OF CHILD-BED  287

96°, quickly dried, powdered,  and  dressed  in
front of a  fire, and not unnecessarily exposed
to  the  cold air.  The eyes,  mouth, nose, and
ears must be first attended to, and washed at
least once  a day with  boracic lotion, using  a
camel's-hair brush  for  the nose.   All  creases
and folds of the skin must be thoroughly dried
and well powdered.
  In the first washing the cheesy material often
found coating the child  may be removed  by the
application  of sweet oil, or vaseline. The child
should be well lathered all over with soap and
soft flannel, and then dipped in the bath, and
the soap well rinsed off. When the child is in
the  bath,  the  nurse  can,  by placing  the left
hand under its back, and at the same time sup-
porting its  neck  with the fore-arm, gain a suf-
ficiently firm hold  on the child, the  head being
prevented  from  falling  back into  the  water,
while her right hand is  left at liberty.
  Before dressing the child, care must be taken
to see that  the  cord has been efficiently  tied,
and that no oozing is  taking  place from  the
stump.  Having been carefully dried, the navel-
string must be wrapped up in antiseptic gauze
or lint.   A hole is cut for the cord  in the center
of  a piece  of  this material about  six  inches
square,  and after freely  dusting the cord with
toilet powder,  the  four  sides are folded round
it.  The cord and its dressings ought to be kept
firmly  in place by a  flannel  roller,  five  inches
wide and twenty-four inches long.  This must
be  firmly applied,  and the end  over-sewn.   If
the child is bathed every day, the dressings will
have to be renewed, but if  washed without im-
mersing in the  bath care must be taken to avoid
wetting the dressing.  The further dressing  of
the child varies.  In the hospital, the child is
first turned over on its  belly, the shirt put on, 
288   THE NURSES SERVICE DIGEST

a napkin  folded diagonally being laid over the
back, and a flannel petticoat placed on it.   The
child is  then turned over, the  napkin  folded,
and  the  shirt  and  flannel petticoat  brought
round  the chest and  also folded.  These are
fastened  in  position by  a white binder four
inches wide and three-quarters  of a yard long:,
rolled  round  like the  flannel,  and also  over
sewn.  In dressing a child, no pins should be used.
The  flannel band is put on like the napkin, but
the lower corner,  instead of  being brought up
between the  thighs,  should he left loose.   The
long flannel petticoat also folded  over the feet,
either  toward the front or back, and fastened
with two  or three stitches, keeps the  band  in
place.   The  child's  night-dress  can  then  be
slipped up from below  over the legs, the arms
placed in  the sleeves, and the garment fastened
behind. The head flannel  thrown loosely over
the head  and shoulders completes the dressing.
In many  private  houses  the swath has fallen
into  disuse, and a fine woollen  vest is used in-
stead of a linen shirt.  All the garments  may be
made to fasten  behind, and so be stitched  to-
gether, and all put on at  the same time.
  Rashes.—Infants are frequently affected with
rashes, a common  one consisting of red elevated
pimples, being called the "red-gum"  (strophy-
lus).   It  may be  produced by  gastric  disturb-
ance, or by the child being too closely covered
up.  The  head flannel must never be worn  in
bed.
  Micturition.—Inability  to  pass water may
often be relieved by placing the  child in a warm
bath.  If  unrelieved,  or there is pain, the fact
should be  reported to the  medical attendant.   If
the fore-skin is too long, or if there is straining
on passing urine, circumcision may be  neces-
sary. 
     THE MANAGEMENT OF CHILD-BED  289

  The Navel.—The cord usually separates  on
the  fifth  or  sixth  day.  It should always  be
kept clean, dry, and powdered.  The odor should
be  noticed, whether offensive  or not.   After
separation,  the surface  should be  examined,
whether   bleeding,   discharging,  inflamed,  or
otherwise unhealthy.  Starting  of the navel or
unusual prominence  on crying should be report-
ed,  as it  may be necessary to apply a compress.
A  pad of  absorbent  cotton  should be  adapted
and kept on for a month, and the flannel binder
worn for several months.
  Breasts.—The  breasts in  children  of  both
sexes are  apt  to  swell in the first few  days
after birth, and even to secrete milk.  No treat-
ment is generally required.  They should be pro-
tected from being rubbed or irritated by a pad
of absorbent cotton.
  Eyes.—Attention  to the eyes is a point of the
very greatest importance, and in which neglect
may be followed by impairment  or complete loss
of eyesight.  Any weakness  of  the eyes should
be noticed and at once reported to the medical
attendant.  The application of a little sweet-oil
or  vaseline to  the  margin  of the lids,  with a
camel's-hair pencil,  after they have been bathed
with warm water, prevents them from  sticking
together,  and causing  further  damage  by the
action of pent-up matter. If there is discharge,
it  should be constantly  removed, and the eyes
bathed.   The  matter is infectious,  and  care
should be taken not to infect the sound eye by
using sponges or lint which have been  applied
to  remove the matter from the inflamed eye.
All should therefore be burnt,  and the  nurse's
hands carefully disinfected.
  Swelling in the Groin.—A  swelling in the
groin may be due to various causes, especially
in  males.  A  soft swelling which increases in 
290   THE NURSE'S  SERVICE DIGEST

size  when the child cries,  but decreases or dis-
appears at other times, is in all probability  a
hernia.   All  such cases should be  reported  to
the medical attendant.
  Snuffles.—Apparent cold in the nose,  when
persisting,  is a  strong  indication  of syphilis.
It may often be relieved  by applying campho-
rated vaseline to the bridge of the nose.
  Buttocks.—The  buttocks  must  be kept  as
clean and dry as possible, especially if the mo-
tions are green  and liable to irritate;  conse-
quently, in cases of diarrhoea and thrush, scru-
pulous attention is required.   Napkins should
be washed with pure yellow  soap,  and soda
should never be used,  as  it  is apt to produce
soreness of the buttocks; the same remarks ap-
ply to napkins  which, having been  soiled, are
dried, and again put  on the child unwashed—
such a practice is  objectionable and  cannot be
too strongly  condemned.  A little  vaseline or
zinc  ointment rubbed on the buttocks  after they
have been washed protects the skin  to a certain
extent from  irritating discharges.
  If the buttocks become sore, the fact must be
mentioned.  Spots limited to the buttocks which
break at the  summit and leave minute holes are
probably of a syphilitic nature, and this is ren-
dered still more probable if the soreness has ap-
peared in the absence of green stools.  All sore
spots on  the buttocks  may be  touched with
an  iodoform pencil  each   time  the  napkin  is
changed, as  if these minute ulcers increase  in
size, and run together, they produce a very raw
surface.
  A  syphilitic child generally snuffles  and  has  a
hoarse cry;  is  frequently  small, ill-nourished,
and  weakly,  with an aged look and wizen face,
and is liable  to various eruptions. 
CHAPTER XIV.
                 APPLIANCES.

Baths:—Vapor-Bath—Wet  Pack—Half  Pack-
  Tepid Sponging—Enemata, Aperient and Nu-
  trient — Douche — Vaginal  Injections — Nasal
  Douche — Ice  Bags — Poultices — Mustard
  Leaves—Fomentations  and  Stupes—Counter-
  Irritation—Blisters—Leeches—Cupping, Wet
  and  Dry — Ointments — Suppositories — Eye-
  Drops—Collyria—Ear Syringing—Throat Ap-
  plications— Gargles— Sprays— Inhalations—
  Bronchitis Kettle.

           Various Kinds of Baths.
  Baths, Hot and Warm.—In ordinary cases, a
hot bath should be from 100 to 108 or  110 de-
grees Fahrenheit, the patient remaining in from
ten to fifteen minutes.   The temperature of a
warm bath  ranges from 90  to 100 degrees, and
of a  tepid bath from 80 to 90  degrees, in all
cases regulated by a thermometer.
  The nurse should prepare the  bath for an in
valid of a low temperature, adding hot water to
prevent the  water cooling  or  to increase  the
temperature.  The patient  may be  immersed
from half  to one hour.  In cold weather  the
bath  should be  given in  a  warm room  and a
warm blanket kept ready for the patient after-
ward.  The patient's body should be wholly im-
mersed except in cases of respiratory difficulty,
when the chest should be left out of water cov-
ered  with  a blanket.  Invalids are liable to
                     291 
 292  THE  NURSE'S  SERVICE DIGEST

 fainting attacks when  taking  a hot  bath,  so
 that the attendant should not leave them alone
 for fear of  their passing into  an  unconscious
 state.   Exposure to draught  should be  avoided
 when drying, and the patient should go to bed
 without delay.
   In  giving  a child a bath  for fits,  the child
 should  be seated in the hot bath, and a sponge
 full of  cold water squeezed over the head.
   Continuous Bath.—In the case of a patient
 suffering from extensive burns, it  may be  de-
 sirable  to keep him constantly in the bath.  The
 bath should  be kept at a temperature which he
 feels  comfortable, and he may  be  slung in  it
 with a  support for the head,  the nurse  remain-
 ing by his side.
   In preparing hot  baths for the irresponsible
 and children, accidents may be saved by putting
 some cold  water into the bath  before  the hot
 tap is  turned on, so  that  if the child  should
 enter  before the bath is  ready there is  no
 chance  of its being scalded.
   Cold Bath.—For  those in fair health this  is
 best taken before breakfast, and should  be fol-
 lowed by a sensation of glow  and warmth. The
 body need  only be immersed or sponged for a
 minute  or  two, and then rapidly dried with a
 coarse towel.  If  the  cold bath is ordered for
 those in delicate health, it may  be taken two or
 three hours  after breakfast.  Children  may be
 allowed to  stand  in hot water, and be then rap-
 idly sponged over with cold water.
   Graduated  Cold  Bath.—When  the  bodily
 heat exceeds 105 degrees, and is attended with
 the first symptoms of coma and an increasing
 rise of  temperature, the cold  bath may  be nec-
essary.  It  is given under medical superintend-
ence, not being free from risk.  A bath of suf-
ficient size  to immerse the patient is  required. 
APPLIANCES
293
The patient, after being stripped, should have a
large  towel spread over  him, and then be low-
ered by  means of a  sheet or blanket into the
bath, which should be of  a temperature of about
90 degrees F.  The water is then cooled down
by adding  cold water, or if necessary ice, until
the temperature gradually reaches 70 or  65 de-
grees, or until the patient's temperature, ascer-
tained by a thermometer placed in the mouth or
rectum, is  sufficient lowered. The patient can
be removed by  several strong hands, or else be
lifted out by means of the blanket  or sheet in
which he was lowered, the water being drained
off  as far  as possible.
  The  bath may  have to be repeated several
times, if the temperature again ascends; and if
followed by shivering, or great lividity, the pa-
tient should be placed between the blankets, and
hot-water  bottles applied to the  extremities,
warm beef-tea or brandy  being administered by
the rectum.
  In cases  of emergency  where a cold bath can-
not be given, a sponge bath may be used, the
cold wet pack, or ice  cradle.
  Hip-Baths.—These are useful in disease of
the pelvic  organs, when it is not desirable to
immerse the whole body.  Care should be taken
not to fill them too full so that  the  water runs
over when  the patient sits down, and the upper
part of the patient should be covered with  a
blanket.
  Foot-Bath.—A  mustard  bath may  be  em-
ployed for  the feet.   The foot-bath should con-
tain water  at about 110 degrees F., to which an
ounce of mustard has been added; the feet may
be kept in  it until a warm glow is  felt in the
skin.
  Hot-Air  Bath.—To promote perspiration in
dropsy,  Bright's  disease, or chronic  rheuma- 
294   THE NURSE'S SERVICE  DIGEST

tism, these baths are invaluable  in  such eases.
They are best given to the patient in  bed  by
making use  of  Allen's lamp, the boiler being
removed.  The patient is  stripped,  covered in
flannel  or a  blanket, and  a blanket is laid  on
the bed; a body-cradle or  wicker-work support
with  a mackintosh  over it, is then placed  on
the bed over the patient and one or more blan-
kets thrown over this, so as to completely cover
him,  and  the clothes tucked  in round the  bed
close  to the  neck.  The covering blanket being
removed, the  lamp is then lighted,  and  raised
from  the  ground  to the  required height,  the
tube  being passed under the bed-clothes above
the level of the body (fig. 56).
  The hot air enters and surrounds the body in
a  warm bath, soon  producing  a copious per-
spiration.  The head may be wrapped  round in
a towel wrung out in cold water, and changed
if necessary.  Fifteen to thirty  minutes  is
usually a sufficient  length of time for  the bath,
and  the patient must not  be left  alone.  The
effect  may   be  much  increased  by  imbibing
plenty of fluids, or by the  previous administra-
tion  of drugs, such  as pilocarpine, which  en-
courage perspiration.  The temperature  of  the
bath should  be measured by a thermometer sus-
pended  inside the  cradle,  and may range from
110 to 150 degrees F.
  Vapor-Baths may be given in  the same way
if steam is used instead of air, the temperature
varying from 100 to 110 degrees F.  Extempore
arrangements may  be made with a  kettle pro-
vided with a  long rubber tube to pass under the
bed-clothes and convey  the  steam, or  bricks
may  be heated and wrapped in a flannel which
has been previously soaked in water, or vinegar
and water, and then placed on a dish inside the
bed under the raised bed-clothes.  Some form of 
APPLIANCES
295
cradle may  always be extemporized with card-
board  or some  stiff  material, such as  half a
band-box, etc.
  The same baths can be given to an individual
in a sitting posture.  The patient being seated
in a  cane-bottomed chair, the lamp is  placed
underneath the chair, and then a blanket is ar-
ranged to cover  and surround  him  and  the
chair, but leaving the head uncovered.
  Wet Pack.—The Cold  Wet Pack is used to
reduce temperature in fever, or to promote free
perspiration  and  sleep.  The bed should  be
guarded  by a waterproof sheeting, with a blan-
ket placed over it; the patient is then  stripped,
and lies on his side with a blanket over him.  A
sheet,  previously wrung out in cold water, is
folded lengthways  with  the  edges toward  the
middle, and is closely adapted all over the pa-
tient  under the blanket, but  leaving the head
uncovered;  the  blanket  is then  tucked round
him.
  The Hot Wet Pack is given  in a similar man-
ner, hot  water at 110 degrees F. being used in-
stead of cold, and three or more blankets  are
thrown over  the patient and tucked round, two
hot bottles being placed at the feet and  one on
either side.  The effect of the pack  must  be
noticed, and if severe exhaustion is produced it
must  not be continued;  but  if the  result is a
feeling of comfort it may be continued for half
an  hour  or  more, when the patient may  be
quickly sponged  with tepid water, dried,  rubbed
briskly with  alcohol, and wrapped in a blanket.
  The Half Pack is a modification of the cold
wet pack, and is carried out in much the same
manner.  Instead of the large sheet, one  or two
towels folded lengthwise  should be wrung  out
in cold water, and folded round the body below
the armpits and  over the hips, leaving the limbs 
296   THE NURSES SERVICE  DIGEST

uncovered;  the  blanket is  then folded round
and tucked in.
  Tepid Sponging  may  be employed with great
benefit and  comfort to  the  patient in eases of
fever  and restlessness, and reduces the temper-
ature when  the skin is dry  and pungent
  The bed should  be guarded with a  thin rub-
ber sheet and a blanket laid underneath  the pa-
tient.   The bed-clothes  and  the patient's night-
dress  being removed, he is covered  with  a blan-
ket,  and  the  skin  slowly sponged over from
above downward with tepid water, or water at
a temperature of 116 degrees F.,  to which some
alcohol has been added.  A small portion of the
body  only should  be exposed at one time, and
the wet sponge passed two or  three times over
each part before drying it; a hot bottle may be
placed at  the feet  during this process.  The ef-
fect  is to reduce  the temperature, soothe  the
nervous system, and promote sleep,  and it has a
very  refreshing effect  in  typhoid and other
fevers.
  For the ni;/ht sweats of phthisis, the spong-
ing should be done quickly  instead  of  slowly,
and a fresh  night-dress  put on  afterward.

