NATIONAL LIBRARY OF MEDICINE
         Bethesda, Maryland

              Gift of
  The New York Academy of Medicine
New York Public Library 

L
o wry 
\ 
THE HOME NURSE 
BZ THE SAME AUTHOR
               HERSELF
Talks with Women Concerning Themselves
                 $1.00
               HIMSELF
 Talks with Men  Concerning Themselves
                 $1.00

             CONFIDENCES
  Talks with a Young Girl Concerning
            Herself.  50 cts.

               TRUTHS
 Talks with a  Bot Concerning Himself
                50 cts.
FALSE MODESTY.  50 OTS. 
           THE
HOME  NURSE
     ^  BY
E. B. LOWRY, M.D.
   Author of "Herself"
  "Confidences;' "Truths," etc.
      CHICAGO
FORBES AND COMPANY
        1914 
COPYRIGHT, 1914,  BY

FORBES AND COMPANY
: i.     WYO^k i

; Pimio  LIBRARY j
'-■"* F '"...RATIONS.

R    l914   L

MC N.Y. ACADEMY
nr MFn>?fVE

 MAY 15 1952
28425U 
PREFACE
  Into every home, at some time, there comes ill-
ness and the necessity for  intelligent  care of  the
sick.  Some patients, more  fortunate than others,
are taken to a  hospital  where  they are sure of
skilled nursing.   Others  are enabled to employ a
trained nurse in  their homes.  But a large percent-
age of the sick must be cared for in their own homes
and the nursing  devolves  upon some member of the
family.  This home nurse may be very intelligent,
willing and conscientious but, as in any other new
work, she realizes her inability always to do things
in the  best possible  maimer.,
  The busy family physician, in making his daily
call, willingly would fhsfcruct her as to the duties
of a nurse but  the; jjiari.y 'demands  upon his  time
make this impossible;  To a large measure the out-
come of a case depends upon the nursing; the phy-
sician  may be entirely competent and prescribe the
very  best treatment possible,  but  how often he
leaves a home with grave doubts in his mind be-
cause he feels certain his orders will not be carried
5 
PREFACE
out correctly!  It is very discouraging for a physi-
cian to use his time and energy in trying to save a
life and then feel that during his absence from the
case something will be neglected that will undo  all
that he has been able to accomplish.
  The home nurse cannot  always be  blamed  for
this  state of affairs, for "she hath done what  she
could,"  but on account  of  lack of  training  along
these lines, she is unable to realize the importance
of following  directions  exactly or  she misunder-
stands the directions and does the wrong thing.
  A nurse seldom is required to assume the respon-
sibility  of a  case.   That  is  the  physician's part.
The nurse has been called a doctor's  right  hand,
very  valuable and  an absolute necessity  at  times
and  yet valueless "if if goes."cbntrkry to the wishes
of the director.** A.dpctocjs employed because the
patient  or family haye. confidence in his ability to
treat the case.  Thl$**bein|£irtt6, if is only fair that
all his directions should Be' carried  out exactly as
given.  If the patient does not have absolute con-
fidence in the doctor, then it is time to  dismiss him
and employ someone else, but as  long  as a doctor
is treating a case, his directions should be followed
to the exclusion of all others.
                        6 
PREFACE
  The doctor makes his  diagnosis and prescribes
the treatment and no matter what the attendants
think, they must not interfere with the faithful exe-
cution of his orders.
  It is to help the home nurses that  this book has
been prepared.   It also is hoped that physicians will
find it a  valuable aid inasmuch as it will explain to
the untrained nurse how  to aid them by carrying
out their directions intelligently.
7 
 
CONTENTS
           PART I.—GENERAL NURSING
CHAPTER                                        PAGE
     I  The Home Nurse..........n
    II  The Sick Room..........16
   III  Bed Making............21
   IV  Observation of Symptoms.......28
    V  Daily Care of Patient........43
   VI  Baths..............49
  VII  Appliances for Relief of Bed Patients  ...  60
  VIII  The Nurse's  Written Report......65
   IX  Administration of Medicine......68
    X  Counter  Irritants.........78
   XI  Douches,  Enemas, Injections......88
  XII  Description of  Positions.......95

    PART II.—NURSING IN SPECIAL DISEASES
  XIII  Nursing in Typhoid........98
  XIV  Nursing in Pneumonia........112
  XV  Nursing in Infantile Paralysis.....121
  XVI  Nursing in Cerebrospinal Meningitis  .   .  .128
 XVII  Nursing in Contagious Diseases.....132

PART  III.—MINOR  DISORDERS, ACCIDENTS, HOME
                    REMEDIES
XVIII  Tonsilitis, Sore Throat, Colds.....154
  XIX  Tuberculosis   ...........161
  XX  Accidents and  Emergencies......172
  XXI  Minor  Disorders..........191 
 
        THE  HOME  NURSE

      PART I   GENERAL NURSING

                 CHAPTER I
               THE HOME NURSE

  "What is everybody's business is nobody's busi-
ness."   This is especially true in cases of sickness
in the homes where the nursing, or care of the pa-
tient, devolves upon the members of the family.  In
such cases, where several try to carry out the phy-
sician's  orders, it  often happens that some orders
are neglected, each member of the family believing
that these things had been attended to by some other
person.
  Whenever there is illness  in a home and it does
not seem advisable, for various reasons, to employ
a trained nurse, one person  should be selected to
take charge of the patient and this person should
receive  all orders from  the  physician and be  re-
sponsible for their fulfillment.
                       n 
THE HOME NURSE
  The chief requirements  for one who is  to  take
the part of the nurse in a home are neatness, quiet-
ness and  an  ability to  carry out the physician's
orders exactly.
  In  her personal appearance a  nurse must be
scrupulously clean and neat.   Her hair should be
tastefully  dressed and  free from ornaments.   Her
hands should be clean and well cared for.  A rough-
ened hand is very annoying  to the  patient.   The
nails should receive especial  attention  and should
be filed rather short.  A nurse should not wear any
rings, for they are liable to catch on the clothing or
the patient's hair  and be  annoying.   The  nurse's
dress should be of some washable,  cotton material,
soft enough not to rustle when she walks.  White
aprons give  a neat and tidy appearance.   Her shoes
should be light, permitting her to step noiselessly
about the  room.  Rubber heels are desirable.
  During the  twenty-four hours  some  provision
should be made for sufficient sleep and outdoor exer-
cise for the  nurse.   She needs seven or eight hours
of sleep and one or two hours for exercise, besides
time in which to dress, attend to her  toilet require-
ments and eat her meals without hurrying.  A nurse
who does  not have sufficient time for  sleep and rest
                        12 
THE HOME  NURSE
becomes not only physically tired, but mentally  so
exhausted  that  she  is  incapable of  giving  proper
care to the patient or of observing symptoms.  For
the sake of the patient,  be sure that the nurse is not
overworked.   She can be relieved of her duties by
some other person.  At such times that she is away
from her patient, written orders for the substitute
should be  left and she should make sure that the
one left in  charge understands the directions.
  The nurse  always should speak in a low, well-
modulated voice that  can  be understood by the
patient without any effort.   One never should speak
in whispers or in a low tone to a third  person  so
the patient can hear the voices but cannot  under-
stand what is being said.   A sick person is  very
sensitive and  whispering is  annoying.  The  nature
of the illness should not be discussed and nothing
but the kindest things said before a patient.   A per-
son who is very ill is incapable of carrying on,  or
even listening to, a sustained conversation.  In  such
a case, there should be as little conversation as possi-
ble in the room.   As the patient becomes convales-
cent, he requires to be entertained.   A nurse  who
can read or tell light, happy stories in an entertain-
ing manner is invaluable at such times.   Gossip  or
                       13 
THE HOME NURSE
tales of  sadness  or unkindness should  not be re-
tailed to any patient.  A patient who is kept in an,
optimistic frame  of mind  has a better  chance for
recovery than one who is melancholy.  The patient
should be made to feel that the nurse is interested
in his recovery and that everything to hasten it is
being done.
  When the physician makes  his daily visit,  it is
considered a mark of respect for the nurse to arise
when he enters the room and remain standing un-
less asked to be  seated; she should  hand him her
written report (which will be explained later), an-
swer any questions he may ask and then quietly
leave the room, and wait outside until he leaves the
sick-room.
  This  will give  the patient  an opportunity to
talk  privately with the  physician  about  anything
he wishes.  Often  a patient  does not  talk freely
with the  physician  nor  tell him essential things,
because of an inability to  be frank before a third
party even  if that person  is an intimate relative.
Then, too, the nurse is thus given an opportunity of
speaking with the doctor about anything she wishes
to know, and of reporting to him anything she
does not  deem it desirable to say before the patient. 
THE HOME NURSE
Of course when a mother is caring for a child who
is too young to answer questions, she should remain
sitting by the patient.
15 
CHAPTER II
                 THE SICK ROOM

  The choice of the sick room  is very important.
A patient in a  dark,  poorly  ventilated one has a
harder battle to fight than one in  a properly selected
room.  It should be on the sunny side of the house,
well ventilated and as far as possible from the noise
of the streets and the odors of the kitchen.
  In arranging the room, all unnecessary  furniture
should be  removed,  especially  bric-a-brac, which
forms a  repository for stray  germs.  The floor is
preferably  bare,  although small  rugs or  strips of
carpet should be laid down to deaden the noise of
footsteps.  Place the bed in a position so that the
direct light  from a window  does  not fall on the
patient's  eyes.   Provide  an artificial light that also
is shaded from the patient's eyes, but which can be
turned on  brightly in case of necessity.   Sudden
changes are liable to arise in the night, when a good
light is an  absolute necessity.   In cases of diseases
of the brain or eyes the physician probably will wish
                        16 
THE SICK  ROOM
to keep the room darkened.  Care should be taken
that the curtain or shade does not flap in the wind
and so annoy the patient.
   The temperature of the room should be kept as
even as possible.  Remember that the temperature
usually falls at night during the time when the vital
powers of the patient are at the lowest, that is, in the
early morning hours.   Because of this, care should
be taken to provide extra covers at that time.  Un-
less otherwise directed, it is safe to keep the tem-
perature of the room  for a  fever patient at about
6o° F.  For patients  afflicted with  other diseases
the thermometer should register about 68° F.
   The temperature of the room must be  regulated
by turning the artificial heat off or on, not by closing
windows that are needed for ventilation.  In some
cases dry heat  from a furnace is very irritating.
This may be remedied by keeping a kettle of boiling
water  in the  room.   To keep the room cool  in hot
weather is not always a very easy matter.  Keeping
the blinds down and  the  windows  closed  on the
sunny  side during the day will produce very good
results.  A wet sheet hung in the window or where
a breeze will blow over it often is a material aid in
cooling the room.   If an electric fan is used, care
                       17, 
THE HOME NURSE
must be taken that the direct current does not strike
the patient.
  Good ventilation  is necessary in every disease.
Formerly patients were confined in dark rooms with
all doors and windows closed.  It is surprising how
many recovered under these conditions.  Sunshine
and fresh air are Nature's two most potent reme-
dies.  In cold weather it may not be desirable to
have the windows open in the patient's room, but in
this case windows in an adjoining room should be
lowered and the door between the rooms left open.
Usually, however, the room can be ventilated  di-
rectly.   Raise the window about six inches from the
bottom, fit a board tightly under it.   Fresh air will
then come in between the two sashes and danger of
a direct draft on the patient will be avoided.   Every
morning the room should  be ventilated  thoroughly
by throwing open all windows and doors for a few
minutes.  Before doing this, the patient should be
covered with one or two extra blankets  and a light
covering thrown over the face.   Do not remove this
extra covering at once when you close the windows
but remove it gradually as the air in the  room
regains its normal warmth.
   It is better not to keep plants or flowers in the
                       18 
THE SICK  ROOM
room, but if the patient desires a few during the
day they always should be removed at night.  Keep
all medicine bottles, empty glasses, etc., out of sight
and if possible out of the room.
  All excreta, soiled linen and dressings should be
removed from the room at once as they pollute the
air.  In infectious or contagious diseases the urine,
feces (bowel movement) and vomited matter should
be disinfected with chloride of lime or with carbolic
acid.  Care should be  taken not to  empty the ex-
creta  near a well or  any place where  the water
supply will become contaminated.  If no sewerage
system is convenient, the feces should be buried or
burned  after being  disinfected.  If a patient ex-
pectorates he may be supplied with small pieces of
cotton to receive the sputum.  A paper cone pinned
to the side of the mattress, within easy reach of the
patient's hand, makes  a convenient receptacle for
these pieces.  A new cone should be provided  once
or twice a day.
  The sweeping in a sick room must be done slowly,
keeping the broom always near the floor so the dust
will  not fly.  Before  commencing  to sweep,  the
broom should  be dampened, or moist sawdust  or
tea  leaves  strewn  over the  floor.   The dusting
                       19 
THE HOME NURSE
should be done with a damp cloth, never  with a
feather duster.  If there is a fire in the room the coal
should be brought  in  wrapped  in  paper and laid
gently on the fire.   The  ashes also should be  re-
moved noiselessly.  The patient's room  is the pa-
tient's home for the time being, therefore everything
possible should be done to keep  it  clean, airy and
comfortable.
20 
CHAPTER III
                  BED MAKING