                  Enemata.
  Pump Syringe.—There  are several  forms of
instruments  in  use for  the purpose of adminis-
tering an injection  into the bowel.  Some  are
provided with a syringe of metal and a piston,
with tubes of a suitable kind.  Others, such as
the Richardson syringe, consist almost entirely
of india-rubber.  This latter  is provided  with a
bulb  which  acts as  a  pump,  to each  end  of
which is fitted a  tube  of india-rubber,  one of
the tubes  terminating in a  bone nozzle  with  a
shoulder-piece.   Before  introducing the nozzle
of the syringe,  the bulb and tube should  be 
APPLIANCES
297
filled with the liquid, to exclude all the air, that
it  may not be injected into the bowel and  cause
distress to the patient.  The nozzle is then oiled
and  introduced into the rectum, the end of the
other tube is previously sunk in the fluid  to be
injected;  the bulb  is then squeezed, and water
is  sucked in to the  syringe,  and injected into
the bowel (fig. .77).  The india-rubber is apt to
get stiff and broken in cold weather, and should
not be coiled up in a box, but  hung up by the
metal eud.  Before using any  form of instru-
ment,  a  quantity  of warm  water should be
pumped through it in order to  make  sure that
it  is in good order and thoroughly clean,  then
the nozzle should be anointed with vaseline or
sweet-oil,  the bulb and tube filled with the fluid
before introducing  the nozzle.
   It  is usual to inject warm fluid  at  a temper-
ature from  90 to 100 degrees F.   The patient
should be placed at the edge of the right-hand
side  of the  bed,  either lying  on the back  with
the knees well raised, or lying  on  the left side
with  the  knees  drawn  up.   A  mackintosh or
rubber sheet is placed  over a folded  towel un-
der the pelvis to guard the bed.   The fluid to be
injected should  be  placed in a basin on a  chair
by the bedside,  and ascertained to be of the
right temperature.  The nozzle of the  bone-tube
should  be  warmed and smeared  with oil or
vaseline.  The syringe should be filled, and the
air  ejected  by  squeezing the  ball  until  the
fluid  begins  to emerge  through   the nozzle,
which may then  be gently passed   into  the'
bowel  in  a direction slightly  backward up to
the  shoulder-piece.  The fluid may  then be
slowly injected, taking care to desist before the
end of the tube in  the fluid is uncovered, other-
wise  air  will  be sucked  in and injected,  dis-
tressing the patient. 
298  THE NURSE'S SERVICE  DIGEST

  A towel or diaper should be pressed against
the bowel as the tube is withdrawn, the patient
being kept quiet  for  a time in order that the
fluid may be retained for ten or more minutes.
The night-stool or bed-pan should be always in
readiness close by the bedside.   If any diffi-
culty  is  experienced in introducing the  nozzle
into  the bowel, or any  resistance  felt to the
injection  of the  fluid,  the nozzle should  be
slightly withdrawn and  pushed  on in  a some-
what  different  direction.
  Glass Syringe.—When  quite small  quanti-
ties,  such as a few ounces only,  have to be in-
jected,  a glass  syringe  with tube  and  nozzle
should  be  employed.   This is also useful for
nutrient injections, or medicated  fluids, and can
easily  be cleaned.
  Long Rectal Tube.—In  cases of faecal im-
paction, or intestinal obstruction, when the use
of the ordinary enema is ineffective, the fluid
may have to  be injected  with  the long tube.
This is used by the medical attendant, but the
nurse  may  be  required  to  employ it.  It is a
long tube  of  india-rubber, one  end of  which
can be fitted on to the nozzle of the enema sy-
ringe.   The tube is previously softened  in hot
water, and  slowly inserted into the rectum; as
it is passed further and  further, the end may
be guided to the left side, but no  force  should
be used, as there  is danger  of damaging the
bowel.  It is not always easy to introduce it,
and  when  it seems to be traveling on it may
really  be coiling upon itself.  When it has been
introduced as far as  it will go easily, the fluid
may be  injected.
   Simple  Enema.—Warm  water,  soap  and
water, oatmeal-gruel, or barley-water are com-
monly used in  ordinary  cases, and  the amount
of fluid to be injected will depend partly  on the 
APPLIANCES
299
age of the patient and the nature of the case.
For  infants one  ounce, for children  from four
to  ten ounces,  will  be  sufficient;  while for
adults two or more pints may be injected.
  Oil Enema.—Olive or  linseed  oil injections
are more effectual in softening hardened masses
impacted in the  bowel; one and a half to two
pints of oil may  be used.  In cases of intestinal
obstruction, the injection may be given with the
pelvis raised  above the level of the head and
shoulders, and the enema should be retained as
long as possible.
  The fluid  should always be carefully warmed
to a  temperature of 80 to  100 degrees F., and
oil  may be heated by surrounding  the basin
containing it with quite hot water, until the oil
is sufficiently  warm.
  Medicated Enemata.—Astringent or  sedative
fluids are often used for injection in diarrhoea,
in haemorrhage from the bowel,  or to  give  re-
lief from pain. The amount of fluid  injected is
considerably smaller than for aperient enemata.
Two  to  four  ounces  of water containing the
astringent is sufficient, or the same quantity of
starch  mucilage   with half  a  teaspoonful  of
laudanum may be used as  an opiate.
  Salt Injections, in the proportion  of one  ta-
blespoonful  of salt to a pint  of gruel, are use-
ful for destroying thread worms  in the rectum.
  Turpentine  Injections should  contain  from
half to one ounce of turpentine, with a pint of
gruel or barley-water.  The instrument should
be afterward cleansed by a stream of soap and
water.
  Nutrient Enemata.—This mode of feeding is
of the greatest value in  prostration, or when
vomiting,  or disease of the  stomach prevents
nutrition being carried on by the mouth.  After
profuse haemorrhage,  long  and  severe opera- 
31 K»  THE NURSE'S SERVICE DIGEST

tions, or during temporary unconsciousness, the
patient's life may be preserved by the injection
of warm fluids or stimulants.
  The quantity injected should not exceed four
ounces, and two or three ounces may  sometimes
be more  easily retained.  The injection should
be warm  (90 to 100  degrees  F.), and may be
slowly administered with a  glass syringe  di-
rectly after a natural motion,  or about an hour
after the bowel has  been washed out with a
simple enema.  If the injections have to be con-
tinued, the bowel is apt to become irritable, so
that they should not be given more  frequently
than every four hours.
  The nutrient  fluid  should  be about the con-
sistence  of cream, and may  be  composed of
strong beef-tea, milk, eggs, gruel, meat extracts,
or stimulants.  Two or three ounces  of  beef-
tea,  the yolk  of an  egg, and  half an ounce of
brandy make a very useful injection.   The food
may be artificially digested before injection by
the addition of a dessert-spoonful of the Liquor
Pancreaticus  (Benger) ;  or  pancreatized  milk
and beef extract may be used  (see Appendix).

        Douches and  Ice-Applications.
  Hot and Cold Douche.—The application of a
stream  of hot or cold water is beneficial for
reducing inflammation  in joint affections,  and
to relieve pain.  The water may be poured from
a can held at some height above the part by an
attendant,  or  a tin can provided with an india-
rubber tube may be placed at a suitable height,
aud  the  fluid  directed  where required   (see
Vaginal Douche).
  Vaginal  Injections are best given with a
glass syringe and  india-rubber  tube,  but the
Richardson's syringe is sometimes used.  A spe- 
APPLIANCES
301
cial tube is provided  with these instruments,
made of hard rubber.  The tube is from five to
six inches long, and is pierced with holes along
its sides  toward the end of the nozzle; before
use it should be soaked in a solution of carbolic
acid, warmed by passing a stream of  hot water
through it.
   The bed  must be  arranged with a sheet  of
rubber or mackintosh and folded sheet, and the
patient should  lie near the edge  on her  back
with the  knees drawn up, with a round bed-pan
or bed-bath underneath her.
   The tube being  oiled, the  nozzle  is  passed
under the right knee into  the vagina in a di-
rection upward and backward.  Care  should  be
taken that  the  tube  is filled with the solution,
and free  from air  before injection, and  the in-
jection  should be  stopped  before the  vessel is
empty.
   The Vaginal Douche may be given in a simi-
lar manner.  An instrument may be obtained
for those who require its  constant use, which
can be managed without assistance.  It consists
of a  rubber bag containing from  two  to  four
quarts,  from the bottom of which comes a long
tube  furnished  with a  stop-cock and a perfo-
rated nozzle.   The reservoir  is filled with the
fluid  to be  injected, and hung up,  or  placed on
a  shelf a few feet above  the patient.  When
the fluid  has  entered the tube, the nozzle  may
be inserted, and  the patient  can control the
flow by using the stop-cock.
   Vaginal injections  may be used at a  temper-
ature varying from 70 to 100 degrees  F., and
the temperature of the hot douche  should be
from  100 to 115 degrees.   For antiseptic  pur-
poses, carbolic acid of the strength of 1-40  to
1-80, or other antiseptics ordered.
  The vaginal tube, preferably of glass,  should 
302   THE NURSE'S SERVICE  DIGEST

not be perforated at the  extremity if the fluid
is not intended to enter the uterus.
  Nasal Douche  (fig.  58).—An  india-rubber
tube a few feet in length is required, provided
with a weight  at one end and a  nozzle at the
other.  The fluid  to be used is placed in a bowl
on a ledge at some distance above the patient's
head.  The weighted end is sunk in the  fluid,
and  the fluid started running by suckim; the
nozzle end, or pinching the long tube to exhaust
tne air, when there will be a continuous stream
kept up.  The patient should be directed to hold
the nozzle in the  nostril, lean over a basin, and
keeping the mouth open to breathe through  it
and  not through the nose.   The fluid should
enter one nostril, and, running round the back,
escape from  the  other.  This process  requires
some practice to  perform efficiently.
  Ice  Bags  (fig. 59).—India-rubber bags are
made for the application of ice, the shape vary-
ing according to  the part to which the ice has
to be applied, or an  efficient  substitute for an
ice bag may be made with a common bladder.
  Ice Caps (fig. 60) are also  used for applying
cold to the head, consisting  of  coils  of tubes
through which  iced water is made to percolate
by means of a syphon, and is received into  a
bucket at the bedside.  Metal tubing  (Leiter's)
may be used  in the same manner.  This tubing
is pliable, and can be adapted to the part, the
water  passing  through by  the  syphon  action,
and  it  has  the  advantage of being  less  dis-
agreeable to  the  patient than the india-rubber
apparatus.
  Ice  should  be  kept  in  large  lumps,  from
which pieces are  separated by a hat pin or long
needle.  To prevent its melting too rapidly,  it
should be kept in  a refrigerator or  in a  cool
room.  It is best  to wrap it in flannel and place 
APPLIANCES             303
it in a receptacle so arranged that the water
can drain off as soon as the ice melts, and not
to  keep  it standing  in  the water  which  has
melted  off.
  Ice  Poultice.—Take  a fold of gutta-percha
tissue a little larger  than the area to be cov-
ered.  Sprinkle on the lower leaf of the tissue
a thin layer of linseed-meal, and upon it place
ice crushed small to the depth of half an inch,
sprinkle the ice with common salt, and on the
top  of  it add another  layer  of linseed-meal.
Turn the  upper leaf over the lower and seal the
edges with chloroform  or  turpentine; put  the
poultice into a flannel bag, and place under it a
layer of lint.   (Guy's Pharmacopoeia).
  Ice Cradle (fig. 61).—A special form may be
used, or  else  one or more cradles  sufficiently
long to cover  the whole body  are  placed  over
the patient under the sheet, which is  the  only
covering left on the bed.  The ends of the sheet
are turned up over  the  cradles to allow a free
current of air.
  From the cradles  are  suspended a number of
small pails filled with ice.  Children's toy pails
answer very well, or  round tin boxes, such as
coffee tins, can easily be  adapted for  the  pur-
pose.
  It is a good plan to cover the pails with bags
made of flannel or absorbent cotton, to absorb
the  moisture  caused  by  condensation,  which
might otherwise drip on the bed.
  The  patient's feet should  be wrapped  in a
small blanket  or  a  hot-water bottle placed at
the soles,  as they  usually get very cold.

         Poultices and Fomentations.
  Poultices.—The application of heat and mois-
ture to  the surface of the body is best effected
 
304  THE NURSE'S SERVICE DIGEST

by a poultice.  Various substances are used for
this purpose: linseed-meal and  bread are  best.
  Linseed  Poultice of crushed  meal.   A  bowl
and spatula or broad knife are  required, which
should previously  be heated  by  being dipped in
boiling water.  A  sufficient quantity of boiling
water is put  into the basin to make the poultice
of the required size;  the linseed-meal is  then
quickly added little  by  little  with one hand,
stirring well  the  whole time with the spatula
or knife until the  right consistence is  attained.
  The  mass   should  not  be too  firm or  too
sloppy, but sufficiently moist to turn out of the
basin without sticking  to the sides.  The poul-
tice  is  evenly spread  on a  piece of warmed
linen, lint, or teased-out tow.  The extra margin
is then turned in over the edges.  A single layer
of thin umslin may be spread over the face of
the poultice if not required to be next the  skin.
The heat  of  the poultice should be tested  with
the back  of  the  hand before being placed  on
the body, and should be  as hot  as can be  com-
fortably borne.  An external covering of cotton
batting, lint,  or waterproof  should be adapted,
and  the whole  well  secured in  position by a
bandage,  napkin,   or  binder.   The  essential
points  in giving a  poultice are that it should be
hot and  of the right consistence; it  is neces-
sary that the water should be boiling, that the
implements should previously have been heated,
and that there should  be no delay in applying
it when made.  If  the poultice has to be carried
from one  room to another, it should be placed
on a hot plate and covered over with a napkin.
To  make it of the right consistence, too much
water  should not  be used, but  if  too little is
added  it will be hard and cold, and the thick-
ness should not be out of proportion to the size,
since  the weight  pressing  on a tender  or in- 
APPLIANCES
305
flamed part will in itself cause pain.  The poul-
tice should  be removed before it gets cold, and
a fresh one applied if necessary every four or
six hours, but the  old one should not  be  re-
moved until the new one is ready.   When dis-
continued, the skin should be dried with a soft
towel, and  covered  with  flannel or  cotton-bat-
ting.
  A  Jacket Poultice is  often used  for chest-
affections.  A  large piece  of linen should be cut
out of  sufficient  size to cover  the back, sides,
and   front,  and  after  the  poultice  has been
spread  it is placed round the chest,  and  the
edges secured with  safety-pins over  the shoul-
ders,  and underneath  the arms.  It  may be
made in two pieces for an adult, or  in one for
a child.
  Bread Poultices.—Coarse bread-crumbs from
stale  bread should  be  added  to  boiling water
in a  basin  and well stirred.  The basin  should
be covered  up and placed by the  fire for a few
minutes.  The water must then be drained off,
and   fresh  boiling  water  added,  and  again
poured off, when the poultice may  be  spread
and  applied.
  This  form of poultice  is very soft,  and well
suited for  small  applications to tender parts,
but  does not retain the  heat so well  as  the
linseed-meal.  An excellent poultice is  made by
mixing  equal  quantities  of  linseed-meal  and
bread-crumbs.
  Charcoal Poultice.—This is often  required
for foul and sloughing parts, as in gangrene or
decomposing ulcers.  A  bread poultice  is pre-
pared, to which  a quarter to half an  ounce of
finely powdered charcoal or more, according to
the size required, is gradually added  and well
mixed,  or  the charcoal  may  be  added  in  the
proportion  of half an ounce to four ounces of 
306  THE NURSE'S SERVICE  DIGEST

linseed-meal  and bread  in  equal parts.   The
surface of  the prepared  poultice  should  be
sprinkled  with  fine charcoal  before application.
  Yeast Poultices are useful for wounds or ul-
cers,  and  the  following proportions  may  be
used:  Two  ounces  of  beer yeast should  be
mixed  with an equal quantity of hot water, a
quarter of a pound  of  flour, linseed-meal, or
fine oatmeal  is  gradually stirred  in,  and heated
until it rises, and is sufficiently hot; an earthen-
ware vessel should be used for its preparation.
  Mustard  Poultices  may   be  made of  any
strength.  The  directions in  the  Pharmacopoeia
require equal parts of mustard in powder  and
linseed-meal.  The meal should be mixed with
boiling  water  and the  mustard added  while
stirring.   A  less proportion  of mustard should
be added  for patients with delicate skins,  and
the poultice  may be applied  for  a longer time.
It should be spread  on a cloth  or  on  brown
paper,  and  a layer of cheese-cloth or muslin
may be placed  over it.
  A redness of  the  skin,  accompanied  by a
burning sensation,  is produced  after  a  time;
but there is  a  great  difference in the delicacy
of the skin  in individuals;  a strong  mustard
poultice should not therefore be  left  on, espe-
cially in the case of children, without ascertain-
ing its effect. A corner should be turned down
after a time, and the skin  examined to prevent
the production  of a blister.
  Fomentations and  Stupes.—These are con-
venient methods of applying  warmth and mois-
ture to the  skin,  and  have  the  advantage of
cleanliness and  simplicity.   A piece of  coarse
flannel about a yard  square should be  folded
to the size required  and placed in  a basin of
boiling water.  It  is  then  put on a towel,  and
the ends  of  the towel twisted tightly in con- 
APPLIANCES
307
trary directions until the water is thoroughly
squeezed out of the flannel, which is then car-
ried inside the towel  to prevent its  cooling,
and applied.   The  outer  surface should  be
guarded by  several folds of  dry flannel  to
avoid wetting the clothes.
  The  fomentation will require changing every
half hour,  or more  often, if great heat has to
be constantly kept up, and the second hot flan-
nel should  be ready before the first is removed.
  Wringers  (fig.  62)  are used  in  hospitals
where   fomentations are  constantly  required.
They consist of coarse toweling  or canvas pro-
vided with a wooden rod at each  end, to take
hold of while wringing out the boiling water,
and prevent  burning the fingers.
  Poppy Fomentation.—Break  up two  poppy
heads,  and boil them in two pints of water until
the quantity  is nearly reduced to one pint, then
strain, and soak the flannel in the boiling fluid.
  Laudanum  Fomentation.—When the flannel
has been wrung out of the hot water,  the sur-
face should  be quickly sprinkled with half  an
ounce or an ounce of laudanum before applying
to the skin.
  The Turpentine  Stupe is used for  counter-
irritation, three or four teaspoonfuls of turpen-
tine being  used and well distributed over the
surface of  the flannel by afterward wringing it
out in hot water; care should be taken that it
does not blister the skin.
  Spongio-Ptline is a thick, soft material, one
surface of  which is covered with waterproof to
prevent evaporation.  It may be  used for  fo-
mentations instead of flannel

         Counter-Irritation—B listers.
  Counter-Irritation.—Various means are em-
ployed  to produce redness of  the skin and to 
308   THE  NURSE'S  SERVICE DIGEST

assist in relieving pain and inflammation in the
deeper  parts, among which  are  mustard  appli-
cations and turpentine stupes.
  Mustard  Leaves.—A very  convenient  substi-
tute for a mustard  plaster can  be obtained in
the form  of a leaf or thin sheet of paper pre-
pared with  mustard.  The leaf is  soaked for n
few  seconds in cold water, or  tepid water in
winter,  applied wet  to the skin,  and secured by
a napkin or bandage.  The action is very rapid,
and  sometimes too severe.
  Counter-Irritant.—One of the  best counter-
irritants we have ever used to relieve  severe
pain quickly is composed of  equal parts of es-
sential  oil of mustard and  menthol.
  It should  be lightly and  rapidly applied to
the surface with  a camel's-hair  brush, or with
a pledget  of absorbent cotton tied  to the  end of
a small stick; it will  burn  for a few moments,
when first applied, but without  blistering.
  It is  exceedingly volatile, and  for this  reason
is apt to  smart the eyes of  the patient  or at-
tendant when  used  near the face; which  may
be avoided  by the patient  holding a handker-
chief over the face  during  the application and
the attendant turning the face away while ap-
plying the remedy.
  The pungent odor of the  mustard, in no way
harmful, passes out of the  room in a few min-
utes,  while  the patient rejoices at the  rapid
relief received from the pain.
  Liniments are also used for this purpose,  the
stronger  ones requiring care  in  application,
such  as  croton  oil,  belladonna,   iodine,  etc.
These should be painted  on with  a brush and
not rubbed  in, and the fluid  used  sparingly  at
first  over  a  small  surface to test its effect.
  Blisters are a powerful form of counter-irri-
tation, the cuticle  or superficial part of the skin 
APPLIANCES
309
becomes  raised  from  the  part beneath by  an
effusion of fluid  or serum, drawn from the blood
by the action of the blistering material.
  There  are two methods in common use.  The
application of  blistering  ointment  spread  on
stiff paper or leather to form a plaster, the Em-
plastrum Lyttae;  and painting the  part  with
blistering fluid.
  The plaster may be secured by a bandage or
handkerchief, a less painful method than  using
sticking-plaster, which drags  when the blister
rises, and adheres to  the skin and hairs round
the  tender region.  In  order to vesicate, the
plaster  should  remain  on  from  eight to ten
hours; three  or four  hours will suffice to pro-
duce redness to the skin.
  When  vesication has been produced,  the plas-
ter should be gently removed  without  breaking
the blister.
  Dressing  Blisters.—The vesicle  should be
opened at the  most dependent part by sharp-
pointed  scissors,  and  the  fluid  allowed  to  es-
cape into a  test-tube  or glass vessel and kept
for examination.
  The surface may then be dressed with a fold
of  lint covered with  sweet oil or ointment, a
thin  layer of absorbent cotton being secured
over  it  by a bandage.   A warm linseed-meal
poultice  is a comforting application after severe
vesication; but  if it is desired to keep the blis-
ter from healing, savin ointment should be  ap-
plied on lint instead of simple dressing.

              Leeches—Cupping.
  Leeches are used to remove a small quantity
of blood.  Before applying them, the skin should
be  washed over with warm  water  and dried,
and the leech should  also be wiped with a soft
cloth. 
310   THE NURSE'S SERVICE DIGEST

  To  apply the leech, hold  it by its larger end
in the folds  of a cloth, and  allow  the smaller
extremity or head to be directed over the skin
in the necessary region.   When  the head has
taken hold,  the body may be released, and the
leech  will adhere  to  the  skin  by  its sucker.
Another method of application is by  means of a
leech-glass, or an ordinary wine-glass or  test-
tube may be inverted  over the part with  the
leech  inside until it has begun to bite.
  If there is difficulty in getting the leech  to
bite, a little milk or sugar and water  may  be
first smeared over the skin.
  The leech should be allowed to drop off when
it has sucked its fill, and  not be dragged  off.
If the leeches are likely to be used  again,  they
should be sprinkled  with a  little salt until  they
have  disgorged the  blood,  washed, and kept  in
a  glass or earthenware jar with  a perforated
cover, filled  with fresh water.  The leech bites
should be washed with warm water, dried, and
covered with cotton batting, which will in most
cases  stop the bleeding.
  If  necessary,   the bleeding may  be  further
encouraged by applying a hot fomentation.
   To  Arrest Bleeding  from  Leech-Bites.—The
bleeding  may be  so  persistent as to produce ex-
haustion.   Patients, and  especially  children,
should not be left for the night after the appli-
cation of  leeches until  the  bleeding  has ceased.
If the bleeding is over a hard surface of bone,
it may be easily  stopped  by firm pressure  with
a  pad of lint or absorbent cotton  held on  or
bandaged on for a few  minutes.
  If there is difficulty in stopping the bleeding,
a  surgeon should be summoned, pressure being
applied  until his arrival.
  Cupping is a method of abstracting blood  lo-
cally, and there  are two  ways of applying It— 
APPLIANCES
311
wet cupping  and dry cupping.   Wet cupping is
only practiced by the surgeon; several incisions
being made in the skin,  and the blood drawn
into a cup by atmospheric  pressure.   Dry cup-
ping  is used  when  it  is desired to draw the
blood into the superficial tissues without shed-
ding  it.   In  either  case, the cups are  applied
after the  same manner.
  The part to be cupped should be  previously
sponged with warm  water,  and the spot chosen
should be as  flat as possible.  The cups are of
different sizes, and made of glass.  A few drops
of spirit  are  placed in the cup, which  is then
shaken so as to moisten the sides, the excess of
spirit is thrown out, and a small piece  of blot-
ting-paper moistened with  spirit is set on fire
and dropped into the cup.  When the spirit in-
side  flares up, the  cup is  immediately turned
over, and the edges firmly  applied to the skin.
The  flame immediately  becomes extinguished,
and the air being exhausted, the skin in the in-
terior rises up into the cup,  forming a consid-
erable swelling; or if incisions  have  been made
by  the scarifier, the blood trickles out and slow-
ly fills the vessel. To remove the cup, one edge
should be raised, and the skin  firmly depressed
with the  thumb until the air gains admittance,
when it  can be easily removed.  If  blood  is
drawn, it should be  received  into a measure
without spilling it, and the amount noted.  The
wounds may  be sponged and covered with lint
or  plaster, or allowed to bleed further into a
hot poultice.

          Ointments and Suppositories.
  Ointments are used for application to raw
surfaces  and skin affections.   They  should be
evenly spread by a  spatula or broad knife over
the smooth side of  stripe of  lint cut to a  suit- 
312  THE NURSE'S SERVICE  DIGEST

able shape; then spread over the affected part
and secured by a  thin bandage.
  Inunction may  be used  for parasitic affec-
tions, such as the itch  (see Scabies).
  Suppositories,  Medicated.—These  are  used
for the purpose of introducing drugs of differ-
ent kinds into the rectum.  The  drug is mixed
up  with cacao-butter, or some  fatty material
which is easily dissolved, and the ingredient  be-
comes absorbed into the circulation.  They are
shaped like a cone,  and may be introduced  by
the  patient himself, inserting  the  small  end
first, and pushing  it in well up into  the bowel.
If necessary, the nurse can  pass it, by previous-
ly oiling one finger and pushing the suppository
well beyond the sphincter, the patient lying on
the left side with  the knees well drawn up.
  Glycerine Suppositories are useful in consti-
pation,  and are of different sizes  for children
and adults, or the  large size (double  cone) may
be halved.
  Nutrient Suppositories  may be made  of sol-
uble meat or of meat peptone, and the  outside
should be oiled before introduction.

    Applications to  Eye, Ear, and Throat.
  Eye-Drops.—To  be efficacious,  the  fluid must
have access to the  surface  of the eyeball un-
derneath  the  lids.  The  patient,  sitting in a
chair, must throw the head well back,  the un-
der eyelid is then  drawn  down with  the finger,
and the upper lid drawn  up with the  thumb,
and a  drop is placed in  the eye  at the inner
corner near the nose; the patient's head  is then
tilted over so that the drop runs across  the eye
while  the lid  is  still  held up,  and the fluid
bathes  the  surface  of  the eyeball.  The fluid
may be  dropped in with  a drop-tube  or eye- 
APPLIANCES
313
dropper specially constructed, or a camel's-hair
brush may be used  for the purpose.
  Eye-Lotions or Collyria ought generally to be
applied  warm, absorbent cotton being used as a
sponge and destroyed afterward.  In inflamma-
tory and purulent discharge from one eye, great
care should be exercised to prevent the disease
from being conveyed to  the  sound eye, or to
the eyes of others by the nurse's  hands or by
the dressings.
  Ear-Syringing.—A syringe of  suitable  size
should  be  used,  capable  of  containing  several
ounces of fluid.  Two slop-basins are required,
one  to hold the fluid, and the other to receive
it as it returns from the ear.  To prevent the
water from running down the neck, a trough is
used which fits on to the ear, and is held in po-
sition by a spring passing over the top of the
head, or by a string round the ear (fig. 63); in
addition, a towel should be closely fitted round
the neck.  Warm water is  drawn into  the sy-
ringe, and the air discharged before introduc-
ing the  nozzle, which should be kept applied at
the upper  part  of the  orifice, while the upper
part of the  ear is  drawn gently  upward  and
backward.
  The fluid returns along the floor  of the canal,
and is  directed  by  the  trough into a  basin,
which can be held by the patient  ready to re-
ceive it.  Attacks of coughing or giddiness are
apt to accompany syringing of the ear, but soon
pass off.  When there is hard wax blocking up
the canal, it may be softened by introducing a
drop or two of warm olive-oil previous to using
the  syringe,  when it  may  be more easily re-
moved.
  In placing absorbent cotton in the ear to soak
up  discharges  of matter, the plug  should be 
 314   THE  NURSES  SERVICE DIGEST

 placed in the fold just outside the orifice, and
 not inside the canal.
  Throat Applications.—Gargles are employed
 for washing the tonsils and back of the throat.
 About half  an  ounce of the  fluid is  taken into
 the mouth,  the head being held well back, and
 moved from side to side so as to wash the fluid
 against the  back of the throat, or the breath is
 expired through the fluid, causing it to bubble
 and  extend to  the  adjacent parts.   Gargling
 should be repeated several times.
  Sprays are in many  respects more convenient
 than  gargles, and  are more  pleasant for  cases
 of  ulcerated  or painful  sore  throats.   The
 spray-producer is a simple contrivance by which
 fluids can be pumped in the form of a fine spray
 on to the tonsils and back of the pharynx.  The
 fluid  is introduced into  the  glass jar,  and the
 apparatus worked  by pressing the india-rubber
 hand  ball (fig.  64).
  Inhalations.—These are useful for the appli-
cation of remedies to the air passages in laryn-
geal and bronchial affections, or for asthmatic
 seizures.  Steam is often used by itself, or the
 vapor  is rendered  sedative, stimulant,  or anti-
septic by the addition of solutions to  the water.
  Inhalations may be managed in a simple man-
ner by covering over the mouth of a jug con-
taining boiling  water  with a towel or napkin,
leaving an aperture  of sufficient size to admit
the mouth and  nostrils.  The patient should sit
with the head bent over the  jug, and gradually
 bring  the mouth near to the  orifice  through
 which the  vapor  is  issuing.   The  breathing
should be quiet and natural, and  after six or
seven inspirations the face should be withdrawn
 for half a minute, and the process repeated at
 intervals for a period lasting from ten to twen-
 ty minutes.   The best time for inhaling is  be- 
APPLIANCES
315
fore bedtime, and the patient should avoid go-
ing out, or into a cold room,  for  some  time
afterward, if it has been performed in the day-
time.
  Vessels  of various  forms have  been devised
for inhaling; the simplest being an earthenware
vessel provided  with  a mouthpiece and  a tube
issuing  from the side to admit the entrance of
air.  The  vessel is filled half full by removing
the mouthpiece and pouring in  hot  water con-
taining  the solution  for inhalation,  or  else  a
sponge is  fitted into the mouthpiece and  the re-
quired number of drops poured on to it.
  The steam passes through the sponge,  and is
saturated  with the solution.
  Fuming  Inhalations are  used  in  spasmodic
asthma, either in the form  of cigarettes, nitre-
papers,  or powders.  The papers may be placed
on  a plate and allowed to smoulder, the smoke
being directed toward the patient's  mouth and
nose.  When the fumes of powders are inhaled,
they may  be conveniently  directed  in the fol-
lowing  manner:  A sheet of foolscap paper is
rolled into a sugar-loaf form, and the broad end
placed over the plate on which the powder is
burning.  The upper end of the cone is  opened
sufficiently to allow a stream of smoke to issue
forth under the  patient's nostrils.
  Bronchitis Kettle.—An ordinary  kettle may
be furnished with a steam pipe, and kept boil-
ing on  the fire,  or a special kind may be pro-
cured.   Some are provided  with a spirit-lamp,
and may  also   be  used for  the  vapor-bath
(fig. 66). 
               CHAPTER XV.