  One of the most essential items in the care of a
patient is proper preparation and care of the bed.
One of the first requirements of a good nurse is her
ability in this line, and yet how seldom do we find
anyone except a trained nurse who understands this
matter so essential to the patient's comfort!
  First,  the  mattress must be  protected, both  for
the sake of cleanliness and for economy.   Unless
the patient  has  involuntary  urinations  or bowel
movements, a soft pad will be sufficient.  Over this
the lower  sheet should be drawn  smoothly and
pinned to the mattress at the corners.  The upper
sheet and blanket come next.  These should be well
tucked in at the foot of the bed, but not so  tightly
as to be uncomfortable for the patient.  The upper
edge of the blanket must be protected by turning the
end of the sheet back  over it.  A patient often is
uncomfortable with the usual heavy white counter-
pane over him,  although  he may  fail to find  the
                       21 
THE HOME NURSE
source of his discomfort.   Counterpanes  interfere
with the circulation of the air and although  they
add to the looks of a bed, the patient's comfort must
be the first consideration.   A light weight, loosely
woven spread may  be used.
  When the  patient is very ill, or if the nature of
the illness is such that the lower  sheet becomes
soiled, a  draw sheet should  be used.  After  the
lower sheet has been fastened in place, a sheet of
rubber cloth, about a yard square, is placed across
the middle of the bed,  allowing  the upper edge to
meet  the pillow.   This is  pinned in place by  one
safety pin at each corner.  Over this is placed a
sheet  that  has been folded crosswise.  The hems
should come  at the lower end so as not to form a
ridge  under  the patient's back.  The sheet should
be securely tucked in at the sides.
  The changing  of the linen should be  managed
with as little fatigue and discomfort to the patient
as possible.   This can be done easily by one person,
unless the patient is very ill or helpless.   Only the
upper sheet or blanket  is left over the patient, the
lower sheet is loosened at top,  bottom and sides;
one  side  then is  folded  along  its  entire length,
lengthwise as flatly as possible, close up to the pa-
                       22 
BED MAKING
tient.   The  fresh sheet  should be folded length-
wise,  alternately  backward  and forward, for half
its width, and placed on the side  of the bed from
which the soiled one has been removed.   The nurse
then  goes to the other side of the bed, turns the
patient carefully on his side facing the nurse.   She
tucks the folded sheet close up to him, smoothing the
clean sheet  carefully. She then  turns the patient
over  onto his  other side.   In so doing he  passes
the folded sheets, so that they are now at his back
and he is lying on the clean sheet.  The soiled sheet
now  can be removed and the other half of the clean
one smoothed out and the sides and ends tucked in.
The  upper sheet and blanket are replaced as before.
In changing the upper sheet the clean one is spread
over the top of the bed and held  in place while the
blanket is removed from top downwards.   This is
put over the clean sheet and both held in place while
the soiled sheet and other clothing are removed.   In
this  way exposure and chilling  of the patient is
 avoided.
   When the patient cannot be turned on his side
 the sheet must be changed from top to bottom.  The
 soiled sheet being loosened at the top and  pushed
 well down  under  the pillow, the clean sheet is
                        23 
changing the draw-sheet
2* 
BED  MAKING
started at the top and pushed down under the pillow
also.  In changing the sheet  in  this manner two
persons are required, one standing at each side  of
the bed and working the sheets  down  slowly and
carefully.
  In changing the pillows, the patient's head must
be raised by placing one arm under it and raising
it gently, then the pillows are  arranged or removed
with the other hand.   In arranging the pillows the
patient's individual taste must be  consulted; usually
two are required for comfort,  one being pulled well
down under the patient's shoulders, while the other
supports the head.  The pillows never should  be
shaken  on  the bed.   The upper  one should be  re-
moved and shaken away from  the bed, replaced, and
the other one removed, shaken and replaced.
   In making a bed,  care must be taken that a seam
of the sheet does not come under the patient's back.
Several  times  a  day  the under sheet must  be
smoothed free from  wrinkles.   All bed linen should
be warmed and aired  thoroughly before commenc-
ing the  making of the bed, and  everything should
be placed in a convenient place so there will be no
delay during the process.
   In special cases it is necessary to vary slightly
                       25 
THE HOME NURSE
the manner of making the bed.  In some operative
cases, the bed must be arranged so one portion can
be changed without disturbing the  remainder.   In
confinement cases, the bed should be made up with
a draw sheet,  and then a second rubber sheet  and
draw sheet should be placed over the first one.  By
this arrangement, the second one can be withdrawn
after labor, leaving a clean bed well protected with
the draw sheet.   If there is no provision made for
a rubber sheet, about twenty  thicknesses of news-
papers may be substituted very well.  Many people
think an old blanket or comforter can be used but
these should not be allowed if they possibly can be
avoided, for invariably they are full of germs.
   In cases of  fractured limbs one person must lift
the injured limb  gently while another changes the
sheet under it.  In these cases a wide board (table
leaf or ironing board) should be placed across the
bed under the mattress to prevent it from sagging.
   Water beds and air beds are used in cases of pro-
longed illness to prevent bed sores.  Care should be
taken  to prevent  damaging  by sticking pins  into
them.
   The old-fashioned feather bed has no place  in a
sick room.  Where one is in use,  the  nurse must
                       26 
BED MAKING
use a great deal of ingenuity to be able to dispense
with it, for in this age any one who uses a feather
bed is liable to be very "set" in her ways.
27 
CHAPTER IV
           OBSERVATION OF SYMPTOMS

  In a large percentage of the cases of illness the
physician sees his patient only once  in twenty-four
hours.  It may happen  that at the time of his visit
the patient's condition is entirely different from what
it is the greater part of the day.   He may be feeling
unusually well at that particular time while he may
be in severe pain at other times of the day.  We
see,  then,  that it is impossible for  a physician to
judge a case entirely by  the patient's condition at
the  time of his visit.   He must depend, in a large
measure, upon the report given  him by the patient
or by the nurse who has been with the patient con-
tinually. It then becomes necessary for the nurse
to observe all  symptoms closely  so as to be able to
give the physician an accurate report.
  It is  important  to  remember  that the physician
wants facts and not opinions.  Never make a state-
ment unless you are certain it is true.  For instance,
if the bowel movement  is red, one should not jump
                       28 
      OBSERVATION OF SYMPTOMS

to a conclusion and report that it  contains blood.
The discoloration might be due to some food or to
some medicine taken by the patient.   Such a report
should be that the  bowel movement looked red as
though it might contain blood.
  Do not fail to report things because they may
seem trivial.  What seems unimportant may have
a serious bearing on the case.   Sometimes it is a
very trivial symptom that enables a physician to dis-
tinguish  between two similar diseases.
  The three most  important signs to be recorded
are the pulse, temperature and  respiration.  Ordi-
narily these are taken every four hours.
  Pulse.  The rate of the pulse corresponds with
the rate  of the heart beat.   Every time the heart
contracts it sends a quantity of blood into the arter-
ies, causing them to distend.   The arteries lie nearer
the  surface at some places than at  others, so in
counting the pulse  we choose  a place  where the
artery lies  near the surface.   The most common
place is on the inner side of the wrist, on the thumb
side. At this point the radial artery lies close under
the skin. The first two fingers are pressed  lightly
on the artery and the number of pulsations a minute
are  counted.  The  thumb never should be used in
                       29 
THE HOME NURSE
counting the pulse, not only because it is awkward,
but because the pulsations of the artery in the thumb
frequently are so perceptible as to cause confusion.
  The pulse rate is much higher in children than in
adults.  In an infant at birth the rate is 130 to 150
a minute.   It gradually decreases as the child grows
older until  in  adult  life it is about 72,  although
some people normally have a  much slower pulse
rate while others have a faster one.  The pulse rate
usually increases  with  exercise or during  excite-
ment.  It generally  is  faster when  standing  than
when sitting and when sitting than when lying.  It
usually is faster in women than in men.  In fever
cases the pulse rate ordinarily increases as the body
temperature rises.   If  the  pulse increases  as the
temperature falls,  the outlook is grave.   This con-
dition has been called "the death cross."
  The rate or frequency is not the only observation
to make  regarding  the pulse.  We should notice
its  fullness and regularity.   It is said to be  full
when the artery is distended by a large volume of
blood.  It is regular when the beats  occur at regu-
lar intervals and are of  the same fullness.  An in-
termittent pulse is one that skips one out of every
few beats, as every  fourth beat.   Often  this  indi-
                        30 
OBSERVATION OF SYMPTOMS
cates a  nervous condition rather than any change
in the  structure of the heart.  It may follow the
immoderate use of tobacco, tea, coffee or other stim-
ulant.   A pulse is said to be dicrotic when there
seems to be two beats, one strong and one weaker,
to each beat of the heart.  In reality there only is
one beat, the second one being a recoil wave.   Only
the first one should be counted.   This condition is
common in some diseases, such as typhoid.
   Temperature.  The  normal temperature of the
body is 98.60 F., but,  like the pulse, there may be
some variation  with the individual.   In infants the
temperature usually is slightly higher than in adults,
while in old age the temperature not uncommonly is
a little subnormal.  A body temperature below 950
or above 1080, if it persists any length of time, is
likely to be followed by death.   In many cases as
death  approaches  the  temperature  increases  and
may be  as high as no°.  In sunstroke the tempera-
ture has been known to go as high as 112°.  There
seems  to be a nervous temperature,  too.  Some
people  with a slight cold will have a high tempera-
ture while others  may be quite seriously ill and
carry very little temperature.  With them, the nerv-
ous equilibrium seems to be so well balanced that
                       31 
THE HOME NURSE
it  requires considerable change in the body health
to affect any change in temperature.
   The temperature varies slightly during the day,
being at its  lowest between five and nine in the
morning.   For this reason we see the necessity of
providing a patient with extra bed-clothing during
the early morning hours.
   In  taking the temperature,  the most  common
method is to insert the thermometer in the mouth
under  the  tongue,  holding  it there with  the  lips
closed  for two  or three minutes.   The  time re-
quired varies with the thermometer.  The ones in
most common use require two minutes even though
they are claimed to be half minute thermometers.
With  young children or with delirious or uncon-
scious persons the temperature must be taken per rec-
tum or per axilla.  If taken the former way, the
thermometer is oiled slightly, then inserted  one and
one-half inches in the rectum and held in place for
a few minutes.   Care must be taken that the rectum
is not loaded with feces as this might interfere with
the correct record.  The temperature per rectum is
about one-half degree higher than by mouth, so if
the temperature  is  taken in this  manner this fact
must be reported to the physician.   In taking the
                       32 
      OBSERVATION OF SYMPTOMS

temperature per axilla, the axilla,  or space under
the arms, is first wiped dry from perspiration, then
the bulb of the thermometer is placed between the
folds of the skin of the arm-pit, the elbow bent and
the arm held close to  the  side.   The thermometer
should remain in place at least five minutes in order
to insure a correct record.  The record  here will
be about one-half a degree lower than in the mouth,
therefore this fact also must be reported.
  After using the thermometer it should be washed
carefully  in soap and water,  then cleansed  with
alcohol or  a  five  per-cent.  carbolic solution and
wiped  dry.  Before being  used again it should be
washed with clean water and shaken so that it regis-
ters below ninety-six.  The temperature by mouth
should  not  be taken for half an  hour after eating
or drinking, as hot or cold drinks affect the tempera-
ture of the mouth for some time.
  Fevers are said to  end by  crisis  or lysis.  By
crisis is understood a sudden fall  of temperature,
which usually is accompanied by a profuse perspira-
tion and a  lessening of the pulse rate and  also of
the rate of respiration.  Diseases which commence
suddenly usually end by crisis (as  pneumonia). Dis-
eases of a slow onset, as typhoid  fever,  usually end
                       33 
THE HOME NURSE
by lysis, that is, the temperature gradually lowers,
but there is no sudden drop.   A sudden rise or fall
of temperature should be reported to the physician
immediately.
  Respiration.  By respiration is meant the act or
function of breathing.  We breathe about  once to
every four heart beats or about eighteen  times a
minute.  Children and men usually breathe chiefly
from the lower part of the lungs, that is, abdomi-
nally.  Women are inclined to use the upper part of
the lungs chiefly.   They  are said to have a thoracic
breathing.  The  respirations  may  be  counted by
watching the chest rise and fall, counting the num-
ber of times per minute.  This should be done when
the patient is not aware of what is taking place, as
no one ever breathes naturally  if conscious that some
one is watching him breathe.   A physician usually
counts the respirations while  the patient  thinks he
still is counting the pulse as he keeps the hand on
the pulse while counting  the respiration.  In count-
ing the respirations one also should note if they are
deep  or  shallow,  regular  or  irregular,   free or
labored.
   A peculiar form of breathing is called the Cheyne-
Stokes  breathing.  The  patient appears to be  not
                        34 
OBSERVATION OF SYMPTOMS
breathing, then  the  respirations begin slowly and
gradually increase in  frequency  until very rapid,
then gradually decrease until they appear to cease.
This breathing  frequently  accompanies a disorder
of the brain and always is a serious symptom.
  General Conditions  of the Body.  The general
condition of the body of a patient should be noted.
Any deformity should  be remembered by the nurse
and recorded on her report.  This is important as
the deformity may  account for some symptoms.
Obesity or emaciation  should be noticed, especially
if it affects one portion of the body more than
others.
  General Conditions of the Skin.   The condition
of the skin, if it is hot and dry, or cold and clammy,
should be  noticed.  A high  temperature  with a
damp skin indicates great weakness and is a grave
symptom.  The  perspiration should be noticed as
to its amount and its location if confined to certain
portions  of the body.   Sometimes there is a pecul-
iar odor  to the perspiration.  Any eruption on the
skin should be  noted as to its character and location.
Any ulcers,,old or recent scars should be reported.
Sometimes great nervous symptoms are due to pres-
sure from a scar which has escaped notice.  Any
                       35 
THE HOME NURSE
redness of the skin or commencement of bed-sores
should be  attended to at once.  If the physician's
attention is called to such a condition he will at once
prescribe the treatment.
   Face.   The expression of the face  is important.
A pinched, anxious expression often  is associated
with  grave prognosis.   A  dull, apathetic,  expres-
sionless countenance often is significant of a serious
illness.  Such  a condition  frequently is   seen  in
typhoid.   After the crisis of a disease there may be
a  noticeable  calm and  peaceful  expression.  A
drawn appearance around  the mouth often accom-
panies nausea.   A flush or bright red spot on one
or both cheeks  may  accompany  a disease of the
lungs, as  tuberculosis.   The spot may  be on the
side of the afflicted lung.   Sudden  paleness of the
face may  indicate a hemorrhage.   In cases of par-
alysis or mental disease one  should notice  if  both
sides  are  afflicted  alike.  The color  of the  skin
varies with different  diseases.  It may be  pale  or
jaundiced; it may be  cyanosed or bluish, indicating
an insufficient  supply of oxygen.  In pneumonia
the face  usually becomes  markedly  blue  before
death.
   The Eyes.  The eyes should be noted as to the
                       36 
      OBSERVATION OF SYMPTOMS

color of the conjunctiva and also as to the condition
of the pupils,  which may be dilated, contracted or
unequal in size.  The  eyes may be wide  open al-
though the patient  is unconscious.  This  is called
coma-vigil  and is a serious indication.  The  eye-
balls may be rolled  from side  to side as  in great
nervous excitement.  There may be  a protrusion
of the eyeballs.
  Mouth and Speech.  The condition of the tongue
varies greatly  in  different diseases and at  different
times with the same disease.   It may be  pale and
flabby with teeth  marks along the edge.  It may be
bright red or it  may  be spotted with bright red
spots.  This condition is called the " strawberry "
tongue and is  noticeable in scarlet fever.  The en-
tire tongue may  be coated with a fur which  may
vary in color from a dirty white to a dark brown.
It may be dry or moist; it may be sore, tender and
bleeding; it may be swollen.  The condition of the
teeth and gums should be noted.  Some distressing
stomach conditions are due to decayed teeth.  In
some  diseases, as typhoid, the teeth may be coated
with a brown  coating  called sordes.
  Taste and Appetite.   The amount of food taken
and the time at which it was  taken should be re-
                       37 
THE HOME NURSE
corded.  Also  one should note whether the patient
seems to relish the food or if it is eaten without any
relish.  Sometimes the patient  seems to be  fairly
ravenous  for food.   The amount of  liquids  taken
should be recorded.   It is not uncommon for a phy-
sician to be told that the patient has not eaten any-
thing for a day or two, but upon closer inquiry  he
obtains the information that  the patient has  taken
a quantity of milk, soup or broth sufficient for his
needs.
  A bitter taste is common with  indigestion  while
a salty taste is common in pulmonary tuberculosis.
Certain drugs produce a characteristic taste in the
mouth.
  The Mind.   If  at any time the patient is uncon-
scious the  time and duration  should  be noted.   If
he appears irrational, this also should be recorded.
He may be very  much depressed or  be hilarious.
There may be  active delirium or  persistent melan-
cholia.  The speech should  be noted  if it is thick
or clear.   The patient may be hoarse or may scream
continually.
  Sleep.   The  number of hours of  sleep, also the
character of the sleep should be reported.  The pa-
tient may sleep quietly or he may be restless and dis-
                       38 
OBSERVATION OF SYMPTOMS
turbed.   He  may  sleep lightly  and be  awakened
easily or he may be aroused with difficulty.   Some-
times a patient is not aware he has been asleep and
will  insist  that he  has  not slept a wink when  in
reality he has had several hours'  sleep.
  Excretions.  All  excretions from the body should
be promptly  disinfected and then  removed from
the room and disposed of.  The nature, quantity
and time of voiding of these excretions  should  be
reported to the physician.  The condition  of the
bowels should be watched  carefully, noting if there
is a diarrhoea or constipation.   The nature  (liquid
or solid),  also the color  of the feces  should  be
noted.  They may be  discolored  from  medicine,
from blood or from something  else.  Some medi-
cines, as bismuth, produce a black movement.  If a
hemorrhage has taken place and  the blood has been
retained in the bowels for some time, it may give a
tarry appearance to the feces.  So it is wise to save
any unusual looking specimen for the physician  to
inspect.  It may be kept  in a  covered vessel, but
the better way is to place some of the  feces in a
wide-mouthed bottle, as a  mason jar, and cover it
tightly.  Then,  if  the  physician desires, he may
take it to be examined under the microscope.  One
                       39 
THE HOME NURSE
should notice  if the feces  contain pus, undigested
food or milk-curds.  The latter show that the milk
taken is not being digested.  With young babies
especially, the bowel movements  are  an important
item in  the diagnosis, as the greater portion of the
disorders  of babyhood  arise from improperly di-
gested food.
  The urine should be measured when voided and
the amount and time of  voiding should be recorded.
This is important as the patient may be passing too
much or too little urine.   If the urine appears other-
wise than normal  a specimen should be saved for
the physician.  To do this a  bottle holding about
six ounces should be thoroughly washed and boiled.
The urine is then  voided in a clean vessel  and im-
mediately poured in the bottle and stoppered with
a clean stopper.
  Vomiting.   Should this occur, the time of occur-
rence, also the nature of the vomitus should be re-
corded and  a specimen  saved in a closed vessel.
Anything that might cause the vomiting should be
noted, as medicine taken just a few moments previ-
ously.   If the patient is nauseated but does not
yomit this should be noted.
  Cough.  When  this  occurs the frequency and
                       40 
OBSERVATION OF SYMPTOMS
duration, also the nature, should be  recorded.  It
may occur  in paroxysms or be short, barking and
difficult to  control; it may be deep and hollow  or
ringing and  brassy;  it may  be  high-pitched and
superficial,  it may be a croupy cough with a crow-
ing sound or  it may be the typical whoop of whoop-
ing-cough.   It may be  worse at times  of  day  or
night or brought on by certain positions as by lying
down or by moving.   The quality of the expectora-
tion is an important symptom.  It may be clear and
tenacious like the white of an  egg, it may be muco-
purulent, that is,  consisting of a mixture of mucus
and pus.   It may be  ropy and tenacious or frothy
and streaked with  blood.  This  latter  condition
often is called " prune juice "  sputum.
   Position of Patient in Bed.  This often is indica-
tive of the portion  of  the  body affected.  If the
heart  is affected  the patient  may  be much  more
comfortable  sitting than lying.  If one lung is af-
fected he may lie on that side so as to give the well
lung all the  freedom possible.  In any abdominal
trouble the patient usually is easier with the thighs
flexed as that relaxes the abdominal muscles.
   A patient  in great pain usually lies quietly, while
a nervous condition is indicated  by  restlessness.
                       4i 
THE HOME NURSE
Extreme restlessness often is common towards the
end in fatal cases.  In these cases also the patient
seems to slip down towards the foot of the bed.
  Rigors or Chills.  Should these occur  the dura-
tion, intensity  and time of  occurrence  should be
recorded.   The temperature  should  be taken dur-
ing and after a chill.  Chills are a very important
symptom in any disease, except malaria, as they in-
dicate  a complicating suppurative process, that is,
they indicate that pus is forming in some part of
the body.
  Hemorrhage.   In this case the appearance of the
blood,  whether it is fluid or coagulated, its color, and
whether it is mixed with other substances are im-
portant.  The  quantity should be estimated,  also
the source of the bleeding if possible.
  Pain.  Its position, duration and character should
be noted, also any attending circumstances.  In hys-
terical cases the  patient always complains of  pain
when  in the presence of one who  is sympathetic
while if he is alone, or thinks he is, the  pain  does
not seem to be present.  The real pain may be dull,
aching, or sharp and cutting.   It may be steady or
be worse  at times.  All these are valuable aids in
diagnosis.
                       42 
CHAPTER V
          DAILY CARE OF THE PATIENT

  In the daily care of the patient, the first consider-
ation  is  to  carry  out all orders of  the  physician
exactly on time.  The next consideration is to make
the patient as comfortable as possible.
  Absolute cleanliness of patient and bed is a great
aid towards  hastening convalescence.  As soon as
the patient awakens in the morning, his face  and
hands should be bathed, his teeth brushed, and the
bed clothes  straightened.  Then the patient  may
be given his  breakfast, after which  the more exten-
sive toilet may be made.
  As a rule, bed patients should be given two full
baths a week, and on the other days the face, hands,
groin and axilla should be sponged.   The bed cloth-
ing should be  loosened and smoothed every morn-
ing, even though no change in linen is made.
   The  hair  should  be combed at  least  once every
twenty-four  hours.  Frequently this  is a  point
neglected by the untrained nurse.   It is best to part
                        43 
             THE  HOME  NURSE

the hair  of  women patients in two strands  at the
back, then one side at a time can be arranged with-
out placing the patient in an uncomfortable position.
The combing and brushing should be done  gently
but firmly.  One should  begin at the ends  of the
hair and  work upwards, grasping the hair with the
left hand between the comb and scalp in order to
avoid pulling on the  roots.   The best way  to ar-
range the hair  is in two braids.  Be sure to start
them well around at the side and down low enough
so they will not be uncomfortable,  or so that the
patient will not be compelled to lie on a hard knot.
When a patient is compelled to lie in bed a number
of weeks the hair may be washed without danger
to the patient.   The patient's head should be  moved
well towards the edge of the bed, the pillow pro-
tected with a rubber sheet, then one  side at  a time
may be washed.  Have ready two basins of  rather
hot water, one  containing  borax and a shampoo
mixture,  the other  plain water  for  rinsing. The
washing  can be done quickly and the scalp and hair
nearly  dried at once by the use of several towels.
The hair may remain spread out on the pillow until
thoroughly dry.  If, through neglect, the hair has
become matted, olive oil should be applied and then
                      44 
DAILY  CARE OF THE PATIENT
the hair untangled one strand at a time.  Be care-
ful not to tire the patient by doing too much at
once.   If  the hair is tangled badly it may  take
several days before it is all straightened out.
   The mouth and teeth should receive  close atten-
tion and  be  kept  as  sweet and clean  as possible.
In some cases the accumulation of sordes (brown
coating) is rapid and the mouth must  be cleansed
frequently.  There are many good mouth washes.
A solution of boracic acid  or diluted listerine is
good.  With a very  sick patient a tooth brush is
inconvenient, therefore the mouth should be cleansed
with small squares of gauze  which may be thrown
away after use.
   The condition of the hands and nails  of a patient
often indicates the thoroughness of the nurse.  The
nails should be kept clean and filed when necessary.
The toe nails also  should be given attention and not
allowed to become long.
   Usually bed sores indicate neglect,  although in
some cases it is  impossible  to  avoid them.  To
guard against them the  back, especially the lower
part, should be rubbed with alcohol, vinegar or other
astringent at least night and morning.   Every day
the nurse should examine the body to see that there
                       45 
THE HOME NURSE
are no  red spots  showing pressure.   When  these
occur they should be well  rubbed with the alcohol
and the pressure on the parts relieved by the use of
a ring or pad.   If the patient has involuntary urina-
tions, it is well to massage the lower part of the
back with castor oil.   This should be repeated every
time the bed clothing is changed as it  makes the
skin impervious to water  and helps  to  avoid bed
sores.   If a bed sore develops the physician should
be notified at once so that he may prescribe the treat-
ment.   Keeping the  bed  free  from  crumbs  and
wrinkles is another preventive.   Changing the posi-
tion  frequently so as to avoid pressure on any one
part is  another measure.
   In  moving  a helpless  patient  the  nurse never
should attempt to  lift him alone.   She  must  have
at least one assistant.  She should place one arm
under the neck of the patient in such a manner that
the head will rest on her arm.  Her other hand and
arm should be placed under the middle of the back.
The  assistant places one hand and arm under the
lower part of the back and the other under the knees.
Then they lift together.   If the patient  has an in-
jured limb it will require another assistant to hold
that.  The patient can be moved from one side of
                       46 
DAILY  CARE OF THE  PATIENT
the bed to the other on the draw sheet which can
be pulled  gently.  To carry a patient requires two
persons.   A  nurse never should overestimate her
strength nor  strain her back by lifting.
  In placing  a bed pan under the patient he should
raise his hips from the bed; the nurse then inserts
the bed pan gently.  She never should drag the pan
out.  Especially in cold weather, the pan should  be
warmed before use.
  In feeding a putient one should strive to make the
food as attractive as possible.  Always have a clean
napkin on the tray.  Use the prettiest dishes obtain-
able and  serve everything  daintily  so as to attract
the patient's  appetite.   Serve only  a small  amount
of anything.   It is better to serve a second helping
than to have  an overloaded tray.   A sick person's
appetite may be tempted by a daintily served meal,
while an  overloaded tray may cause the capricious
appetite to vanish.  Every hot dish should be served
hot, not lukewarm.  It frequently is necessary for a
nurse to  feed a feeble patient.  In doing  so she
never should  hurry.   An unconscious  person may
be  fed by putting a few drops  of liquid at a time
in the mouth, but should  not be  given enough  at
any time to cause choking.   A patient who refuses
                       47 
THE HOME NURSE
to swallow may be compelled to do so by placing
a spoonful of liquid in the mouth and holding the
mouth  and nostrils closed.
48 
CHAPTER VI
                     BATHS