    THE  ANTISEPTIC TREATMENT—BANDAGING

The Antiseptic Treatment — Method — Impor-
  tance of Cleanliness—The Dressings—Bandag-
  ing—The Roller Bandage—Rules for Bandag-
  ing—Simple Spiral—Reversed  Spiral—Figure-
  of-8—Spica—Capeline—Leg  Bandage—Finger
  Bandage — Stump  Bandage — Many-tailed
  Bandage—T-Bandage— Slings— Pads—Sand-
  Bags.
  The Antiseptic  Treatment.—This method,
which  is almost  universally  adopted in  the
treatment of  wounds,  was introduced by  Sir
Joseph Lister, and is based upon the principles
of the Germ-theory, namely, that the putrefac-
tion in wounds exposed to  the air is not due to
the air itself,  but to the  solid particles floating
in it in  the form of dust.  This dust may  be
easily observed in the track of  a sunbeam as it
passes  through a room, and may be shown  by
the aid  of the  microscope to  contain a  very
great number of organisms—bacteria—varying
in their  size,  vitality,  and virulence, according
to  the unhealthiness  of  the  surroundings  in
which they have been developed.
  These  organisms are  the germs or spores
which,  when introduced into wounds, cause pu-
trefaction, inflammation  and suppuration,  ery-
sipelas, pyaemia, tetanus,  and the like; or when
inhaled into the interior  of the body, may  give
rise to one  or other  of  the infectious fevers,
such as scarlet fever or diphtheria.
                    316 
         ANTISEPTIC TREATMENT      317

  A wound which is kept entirely free from all
organisms will heal without fail, and the  best
antiseptic method is that which succeeds in ex-
cluding these agents in the most effective man-
ner.
  The completeness with which  these  minute
particles  can  be prevented  from  entering  a
wound must necessarily be limited;  hence, en-
deavor is also made to destroy any germs which
may  have succeeded  in gaining an entrance.
For this purpose, certain fluids found by experi-
ments to be detrimental to germs are used.
  Inasmuch  as the secretions and  discharges
from  the wounded surfaces, or blood  left in the
wound after operation, are a medium in which
germs are able to flourish and multiply with ac-
tivity, it is also a great object in the success-
ful treatment of wounds to make and preserve
the wounded tissues  in as dry a state  as  pos-
sible.
  Antiseptic  Method.—Although the methods,
materials,  and  fluids  used by surgeons differ
considerably, the principles are  the  same, and
everything and everybody  connected with the
operation has  to  be  subjected to a  process of
purification.
  Cleanliness  is the  first and most  important
virtue, and it cannot be too strongly insisted on.
It is useless to surround the wound with spray-
producers, and to employ all  the  paraphernalia
of antiseptic  dressings and  fluids,  if the pa-
tient's skin has not been previously cleansed, or
if the hands and nails of the  nurse or assistant
have  not received the necessary attention, or if
the room is full of impurities.
  In the case of operation it will  be the nurse's
duty  to see that the  room has been  thoroughly
cleaned, and all unnecessary furniture,  or ar-
ticles that are likely  to harbor  dust, removed. 
31S  THE NURSE'S SERVICE  DIGEST

She will also be expected to ascertain that the
patient  is thoroughly clean, and that the gar-
ments worn at the operation are clean.
  The hands of aU those assisting at the oper-
ation, the instruments, sponges, and  everything
required to  come into contact with the wound
will have to be rendered aseptic, and the skin
in the neighborhood of the  part  to be operated
on must be  thoroughly purified.
  The  nurse  should prepare  a basin  of  hot
water, soap, and  a  nail brush; after the hands
have been thoroughly cleaned,  they  should be
dipped in a solution of perehloride of mercury
(1 to 2000) or in  carbolic  solution  (1  to 20).
Before the operation, the patient's skin should
be scrubbed over with hand sapolio  or  a good
soap, and the parts to  be operated  on  shaved,
then washed over with the perehloride,  or  car-
bolic solutions.
  In some cases it  may be necessary to employ
a preliminary washing with  alcohol.  Mackin-
tosh sheets, or a sheet  of thin rubber,  covered
with hot carbolized  towels,  should  be spread
over the blankets covering  the patient,  and  ar-
ranged  so as  to surround the part to be oper-
ated on.
  The instruments  are prepared beforehand by
being boiled  for  ten minutes,  and are then
placed ready in a  tray containing the carbolic
solution (1  to 20).
  Sponges or mops  should be wrung  out in car-
bolic solution (1 to 40)  before the operation,
and the sponges  should be  thoroughly cleansed
in 1 to  20 afterward, and kept in  a  jar of this
solution.

                The Dressings.
  The  Dressings.—After the wound and  the
surrounding  parts  have   been   thoroughly 
         ANTISEPTIC TREATMENT      319

cleansed from blood, etc., with an antiseptic so-
lution,  the  soiled towels are  removed, and  a
clean towel wrung out in perehloride of  mer-
cury  (1 in  2000)  should be  placed  around the
wound.   The dressing is then applied.   It gen-
erally  consists  of layers of double  cyanide
gauze, wrung out in  carbolic (1 in  40), and
over this some antiseptic cotton  is placed, and
then a bandage.
  Before applying the gauze to the  wound, the
amount  required  for the dressing  should  be
placed in a basin of boiling water.  It should
then  be squeezed tightly, and shaken loosely
out before use.  The  gauze must be covered by
layers of salicylic, or  other  antiseptic cotton,
and  over this a light  bandage of  carbolic gauze.
If pressure is  needed,  a flannelette  bandage
should  be applied over all.

                  Bandaging.
  The art of bandaging can  only be learned by
practice, but  there  are certain fundamental
principles  which  require  to be  known.  The
simplest form of bandage is  the  roller  bandage,
and  this can be used for all purposes.
  Roller  Bandages  are made  of  unbleached
cotton,  flannel, or domett.   The length should
be from six to eight yards, and the  width must
be suitable to the part to be bandaged.
  For  the  head  and  upper  limb,   the width
should  be two and a half inches, for  the lower
limbs three inches,  and  for the  trunk four
inches,  while for the fingers three  quarters of
an inch is sufficient.
  After the selvedges have been removed from
the  material, the bandage should be rolled up
evenly  and firmly by the hand, or by a winding
machine.  Starting at one end, the strip should
be doubled upon  itself  into a small  roll, and, 
320  THE NURSE'S SERVICE DIGEST

being held between the forefinger and thumb of
each hand, it is rolled tightly up (fig. 67).

            Rules for Bandaging.
  1.  Fix the bandage by two or three turns,  one
over the other, the outer surface of the  roller
being next the skin.
  2.  Bandage  from  below upward,  and  from
within outward, over the front  of the limb.
  3.  Use firm equable pressure throughout.
  4.  Let  each  succeeding turn overlap  two-
thirds of the preceding one.
  5.  Keep all the margins parallel,  and let the
crossings  and reverses  be in one line, and  to-
ward the  outer aspect of the limb.
  6.  End by fixing the  bandage securely.
  In order to carry a bandage evenly up a limb,
it is necessary to use  a combination of three
different turns,—the simple spiral,  reverse,  and
figure-of-8 (fig. 6S).
  The  Spiral  Bandage is  used  only when  the
circumference  of  the part increases by very
slight degrees, and consists in covering the part
by a series of spiral turns, each overlapping the
one below for about two-thirds  of its width.
  The Reverse or  Reversed  Spiral is  mostly
used for  bandaging a  limb, owing to the  en-
largement of the limbs at the upper part.  The
bandage is carried  up in the spiral form,  but
turns or reverses are made to  accommodate it
to the shape of the  limb.  To make these turns
evenly,  the bandage should be held quite slack
at the moment of  reversing,  and  not unrolled
more than is  necessary  to make  the reverse.
All the reverses must be carried one above  the
other  along  the outer  side of  the limb,  and
should  never be made  over  a  prominence  of
bone.
  Figure-of-S  Bandage.—The nature of  this is 
         ANTISEPTIC TREATMENT      321

indicated by its name, and it is useful for car-
rying a  bandage over  a joint, and  for other
purposes.  The end  of the bandage is  made fast
below the joint, or else the roll is carried  on
from  the reversed  spiral, up in  front  of  the
joint, behind the limb above the joint, and down
again in front, and continued in the same man-
ner until the joint is quite covered in (fig. 69).
  The Spica is an adaptation of the  figure-of-8
bandage, and  is useful for retaining  dressings
or applications to the groin, or  for  bandaging
the breast.
  To  bandage  the  groin, two turns  should be
made round the thigh of the affected side from
within  outward, then  the  bandage  is  carried
along the  lower part of the groin  over  the
dressings round the pelvis, and  back over the
lower part of  the abdomen, crossing the former
fold at  the groin, and completing the figure-of-8.
The remainder of the groin is covered  in in a
similar  manner (fig. 70).
  To bandage  both groins, the double spica  is
used, the bandage being used in a similar man-
ner as for one groin, but is brought down from
the opposite side of  the pelvis to  form a loop
round the other groin.
  7"o bandage the breast.—Two turns are to be
taken round the waist, immediately  below the
breast,  in  order to fix the bandage, which  is
then  carried under the affected organ and over
the opposite shoulder; then  around  the waist,
so as to fix the former turn, and again under
the breast and over the shoulder as before, un-
til  the  part is sufficiently covered.  The breast
should  be gently raised and supported while
the bandage is being applied  (fig. 71).
  The two breasts  may be bandaged separately
with the spica, or the many-tailed bandage  may
be used for retaining dressings in  place. 
322   THE NURSE'S SERVICE  DIGEST

  To bandage the head.—For ordinary purposes
it is  sufficient to carry two turns of the band-
age  round the forehead and occiput, and then
fastening the bandage  behind  one of the ears
to carry it round the chin and over the  top of
the  head.  The bandage should be pinned  or
sewed where the turns cross  one another,  to
make it  secure.
  Capeline  Bandage.—To cover in the  whole
head  by  this method,  two rollers are fastened
together  as  shown in fig. 72,  one being rather
longer than the other.   The larger roll should
always circle round the head, while the smaller
should travel backward  and forward, the hori-
zontal turns serving to fix the  vertical.   In
keeping  this  bandage, it is necessary  to keep
the first  circle low down close to the brows in
front, and well below the occiput behind.  The
middle of the roller is laid against the  fore-
head, and the ends  passed behind the  occiput,
where they  are  crossed.  After this  one end
continues to  encircle the head, fastening down
at the forehead and occiput the other end  of the
roller which  is carried  backward  and forward.
The  second head of  the bandage starting from
the occiput  is brought  over  the crown to the
bridge of the nose in the middle line, and after
being fixed is brought back on the right of the
mesial line  to  the occiput, where it  is  again
fixed  and carried forward  to  the left  of the
mesial line.   This arrangement is repeated un-
til the whole of  the  scalp has been  covered
over (fig. 73).
  To  bandage the eye, take a  turn once  round
the head and then bring across  the  eye diag-
onally behind the ear of the same side; a small
square of linen and a pad of absorbent cotton
should be placed  over the closed  lid before the
bandage  is  applied.   If it is desired  to get 
         ANTISEPTIC TREATMENT      323

pressure upon the eyeball, the bandage should
be brought upward across the eye in the reverse
direction to the diagram (fig. 74).
  To bandage the leg, one or two turns are car-
ried round the foot close to the toes,  and  the
remainder of the  foot  covered  by the reverse
turns;  a figure-of-8 is  then  made round  the
ankle,  leaving out the  heel.  The bandage is
carried up the leg by reverse turns to the knee,
where the figure-of-8  is again  used,  and  the
thigh covered by  the  simple  spiral or reverse
turns if necessary.
  To  bandage the finger.—A bandage of half or
three quarters of an inch should be used.  One
or two  turns are made round the wrist, leaving
out a  loose  end; the  bandage is  then brought
over the back of the hand and taken in a series
of spirals to the tip of the finger which it sur-
rounds.  A series of regular spirals are made in
an  opposite  direction  to the root of the finger
again,  and the bandage is  then  taken across
the back of the hand, and tied  round the wrist
with the loose end left on commencing.
  To bandage a stump.—This is  first fixed by
simple   turns  below  the  nearest  joint,  and
brought downward in  figure-of-8 round the limb
till the  end  of the  stump is  reached,  which is
next  covered in by oblique and circular turns
carried  alternately over the face of  the stump
and round the limb.  If a double-headed roller
is used,  it may  be applied in  the manner di-
rected for the capeline bandage.
  Many-tailed  Bandage.—This form  of band-
age is useful for retaining  dressings on the
limbs, abdomen, or breast, so that the dressings
can be  renewed with  as little disturbance to
the patient as possible.
  For  a limb, it  is only necessary  to take a
piece of bandage the length of the limb and lay 
324   THE NURSE'S SERVICE  DIGEST

across it strips  of  another roller, long  enough
to go once and  a half  round the limb.   These
are tacked at the center at right angles  to the
central  strip,  so as to  overlap one  another by
one-third.  The long central piece is  then placed
behind  the  limb, and  the  cross pieces folded
round separately, commencing  from below  and
crossing one another in front.
  The many-tailed bandage for the  abdomen is
often  used after ovariotomy or abdominal  sec-
tion, and should be made of flannel, the strips
being  cut of a length suitable for the patient.
  The T-Bandage is useful for retaining dress-
ings on  the perineum.  It is'formed of one piece
of bandage  to go round the waist,  and fasten
by  tying or a safety-pin;  to the center is at-
tached another piece to  pass between the thighs,
being  fastened in front to  the  circular portion.
This vertical  piece  may be conveniently split
toward  the  end, so as  to pass on each  side of
the scrotum, and is useful for keeping dressings
upon  the  groins.  An  extemporary  T-Bandage
may be  formed from an ordinary roller  by  fas-
tening it round  the waist with a knot in front,
and then carrying  the  end  between  the thighs,
on one  side of the  genitals, looping  it over the
circular band behind, and bringing  it forward
again  on the other side of  the genitals  to  fas-
ten in front.  For females, an ordinary diaper
may be  used as  the vertical portion.

        Slings,  Pads, and  Sand-Bags.
  Slings.—A sling  for  the  hand or wrist may
be formed by a  large handkerchief  folded into
the shape  of a broad cravat, which can then be
knotted round the  neck, so as to  support the
hand rather above the level of  the elbow.
  Slings for the Arm.—A  large handkerchief
must be folded into a triangle, and placed with 
         ANTISEPTIC TREATMENT      325

the base  beneath the wrist.   The  end of the
sling in front of the affected arm is then passed
over that shoulder  to meet its fellow at the
back  of the neck.  The apex  of the  triangle
may be brought round the elbow and pinned in
front.
  Pads for  splints may be made of tow care-
fully  teased out, or of  absorbent cotton.  The
covering should be of soft cloth, muslin,  or old
linen.   The pad  should be  made  to slightly
overlap  the splint in  all directions.   Disused
pads should be burnt,  and the splints washed.
  Sand-Bags  should  be kept  in readiness to
support injured limbs or cases of fracture.  The
covering  may be of soft leather or strong cal-
ico.   The sand should be fine  and well dried,
and the bags need only be  three-quarters filled. 
CHAPTER  XVI.
       ARTIFICIAL RESPIRATION—APPLICATION OF
                ELECTRICITY—MASSAGE.

    Artificial Respiration—Clinical Thermometer—
     Hypodermic  Injection—Transfusion—Batter-
     ies—Application  of Electricity—Massage,  or
     Rubbing.

                Artificial Respiration.
     Artificial Respiration is required for cases
    of suspended animation  after hanging, drown-
    ing,  suffocation from noxious gases, or for fail-
    ure  of  respiration  in  chloroform  inhalation.
    Asphyxia, or deficient oxygenation of the blood,
    is the main cause of the condition, and the pa-
    tient lies in a state of insensibility, the respira-
    tory  movements are  absent,  the pupils  often
    widely  dilated, and the  countenance and ex-
    tremities livid or dusky  pale.  The heart  may
    continue to beat for some time,  and if  the res-
    piratory movements are artificially kept up, life
    may be saved.  In cases  of this  description  no
    time  should  be lost in carrying  out  the move-
    ments, with the greatest  possible promptness.
     Sylvester's  Method   (fig.  75).—Loosen  all
    clothing about  the  neck, chest,  and abdomen,
    and  lay  the person  on his  back  on the ground.
    Clean the mouth of dirt,  blood, etc., and extend
'    the  neck by  throwing the  head well  back,  a
    support  being  placed  under the  shoulders.  If
    the chin be well kept up, there  is no need for
                         326 
        ARTIFICIAL RESPIRATION     327

the tongue to be drawn out of the mouth. Stand
or kneel at the patient's head, and take hold of
the arms  at the elbows and  carry them  well
upward until  the hands meet above  the head.
The chest walls are expanded by this movement
and air enters the  lungs, as  in  inspiration.
After  a pause  of  two or three seconds, the
arms  are  brought down against  the  sides and
front  of the chest, forcible pressure being made
by  the  operator leaning over  and bringing the
weight  of his body to bear on the chest for a
moment.  By  this second movement the air  is
expressed from the lungs, as in expiration. In
three or four  seconds the same series of move-
ments are repeated,  about fifteen  respirations
being made per  minute.  The process should be
steadily continued for an hour or  more before
success is despaired of.
  When natural breathing is  restored,  the cir-
culation should be encouraged by  rubbing the
limbs  in  a  direction  toward the heart,  and
warmth may  be applied by a hot  blanket, hot
bottles, etc.   Stimulants may be given by the
mouth  as soon  as the  patient is able to swal-
low;  or, if the collapse is  great,  stimulant ene-
mata may be  administered.