  Ordinarily, we think of a bath as a cleansing
agent only.  There probably is no other health pro-
ducing agent so imperfectly understood and yet so
capable of yielding comfort and benefit.   Cleanli-
ness is essential to health and hence a bath is use-
ful for that purpose alone.   There are innumerable
small glands in the skin that have important func-
tions to perform for the welfare of the body.  One
set of these glands produces an oil which keeps the
skin in good condition, another set helps to carry
away the waste material formed in the body.  The
watery portion  of the waste  material evaporates,
leaving a residue on the skin which becomes rancid
after a time and not only produces an unpleasant
odor but clogs the pores.   If any of  the pores be-
come clogged with waste material it will be impossi-
ble for the glands to do their work properly.   Hence
a cleansing bath  is necessary for the  health of the
body.
                       49 
THE HOME NURSE
  Another important result  of intelligent bathing
is the effect upon the blood and circulation, and upon
the nervous system.  Besides being given for clean-
liness, baths  are  given  to  reduce inflammation or
fever,  to  produce relaxation of the muscles  and
nerves, to induce perspiration and to modify the cir-
culation of the blood.   They may be classified ac-
cording to the special purposes for which they are
given, according to their mode of preparation and
ingredients,  or according  to the temperature at
which they are given.
  According  to temperature,  they may be classified
as hot (from ioo° to 1120 F.), warm (from 900 to
ioo°  F.), tepid (from 700  to 900  R),  and cold
(from 330 to 700 F.).
  Effects of  Baths.  Baths of all temperatures are
given to reduce fever and inflammation.  The tem-
perature is reduced by cooling the blood and equal-
izing  the  circulation.  The  older method was to
give only  cold baths to  reduce  fever, but  the more
modern method is to give warm baths.  Cold water
applied to the surface tends to contract the surface
capillaries and drive the  blood  inwards.  If the
system is strong enough,  the  reaction will be to
dilate the surface capillaries; but if  the system  is
                       50 
BATHS
weakened, this reaction may not take place.  With
warm baths the temperature is reduced by evapora-
tion.  The heat applied to the skin dilates the sur-
face capillaries and tends to bring the blood to the
surface, then the water which is allowed to evapo-
rate from the  skin takes up the heat and  so cools
the blood.
  Baths also are given to relieve thirst.   Thirst is
a sign that the system needs water, and this may be
absorbed  through the skin.  After  an abdominal
operation  when a patient is not allowed a drink on
account of the vomiting which would result, bathing
the face and hands will lessen the thirst.
  Hot and vapor baths are given to induce perspira-
tion.  They are given especially in diseases of the
kidneys to cause the  skin to carry away the waste
material which cannot be taken care of by the dis-
eased kidneys.  These baths  also are given  for
nervousness.   Hot baths stimulate the nervous sys-
tem but they should not be continued too long at a
time as overstimulation  would  result in faintness.
Warm baths have a sedative effect.   For this reason
they frequently are given at night to induce sleep.
Their general  effect is to relieve the congestion of
the brain and internal organs.  They dilate the sur-
                       5i 
THE HOME  NURSE
face capillaries and as the blood is  drawn to the
surface the congestion in other parts is relieved and
sleep follows.   In the same manner, hot foot baths
may relieve sleeplessness and also cure  headache.
Whenever any hot bath or hot foot bath is given for
these purposes a cold cloth should be applied to the
head at the same time.   This prevents a  rush  of
blood to the head and also  is an aid in the equaliza-
tion of the circulation.  The same principle  is in
force  when heat is applied  to  the  feet  to reduce
fever.  Very frequently when the head  is " burn-
ing up" with  fever  the feet will  be found  to  be
cold.   At such times cold  applied to the head and
heat to the  feet  will reduce the  temperature  by
equalizing the circulation.
  Hot alcohol  sweats sometimes are given instead
of hot baths in severe kidney lesions.  Acid  steam
baths  often are given in  rheumatism.  These are
similar to alcohol sweats only vinegar is used in-
stead of alcohol.
  Baths may be given to overcome stupor or delir-
ium and to soothe irritations of the skin.   For the
latter,  starch baths, either sponge or tub,  are given.
About eight ounces of starch are used to a gallon
of water.
                       '52 
BATHS
          DIRECTIONS FOR GIVING BATHS
  Sponge Baths.   The bath most commonly given
a bed patient is a sponge bath.   This may be given
for cleanliness, for nervousness, or to reduce tem-
perature.  The water may be  of  any temperature
desired and may, or may not, contain various drugs,
as alcohol.
  In giving a sponge bath, everything should be in
readiness  before commencing the  bath so that the
nurse will not have to leave the  patient until the
bath is  finished.   The clothing that  is to be used
after the bath should be well aired and in readiness.
When the sponge is  given for  temperature, the
necessary articles  besides the clothing are  two
blankets, one basin of warm water and one  of cold
water containing ice, a cloth for the head and a wash
cloth.
  The patient is placed between blankets, using the
same  method as in changing  the bed linen.  All
clothing is removed.  A cloth wrung out of the ice
water is applied to the forehead.  (This should be
renewed from time to time so that it does  not be-
come  warm.)   The face is first bathed lightly with
the wash cloth wet in warm  water,  then  the re-
                       53 
THE HOME NURSE
mainder of the body is  bathed in the following
order,—chest,  abdomen,  back,  arms,  legs.   Re-
member the benefit is to be  derived from the evap-
oration which  is  to  cool the  blood,  so the  body
should not be dried but the  water allowed  to evap-
orate.   The wash cloth should not be wrung tightly,
neither should it be so filled  with water that the bed
will become wet.   The bathing should  be done with
long strokes, always  towards the heart.  For ex-
ample, in bathing the arms the strokes should be the
full length of the arm, going from the hand to the
shoulder.   A  light stroke  should be used.   The
inner surface of the arms  and legs, the axilla, groin
and  neck should  receive  especial attention, as in
these places the larger blood  vessels  lie near the
surface and the bathing will have greater results.
The  entire bath should last from twenty  minutes
to half an hour.  Only the portion of the body that
is being bathed should  be exposed,  the  remainder
being kept covered with the  blanket.
  A sponge bath for nervousness should be given in
a similar manner.   In giving a bath, a nurse's man-
ner should be quiet and calm so as not to excite the
patient.  Even  in  a bath  for temperature,  half the
benefit of the bath  is lost if the patient becomes rest-
                       54 
BATHS
less and fretful.  By her calm, yet assured manner
the nurse should quiet the patient.
  In giving a sponge for cleanliness, practically the
same method  is used except that the ice water for
the head is not necessary and an additional basin of
warm water  and soap  are required.  The nurse
should bathe one portion of the body at a time  with
the soapy water, rinse it with clear water and  wipe
dry.  With delicate patients it is not necessary to
expose the body at all as it is possible to bathe the
patient by reaching under the blanket.  However,
one portion at a time usually is exposed as the nurse
can work more quickly and easily by this method.
   Foot Baths.   To  give a foot bath in bed the
upper bed clothes are loosened  at the foot.  The
lower sheet is protected by a rubber sheet or several
thicknesses of newspapers.   The patient lies on his
back with the thighs and legs flexed so that the feet
are easily  placed in  the foot tub.  The upper bed
clothes are then drawn around the feet.  The water
for a foot bath should not be too hot at first.  It is
better to place only a small amount of comfortably
warm water in the  tub  at first and then gradually
add hot water until the water in the tub is as hot
as can be borne.  The  feet should  remain in the
                        55 
THE HOME NURSE
water  about  fifteen minutes.  A  little  mustard
added to the water increases the benefit derived from
the bath.   This should  be added in the proportion
of a tablespoonful to a  gallon of water.  It should
be mixed with a little cold water before being added
to the hot water.
   Hot foot baths are used for headache, neuralgia
in various parts of the body,  dysmenorrhoea and
sleeplessness.  They also are useful for the chronic
cold feet of elderly people which are due to poor
circulation.  Such a person should take a hot mus-
tard foot bath before retiring,  allowing the feet to
remain  in  the  water fifteen or  twenty  minutes.
After any hot foot bath  the feet should be well dried
and then not exposed to draughts.
   Sits Baths.   Sitz baths are given for dysmenor-
rhoea  (painful menstruation) and diseases of the
pelvic organs.   The patient should sit in a tub with
the feet and hips  immersed  in water.  Hot water
should be added from time to time so as to keep the
bath hot.   The patient  should remain in the water
about fifteen minutes.  A cold cloth  should be ap-
plied to the head.   The hot water draws the  blood
to the surface  and so relieves the congestion of the
                       56 
BATHS
internal organs.  Mustard added to the bath  in-
creases its action.
  Tub Baths.   In giving a patient a hot tub bath,
the water should be only comfortably warm at first
and the hot water should be  added gradually.  A
cold cloth  always should be  applied to the head.
The patient never should be left alone in the tub as
the overstimulation may produce faintness.   A hot
bath never should be taken for at least two hours
after  a meal and is best followed by a  cool sponge
or shower.  A  patient should rest in  bed  for at
least an hour after a hot tub bath.
  Alcohol Sweat.  To give this, the patient is placed
between blankets as  for a sponge bath.  A couple
of extra blankets are placed on top of the bed and
a small blanket is pinned around the shoulders of
the patient so as to prevent them becoming exposed.
A rubber sheet is placed under  the  lower  blanket
and the  edges drawn up to  meet the  edges of a
similar rubber sheet  which has been placed, rubber
side down, over the top blanket.  This leaves  the
patient in  a rubber  case  wrapped in blankets.  A
cloth  wrung out of  ice water is  placed on  the pa-
tient's head,  well down  over the  temples.  This
                       57 
THE HOME NURSE
must be renewed frequently.  It is well even to lay
a few pieces of ice in the  folds of the cloth.   The
patient  is then given a hot drink.  Hot bricks en-
cased in flannel bags are laid near the patient, be-
tween the first and  second blankets.  Great  care
should be exercised to be  sure  that the bricks are
at least a couple of inches from the patient's body
and that one or more thicknesses of blanket are be-
tween the bricks and the body.   One brick should
be placed at each foot, two beside each leg,— one
midway between the hips and knees and one mid-
way between the knees and ankles.  A brick should
not be placed near a joint, for if a burn should oc-
cur it would be more serious if directly over a joint.
About a tablespoon ful of alcohol is poured on  each
brick and then the blankets are tucked in tightly as
before.  This allows the vapor from the alcohol to
reach the patient and so aid in the sweating process.
  Hot Pack.   A sheet is wrung out of hot water
and the entire body of the patient is wrapped in this.
A blanket is laid over the top and the bed is  pro-
tected by a rubber sheet.  A cold cloth should be ap-
plied to the head.  This  treatment  frequently is
prescribed for nervousness.
  Ice Pack.   This is prepared similar to a hot pack,
                       58 
BATHS
only after the patient has been wrapped in the sheet,
pieces of ice are laid along the course of the large
blood vessels and the blanket is omitted  from over
the patient.   This treatment is given to reduce tem-
perature and the patient should remain in the pack
about twenty minutes.
  Affusion or Pouring  on of Water.  The patient
is wrapped in a wet sheet as in the previous case,
the rubber sheet is  folded up at the sides,  top and
bottom  and pinned  at the corners so as  to form a
basin; water is then poured on gently,  sometimes
from a  sprinkling can.   Such a bath may be given
to reduce temperature.
59 
CHAPTER VII
   APPLIANCES FOR THE RELIEF OF BED PATIENTS

   When the patient is compelled to remain in one
position for any length of  time he becomes very
tired and also is liable to  develop bed sores at the
points of pressure.   In  order to avoid this, great
care  is necessary and the ingenuity  of  the nurse
often is taxed to devise measure for the relief of
the patient.
   The position of the patient should, if possible, be
changed several times a day.   A person who is very
ill is inclined to  remain in one  position,  and that
position is most often on his back, which is the posi-
tion that  predisposes to pneumonia.  The patient
should be turned on his side and his back supported
by a pillow tucked snugly along  the middle  of it.
Rubbing downward along  the spine with the hand
moistened with alcohol is very restful to the tired
patient.  Rubbing the limbs  lightly also  helps to
rest the patient.
   Where a patient is compelled to lie on his back,
                       60 
RELIEF  OF BED PATIENTS
pressure should be relieved by the use of a rubber air
cushion or other device.  Where these are not ob-
tainable a good substitute  can be made  of cotton.
A circular  pad  of  cotton about eighteen inches
across, with a hole in the center about  ten inches in
diameter,  is prepared.   This may be wound lightly
with a muslin strip or bandage.  This ring placed
under the patient relieves the pressure at the end of
the spine  which  is the most  common seat of bed
sores.   Similar  rings may  be placed under the
shoulders  and smaller ones under the heels.  The
most common locations for bed sores are the lower
part of the back, hips, shoulder blades, elbows, tips
of ears, back of neck, inner surface of knees,  heels
and ankles.   On the slightest indication of redness,
even before the patient  complains of any pain, care
should be taken to remove all pressure.
  A pillow or old-fashioned bolster placed under
the knees of one lying on his back makes it easy  for
him to  keep them up in a  position that relaxes  the
abdominal muscles and produces considerable  com-
fort.  A pad or pillow, placed at the  foot of the bed
against which the patient can rest his feet,  prevents
him from slipping down in the bed.
  A cradle, made from two half barrel hoops fast-
                       61 
I.  RING FOR RELIEF OF PRESSURE
8.  BED-CRADLE     3.  BACK-REST
62 
RELIEF OF BED  PATIENTS
ened together about a foot apart with three or four
strips of lath, placed over an injured limb will raise
the bed clothes whose weight often causes consider-
able discomfort.
  A back rest can be devised for the patient who is
allowed to  sit up in bed.   A straight-backed chair
is turned upside down and placed so the back will
slope away from the patient's back.   Pillows should
be placed along the-back of the chair.
  In moving a patient simply to change his position
it is of the utmost importance to support the patient.
If this is done properly a heavy patient usually can
be moved by any nurse without  injury to herself.
One thing to bear in mind is that supporting a pa-
tient and lifting a patient are two entirely different
things.
63 

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SPECIMEN RECORD
64 
CHAPTER VIII
          THE NURSE'S WRITTEN REPORT

  It would be impossible for any nurse, trained or
otherwise, to remember everything that occurred in
connection with a patient during twenty-four hours
and then tell it to the physician in a few minutes on
the occasion of his daily visit.  The necessity of
keeping an accurate written report, in such a form
that it may be read by the doctor in a few minutes,
is evident.  A form of chart which is used uni-
versally permits the record of  an entire day being
kept on one page,  and the physician can  see at a
glance all important symptoms.
  At the top of the  sheet should be the date, also the
name of the patient, the physician and the nurse.
This makes it possible to make a permanent record
of the report which may be  filed  for future refer-
ence.   Especially in accident  cases, this has proven
valuable, for such  a report  would be accepted as
testimony in court.
  The first column  gives the  hour at which the ob-
                       65 
THE HOME NURSE
servation is recorded.   The first record necessarily
would be the first one  after midnight.   The second
column contains a record of the pulse rate at various
times during the day.  It is customary to record the
temperature and respiration at  the same  time and
these are placed in the third and fourth columns re-
spectively.
   The  medicine  given  is  recorded in  the  fifth
column.   Professional nurses use the signs 3 and ^
in recording the amount of medicine.  The former
means drams.   A dram is equal to a small teaspoon-
ful.   The second sign  indicates  ounces.   An ounce
is equal  to  eight  drams.  Liquid  nourishment,
water and urine usually are recorded in ounces.  A
prescription filled at a drug store has on its label the
sign ^ with a number following.  The  sign means
recipe  and the number indicates the number of the
recipe  or prescription which has been placed on file
by the druggist.   It is customary for nurses to indi-
cate  the medicine  given by recording the  sign and
number of the prescription.
  The sixth column shows the nourishment taken.
Water or any other drink  also should be recorded
in this column.   If the patient  is eating regular
meals it will be sufficient to record " regular tray."
                       66 
THE NURSE'S WRITTEN REPORT
  The seventh column shows the number of bowel
movements.   Opposite any record of this sort the
character of  the movement  should be recorded in
the last column.  The eighth column indicates the
amount of urine voided.  All urine passed should be
measured and the amount recorded in ounces.
  The last column  might be called miscellaneous,
for it contains all records that cannot well be placed
in any of the other columns.  It might also be called
the explanatory column; for here may be written re-
marks explaining or enlarging upon other records.
  It is well to keep the record in an adjoining room,
out of sight of the patient,  who should not be al-
lowed to read it.  The chief  essentials of a good re-
port are that it should be neat, accurate, and concise
but comprehensive.
67 
CHAPTER IX
         ADMINISTRATION OF MEDICINE

  An important part of a nurse's duty is the ad-
ministration of medicine.  Accuracy  is the keynote
to be kept in mind when dealing with drugs.  There
are some remedies which  are beneficial if taken in
small doses that  would be  poisonous if  taken in
greater quantities.   For instance, a correct dose of
morphine or strychnine given at the right time may
save a life, but an overdose would have disastrous
results.
  A physician who prescribes medicine must be ac-
quainted with the action of the drug in both large
and small doses.  He also knows how  long it will
take for the effect of the drug to wear off and when
it will be desirable to repeat the dose.   He makes a
prescription which may include several drugs but
which  will have  a certain  amount  of a drug to
each dose and can anticipate the action of the medi-
cine.  It is not uncommon for patients to counteract
the effect of the treatment by overzealousness.   For
                       68 
     ADMINISTRATION OF MEDICINE

example, a doctor leaves a bottle of medicine with
the directions that one teaspoonful  is to be taken
every three hours.  After the first dose,  the patient
feels some better, so he thinks to hasten his recovery
by increasing the dose and lessening the time between
doses.   So, instead of waiting three hours, he takes
another dose in two hours and also increases the dose
to a teaspoonful and a half "so as to have a good
measure."  As a result, the effects are not what the
doctor anticipated nor  desired.  It is a similar case
to that of the man who thought if a little exercise
was beneficial more would be doubly so.  As a re-
sult, he rode  a wheel until he dropped from exhaus-
tion.   Taking medicine can be likened to taking ex-
ercise.  It is not violent exercise that is beneficial in
developing a muscle, but the constant repetition of
light exercise.
   There are five principal methods of administering
medicine,— by the mouth, by rectum, subcutaneously
or by the hypodermic method, by inhalation into the
lungs,  by inunction or absorption through the skin.
Occasionally  medicine  is given intravenously or in-
jected directly into the veins.
   The most  common  way to give medicine is by
mouth but sometimes the other methods must be
                       69 
THE HOME NURSE
used.  A patient may be unconscious and so unable
to take medicine by mouth, the medicine given may
be too irritating to the stomach, or a quick action
may  be  desired, in which  case the  hypodermic
method is used.
  The effect of the medicine is obtained only after
it has been absorbed by the blood.  The rapidity of
the absorption depends upon  how the medicine is
given,  the state of the circulation, the solubility of
the medicine and its power of passing through living
membrane.  Medicine  given by mouth reaches the
blood  in  about twenty minutes.  If given  on an
empty  stomach its absorption is a little more rapid
than if given after a meal, but some medicines are
so irritating that they must be given after meals in
order to be diluted with the food.  Pills and powders
are absorbed more slowly than liquid medicine as
they must be dissolved  first.   Medicine given by in-
halation has a more rapid effect, while that given
subcutaneously usually is effective in from three to
five minutes.   Medicine given by rectum requires
about  three-fourths  of an hour for effect as  the
absorption is very slow in the lower intestine.
  Precaution in  Handling Medicine.   It is advis-
able  for a nurse to know the tables of weights and
                       70 
     ADMINISTRATION OF MEDICINE

measures, especially the apothecary's  tables.   She
also  should know the systemic and local effects of
the most  common  drugs.  In measuring medicine
it  is well  to use the regulation medicine glasses or
spoons as the ordinary spoons vary  so greatly in
size.  Medicine  that  is to be  given  before meals
should be given about a half hour before the meal
and  that to  be given afterwards,  a  half  hour
after the meal unless otherwise ordered.  Medicine
may be administered to an unconscious person by
dropping  a few drops at  a time well back on the
tongue.
   In giving  solutions  the  bottle should  be well
shaken and the  medicine poured from the side op-
posite the label so that if any medicine should run
down the side of the bottle it will not soil the label.
A nurse  should  look carefully at the label both be-
fore and after she  has poured the medicine.  This
second inspection serves to avoid many dangerous
mistakes.  No one ever should take  any medicine
in the dark.   The habit which some people have of
going to the medicine case in the dark after a certain
bottle is reprehensible.  Many deaths have followed
such careless  habits.  No matter how certain a per-
son  is that she  can get the  right medicine in the
                       71 
THE HOME NURSE
dark, there is a possibility that some one has changed
the bottles since her last visit to the closet.  Strik-
ing a light  is such a simple matter in comparison
with the risk  of losing a life that it seems  almost
inconceivable that anyone would take the risk.
  Medicine never should be left in the reach of pa-
tients or children.  A sick person is  inclined to be
despondent and in a moment of dejection may take
an overdose of  a drug.  Children are inclined to
taste everything  within their reach and many deaths
have resulted  from  carelessness  in leaving poisons
where they  can  be obtained.   No unlabeled  bottles
ever should be allowed.   Even those  most experi-
enced in handling drugs censure anyone who is so
careless.   All  unused  medicine  left  after the re-
covery of a patient  should be destroyed as  an ac-
cumulation  of " left-overs"  not only  is unsightly
but unsafe.
  Medicine by Mouth.   Liquid medicine usually is
given diluted  with a small amount of water.  A
large quantity of water should not be used as the
large dose may  nauseate.  If the medicine is espe-
cially disagreeable, ice held in the mouth for a min-
ute before the medicine is taken  will lessen the dis-
agreeable  taste.  Sometimes  medicine   may  be
                       72 
ADMINISTRATION OF  MEDICINE
mixed with seltzer or  milk to disguise the taste.
Acids and milk are incompatible and therefore they
should not be  given  together.  Acids  usually are
well diluted  and taken through a straw  or  tube.
The teeth  always should be  cleansed immediately
afterwards.
  Castor oil  may be given in the form of what is
sometimes  termed a " sandwich."  A little orange
juice is poured in the  glass  and the sides of the
glass moistened  with it.   The oil is then poured
directly into the middle  of the glass, care being
taken  not  to get it on the sides.  A little  more
orange juice  is then added to the top, and the whole
taken  at one swallow.   Castor oil  and other oils
also may  be given in  coffee, milk, wine, orange
juice or in capsules.  Castor  oil  may  be  given  to
children in the white of an egg.  The egg  is beaten
stiff, a little sugar and vanilla extract added, then
the oil added  drop by drop,  beating the mixture
constantly.   Children will eat this  as  they would
" frosting."
   Pills should be placed well back on the tongue and
then a glass  of water administered.   If the patient
is  unable to swallow them this way, they may  be
crushed and  administered in jelly or sugar.
                       73 
THE HOME NURSE
  Minims and  drops may be given on sugar or in
water.  If half a drop of  medicine  is ordered,  a
drop is mixed with two teaspoonfuls  of water  and
half the mixture given at one dose.
  Powders may be given dry,  followed by water or
they may be dissolved in a little hot milk or water.
They  also may  be given in jelly or in capsules.
  Purgatives should be given early in the morning
as their action  usually is rather rapid and  if given
at night the patient's sleep would be  disturbed.
Laxatives are best given at  night as their action is
slow and  the  effect usually is  not obtained until
morning.
  Medicine by Inhalation.   Medicines given by ab-
sorption through the lungs usually are administered
through an atomizer but may be given by  pouring
the drug into a  vessel of boiling water and allowing
the patient to inhale the steam.   Another method is
to place the drug on a hot shovel and have the patient
inhale  the vapor.   This  method of administering
medicine formerly was more commonly used than it
is now.
  Medicine  by   Rectum.  Medicine by rectum is
given  in the form of an enema or a suppository.  In
the latter case the drug is incorporated with cocoa-
                       74 
     ADMINISTRATION OF MEDICINE