        How  to Take the Temperature.
  Clinical Thermometer (fig. 76).—The bodily
temperature is ascertained by this instrument,
which is self-registering, and ranges from 90 to
112 degrees F.   Each  degree is marked  by a
long line, and divided into five parts, each part
representing two "points" or tenths of a degree.
An arrow commonly marks the average temper-
ature of health  or the "normal" temperature at
98.4 degrees.  The index marks the  temperature,
and is  either  a small portion of detached  mer-
cury  in the steam  of  the instrument, or else 
32S   THE NURSE'S SERVICE DIGEST

the whole column is cut off just above the bulb
and makes its own  index.
  Before taking the temperature, the  index  or
mercury should be shaken down below the nor-
mal  point, by a  rapid  swing of the arm,  the
stem  being firmly held in the 1 and.  The bulb
is then introduced  between  the folds of  the
skin in the armpit,  the  elbow being drawn for-
ward  across the chest, or else it is placed under
one side of the tongue,  and the patient told to
close  the lips.   The thermometer should be left
in position for five minutes,  and the temper-
ature read from  the upper end  of  the  index,
and noted on  the chart.  Temperatures should
be taken as far as  possible at the  same hours
each  day,  the morning  and evening being suf-
ficient in most cases; the time of the day may
be stated on the temperature chart.  In a case
of  doubtful   temperature,   the  thermometer
should be introduced a  second time.
  In some instances it is advisable  to  take  the
temperature in  the rectum; the  bulb,   being
previously well oiled, should  be introduced  for
about an inch  and a half, and retained for five
minutes.
  The thermometer should always be carefully
cleansed after  taking a temperature.

           Hypodermic Injections.
  Hypodermic  Injections are usually given by
the medical attendant  himself, but in excep-
tional cases it may be necessary  for the nurse
to be  able to use them.  By this process a  small
quantity of fluid containing  the  drug in  solu-
tion  is injected under  the skin, and  becomes
absorbed in a short  time.
  The syringe  (fig. 77) is a small glass cylinder
marked to show the number of drops.  The fluid
is drawn in by means of the piston, and the end 
        ARTIFICIAL RESPIRATION     329

of the cylinder  is fitted with a  hollow needle.
To give the injection, the needle  should first be
ascertained to be clear, and the  required num-
ber of drops drawn in by putting  the  point of
the needle in the fluid and elevating the piston.
The syringe should next be held  with  the point
upward and air-bubbles allowed to escape.   A
fold of skin is then pinched up on the back of
the elbow between the finger and thumb,  and
the needle pushed  quiekly under the  skin into
the loose  tissue  beneath, when the  fluid may be
slowly injected.  The needle is then withdrawn,
and the finger placed over the  puncture for a
moment to prevent the fluid returning.  After
using, a stream of water should be drawn into
the cylinder and the needle cleansed.
  Transfusion or Infusion.—In prolonged syn-
cope  or collapse  from extreme  loss  of blood,
transfusion is often performed by  the surgeon.
A special apparatus  is used, or,  in  cases of
urgency, a large glass syringe and india-rubber
tubing  can be  improvised.  The  nurse would
have  to get ready aseptic vessels, a  measure
glass, and hot water;  aseptic gauze  and band-
ages  for the wound in the veins, and  some salt
solution containing one dram to a pint of water
at  a  temperature  of  100  degrees,  unless  some
other saline solution is ordered.

     Batteries.—Application  of  Electricity.
  Two forms of electricity are used  in medi-
cine:  one the continuous or galvanic current,
the other the interrupted or faradic current.
There are several  different  methods of obtain-
ing the galvanic current, but one common form
in  use is composed of a metal  and carbon im-
mersed in a corrosive fluid.  One  arrangement
of  this fluid is  called a "cell,"  and a  combina-
tion  of several  of these cells forms a galvanic 
330   THE NURSE'S SERVICE DIGEST

battery.   For  medical  purposes,  a battery  of
from  twenty to fifty cells is  usually employed,
and the number in use can be regulated at  the
will of the operator by contrivances which vary
in the different kinds of machines.
  The Electrodes, or instrument  by means  of
which the electricity is applied,  are furnished
with  insulating handles  to  prevent  the  current
passing through  the operator.  They are  pro-
vided at one end  with a  sponge, or else are cov-
ered over with wash-leather.
  The faradic  or  interrupted current is of in-
stantaneous duration, and  occurs only at  the
moment of  making  or  breaking  contact.   The
battery is connected with an induction coil, and
a special  mechanism is  provided  for automati-
cally  making and breaking the primary or  the
secondary current, a spark of electricity being
produced at this point.  The primary or the sec-
ondary current can be  employed  at will by a
simple mechanism, the  latter being by  far  the
stronger  of the two, and the strength of  the
current  may be varied by the dial regulator.
  Before applying the current, the nurse should
ascertain  how to make the necessary wire  con-
nections of the battery  in use, and how to reg-
ulate  the  strength  of  the current;  and   she
should receive  instructions as to the  strength
of the current to be applied in the particular
case,  and  the duration of the application.
  If the electricity is to be  limited in its action
to the skin, the  electrodes must be used dry
and the skin powdered.  But if,  as is  usually
the case, the muscles and nerves are to  be acted
on, the  skin must be thoroughly  moistened by
sponging  over  with water  or salt  water,  and
the electrodes kept moist during the whole time
of the  application.   One electrode is  usually
held still  at a  certain part while the  other is 
        ARTIFICIAL RESPIRATION     331

moved gently to and fro over the  muscle or
group of muscles requiring to be stimulated.
  It is  advisable  always  to commence  with
weak   currents,   gradually   increasing   the
strength, and attention should be paid to com-
plaints  of  pain,  and to the muscular contrac-
tions produced by  the application of  the inter-
rupted current.
  Great benefit often ensues in cases of paraly-
sis  from spinal  or  nerve disease, and in differ-
ent forms of hysterical seizure, after the use of
electricity.

                   Massage.
  Massage, or Rubbing, is useful in restoring
the muscular nutrition, in increasing  the activ-
ity of  the  circulation, and in relaxing the stiff-
ness and fixation of joints after injury. It can
hardly be  learned  without personal instruction,
and this can usually be obtained at the various
institutions and hospitals in which cases requir-
ing massage are treated.
  The method is well described by E. M. in the
Appendix  of Dr. Playfair's small work on The
Systematic Treatment of Nerve Prostration and
Hysteria:—
  "The patient  lying in a blanket, begin at the
feet by taking up  the skin over the whole sur-
face and firmly pinching it, twisting the toes in
all directions, kneading the small muscles with
the ends  of  the fingers and  thumb, the  large
muscles of the legs  with both hands, grasping
alternately, frequently running the hand firmly
up the leg and striking the muscles very often
with the side of the hand.  Before commencing
the kneading of any  of the limbs,  rub  them
freely with cold cream, and  the more oil a pa-
tient's  skin absorbs the sooner does she  begin
to  make flesh.  The hands and arms are manip- 
332  THE NURSE"S SERVICE DIGEST

ulated  in the  same way, working  upward  (fig.
79). The patient then lying flat upon her back
with the knees up, the abdomen is first pinched
all  over,  and  then  the abdominal  walls  are
firmly grasped in both hands, one hand grasping
as the  other relaxes.  This part of the body is
finished by the hands being placed one on each
side just below the ribs, and firmly drawing the
flesh forward,  especially in the direction of the
colon.  Great  attention should be paid to this
part of the body, if the patient is troubled with
indigestion.  The patient  now lying  quite  flat
upon her face,  commence  at the nape of  the
neck, and pinch up the muscles on either side
of the vertebrae, and  along  the whole of  the
back.   Then place the two  first fingers of  the
right hand, one on each side of the spine, and
make  a  sweep  downward  the length of  the
spine; this should be done several times quick-
ly.  By  working at  tender spots longer and
gently,  the  tenderness  soon  disappears.   The
patient  must be taught to  relax  all  the mus:
cles of the body, and to  lie perfectly passive,
otherwise she  will  be much  bruised, and  the
massage, instead of being a pleasure, will be a
source  of pain.  Toward the end  of  the treat-
ment, the limbs are exercised by movements of
flexion  and extension, especially the legs in  the
case of a patient who has not walked  for years.
In the  first  day or two,  about twenty minutes
is sufficient,  but in about a week the  patient is
able to bear the full  time  (an hour and a half)
twice a  day, and she should then be left in  the
blanket for about an hour to rest quietly." 
CHAPTER XVII
            cooking  fob invalids.

Gruel—Arrowroot—Toast  and  Water—Barley
  Water— Imperial Drink— Linseed-Tea—Rice
  Water — Lemonade—Orangeade—Egg - Flip—
  Liebig's  Quick  Beef-Tea — Beef-Tea — Fluid
  Beef—Infusion of Raw Meat—Chicken Broth
  —Mutton Broth—Veal  Broth—Meat Panada-
  Meat Jelly—Raw Meat Pulp—Peptonized Milk
  Peptonized Beef-Tea — Tea — Revalenta  Ara-
  bica—Chicken Cream—Caramel  Custard—Po-
  tato Soup — Scotch Collops — Fish  Omelet—
  Filleted  Sole —Turbot Souffle —The Fin of
  Turbot—Macaroni—Light  Pudding—Calves'
  Feet Stewed.

  Gruel.—One pint of gruel  is made by placing
two dessertspoonfuls  of  patent  groats in a ba-
sin, and gradually stirring  in two  tablespoon-
fuls of cold water.  Next pour the mixture into
a stewpan containing 1  pint of boiling water,
and let it boil for ten minutes, stirring it con-
tinually.
  If the gruel is for a cold, stir in a small  piece
of fresh butter and sweeten it, adding two  ta-
blespoonfuls  of brandy or rum, if the patient
is not feverish.
  A  Cup  of Arrowroot.—Ingredients.—A des-
sertspoonful of arrowroot, half a pint  of milk.
  Time required,  about a quarter of an hour.
  Take a  dessertspoonful of  arrowroot and put
it  in  a small  basin,  add a  dessertspoonful of
                     333 
334  THE NURSE'S SERVICE DIGEST

cold milk, and stir smoothly into  a paste  with
a spoon, adding a  small  teaspoonful of sugar,
according to taste.  Take  a  small saucepan and
put  hah*  a  pint  of cold  milk in  it;  put the
saucepan on the fire, and  when it is quite boil-
ing pour it on to  the arrowroot paste, stirring
all  the time.
  A more nourishing preparation may be made
by  adding to the  mixture above described the
yolks of  two eggs, whipping it  all well  to-
gether.  But the eggs should not be added  until
the  mixture  has cooled a  little,  or they will
curdle.
  Toast  and Water.—One  quart  of toast and
water may  be made by  browning a crust  of
bread before the fire, and placing it in a  glass
jar, after which  1  quart of cold water is poured
over it.  The jar  should  then be covered, and
allowed to stand aside for half an hour.
  Barley Water.—Xbout  half a  pint of barley
water  may  be  made  by  taking  2  ounces  of
pearl barley,  and  washing  it well  in  several
waters,  after  which  a  quarter   of  a lemon
should be carefully peeled  and  placed in the
jar with the washed barley and two lumps of
sugar.   Pour a  pint of boiling water  into the
jar, and set it aside to cool.
  Imperial Drink.—Place a dessertspoonful of
cream of'tartar  and two tablespoonfuls of pow-
dered sugar in a jar.  Pare the rind of a lemon
very thin, and cutting it into little slices,  place
them in  the jar.  Next pour 1 quart of boiling
water into the  jar.  Cover the jar  and  let it
stand until it is cold, then  strain  it.
  Linseed-Tea is  an excellent drink for  many
patients, but should not be given to those who
are taking iron,  lead or copper as  medicines.  In
order to make it, take 1 ounce of sugar and  the
same quantity  of  whole linseed,  adding four 
          COOKING FOR INVALIDS      335

tablespoonfuls of lemon-juice and half an ounce
of licorice-root.  This mixture  should be placed
in a jar, and 2 pints of boiling water poured
over it.
  The  jar should remain  for  four  hours in a
hot  place, after which the  contents  may be
strained and used.
  Rice  Water.—Ingredients.—Three ounces of
Carolina  rice,  1 inch of  cinnamon  stick,  and
sugar.
  Wash 3 ounces of  Carolina rice  in  two or
three waters.  Put 1 quart of  warm  water into
a stewpan, and place it on the fire to boil.  Put
the rice and 1 inch of cinnamon stick into the
stewpan with a quart of boiling water, and let
it boil for one hour.  Then strain the rice water
into a  basin, adding sugar according to taste,
and when cold it will be ready for use.
   Lemonade.—After having placed the kettle on
the  fire,  take  two lemons, and after washing
them clean, peel them very thinly.   Cut off all
the pith or white skin, and cutting  up the lem-
ons  into  thin slices,  take out  all the seeds and
put  the slices of the lemons into a jar, adding
about  1 ounce of loaf-sugar, according to  taste.
Pour one pint and  a half of  boiling water on
to  the lemons  in  the jar, and cover it over.
Put it aside to cool.  When quite cold, the lem-
onade should be strained into another jar ready
for use.
   Time required, about two hours.
   Orangeade.—Pour boiling water on a little of
the  orange,  covering it  up.   Boil  some water
and  sugar  to  a  thin  syrup, and  skim  it.
Squeeze the juice out of the  oranges, and mix
it with the syrup, but not until both  are  cold.
Add as much water as will make a rich  sher-
bet, and strain  it  through a jelly-bag.  It is
then ready for use. 
;!36  THE NURSE'S SERVICE  DIGEST

  Egg-Fltp.—Beat half an  ounce of powdered
sugar and the yolks of two eggs together, add-
ing eight tablespoonfuls  of  brandy  and  eight
tablespoonfuls of cinnamon and water previous-
ly mixed together.
  Liebig's Quick  Beef-Tea.—Ingredient.—Half
a pound  of gravy-beef.
  Time required, about a quarter of an hour.
  Cut up half a pound of gravy-beef very fine,
removing all the skin and fat, and place it  in
a saucepan with half a pint of water.   Put the
saucepan on the  fire, and  let it boil  quickly.
After it has boiled for five minutes, then pour it
off into a cup, and it is ready for use.
  Beef-Tea.—Ingredient.—One pound of gravy-
beef.
  Time required, about six hours.
  One  pound of gravy-beef should be placed on
a board,  and minced up very finely, all the skin
and fat being removed.  The meat should then
be put into a saucepan with one pint and a half
of cold water, half a saltspoonful of salt, and  a
little  pepper.   When  just  boiling,  remove the
saucepan to the side of the  fire  and let it sim-
mer gently for five or six hours with the lid on.
Next pour off the beef-tea, and let it get cold.
  It is well to skim all fat from the  beef-tea
before warming it up for use.  But it  is better
not to strain beef-tea,  as this removes all the
little brown particles which are most nutritious.
  Fluid  Beef.—Take 1 lb. of  newly-killed beef,
chop it fine; add four wineglassfuls of soft  or
distilled water, four or six drops of pure hydro-
chloric acid, a saltspoonful  of salt, and stir  it
well together.
  After  three hours throw the whole on a coni-
cal strainer, and let the fluid pass without pres-
sure.
  Pour a wineglassful of soft  or distilled water 
         COOKING FOR INVALIDS      337

slowly on the flesh residue  in the strainer, and
let  it  run through  while squeezing the meat.
The resulting fluid has a red color and a pleas-
ant taste of soup.  A wineglassful may be taken
at pleasure.  It must not be warmed more than
by partly filling a bottle with it and placing the
bottle in hot water.   A little spice or Worcester
sauce,  or a wineglassful of claret, may be added
to each teacupful  of soup to disguise the flavor.
The acid may be omitted if not desirable.  Fowl
may be used instead of beef.  (Dr. Broadbent)*
  Infusion of Raw Meat.—This is made from
meat chopped up finely or passed  through a
meat chopper, and left to soak in half its weight
of  water  for two  hours;   then  it  is  pressed
through a  cloth  so  that the juice remains  in
the water.   Infusions of raw meat  should not
be kept  longer than  twelve  hours,  and  then
only in ice or in  a  cold cellar, as they  are apt
to  get rancid.  If  made  from raw meat,  an
infusion has the  color of  blood  and is, there-
fore,  disagreeable to most patients.  Veal  in-
fusion is not so nourishing as  that  made  from
beef or mutton; chicken infusion is least nour-
ishing, but most appetizing.  Meat infusions
should never  be  cooked, but may be  flavored
 with a  slice of lemon or  a little  claret when
 taken cold.  They may also be added  to  ordi-
nary beef-tea, Armour's or Liebig's extract of a
moderate  degree  of  heat;  a few tablespoonfuls
of the infusion are enough  at a time.
   Chicken  Broth.—Skin and  chop up half  an
 old fowl or chicken,  then place it in a  stewpan
 with a quart of water, adding  a sprig of celery
 or parsley, a bit of mace, with  a crust of bread,
 salt and pepper.