butter and moulded in the  form of a cone which is
inserted in the rectum, preferably at night as it then
is more liable to remain in position.   It should be
inserted far enough  so as  to be above the internal
sphincter  muscle,  otherwise it would  be expelled.
Suppositories also are made for insertion  into the
vagina and urethra.   The method  of administering
medicine by enema will be explained later.
  Hypodermic Medication.  Medicine  given sub-
cutaneously, or under the  skin, is administered by
means of a hypodermic syringe.  The medicine is
placed in  the syringe, the needle sterilized by being
passed through  a flame or by boiling.   The latter
can be done over a small gas jet or over a lighted
match if  the needle  is placed  in a spoon with just
sufficient water to cover it.  In removing the needle
and attaching it to the syringe care must be taken
to touch only the part that does not come in contact
with  the  patient's flesh.   After the needle is  at-
tached to the syringe the latter should  be held with
the needle pointing upwards and all air expelled by
shaking the barrel gently and then pushing on the
piston until a drop is expelled  from the point of the
needle.   A  portion  of the patient's flesh  over a
muscle is then grasped between the thumb and fore-
                       75 
THE HOME NURSE
 finger of the nurse's left hand, this portion rubbed
 with cotton dipped in alcohol to sterilize the skin and
 also to  numb  it slightly.   The needle is  inserted
 slantingly, then withdrawn slightly and the liquid
 injected slowly.  Gentle massage,  in  the same di-
 rection in which the needle was inserted, will assist
 in the  absorption of the fluid.  In  inserting the
 needle care must be taken to avoid blood vessels and
 nerves.  A  hypodermic  injection usually is given
 in the muscular portion of the arm or leg, but may
 be given in the muscles of other  portions  of the
 body.
  Inunctions.   Some drugs, as mercury, are very
 irritating to the stomach and, if their use must be
 continued long, they  frequently are  given mixed
 with an oily base and rubbed into the  skin.   When
 applying medicine in this manner it should be rubbed
 on some part where  the skin is thin,  as the inner
 side  of the arms  and thighs.   Before  applying the
ointment the skin should be bathed with hot water
and soap to remove the natural  oil  and so permit a
more free absorption.
  Action of Medicines.  Some drugs have a cumu-
lative effect, that is,  if their  use is continued  for
any length of time,  the action is intensified as the
                       76 
     ADMINISTRATION OF  MEDICINE

effect of one dose  does not entirely disappear but
remains to be added to the second.   Such a drug
must be discontinued at intervals.
  Almost the opposite  of these in their action are
the habit  forming  drugs.   One dose makes  the
person crave another and  larger dose.  The sys-
tem adapts itself to one dose and, in order to obtain
the desired result, a larger one must be taken.
  Some people have an idiosyncrasy,  or  individual
peculiarity, to certain drugs which makes the effect
otherwise than  is  expected or desired.  For this
reason, it is desirable for a nurse to know what re-
sult  is anticipated  when any medicine  is admin-
istered.
  A nurse never should take the responsibility  of
suggesting or prescribing  any medicine.   If  con-
sulted as to what to give she should refer the patient
to  the physician.   A  nurse's training  does  not
qualify her to decide as to the advisability of taking
any  drugs.  Her duty is  to  follow directions ex-
actly.
77 
                 CHAPTER X
 COUNTER  IRRITANTS--THE RELIEF OF INFLAM-
                    MATION

  The  four cardinal  symptoms of  inflammation
are heat, pain,  redness and swelling.   The heat is
due to the abnormal tissue change, the redness to
congestion, the  swelling to the increased amount of
blood in the parts and to the inflammatory exudate,
the pain  is due to the pressure on the end organs
of the nerves.  Associated  with the local disturb-
ance there  usually is an  increased bodily tempera-
ture.
  The treatment  of  inflammation,  in  the  early
stages, is to apply heat or cold which may  cause
the inflammation to subside, otherwise abscess for-
mation may follow.  In the latter case, an opening
must  be  made  to  allow free drainage of the pus,
otherwise it will take the line of least resistance and
may find its way into a blood vessel or some body
cavity and produce serious consequences.
  A counter irritant  is any agent which, applied
                      78 
COUNTER IRRITANTS
over an inflamed surface,  will relieve the conges-
tion by bringing the blood to the surface and, there-
fore, away from the affected parts.
  Poultices  and hot fomentations, applied,  soften
and relax the skin and tissues, dilate the blood ves-
sels and quicken the circulation so that pure blood
may flow through and relieve  the  tight painful
feeling and also carry away the products of inflam-
mation.
  If ice is  applied at first it  contracts the blood
vessels and may prevent congestion of blood  in the
parts.  Ice is  valuable only in the early stages of
an  inflammation.  If pus has commenced to form,
heat should be applied so as to " bring it to a head,"
in other words to bring it to the surface.
  In early days, the most common measures used to
relieve inflammation  were  bleeding and leeching.
Either of these methods removed a portion of the
blood and, therefore, the congestion.  The leeches
are little  animals which suck the patient's  blood
when applied to the skin.  Before being applied they
are put in cold water to make them good  natured,
then they are  applied to the skin over the  inflamed
area and  left until full, when they will drop off of
their own accord.  If it is desirable to remove them
                       79 
THE HOME NURSE
before they  are satisfied, salt  is applied to their
heads, which treatment  will cause them to let  go
their  hold.   A  small piece of  cotton should  be
placed between the body of the leech and the skin,
as  the constant wriggling  is  uncomfortable.   A
leech  never  should  be applied  over an artery  or
vein.
  Later, cupping partly superseded these  earlier
methods.  This  was done by either the wet or  the
dry method.   With the dry method, several  glasses
about the size of wine glasses are used.  A small
piece of cotton is wrapped around a stick, dipped in
alcohol, passed through the flame of a candle, and
then the inside of the glass quickly swabbed with the
burning cotton.   This creates a vacuum in the glass
and if the glass is inverted immediately over the sur-
face of the skin,  it will cling fast and the tissues  un-
derneath will fill the vacuum.  Care must be taken
in swabbing the glass that the rim is not touched,
otherwise the patient  would receive a  burn from
contact with the hot glass.  Wet cupping is done
in a similar manner to the dry, only the  skin is
scarified  before  the  glass is applied.   This  causes
the blood to flow after the glass is applied.
  The most common form of counter irritants used
                       80 
COUNTER IRRITANTS
by the home people is the poultice.   For this, nu-
merous ingredients are used, all of which have some
virtue.  However, the most necessary things about
a poultice are that it should be applied hot and re-
newed often enough  so as to be kept hot.
  Perhaps the most generally used  poultice  is the
flaxseed poultice.  This is made of flaxseed meal.
The meal  first is mixed  with a  little cold  water
and then  stirred  into boiling water until it  is the
consistency of mush, after which it should  be re-
moved from  the fire and beaten to  remove the
lumps.  A layer  about an inch and  a half thick is
then spread evenly on a muslin cloth.  This is cov-
ered with another muslin cloth and  the two  sewed
together firmly.  The poultice must  be replaced by
a fresh one before it has become  cold.  A cold
poultice is very annoying to a patient, besides being
productive of much harm.   If a  little olive oil  is
added to the mush after it is removed from the fire,
there will  not be as much danger of burning the
patient if the poultice is a little too hot.
  A  charcoal  poultice is used  sometimes  where
there is a disagreeable odor to the  affected  parts,
as the charcoal absorbs  the  odors.   This poultice
is made by mixing one part of powdered charcoal
                       81 
THE HOME NURSE
with two parts of flaxseed meal and proceeding as
for an ordinary flaxseed poultice.
  A jacket poultice is fashioned by cutting the mus-
lin in the form of a jacket.   This should be made
in two pieces, a front and a back, which are applied
separately  and then  pinned together  with  safety
pins  under the arms and on  the  shoulders.  These
jacket poultices are used frequently in pneumonia
and are filled with various ingredients.
  A bran poultice is made by sewing  the bran up
in muslin,  then heating the  whole  in  the oven  or
wringing it out of boiling water.
  Starch poultices are used to relieve irritations of
the skin.  An ordinary boiled starch is made and
applied either directly or on a thin piece of muslin.
  A spice  poultice is made by  dipping  a bag  of
spices in hot alcohol or vinegar.
  A yeast poultice is used as a stimulant to a slowly
healing wound.   It  should be applied  hot, and  of
the consistency of bread the  first  time  that it is
mixed.
  A slippery elm poultice is made by wringing a
bag  of slippery elm bark out  of  hot water.  Hop
poultices are made  in  a  similar manner.  On  ac-
count  of their lightness,  these are  useful in cases
                       82 
COUNTER IRRITANTS
where the patient cannot bear the weight of other
poultices.
  An onion poultice is made by slicing the onions
and frying in olive oil or lard for fifteen or twenty
minutes.   Another method is to  slice and pound the
onions and then heat them in the oven.
  Where an even dry heat is  required, salt bags
frequently  are  used.   The salt  is  sewed up in  a
muslin bag and then  heated in  the oven.  Such  a
bag will  remain  hot  for several hours.
  Bread poultices, or plasters, are applied cold, the
bread being soaked in milk and applied directly to
the surface and then  covered  with a muslin cloth.
  Mustard plasters are applied  cold.  To  make  a
mustard  plaster, take  equal  parts  of  flour and
ground mustard and mix with sufficient cold water
to form a smooth paste.  This  is spread thinly on
a piece of  thin muslin and applied to the  surface.
It must be removed as soon as the skin becomes red-
dened or it will  produce a blister.  Another way
to make a mustard paste that will not blister is to
mix two tablespoonfuls of mustard and three of
flour with the white of an egg and enough olive oil
to form a smooth paste.
  For spice plasters, all spices but pepper and mus-
                       83 
S    i
8TUPE WRINGER
MEDICINE GLASS 
COUNTER IRRITANTS
tard are used.  Take equal parts of powdered cin-
namon, cloves and  allspice, mix with sufficient Oil
or water to form a smooth  paste.  The effect of
such a plaster is similar to that of the mustard, only
it  is  more mild  and, therefore,  more  adapted  to
the tender skin of children.
  In hospitals, the most common method of apply-
ing counter-irritation is by the  use of hot water,
either alone or in combination with  some drug.
  Hot fomentations or hot stupes are cloths wrung
out of hot water and applied directly to the skin.
An old  flannel cloth should  be  used.  A piece of
an old wool blanket is very good, as the meshes are
coarse enough to  allow the steam to escape.  White
flannel is  preferable,  as the  dye  from colored
flannel may be  poisonous.  The  flannel,  which
should be  of two or three thicknesses, is dipped in
boiling water  and then wrung dry.  This is best
done by placing it in a towel or stupe wringer.  The
latter is  made of  a  piece of  strong cloth  about
eighteen inches square, folded so that the sides meet
in the center and with a hem at each end through
which runs a stick.  By placing the wet  flannel
in the stupe wringer and then twisting the ends
in opposite  directions  the flannel may  be  wrung
                      85 
THE HOME NURSE
dry  very  easily.   It  should  be  carried  to  the
bed in the  wringer so as to retain the heat.  After
being taken from  the wringer, it is shaken quickly
so as to allow the confined steam to escape.   The
fomentation, after being applied, is covered with a
rubber cloth and a pad of cotton or wool and held
in place by a bandage.   The rubber cloth should be
larger than the flannel  cloth so as to keep the pa-
tient's clothing dry.  If  properly  applied,  neither
the patient's clothing  nor the bed  should  become
wet.  The  fomentation  should be replaced by  a hot
one  before it  has  become  cold.  The second  one
should be prepared and ready to be applied before
the first one is removed  so that there  will be no
danger of chilling.  After discontinuing the stupes,
a warm cloth should be applied over the parts for a
day  or two to avoid chilling.  To keep the stupes
hot, it usually is  necessary to change them  every
fifteen or twenty minutes.   If the weight is not un-
comfortable a hot water  bag,  or electric  heating
pad  applied over the fomentation  will keep it hot
for  several hours.
   Turpentine  stupes are applied in two ways.   The
older method is to add three teaspoonfuls of turpen-
tine to a pint of boiling water into which the stupes
                       86 
COUNTER  IRRITANTS
are dipped.   The  objection to this method is  that
sometimes the  turpentine remains  in  drops which
may cause blisters.  The better method is to  mix
one part of  turpentine to eight of olive oil and ap-
ply a little of the mixture to the patient's skin,  then
apply the stupes wrung out of plain water.  These
applications  are especially valuable to relieve gas in
the intestines.  They should not be used in inflam-
mation of the kidneys and, should any blood appear
in the urine, they should be  discontinued immedi-
ately.
   Mustard fomentations are made by adding a ta-
blespoon ful of mustard to a pint of hot water.  The
mustard should be mixed with a little cold water,
otherwise it will form in lumps.
   Other counter irritants that sometimes  are  used
are cantharides, blisters and various liniments which
contain some irritant that  will tend  to dilate the
blood vessels and bring the blood to the surface and
away from  the congested organ.
87 
CHAPTER XI
         DOUCHES, ENEMAS, INJECTIONS

  A douche is a stream of water directed against a
part.  It is given to flush a cavity, for purposes of
cleanliness, for stimulation, or to relieve inflamma-
tion or  hemorrhage.  The most common  douches
are the aural, the rectal, and the vaginal.
  An aural douche is an injection into the outer
ear.   This usually  is given  for  inflammation, ac-
companied by a discharge  (for  a  condition com-
monly known as a running  ear).  A great many
of the simple ear troubles can be relieved by douch-
ing.   Many of  these troubles  are  due to a  little
inflammation of the external canal which causes the
wax to  harden.  This in turn sets up an irritation
or may  be  the cause of partial deafness.  Some
ears have such a deep external canal that it is almost
impossible to cleanse  them with  an ordinary wash
cloth  used when taking a bath.
   To give an  aural douche, or  injection  into the
ear, provide a  fountain syringe,  use the glass part
                       88 
DOUCHES,  ENEMAS, INJECTIONS
of a  medicine dropper  instead  of the ordinary
syringe  points.  Hang the bag of  the  syringe so
that it will be not more than a foot above the ear.
If it is  hung higher, the water will flow with too
much force and will make the injection very pain-
ful.  The bag should be filled with water as hot as
can be borne by the patient.   The medicine dropper
will cause  the stream  to  be very small, which  is
preferable.   The  water should flow so slowly and
in such a small stream that it will take nearly fifteen
minutes to  empty  a two  quart  bag.   After the
douche,  the ear may be dried with a swab made by
wrapping a small piece of absorbent cotton around
a tooth  pick.  Small or hard instruments, such as
pins, never should be allowed in the ear.  It is not
uncommon to  see a mother clean her child's ear by
inserting the head of a pin.   This never should be
done,  as there is  danger of injuring the drum and
producing deafness, or an  inflammation  may be
started  that will  cause serious  trouble later.
  The rectal douche commonly is called an  enema
or injection.   This  is an injection into the bowels
and is given for constipation, diarrhoea, nourish-
ment,  and for medicine.
  An  evacuant enema,  or one given to relieve con-
                      89 
THE HOME NURSE
stipation, usually is given with a fountain syringe.
The bag is filled with warm, soapy water made with
some  pure  soap.   In  some cases,  it is  desirable  to
give this with a rectal tube, which is a long  rubber
tube that is inserted into the rectum about ten  inches,
otherwise the ordinary enema point is used.
  In  giving an  enema,  the  best  results are ob-
tained by having the patient in the knee chest posi-
tion.   This allows the water to  flow farther up
the bowel  and consequently  reaches more  parts.
With a bed patient,  who is unable to assume the
knee  chest position, the Sims' position is assumed
whenever the rectal tube is used.   If the ordinary
enema point is used, the patient may lie in the prone
position  (on his back) with  the  hips  slightly ele-
vated.  Care should be taken  to protect the  bed  by
covering the sheet and mattress with a rubber sheet
or  several  thickness of newspapers.
  In  some  cases  of  obstinate constipation,  a few
ounces of  olive oil or castor oil  are injected into
the rectum and allowed to remain  for several hours
until  the feces are softened.   Then, if there are  no
results, a plain soap suds enema may be given.  An
oil  enema  usually is  given  with  a hard  rubber  or
piston syringe.
                       90 
     DOUCHES, ENEMAS, INJECTIONS

  Another enema, called a 1-2-3 enema, sometimes
is  given.  This  is  composed  of one ounce (two
tablespoonfuls)  of  magnesium  sulphate  (epsom
salts), two ounces of glycerine and three ounces of
warm water.   This should be given very slowly as
it is desirable for it to be retained for about half
an hour.  If a  towel  is pressed against the anus
for a few minutes until the first desire to expel the
solution has passed, it is more liable to be retained.
Usually results  can  be obtained from this enema
when everything else has failed.
  A turpentine enema is given to relieve an accumu-
lation of gas in the bowels.  Although it sometimes
is prepared simply  by adding a teaspoonful of tur-
pentine to a pint of water, yet the better method is
to make a turpentine emulsion.  This is composed
of a dram (teaspoonful) of turpentine, an ounce
(two tablespoonfuls) of olive oil, a  pint of warm
water and the white of an egg.  Mix the turpen-
tine slowly with  the white of the egg, add the olive
oil drop by drop, beating all the time, then  add the
water, which  should be about  blood heat.  This
mixture should be injected slowly and allowed to re-
main  for about a half hour, then followed  with an
enema of  plain  water.
                       9i 
THE HOME NURSE
  An enema given for diarrhoea usually consists
of water in which  has been boiled a  little barley,
flaxseed or oatmeal.  It is given to soothe the irri-
tated  membrane lining the  intestines,  and  also to
wash  out  any irritating  material  which  may  be
causing the diarrhoea.
  In some cases astringent enema, containing starch
and laudanum are given.  To make  the former,
prepare an  ordinary boiled starch and dilute it with
warm water until it is thin enough to pass through
the syringe.  This is  given also for hemorrhage.
  A nourishing enema may consist of almost any
bland liquid,  usually one that is partly digested.
Egg nog, malted  milk, peptonized milk and pre-
digested beef  are among  the ones most commonly
used.   A little salt  always should be added.  From
four to six ounces is all that should be given at one
time.   If a larger  quantity is  given, it makes the
desire  to  expel it  too strong to be  resisted.  A
cleansing enema should be given half an hour be-
fore the nutrient,  otherwise the bowels might be
so coated with fecal  matter that no absorption of
the nourishment could take place.   The nutrient
enema should be given slowly,  and a towel pressed
against the anus  until the first desire  to expel the
                       92 
DOUCHES,  ENEMAS, INJECTIONS
food has passed.  A nutrient enema should not be
given more often that once every four hours and,
if it is to be continued for several days, it should
not be given more than three times in twenty-four
hours, otherwise  the rectum  will become so irri-
tated that  it will not  retain the enema  for  any
length of time.
  A stimulating,  nutrient  enema is given in cases
of extreme weakness.  A stimulating enema may
consist only of black coffee or of normal salt.  The
latter is a solution of common salt in water in about
the same proportion that salt is found normally in
the blood.  An even teaspoonful  of  common  salt
to a quart of warm water makes about the right
proportion.
  An enema  or an external douche often is given
to relieve hemorrhoids or piles.  For  this condi-
tion, an  enema should be taken after each move-
ment  Just enough water should be  used to wash
away all irritating material from the rectum.  After
using the enema, some  bland astringent ointment
should be inserted in the  rectum.  Common vase-
line  may be used, but an ointment containing an
astringent is better.  If the hemorrhoids are very
painful, the water should be used  as hot as can be
                      93 
THE HOME NURSE
borne and a stream of hot water should be allowed
to run on  the external parts for some time.
  A vaginal douche is given for cleansing purposes
or to reduce inflammation.  It is most effective if
given with the patient in the prone position, with
the hips  elevated  slightly.  The water  should be
allowed to  flow slowly so that it takes from fifteen
to twenty  minutes to give  a four-quart douche.
Owing to  the structure of the vagina,  a  curved
douche  point should  be used.   This  is  inserted
downward  and backward.  The injection does not
enter the womb, as many suppose.   It is intended
to flow around the cervix.  The patient should lie
quietly for about  half an hour afterwards.   For
this reason a douche is best if taken at night.  Also,
at that time, it may be taken  in the bath tub after
the patient is ready for bed.
  A douche given to reduce inflammation consists
of clear  water as  hot as can be borne.  In some
cases an  antiseptic, as bichloride of mercury, lysol
or carbolic acid, is added.   A douche  taken for
cleansing purposes should be of warm water.   Cold
water should not be used except by the advice of a
physician as the sudden chilling  is liable to produce
congestion.
                       94 
CHAPTER XII
           DESCRIPTION OF  POSITIONS

  Knee Chest Position.   To  assume this posi-
tion, the patient kneels on the bed, then bends for-
ward until the chest touches the bed.   The  thighs
should be at right angles with the bed.  This posi-
tion is used in giving enemas and for the replace-
ment of certain organs as it allows the  intestines
to  fall  forward and upward,  thus relieving the
pressure on the pelvic organs.
  Sims' Position.   In this position, the patient lies
on his left side and chest with the left arm  drawn
behind him and his head and right arm rather to-
ward the right side of the bed.   The legs should be
flexed and the right knee drawn up above the left.
This is the usual position in which a high rectal
enema is given to a bed patient.
  Prone Position.  In  the prone,  or  lateral posi-
tion, the patient lies on his back, usually with the
legs flexed.
  Fowler's Position.  In this position  the  patient's
                       95 
On
KNEE-CHEST POSITION 
DESCRIPTION OF POSITIONS
back is supported by a back rest or pillows; the legs
and thighs are flexed.  In order to retain this posi-
tion a sheet padded with a pillow is folded so as to
form  a swing with the  ends tied to the head  of
the bed.   The patient is seated in this swing.   A
foot rest is placed against the feet so as to add to
the comfort of the patient.   This position is used
particularly following pelvic operations  that must
be drained downward.
  Trendelenburg  Position.   In this position the pa-
tient lies on his back with the body elevated toward
the foot, the knees flexed over the edge of the table
so as  to help retain the position.
  There are several other positions sometimes used
in hospitals but these are the ones used most com-
monly in the home.
97 
PART II
     NURSING  IN SPECIAL DISEASES