   * N.B.—Valentine's  "Meat Juice" may be used
 as a  substitute  for  "Fluid Beef,"  and, like it,
 should only be warmed by placing the vessel con-
 taining it in hot water for a few minutes. 
338  THE NURSE'S SERVICE  DIGEST

  When sufficiently  boiled,  take  off the  broth,
strain it, and skim  it when  cool.
  Thin  Mutton Broth.—Take off the fat and
skin from two  chops from  the neck or loin of
mutton.   When chopped into thin bits,  boil them
for half an hour, in three-quarters of  a pint of
water, with a little  thyme and parsley. Let the
broth boil quickly,  skimming  off  all  the fat.
  Two  tablespoonfuls of powdered biscuit may
be  added to each  pint,  and boiled  with the
broth for five  minutes, stirring  briskly, if the
broth is not sufficiently nutritious.
  Mutton Broth.—To  make 2  quarts of mut-
ton broth, take 4 lbs. of  the scrag end  of the
neck of mutton, and chop  it into large pieces
on a board,  taking  away the fat  Place it in a
stewpan  with  two  knuckle bones  of mutton,
and pour  5  pints of cold  water over it, adding
a saltspoonful of salt.  When it  is just boiling,
put it aside, and let it simmer  gently for four
hours.  Watch it, and skim  it frequently.  Drain
the stock into a basin, let it cool and  form into
a stiff jelly.  Remove all fat from the surface
of the stock, so as  to take  off every particle of
grease.  After  this  the stock should  be ready
for use.
  Veal  Broth.—Mince up  1 lb. of  lean veal
without bone,  and  putting  it into  a  quart of
cold water with a little salt, simmer beside the
fire for  three hours.
  The broth is  rendered more nutritious  by the
addition  of  two tablespoonfuls of pearl barley,
rice, or  tapioca, which should  be  soaked for
twelve hours, then  boiled  till soft, and added
when the broth is heated for  use.   A  small
piece of onion may be added when desired.
  Meat  Panada.—Grate  an  ounce  of  stale
bread-crumbs, and after having  soaked them in
boiling water, mix  them with about three-quar- 
          COOKING FOR INVALIDS       339

ters of a  pint of chicken or veal broth or beef-
tea; it should then be  boiled until it thickens,
when it is ready for use.
  Meat Jelly.—Put one small  carrot and  one
small onion to fry in a  little butter with a slice
of bacon in a saucepan  (a small piece of  celery
may be  added).  Let  it all fry together  for
about 10 minutes, taking care it does not burn.
Take 2 lbs. either of veal or shin of beef, or a
chicken;  cut it up and put into  the same  sauce-
pan with the fried vegetables with 2 pints of
cold water and a teaspoonful of salt; let it sim-
mer till it is reduced to about three-fourths of
a  pint.   This will take about  6 hours.  Then"
strain off through a fine strainer, and  when
cold take off the fat.  It wiU then be ready for
use.
  If  preferred,  the meat  can be  put  in  an
earthenware jar in the oven instead of in the
saucepan.
  Raw Meat Pulp  is  made by rubbing meat
through  a grater, when it may be made into
sandwiches  flavored  with  cod-rce  or a very
small quantity of anchovy  paste.
  Raw meat pulp may also be run through a
meat-chopper and made into sandwiches.
  Peptonized Milk (Roberts).—Mix three-quar-
ters of a pint of fresh i ilk with a quarter of a'
pint of water, and warm in a saucepan  to the
temperature of about 140° Fahr.'then pour into
a glass jar or basin; add two  teaspoonfuls of
Liquor Pancreaticus and half a level teaspoon-
ful of bicarbonate of soda,  stir, and place near
the  Are  to keep warm.  In a  few minutes a
considerable change will  have  taken place in
the milk, but in most cases it is best to allow
the digestive process to go on for  from ten to
twenty minutes.  A few trials will indicate the
amount of peptonization acceptable to the indi- 
340   THE  NURSES  SERVICE DIGEST

vidual patient;  and as soon as this is  reached
the milk  must be boiled  up to prevent further
peptonization, if it  is not  required by  the pa-
tient  at once.*  Rut, if possible, it is better td
use the milk without the  flnal boiling,  as the
half-finished process of digestion will go on for
a time in  the stomach.
  Peptonized Beef-Tea.—Half a pound of finely
minced lean beef is mixed with a pint of water.
This  is allowed to simmer for an  hour and  a
half.   When it has cooled down to  a lukewarm
temperature (about 140° Fahr.)  a tablespoon-
ful of the Liquor Pancreaticus is added, and it
is then kept warm for two  hours, and occasion-
ally  stirred.  At  the end of this  time it is
boiled for five minutes, a^d the liquid portion,
measuring about half a  pint, is  strained  off.
Beef-tea  prepared in this way is  rich  in pep-
tone,  highly nutritious, -and of very  agreeable
flavor.
  The Liquor Pancreaticus, or  Peptonizing Pow-
ders,  are  prepared  by  Armour, and may be ob-
tained from any chemist.  Full directions  are
given with these preparations  for pancreatizing
and peptonizing  most forms of foods.
  Tea.—Tea may be made with boiling milk in-
stead of water, allowing it  to  stand from three
to four minutes.   (Sir Andrew Clark's recipe.)
  Revalenta  Arabica.—Mix  a teaspoonful  of
the Revalenta in a dessertspoonful of cold milk
until  it is  quite  smooth.  Have  a breakfast-
cupful of  boiling milk; stir in the mixture and
add a little salt.  Continue stirring from half
an hour to  an hour until all rawness has gone.
Serve like white soup.
  Chicken  Cream.—Take half the  breast of a

  • The addition of  a  little coffee to the milk
covers the  slightly  bitter taste caused  by  the
Liquor Pancreaticus. 
         COOKING FOR INVALIDS       341

chicken, cut it up very  fine, then pound it in a
mortar.  Put a  small teacupful of milk into a
little saucepan and heat it, then add the pound-
ed  chicken  by  degrees, stirring  all the  time
until  it  is  of  the consistency  of thick  soup.
Put in a pinch  of salt and pepper and one or
two tablespoonfuls of  cream to  taste.   Serve
hot.  This  may  be made with veal, mutton, or
beef, but the meat must be always run through
a meat chopper,  or thoroughly pounded first and
any fat removed.
  Caramel  Custard.—Put 2  ounces  loaf-sugar
and two tablespoonfuls of cold water into a
small saucepan  and let it  stand on the fire till
it becomes brown, taking care it does not burn.
Take a  flat-bottomed  mould, or several  small
pots, heat them, and  pour enough caramel  into
each to cover the bottom of the mould.  Beat up
three eggs  as you would for an omelet and mix
them with half  a pint  of  boiling  milk,  a pinch
of  salt and 2 ounces sugar,  strain it and pour
into the mould  or moulds.  Let it stand  until
quite cold, then turn out into a dish.
  Potato Soup.—Take 1   lb.  of potatoes,  peel
and slice  them, and  add to them  one  small
onion, two leaves  of celery which  have  sweated
for five  minutes  in 1  ounce of butter.   Pour
over the vegetables 1 pint of white stock (other
stock will  do),  and stir frequently;  let it boil
gently till  the potatoes are reduced  to a  pulp.
Put half a pint  of milk  into  a  stewpan  and
heat it  Pass the contents of the first  stewpan
through  a fine  sieve with a spoon,  adding by
degrees  the half  pint  of  hot milk which  will
enable it to pass through more easily.  Wash
out the  first  stewpan,  and pour  in  the  purge.
Add salt to taste and a  quarter of a pint of
cream;  stir smoothly  with  a spoon  until it
boils, then serve. 
342  THE NURSE'S SERVICE DIGEST

  Scotch  Collops.—Put a small piece of butter
into a  saucepan to melt; have some tender un-
cooked beef or mutton.  Trim  and mince  very
finely,  or  run  through a meat chopper.   Put
into the saucepan with the  butter, add pepper,
salt,  a small bit of onion, and a clove if liked,
or a leek.  Keep on  the fire for one hour,  stir-
ring  now  and then.   When served, the  collops
should be  dry and crumbly.  This dish may be
prepared beforehand, and warmed when want-
ed.  Take  out the onion, etc., before serving.
  Fish Omelet.—Any light fish, such as whiting
or haddock, may be cooked and shredded into
the eggs when they  are being stirred.
  Filleted  Sole  dressed   in  water  souchet.
Serve  the soles in  the  water  in which  they
were boiled, adding sprigs of parsley, and serve
with thin  brown bread and butter.
  Turbot  Souffle  is nice  and  not too  rich.
Haddock also makes good  fish  souffl6.
  The Fin  of  Turbot is considered to  be the
most delicate part of the fish.  It is  very nu-
tritive, and suitable to invalids, as it  is easily
digested.  It should  be plain boiled and served
with slices of lemon.
  Macaboni.—Put the macaroni  or rice   into
boiling water with some salt.  Boil slowly, and
see that  it  is  not  overdone.   Strain off the
water, add butter, good fat,  gravy, or stock.  At
the last moment add some grated  cheese, if de-
sired.
  Light  Pudding.—Put  1  pint of milk  in  a
saucepan  and bring it nearly to the boil.  Take
off the fire, and add 3 tablespoonfuls of small
sago  (rice,  hominy,  or semolina), put  on the
fire and let it boil, stirring  all the time When
it has boiled, let it simmer  for a  quarter of an
hour.  Break 2  eggs, keep whites and wolks
separate,  and stir  yolks  into  the sago.   Beat 
          COOKING FOR INVALIDS      343

whites to a stiff froth, stirring very lightly into
the mixture.
  Calves' Feet  Stewed.—They  must stew very
gently for several hours, as the meat should be
very  tender.  Then  take the  meat from the
bones and put the bones down, boiling until the
stock is  much reduced  in quantity.   Strain off
thicken  with  an  egg  well  beaten up,  add
chopped  parsley, a leaf of lettuce chopped with
it, pepper and  salt, half a glass of white wine
(not  sweet), or  instead  lemon  juice.   Serve
the meat in  this sauce, which must not boil or
it will curdle,  adding the wine or lemon juice
the last  thing.   Sheeps' trotters may be  served
in this way.
  Calves' feet  are also nice plain boiled, with
celery, parsley and butter. 
344
ILLUSTRATIONS
Fig.	1...	
Fig.	2..,	
Fig.	3...	
Fig.		
Fig.	5..,	
Fig.	6...	
Fig.	7...	
Fig.	8..,	
Fig.		
Fig.	10..,	
Fig.	11. .,	
Fig.	12. ..	
Fig.	13...	
Fig.	14...	
Fig.	15...	
Fig.	16..,	
Fig.	17..	
Fig.	18...	
Fig.	19...	
Fig.	20..,	, . . Page
Fig.	21. .	
Fig.	22..,	
Fig.	23..	
Fig.	24..	
Fig.	25..	
Fig.	26..	
Fig.	27..,	
Fig.	28..	
Fig.	29. .	
Fig.	30..	... Page
Fig.	31..	
Fig.	32..	
Fig.	33..	
Fig.	34..	
Fig.	35..	
Fig.		
Fig.	37..	
Fig.	38..	
Fig.	39..	
Fig.	40..	
Fig.		
Fig.		
Fig.		
345	Fig.
345	Fig.
345	Fig.
345	Fig.
346	Fig.
347	Fig.
349	Fig.
348	Fig.
349	Fig.
350	Fig.
350	Fig.
351	Fig.
351	Fig.
352	Fig.
352	Fig.
352	Fig.
353	Fig.
353	Fig.
354	Fig.
354	Fig.
359	Fig.
355	Fig.
356	Fig.
356	Fig.
357	Fig.
357	Fig.
358	Fig.
359	Fig.
360	Fig.
361	Fig.
362	Fig.
363	Fig.
364	Fig.
365	Fig.
366	Fig.
367	Fig.
368	Fig.
369	Fig.
370	Fig.
371	Fig.
372	Fig.
373	Fig.
374	Fig.
44.....Page 373
45.....Page 376
46.....Page 377
47.....Page 377
48.....Page 378
49.....Page 378
50.....Page 390
51.....Page 380
52.....Page 387
53.....Page 370
54.....Page 381
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56.....Page 382
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ILLUSTRATIONS
345
Fig. 1.—Round Bed-Pan.
Fig. 3.—Feeding-Cup.
Fio. 2.—Slipper Bed-Pan
Fig. 4.—Medicine-Glass.
 
346    THE NURSE'S  SERVICE DIGEST
Fio. 6,—Human Skeleton
      front view.
L Skull.    5. Sternum.
2. Spina.    6. Scapula.
3. Clavicle.  7. Hnmerua.^-
1 Ribs.    8. Radius and Ulna; 
ILLUSTRATIONS              347
 9. Cartel bones.      13. Patella.
10. Metacarpal bones.  14. Tibia and Fibula.
1L ttML           15. Tarsal bone*.
12. Femur.          IS. Metatarsal bona*. 
348   THE NURSE'S  SERVICE DIGEST
l  7Cerricat'
r Vvrt.brsa.
Fio. 8—Spinal Column. 
ILLUSTRATIONS
349
Fin. 7.-Skull.
Fio. 9.—Dorsal Vertebra.
a, body; b, transverse process :
     e, spinous process. 
350  THE NURSE'S SERVICE DIGEST
Pia 10.— Pelvis.
Fig. 11.—Scapula, Clavicle and Humerus.
1. Scapula.         4. Ribs.
2. Clavicle.         5. Glenoid cavity.
3. Sternum.        6. Humerus. 
ILLUSTRATIONS
351
Fio. 13.—Bones of Hand and Wrist

 a, carpus ; b, metacarpal bones ;
         e, phalanges.
      «
Fia 12.—R*4iai
   and Ulna.
1. Radios.
i. Ulna.
3. Olecranon, &c.
4. Wrist-joint
 
3:i2   THE  NURSE'S  SERVICE  DIGEST
Fro. 16.—Patella.
Fio. 14.— Femur.
  Fio. Id—Tibia
   and Fibula.
1, tibia; 2,fibula;
3, broad portion of
tibia, forming parti
  of knee-joint. 
ILLUSTRATIONS
353
Fio. 17.—Bones of Foot and Ankle.
a, tarsus; o, os calcis; e, metatarsal banes;
             d, phalanges.
Pia 18.—Muscles and Tendons
          of Hand. 
354   THE NURSE'S  SERVICE  DIGEST
Fio. 19.—Flexion of Fore-Arm {after Huxley).
Pio. 20.—Web of Frog's
        Foot 
ILLUSTRATIONS    355
O § o'
®

8
<S&
ft
II
I_l
3

k
t
\i 
356   THE  NURSE'S SERVICE DIGEST
Fio. 24—Brain and SpIaiXGQaft
     thown in Position. 
ILLUSTRATIONS
357
\---3
I— 5
                   I
      Fio. 26.—Brain seen from below.

1. Finnic                  *• Pons-
2. Nerve of smell.            5. Medulla.
3. Nerve of sight.            6. Spinal cord.
             7. Cerebellum.
Fio. 26,—Section of Spinal Cord
         with Nerves.
      a, anterior nerve root 
358   THE  NURSE'S SERVICE  DIGEST
    Pio. 27.—Air-Passages and Lungs,
a, larynx; 6, trachea: e, bronchos; d, sub-
  divisions of bronchial tubes; e, pleura. 
ILLUSTRATIONS         359
* o
r
o
a
 
360   THE NURSE'S SERVICE DIGEST
                   Fio. 29.
A, expansion of chest in inspiration ;  B, contraction
       of chest in expiration (after Huxley). 
ILLUSTRATIONS            361
Time. |M |	E (Tie	U	E	MiE	m|e	MjE		M;E	m;e	m!b	mIe	MiE	
Bmveli ~o]	0 Q;l	0	1	ojo	oj,	0	1	ojo	010	i :o	O'.C	1 jo	
Urine. '•	j				i			i		;		i 1	
						I							
s « '	jA							V|I		!			
-s: „								i	1	i	j	1 i	
V									s\.r Pro/ P^rs	use	i ton.		
	^'|PT							i		!			
fc.100 ,								i		i		j	
		i						:		i 11		1	
		1		j						\^			
	r	1 j			i			•		i		i i	
o/Dis.	2	3		4	6	6		7	8	9	10	it	
PuUe. >ie	^728.	t*		rea	tSQ	»*,		m	too	V	*,	^	
Res/. ^	^38,	*a.		•38,	'sa.	X		X	X,	x,	X	18s	
DaU.													
Fio. 30. —Temperature Chart. Acute Pneumonia
             Crisis on 7th day 
362 THE NURSES' SERVICE DIGEST
cy 
ILLUSTRATIONS
363
Time.	mTT	MiE	m|e	M|E	m!e	MiE	MIE		M'E	*'i	M'E	mIe	MiE	MiE	u!e
Bowls	:	1	i	!	i					1			T-		
I'rine.	1	i	i		i	|	j			j			j		
104' I 103° 1 ,of *- iod 99' .Vornal 1 98 Day o/Dis. Pulse. Res/.															
	I j	|	1			i	;I						\		
	1	i	X			II				1	in	i			il
	i	l	\			11				r	f\	1	j		1
	1	I	\						II;,		ii	Ji			j
		J	\			i			{[!	i		1			
		j!	yi	yi					i				1*		II
		|;	1;	1;								!	j		fi
			i	i	1	j			|	i i		|	1 1		|
															
															
															
	16	\1	18	19	20	21	22		23	24	26	26	27	28	»
Pro. 32.—Hectic Fever.  Pulmonary Consumption* 
364    THE  NURSES'  SERVICE  DIGEST
                10         u
             Fio. 33.—Beart and Blood-V«s«ls.
L Trtchea             5. Aorta.                 9. Lung.
2, Cerotid artery        6. Superior vena cave.     10. Annul*.
3> Jngnlarveia.        7. Pulmonary artery.      11. Ventricle
4. SubcUviea vain.      8. Pulmonary veto. 
ILLUSTRATIONS
365
Fio. 34.—Interior of Right Bide of Heart. 
366  THE NURSES' SERVICE DIGEST
puhrwnary  vans.
Fia 36.—Interior of Left Sid« ol Heart* 
ILLUSTRATIONS              867
fio  X —Syatemic Circulation.  Aorta and Mam Branches. 
368   THE NURSES' SERVICE  DIGEST
Fig. 37.—Diagramatic Represen-
          tation of
a, pulmonary circulation; b, por.,
    tal circulation; c, systemic
    circulation.

m 
ILLUSTRATIONS
369
FlO. 38.—Alimentary Canal 
370  THE NURSES' SERVICE  DIGEST
Fig. 39.—Vertical Section
 through Face and Neck.
 
ILLUSTRATIONS
371
^
tf
Fio. 40 —Stomach and Duodentuu. 
372   THE NURSES'  SERVICE  DIGEST
Fia 41.—Section ol Skin  (magnified),  showing-
 Hair with'Sebaceoum Glands, and Sweat Gland* 
ILLUSTRATIONS
373
1. Kidney.
2. Ureter.
Fig. 42
    3. Renal Vessels;
    4. Bladder.
HS
Lg 
Fia 43.—Temperature Chart from case of Typhoid Fever,'ending in recovery. 
ILLUSTRATIONS
375
 
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> e a ''J'7 o* at w « et »c »t et tt it 01 et at u m si m ti « —N'fa
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ill « ljaTJITTiTia'iriTja nil liajji* i>3i" ?1* 3lf 1 » ' " Ul2.iIJ! ' il « ""W
 
ILLUSTRATIONS
371
ff
••t—f*"
Fio. 46.-~Tape>,Wd.rjp.;
 1. Head.  2.'Tailr
Fio. 47.—Extempore Tourni-
   quet.  Handkerchief and
   Stick. 
'378  THE NURSE'S  SERVICE  DIGEST
Fia 49.—Mode of applying pressors
      to the Femoral Artery 
ILLUSTRATIONS
379
     Fig. 68.—Bandaging the Foot.
A, Fixing; B, Reversing; C, Figure of 8.
Fio. 73.—Capeline Bandage, viewed
        from the front. 
380  THE  NURSE'S SERVICE DIGEST
Fia C2.—A Wringer.
•a
9





a
ii . 
ILLUSTRATIONS
381
Fio.59.-JceBag,
Fio. 54.   Trusa for Inguiual Heruia. 
382  THE NURSES SERVICE DIGEST
 
ILLUSTRATIONS
 
384  THE NURSE'S SERVICE DIGEST
Flp. CO.—Ice Cap.
Fro «!.—Ice Cradle. 
ILLUSTRATIONS
385
a,
GQ


a

X

I 
386   THE NURSE'S SERVICE DIGEST

W
E 
ILLUSTRATIONS
387
T
T7
T
•C7-1
Fio. 52.—Fracture Cradle.
 a, board; 6, c, iron rods.
Fio. 58.—Nasal Douche.,
Fio. 67.—Rolling the Bandage. 
388  THE NURSE'S SERVICE DIGEST
7
Pio. 69.—Figure-of-8 round
      Knee-Joint.
Fro  70.—Spica tor the Grola. 
illustrations
389
J&&L
Fio. 71.—Bandage for Left Breast;
r/?s»'~*
Fio. 74.—Bandaging1
     the Eye."-* ~ 
390   THE NURSE'S  SERVICE  DIGEST
Itoj 50.—A, Fbnr-tafled Band-
  age for Fracture- of the Jaw ;
  X, Aperture for Chin.
lie 72.—Beginning the CapehM
  Bandage, viewed from beniaal, 
ILLUSTRATIONS            391
Fio. 75.—Artificial Respiration: Sylvester's Method, 
392   THE  NURSES SERVICE DIGEST
y>
G
1
Fio. 78 —Transfusion of Blood.
Fio. 79.—Pinching Hand and
        Fore* Arm. 
ILLUSTRATIONS

      Fig. 80

         9
393
&r
>d
  He* an Teeth —Upper Jaw.—a. Incisors.  6. Oar
•.^Anterior molars,  d. Posterior molars.

                    Fig. 81
 ^BffCClt AND Glandclab Ep ITB B i. | &«, \r\th
jOraoalar Matter and Oil-globules; deposited aa' sett-
fsMat from ha man saliva. 
394   THE  NURSE'S SERVICE  DIGEST
                       Fig. 82
  HPMAif  Larynx,  posterior
»isw.-a. Thyroid cartilage, 6. Bpt
glottis, ce. Arytenoid  cartilage*.  <!.
Cricoid cartilage, te. Posterior crico-
arytenoid muscles. /.  Trachea.
2
 b  " • °S

'   *"§ *
 O  «S *a  -
 si**


5  (4 1

 2 Si I

/" " « *. . 
ILLUSTRATIONS              395
       Fig. 84
  DUfTUB of th« ClBOBLATIOB.—fe]
Heart.  % Langa. &  Head sad osfsr
•xtnalUta,  4. Spleen. & latastia*. «•'
SUatj. 1. Lower ext remittor R UtsrI 
396   THE  NURSE'S  SERVICE  DIGEST
Fig. 8H
  CBRBBR0-8PIN A L 8TBTBM OF M A ■
—I. Cerebrum. 2. Cerebellum  3,3,1 Spinal
cord and nervea.  4, 4,  Brachial nerves
6, 6. Sacral nerves. 
ILLUSTRATIONS              397
       Fig.  86
  Diagram of PaaDHOSAsriTal
K £B v e. wilb >is prineipalbranebes.*
—L Pharyngeal branch.  2. 8apa-j
rlor laryngeal  3. Inferior laryn-j
geali  4. Puftnooary branches. ^A.)
6tomacb.  6.  Liver. 
INDEX
i 
INDEX.
Abdomen—27
Abscess—224
Addison's disease—135
Adipose tissue—31
Ague—188
—management of—189
—symptoms of—188
Air-passages—71
Albumen—145
—tests for—145
Albuminuria—40
Alimentary canal—
       117, 200
—diseases of—117
Amputations—262
Amyloids—115
Anatomy—21
Aneurysm—108
Angina pectoris—106
—management of—106
—symptoms of—106
Antiseptic dressing—252
—gauze—252
—method—317
—rules for nurses—278
—solutions—285
—treatment—316
Aorta—97
—Aneurysm of—108
—Valvular disease of—
       105
Aphasia—49
Apthae—200
Apoplexy—48
Appendicitis—130
Archnoid fluid—44
Arteries—98
—axillary—98
—brachial—98
—carotid—98
—femoral—98
—popliteal—98
—pulmonary—99
—radial—98
—subclavian—98
—ulnar—98
Artificial respiration—
      326
Ascites—102
Aseptic preparations—
      252
Aspiration—85
Aspirator—85
Asthma—79
■—management of—80
■—symptoms of—79
Auricles—97
Bandaging—319
Bandages—316
—breast, for—321
—capeline—322
—eye, for—322
—figure of 8—320
—finger, for—323
—four-tailed—240
—groin, for—321
—head, for—322
—knee-joint for—321
—leg, for—323
—many-tailed—323
—plaster of Paris—247
—reverse—320
—roller—319
—spica—321
—spiral—320
—stump, for—323
—T—324
Baths—292
—cold—292
—continuous—292
—foot—293
—graduated—292
—Rip—295
—hot-air—293
—hot and warm—292
399 
400
THE NURSES SERVICE  DIGEST
—vapor—294
Batteries—329
—faradlc—329
—galvanic—329
Bed and bedding—6
—changing sheets—9
—water—7
—Bed-pans—11
Bed-rest—13
Bed-sores—9
—prevention of—9, 52
Bile—144
—pigment, test for—145
Binder, application of—
      280
Bladder—37, 281
Blisters—307
Blood—38
—clotting of—39
—corpuscles of—39
—poisoning—228
—serum—40
—test for—145
Blood-vessels—99
Bowels—33, 281
—obstruction of—127, 204
—ulceration of—169
Brain—31, 44
—compression of—239
—concussion of—238
—membranes of—44
—tumors of—57
Bright's disease—147
—acute—147
—chronic—148
—diet in—148
—management of—147
—symptoms of—147
Bronchitis—77
—kettle—315
—management of—77
—symptoms of—78
Bronchus—71
—inflammation of—74
Burns—232
—management of—232
Caecum—113
—inflammation of—117
Callus—236
Capillaries—220
Carbolic solution—285
Carpus—28
Catarrh—76
Catheter—263
—fever—263
—passing—263
—washing—264
Cellulitis—225
Cerebellum—45
Chest—26
Chicken-pox—162
—management of—162
—symptoms of—162
Child-bed—274
—management of—277
Children—190
—artificial feeding of—
      193
—cry of—190
—diseases of—197
—feeding of—193
—observation of—190
—Chloasma—142
—Choking—112
Cholera—180
—Asiatic—180
—English—128
—Infantile—205
—instructions for nurses
      —158
—management of—207
—precautions to  be ob-
      served by nurses—
      182
—symptoms of—206
Chorea—62
—management of—63
—symptoms of—62
Chyle—116
Circulation—38
—capillary—38
—portal—99
—pulmonary—99
—systemic—98
Circulatory system—32,
      98
Clavicle—27
Cleft palate—257
Clotting  of blood—39
Colds—76
Colic—123
—gall stones—123
—management of—124
—symptoms of—123
—renal—150
Collar-bone—27
Colon—114
Coma—49
Compression of the brain
      —239 
INDEX
401
Concussion  of the brain
      __238
Condy's fluid—285
Connective tissue—22
Constipation—203
Constitutional    disturb-
      ance—223
Consumption—87
Contagion—157
Convulsions—195
—brain—57
—epileptic—60
—hysterical—60
Cooking for invalids—333
Corns—133
Corpus callosum—45
Corpuscles—39
Cough—74
Counter-irritation—307
Cranium, bones of—23
Croup—77
—false—200
Crutches—247
Cupping, wet and dry—
      310
Cuticle—132
Cutis—132
Delirium—66
—active—66
—busy—66
—management of—67
—quiet—66
—tremens—66
Desquamation—16 5
Diabetes—151
—dietary—152
—management of—152
—symptoms of—151
—urine in—151
Diaphragm—3 2
Diarrhoea—127, 205
—diet in—129, 205
—management of—
      128,295
—motions—128, 205
—summer—128. 205
Diet—114
Digestion—115
Digestive organs—117
—system—32,117
Digitalis, over doses of-
      105
Diphtheria—178
—management of—178
—paralysis from—179
—symptoms of—178
Disinfection—11,159
—rules for—159
Dislocations—249
Douche—300
—cold—300
—hot—300
■—nasal—302
—vaginal—301
Draw-sheet—10
Dropsy—101
—management of—102
Drugs—18
•—effects of—18
—doses—18
Duodenum—113
Dyspepsia—117
—management of—118
Dyspnoea—75,  100
           E

Ear-syringing—313
Eczema—135
—management of—136
Electricity—329
—application of—329
—electrodes—330
Empyema—86
—management of—86
Emulsion—115
Enemata—296
—medical—299
—nutrient—299
—oil—299
—simple—298
Enteric fever—
           (see Typhoid)
Epiglottis—112
Epilepsy—60
—management of—61
—symptoms of—60
Epithelium—132
Erysipelas—226
—management of—220
Erythema—133
Excreta—12
Excretion—41
Excretory system—37
Expiration—73
Eye-drops—312
—lotions—313
—syringing—313 
4U2    THE NURSES
            P

 Face—24
 —bones of—24
 Faces—129
 Fats—31, 115
 Feeding-cup—12
 Femur—28
 Fermentation test for
      sugar—145
 Fever—156
 —continued—156
 —hetic—156
 —infectious—157,162
 —non-infectious—186
 —kinds of—156
 —remittent—156
 —typhoid—169
 —typhus—168
 Fibula—28
 Fistula—266
 Flatulence—203
 Fomentations—306
 —laudanum—307
 —poppy—307
 —turpentine—307
 Food—15, 114
 —administration of—15
 Foot—29
 —bones of—29
 Fracture—334
 —apparatus—243
 —collar-bone, of—241
 —Colles'—242
 —comminuted—235
 —compound—248
 —first-aid in—236
 —humerus, of—242
 —kinds of—234
 —leg, of—245
 —lower jaw, of—240
 —patella, of—246
—pelvis, of—241
—rib, of—241
 —skull, of—238
—spine, of—240
—thigh-bone, of—243
—ulna, of—242
—radius, of—242
—setting—236
—signs of—235
—simple—235
—union—235
—ununited—236
SERVICE DIGEST
            a

 Gall-bladder—113
 Gangrene—201
 —dry—261
 —management of—261
 —moist—260
 Gastric catarrh—202
 —Juice—113
 —management of—122
 —symptoms of—122
 —ulcer—122
 Gastritis—122
 Germs—157, 316
 Grand-mal—60
 Gullet—113

            H

 Haematemesis—120
 —management of—120
 Hematuria—144
 Haemoptysis—93
 —management of—93
 Haemorrhage—219
 —after operation—220
 —kinds of—219
 —methods of arresting—
      220
 —reactionary—2 2 0
 —recurrent—257
 Haemorrhoids—267
 Hair—133
 Hand—28
 —bones of—28
 Hare-lip—257
 Heart—96
—chambers of—107
—dilation of—107
—diseases of—100
—fatty diseases of—107
—malformation of—107
—movements of—99
—valves of—97
—valvular disease of—
      104
Hem ipl egia—4 8
Hernia—268
—forms of—269
 —reducible—269
 —strangulated—269
—truss for—269
Herpes—138
Hot-water bottles—13
Humerus—27
Hydrocephalus—213
Hysteria—64 
—management of—65
—symptoms of—64
           I

Ice—302
—application of—302
—bag—302
—cap—302
—cradle—303
—poultice—303
Incubation period—162
Indigestion—117
—management of—118
Infantile paralysis—55
—management of—55
Infants—190
—artificial feeding  of—
      193
—constipation in—203
—convulsions—195
—diarrhoea in—205
—disorders of—192
—feeding—193
—management of new-
      born—186
—observations of—190
—teething in—195
—wasting in—193
Infection—157, 275
—prevention of—158
Inflammation—223
Influenza—185
—management of—186
—symptoms of—185
Infusion—329
Inhalations—314
—fuming—315
—inhaler—315
Injections—300
—hypodermic—328
Insanity—68
Inspiration—73
Intermittent  fever—188
Intestinal colic—123
—management of—123
—obstructions—126
----management  of-—126
—symptoms of—126
Intestines—113
Invasion period—162
Isolation—158
Itch, the—139
403
           J

Jauudice—121
—management of—121
Joints—29
—HStiffness after fracture
      —243
           E

Kidneys—37,147
—diseases of—147
—inflammation of—147
    (see Bright's disease)
           L

Labor—276, 280
—management of—
      277, 280
—stages of—276
Lactation—282
—Lacteals—36,116
Laryngismus—200
—management of—200
Laryngitis—77
—management of—77
—symptoms of—77
—tubercular—9 4
Larynx—71
—inflammation of—77
Leech-bites—310
Leeches—309
Lice—138
Ligaments—30
Limbs—27, 28
Liniments—308
Lithotomy—265
Lithotrity—265
Liver—113
Lochia—281
Lockjaw—229
Locomotor ataxy—55
—management of—56
—symptoms of—55
Lunacy—68
Lunatic asylum—68
Lungs—32, 70
—inflammation of—80
Lying-in room—275
Lymphatic glands—37
—system—116
Lymphatics, inflamed—
      228 
 404    THE NURSE'S

            M

 Malaria—188
 Massage—331
 Measles—167
 —management of—167
 —German—168
 Medicines—17
 —administration of—17
 —measured glass for—12
 Medula oblongata—45
 Melsena—128
 Meningitis—56
 —management of—
        58,  212
 —symptoms of—56, 211
 —tubercular—211
 Metacarpus—28
 Mitral valvular disease—
      104
 Mouth—109
 Mucus in urine—144
 Mumps—180
 —management of—180
 —symptoms of—180
 Muscles—30
 Mustard leaves—308
 —poultice—306

            N

 Nsevus—138
 Nails—133
 Navel—289
 Nerves—31
 Nervous system—31, 44
 Nettle rash—134
 Neuritis—53
—management of—54
—symptoms of—53
 Nits—139
 Nurse, duties of—251
—dress—5
Nutrition—40

           O

GEdema—101
CEsophagus—113
Ointments—311
Operations—251
—arrangement  of  room
      in   private houses
      —19 252
— hemorrhage after—256
—management of patient
      after—255
SERVICE DIGEST
—preparation  of  patient
       for—251
—room—252
—table—262
Osmosis—41
Ovariotomy—270
—complications—272
—management of—271

            P

Pads—325
Pains after labor—282
—false—276
—labor—276
Pancreas—35, 113
Papillae—132
Paralysis—48
—brain—48
—nerve—53
—spinal—51
Paraplegia—51
—management of—51
—symptoms of—51
Parasites—138
Parotid glands—112
Patella—28
Patients—9
—attendance on—9
—daily report—15
—lifting—10
—observation of—14
—washing—9
Pediculi—139
—management of—139
Pelvis—26
Pepsin—116
Peptones—116
Pericarditis—103
—management of—103
—symptoms of—103
Perin.aeum, lacerations  or
      —283
Periosteum—22
Peristalsis—114
—Peri toneum—114
—inflammation of—124
Peritonitis—124
—management of—126
—symptoms of—124
Perspiration—92
Fetechiae—135
Petit mal—60
Peye^s glands—114
Phalanges—2 8
Pharynx—112
Phosphates—144 
INDEX
405
Phthisis----87
Pigmentation—135
Piles—267
Pleura—71
—inflammation of—84
Pleurisy—84
—management of—85
—symptoms of—84
—with effusion—84
Pneumonia—80
—management of—82
—symptoms of—81
—varieties of—81
Pneumo-thorax—94
Poultices—303
—bread—305
—charcoal—305
—ice—303
—jacket—305
—linseed—304
—mustard—306
—yeast—306
Proteids—115
Psoriasis—135
Ptyalin—115
Puerperal fever—284
—prevention of—284
Pulmonary consumption
      —87
—acute—88
—chronic—89
—complications of—92
—management of—90
 -symptoms of—88
Pulse—100
Pus—144
Pyaemia—228
—management of—229
—symptoms of—228
Pylorus—113


            Q

Quinsy—201

            R

Radius—28
Rash—28
Rectal cases—267
Reflex action—48
Renal colic—150
—management of—150
Respiration—7 2
—artificial—326
—mechanism of—72
Respiratory act—73
Respiratory system—
      32,73
—diseases of—70
Respiratory tract—70
Rheumatic fever—186
—complications of—186
—hyper-py r exia—18 7
—management of—187
—symptoms of—186
Ribs—26
Rickets—197
—management of—198
—symptoms of—197
Ring-worm—141
—management of—141
Rotheln—168
Round worms—209
Rubbing—331

           S

Sacrum—26
Salivary glands—33,112
Rand-bags—325
Scabies—139
—management of—140
Scalds—233
Scapula—27
Scarlatina—163
Scarlet fever—163
—management of—164
—symptoms of—163
Sebaceous glands—133
Sensation, loss of—149
Shingles—138
Sick-room—1
—arrangement of—19
—cleanliness—8
—furniture of—6
—temperature of—2
—ventilation of—3
Skeleton—22
Skin—132
—diseases of—133
—grafting—273
—structure of—132
Skull—23
Slings—324
Small-pox—165
—management of—166
—symptoms of—165
Snuffles—290
Sore throat—201
—management of—201
Sphincter—114
Spinal column—25
—cord—45, 54 
406    THE NURSE'S
—nerve—46
Splints—248
Spongio-piljne—307
Sprains—249
Spray-producer—373
Starch—115
Sterilizing dressings—
      254
—instruments—254
Sternum—27
Stimulants—17
—administration of—15
Stirrup  for  extension—
      244
Stomach—32,113
—perforation of—122
—ulcer of—122
Stone in bladder—265
Stools—129
—examination of—129
Stupes—306
St. Vitus' dance—62
Sugar—115
—digestion of—115
—in urine—145
—test for—145
Suppositories—312
Sutures—24
Sweat glands—133
Sweaty feet—155
Sympathetic system—31
Syphilis, congenital—199
Syringes—296
—enema—296
—hypodermic—328
—pump—196
—glass—298

            T

Tape worm—210
Tarsal—29
Teeth—109
Teething—195
Temperature—2, 281
—of body—42
—of sick room—2
Tendons—30
Tepid sponging—296
Tetanus—229
—management of—230
—symptoms of—229
Tetany—198
Thermometer, clinical—
      327
Thigh-bone—28
,'ICE DIGEST
 Thoracic duct—116
 Thorax—26
 Thread worms—209
 Throat applications—314
 Thrush—200
 Tibia—28
 Tinea tonsurans—141
 Tongue—112
 Tonsils—112
 —enlargement of—201
 Tourniquet—222
 —artificial—222
 Trachea—71
 Tracheotomy—258
 —management of—258
 —tubes—258
 Transfusion—329
 Trepanning—329
 Trunk, bones of—25
 Truss for hernia—268
 Tube, rectal—298
•Tubercle—87
 Tubercular meningitis—
      211
 —management of—212
 —symptoms of—211
 Typhlitis—125
 —management of—125
 —symptoms of—125
 Typhoid fever—169, 208
 —complications of—171
 —constipation in—174
 —convalescence—176
 —diet and feeding—
 •     172,208
 —management of—208
 —motions in—175
 —relapse in—170
 —symptoms of—169, 208
 Typhus fever—168
 —management of—168
 —symptoms of—169

           U

 Ulcers—231
 Ulna-—28
 Urates—144
 Ureters—37 142
 Urethra—37
 Uric acid deposits—144
 Urine—143
 —examination of—143
 —retention of—263
 —suppression of—146
 Urticaria—134 
INDEX
407
Vaginal examinations—
       278
Valves of heart—97
Varicella—162
Variola—165
Veins—38
—hepatic—99
—inferior vena cava—99
—portal—99
—pulmonary—99
—superior vena cava—99
—valves  of—99
Ventilation—3, 73
Ventricles—97
Vermiform appendix—
       114
—inflammation of—125
Vertebrae—25
Vesico-vaginal fistula—
       226
Vomit—118
—of blood—120
Vomiting—118
—management of—119
           W
Warts—133
Water-beds—7
Water-brash—118
Wet-pack—295
—cold—295
—half—295
—hot—295
Whitlow—227
Whooping-cough—75
Wind-pipe—71
Work and waste—37
Worms,  intestinal—209
—management  of—209
Wounds—214
—complications of—219
—contused and lacerated
       —215
—dressing of—215
—healing of—215
—incised—214
—inflamed—223
—face, of—218
—scalp,  of—218
—throat, of—219
—trunk,  of—219
—poisoned-s-227-408
                     TABLES

Poisons  ......................................*• • • 408
Solutions  ..........................................410
Hypodermics .....................................-412
Abbreviations .....................................xl" 
408
         NAME
Adds
  Nitric, Muriatic,
  Sulphuric, Oxalic
  and Carbolic.  Creasote
Prussic Acid; Cyanide
  of  Potassium
Alkalies
  Ammonia, Lye, lime
  Potash and  Soda

Narcotics
  Opium,  Laudanum,
    morphine and chloral


  Alcohol,  Chloroform
Illuminating, Chlorine
Miscellaneous
  Arsenic
    (Paris  Green),  etc.
Antimony
  (Sugar of lead)
Iodine
Aconite
'NS
  First Aid—Antidotes
Emetic—Magnesia,   soap
  and  water,  chalk  and
  water,     whitewash.
  scraped   from  wall  or
  fence mixed  with water,
  Opium for pain.

Emetic  if  possible-
  Stimulate   with   Am
  monia. Brandy, sooth
  ing liquids,  cold  water
  on head  and chest, ar
  tiflclal respiration.

No emetic—Lemon  juice
  or weak  vinegar or any
   dilute   acid.

Emetic—Give  hot  coffee
  by  mouth  or rectum,
  keep patient awake.

Emetic—Rouse   patient,
  hot  coffee   and   am-
  monia,  apply  warmth
  to the extremities. Ar-
  tificial respiration.

No  emetic—Fresh   air,
  water dashed  on  head
  and chest, artificial res-
  piration.

Emetic — Iron   Sulphate
  and   Magnesia.    Am-
  monia or  Castor  Oil.
   Opium   for  pain,  ex-
  ternal heat.   Plenty  of
  water.  Stimulants.
Emetic —  Epsom   aalta.
   Tannic  acid  or  strong
   tea,  quantities of warm
  water, soothing liquids,
  afterwards.    Treat  for
   shock.
Emetic—Starch and wat-
   er, stimulants. Exter-
   nal heat.
Emetic—Stimulate, apply
   warmth   to extremities
   and  employ  artificial
   respiration.  Head low. 
POISONS
409
Belladonna
  (Atropin)
Phosphorous
Corrosive Subminate
  (Bichloride  of  Mer-
  cury)

Strychnine
  (Nux  Vomica)
Lunar Caustic
  (Nitrite of Silver)
Digitalis
  (Foxglove)
  and other poison
  plants

Ptomaine
  (decomposed foods)
Poisoned  Bites—
  Dog. snake,
  Spider,  insect
Unknown Poisons
Emetic—Give  hot  coffee
  and  charcoal  powder
  and water.  Warmth.

Emetic  — Magnesia   or
  chalk in milk or water.
  Turpentine.  No oils.

Emetic—Strong  tea, raw
  eggs,  milk.   Stimula-
  tion.

Emetic  — Tannic  acid,
  morphine, purgativ and
  absolute  quiet.  Artifi-
  cial respiration if nec-
  essary.  Stimulant.

Emetic  not  necessary—
  Salt and water copious
  draughts   of   diluted
  vinegar  or lemon juice
  in  water, followed   by
  milk and  olive oil.

Emetic—Tannic  acid,  op-
  ium; external  heat  on
  stomach.  Quiet.
Emetic—Castor  Oil  with
  few  drops  of  opium
  (for  adults)  pow,dered
  charcoal.   Hot  blank-
  ets, heat  to  feet and
  over  stomach.   Stimu-
  lant.   To children give
  castor    oil    without
  opium.

Suck  poison  out  several
  times. Tie handkerchief
  or cord  tightly  above
  wound.   Cauterize im-
  mediately,  caustic  or
  burning  match.  Burn
  deep.    Strong  stimu-
  lant,  prevent  sleeping.
  Insect or spider bites,
  apply  wet  salt,  am-
  monia,  onion  juice  or
  bicarbonate  of soda.

Emetic—Soothing  liquids
  and stimulation. 
410
SOLUTIONS
Table fob Making One Pint ok Ant Dbtjg
1-20,000 (1/200%)	use %	gr. or min
1-10,000 (1/100%)	1	gr.
1-5,000(1/50%)	1%	grs.
1-4,000 (1/40%)	2	grs.
1-3,000 (1/30%)	2%	grs.
1-2,500(1/25%)	3	grs.
1-2,000(1/20%)	3y2	grs.
1-1,000 (1/10%)	IVi	grs.
1-500 (1/5%)	" 14%	grs.
1-400 (%%)	18	grs.
1-300 (1/3%)	24	grs.
1-200 (%%)	36	grs.
1-100 (1%)	72	grs.
1-50(2%)	" 144	grs.
1-40 (2%%)	" 180	grs.
1-30 (3%%)	" 240	grs.
1-25(4%)	" 288	grs.
1-20 (5%)	" 365	grs.
1-10 (10%)	" 720	grs.
1-5 (20%)	" 1,440	grs.
1-2 (50%)	" 3,600	grs.
approz
    Apothecabies Weight.

20 grains   = 1 scruple.
 3 scruples = 1 drachm.
 8 drachms = 1 ounce.
   Apothecabies  Measubes.

60 minims  = 1 drachm.
 8 drachms = 1 ounce.
16 ounces   = 1 pint.
 2 pints    = 1 quart.
 4 quarts   = 1 gallon. 
                 SOLUTIONS              411

Table fob Making Foub Fluid Ounces of Ant
                    Dbug

  1/10 of 1%  use  14/5 grs. or min., appro*
  1/8  of 1%   "    2%   grs.
  1/6  of 1%   "    3     grs.
  1/4  of 1%   "    4y2   grs.
  1/3  of 1%   "    6     grs.
  1/2  of 1%   "    9     grs.
          1%   "   18     grs.
          2%   "   36     grs.
        2%%   "   45     grs.
          3%   "   54     grs.
          4%   "    1     dram.
          5%   "    1%   drams.
          6%   "    14/5 drams.
          7%   "    2    drams.
          8%   "    2%   drams.
         10%   "    3    drams.
        How  to Make 1-500  Solution.

        1 gr.  or min., water 1 oz.
        15 grs.  to 1 pint water.
        30 grs.  to 2 pints water.
        120 grs. to 1 gal. water.
        40% Formaldehyde 38 m.—1 pt.


How to Find Numbeb of Gbains Pee Oz. When
            Pebcentage  is Given.

  5 grs. to oz. makes 1%.
  Multiply per cent by 5.
  Example.   5% sol.  would require  5 z  5,  or
25 grs.-oz. 
412

    Drug.

1-1000— Supra
  Adrenalin
Morphia Sul-
  phate
Strychnine
  Sulphate

Digitaline

Apomorphia
Atropine

Aconitine
Belladonna

Cocaine

Nitroglycerin


Ergotine
Ergotole
Pilocarpine
Codeine
Strophanthus

Hyoscyanine
  Sulphate
   HYPODERMICS

  Dosage.


M.  10-15

gr.  1-8—1-4

"   1-60—1-30

"   1-50

"   1-100—1-10
"   1-120—1-60
"   1-200—1-50


     1-8—1-4

"   1-8—1

"   1-200—1-50


"   5—6
M.  5—20
gr.  1-8—1-3
"   1-4—1-2
"   1-200—1-60


"   1-40—1
Hyocine-hydro-
  bromide
Adrenalin
  Tablets
1-100—1-50
1-25
Camphorated
 Oil, 20% sol. M. 10-15
     Efikct.


 Stimulant

 Narcotic

 Cardiac stimu-
  lant
 Steadies heart
  action
 Emetic
 Respiratory
  stimulant
 Depressant, diu-
  retic and dia-
  phoretic
Respiratory stlin
  ulant
 Cardiac stimu
  laut
 Dilates blood
  vessel and
  equal, cir.
 Oxytocic
 Oxytocic
 Diaphoretic
 Anodyne
 Muscular  tonic
  and stimulant

 Hypnotic.  Ite
  duces pulse
  rate

 Hypnotic and
  respiratory
  stimulant

 Controlling Hem-
  orrhage

 Heart stimulant.
  (Use large
  needle.) 
 
 
 
The New York Academy of Medicine

   This book must not be retained for
longer than one  week after the last
date on the slip unless permission for its
renewal be  obtained from the library.
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