               CHAPTER  XIII
          NURSING IN  TYPHOID FEVER

  In perhaps no  other disease is the nursing of as
much importance as  it  is in  typhoid  fever.   In
fact, in this disease, if I were  to choose between
medicine and a good  nurse, I would take the  lat-
ter.  Upon the nursing depends, to a great  extent,
the life of the patient.
  To properly care for a patient with any disease,
the nurse, first of all, must understand the nature
of the disease, what it is and what are its dangers.
  Typhoid fever  is an acute,  infectious  disease
which has its seat of infection in the intestine where
it  forms ulcers.  It is  characterized by  increased
temperature, prostration  and  a  tendency to  hemor-
rhage and perforation.
  Although  the exciting cause of the disease  is a
                       98 
NURSING  IN TYPHOID FEVER
germ called Eberth's bacillus, there are several pre-
disposing causes.  If the resistance  of the person
has been lowered by exposure, poor food, overwork
or previous diseases, he is much more liable to con-
tract  the disease than  if he were  strong and well.
A healthy  person may be able  to resist the disease
even  though some  of  the germs have entered his
system.
  The germ or bacillus gains entrance to the body
in several ways, but the principal means of ingress
is through  the drinking water or through the food.
The former probably is the  most common  method.
The small  creeks and streams that  lead  into  the
water supply of cities frequently carry germs from
some  sewage that  has  been   thrown into them.
Hence the  importance of  having pure drinking
water.  The germs  are found in abundance in  the
feces  of a typhoid fever patient, and through care-
lessness may be carried to others.
  The onset of the disease is  slow.   The patient
complains of feeling tired with a  disinclination to
any exercise.  He usually has a headache and nose
bleed, perhaps a backache.  His  appetite  is poor,
the  bowels  either constipated or too  loose.   These
symptoms may continue for a week or two before 
THE HOME NURSE
they become so severe  as to cause him to consult
his physician.
   The disease  runs a rather typical course.   The
temperature ranges from 990 to io3°-io5° for two
or three weeks, then gradually declines.   The  pa-
tient is not considered well until the temperature
has remained normal  for ten  days.   This usually
means  that he will be confined to his bed  for about
six weeks.
   Now if we consider  that the disease really  is a
number of ulcers in the intestine, we  can care  for
the patient  more intelligently.   Movement of any
kind would tend to irritate the inflamed area; there-
fore the patient should lie quietly in bed.  Food
taken into the intestine would have to pass over
the inflamed area and irritate it more; therefore it
is  advisable to eat as little  food as possible.   As
solid matter would irritate  more than liquid, it is
deemed wise to restrict the patient to a liquid diet.
As there are a number of blood vessels in the in-
testines, some of which are perilously near the ulcers,
there is danger that the ulcer  will slough into  the
blood vessel wall and cause a hemorrhage.  Some-
times the wall  is worn very thin by the  ulcer and
any little exertion would cause it to rupture.   For
                       100 
NURSING IN  TYPHOID  FEVER
this  reason, the patient should not be allowed to
exert himself in any way.   He  should  not sit up
nor, in  some cases,  even  turn  over without  as-
sistance.   He should not be required to raise  his
head to  take  a drink but  should  have the water
and food given  him through a tube.   As the feces
and other excretions contain the  typhoid germs we
must take care  in  their disposal that no one else
contracts the disease through our carelessness.
  Now that we  have a general idea of the disease,
we  shall  take  up the special points in nursing and
the measures recommended  in the treatment.
  Prevention.   The nurse is responsible to the com-
munity for the  precautions she  takes against the
spread of  the disease;  therefore it is  incumbent
upon her that she  should not neglect any  detail.
No half measures should be tolerated.  The germs
of the  disease are  in all the secretions of the pa-
tient.   These  include the feces, the urine  and the
perspiration, as  well as the secretions of the nose
and mouth; therefore all those must be disinfected.
The germs can be carried from the patient on the
hands,  the hair, the clothes or anything that has
come in  contact with  the patient;  therefore these
also must be sterilized.
                       101 
THE HOME NURSE
   The urine of the patient may be disinfected by
adding to it an equal amount of five per cent car-
bolic  acid and mixing  the two thoroughly.   The
urinal should be washed thoroughly  after being
used  and a  small amount of the carbolic acid al-
lowed to remain in the  vessel.  The feces may be
disinfected in the same manner, but they should be
allowed to stand mixed  with the solution for  from
one to three hours.  If  they are thrown out before
this time, the germs will remain in the  ground and
then be  washed away  by the next rain and carried,
perhaps, to some stream  of water used for drinking
purposes.  There are  on record a number of  cases
of an epidemic starting  from one patient.   In one
case,  the patient had  typhoid during the late  fall.
The  feces were  thrown out on the ground.   The
next spring an epidemic of typhoid was started in
a  town two miles  away.  The spring rains  had
washed the germs down into the water  used by the
inhabitants of the town.
  The secretions from the mouth and nose should
be burned.   The  patient may  be  provided  with a
number  of  small pieces of cloth which  may be
burned after being used.  A paper cone pinned to
the side of  the bed within easy reach of the pa-
                      102 
      NURSING IN TYPHOID FEVER

tient's hand makes a  good receptacle for the soiled
cloths.  Once or twice a  day the cone should be
burned and replaced by a new one.   This makes it
unnecessary for the nurse to handle the soiled cloths
and is very convenient.
  The dishes used by the patient should be  kept
separate, washed in a pan that is not used for other
purposes, and boiled  before being used by any one
else after the patient is well.
  As the  secretions  of the skin  also  contain the
germs, the bath water should be disinfected with
a little  chloride of lime before being thrown out.
The bed linen and night clothes of the patient should
be placed  in a five per cent  carbolic acid solution
as soon as removed from the bed, and  then  should
be boiled thoroughly before being used again.  The
nurse's clothes should be treated in the same man-
ner as the  patient's clothes.  The nurse also  should
bathe her own  face and hands carefully before even
taking a drink of water,  thus avoiding danger of
carrying into her system any germs that may have
gotten on her hands and thereby carried to her lips.
  Great care should be taken to prevent the access
of flies  to  the  patient's room or to  any of the ex-
cretions, as these flies take  upon their feet the germs
                       103 
THE HOME NURSE
of the disease, carry them away and deposit them
upon food  which may be  eaten  by other people.
Even after the patient is convalescent, he  should
disinfect his own urine and  feces as the germs re-
main in the system for some weeks.
   Curative  Treatment.  In  regard to the patient
himself, strict  measures of hygiene should be car-
ried out.   He  should be in a room by himself, far
enough from the noise of the living  room  so he
will not be disturbed, and  far enough from the
kitchen so  that he  does  not get  the smell  of the
cooking.  If possible, a single  bed should be pro-
vided as this makes the  care of  the patient much
'easier.  He should lie in  bed with, preferably, only
one  small pillow.   His position should be changed
frequently,  so  as to prevent bed sores.  The nurse
should  help the  patient turn.   During the height
of the disease, the patient is inclined to lie on his
back all the time,  but the nurse should help him
turn on his  side and then arrange pillows so that
they will support his back,  for the patient is too
weak even  to  hold  himself  in that position.  The
back should be rubbed morning and evening with
alcohol.  If there are frequent  urinations, the but-
tocks should be rubbed with alcohol, then castor-oil,
                       104 
      NURSING IN  TYPHOID FEVER

which treatment makes the skin impervious to mois-
ture.  Should any  redness appear, a  rubber air
cushion should be inserted under the patient to re-
lieve the pressure.  Bed sores usually  are an indi-
cation of careless nursing, although in a few cases
they are unavoidable.
  The mouth should be kept scrupulously clean.  In
this disease there is a tendency to the accumulation
of a brown deposit called sordes.  In order  to keep
this  from  accumulating  it  will  be necessary to
cleanse the mouth several times a day.   Boric  acid
solution makes a good mouth wash.  To this  may
be added a little glycerine or lemon juice.
   The diet in typhoid is a debated question and
each  physician  has his  favorite  list.  However,
nearly all agree that the diet must be liquid.   Some
limit this to milk and  its preparations, while others
allow soups, broths and, in fact, anything that will
pass  through  a fine  sieve.  Whatever  the  diet,
about four ounces should be given every two hours.
Water should be given freely at all times.   When
a  change of diet is allowed, this should be quite
varied.   Meat broth,  cocoa, strained  gruel,  egg
albumen,  nutrient  tea and  coffee, lemonade and
orangeade are some of the common articles allowed.
                       105 
THE HOME NURSE
Nutrient coffee  is made by adding  a little strong
coffee to a cup of hot milk.  Nutrient tea is made
in a similar manner.  Albumen water is made by
straining the white of an egg through a cloth and
adding this to a cup of water.   A little lemon juice
also may be added.  No solid  food should be given
until  the temperature  has remained normal ten
days and then it  should be added very  gradually,
the temperature being watched closely in the mean-
time.   Should there be any rise in temperature, the
solid  food must be discontinued for a  few  days.
While the patient is very ill he  should be fed
through a tube so that it will not be necessary for
him to exert himself to raise his  head.
>   The temperature  is kept in check by means of
baths.   The  daily warm sponge bath  should not
be neglected.  At this time it  is wise to change the
bed  clothing  also.  There is a typical odor to
typhoid  patients  which  necessitates  the frequent
changing of the clothing.  Whenever the tempera-
ture is 1030, or above, the patient should be given
a sponge every four hours.  The warm sponge for
temperature is given more commonly now than the
cold sponge.   In a  few  cases it  may be necessary
to give the ice pack.  Whenever a sponge or pack
                       106 
NURSING  IN TYPHOID FEVER
is given, the pulse should be watched carefully and
a record made both before and after the sponge.
A weak heart is a counter-indication for sponging.
The temperature should be taken before the spong-
ing is commenced and a half hour after it is finished.
Plenty of water given internally  helps  to  reduce
the temperature as, also, does heat to the feet and
cold to the  head.
  If the patient is delirious or complains of head-
ache, a cloth wet in cold water should be placed  on
the head and renewed frequently.
  Diarrhoea and constipation both are frequent in
this disease  and usually are relieved by the various
enemas.  Many physicians prescribe a  daily soap
suds or normal salt enema  in order to  keep the
bowels free.
  Tympanites or distention of the abdomen by gas
in the intestines  is a frequent complication.   This
usually can be  relieved by hot turpentine  stupes.
Occasionally it  is necessary to give a  turpentine
enema.
  Hemorrhage  from the bowels  occurs  in  about
four per cent of the cases of typhoid fever and  al-
ways  is a  serious  complication  which  demands
prompt and  active treatment.  All during the  ill—
                       107 
             THE HOME NURSE

ness, the patient  should  be required  to  use  a bed
pan and every bowel movement should be inspected
carefully to determine if there has been  a hemor-
rhage.   As the hemorrhage usually occurs some lit-
tle  time before  the  blood is expelled  from the
rectum, it will be shown by the evidence of dark,
tarry looking stools.  Fresh blood would be bright
red in color but blood  that has  remained in the
intestines  for a short time and been mixed with
the secretions found  there will not be red, so the
movements must  be watched for the  tarry looking
material.  Should this be found,  the doctor  must
be summoned immediately.  In  the meantime, the
nurse should stop all diet and medicine, not even
giving the patient a  drink of water.  She should
remove the pillow and elevate the foot of the bed
so that the patient is lying with his head lower than
his feet.   The patient should lie quietly on his back.
The nurse should maintain a quiet,  matter-of-fact
manner so as not to  alarm the patient, for,  if the
patient becomes nervous  and restless,  there is liable
to be a second hemorrhage.   The majority of pa-
tients recover after one  hemorrhage  but a second
one makes the outcome  doubtful.  When the phy-
sician arrives, he probably will  give  the patient a
                      108 
      NURSING IN  TYPHOID  FEVER

hypodermic of morphine and may order an ice
coil to be  applied to the abdomen.  This ice coil
consists of a long rubber tube arranged to form  a
mat  about a foot in  diameter.  One  end of the
tube is placed in  a bucket of ice water on a  stand
near the bed, the other end is allowed to hang at
the side of the  bed.  Under  this second end is
placed a bucket to receive the waste water.   The
flow of water is regulated so that it passes through
the coil very slowly and  empties drop by drop into
the lower bucket.  This  procedure keeps the coils
cold all the time and is a much better arrangement
than to place an ice bag on the abdomen as the lat-
ter is too heavy.
   Perforation of the  intestinal wall by an  ulcer
sometimes occurs.  This  allows the contents of the
bowels  to escape into the  abdominal  cavity and
produce  peritonitis.  This complication almost al-
ways is fatal.  The  only chance there  is of saving
the life of the patient is to  open the abdomen and
sew up the opening into  the intestines.
   The period of  convalescence is an important one
in typhoid.  A very little laxity in the  rules may
result  in a relapse which is liable  to  be more se-
rious than the first attack.   One reason  for this is
                      109 
THE HOME NURSE
that  the  patient's  strength  already  is  nearly  ex-
hausted and he will not be able  to  stand  another
siege.
   The usual cause  of a relapse is the partaking of
solid food.   The convalescent patient always is ra-
venously hungry and will not use any judgment in
his diet.   He must be watched or he will bribe some
one to give him something to eat.   A banana eaten
at this period has been known to  result fatally.
   During this  period, the physician makes fewer
visits  and the  nurse's  responsibility  is doubled.
Great  vigilance on her part is  necessary  as  the
patient will  have some visitors who do not under-
stand the dangers at this time and may be persuaded
to give him some article of food that he should  not
have.  Hemorrhage  and  perforation  have  been
known to occur from eating meat after the patient's
temperature has been normal for several days.   The
diet must remain liquid until the temperature has
been normal  for ten days, then solid food must be
added as gradually  as it is to the diet of a year old
child.  At first, the  only solids given  should be
those that are  easily digested, as toast, cereals,
poached or soft-boiled eggs.
   The temperature should be watched during this
                       no 
      NURSING IN  TYPHOID FEVER

period and any elevation must be reported immedi-
ately to the doctor even though he may have ceased
his visits.  The  rise in temperature may be due
to an error in diet, to constipation or to excitement.
Too many visitors  during this  period is not  ad-
visable.  If the patient can lead  a quiet  rural life,
he will  gain much faster than if he led a more ex-
citing life.
in 
CHAPTER XIV
            nursing in pneumonia

  One of the most dreaded diseases of infancy and
old age is pneumonia.  Although it is just as com-
mon during youth and middle age, yet it is not as
liable to  be fatal as  it is during either of the  ex-
tremes of life.
  There  are two common forms of pneumonia,—
lobar and bronchopneumonia.  The former is more
common  with adults and the latter with children.
In the former, one or more entire lobes of the lungs
are involved while the remaining lobes are intact.
In  the latter the disease is  scattered  in patches
throughout  the lungs.  Lobar  pneumonia some-
times is called lung fever, while bronchopneumonia
is  known  as lobular  pneumonia  and  capillary
bronchitis.
  Lobar  pneumonia usually is due to a bacterium
called the pneumococcus, although it may be due
directly to an injury  or an irritant that causes con-
gestion.   Old people  if compelled to lie in bed  for
                      112 
         NURSING IN PNEUMONIA

any length of time on account of an accident or an
operation are liable to contract what is called static
pneumonia.  In the  aged the circulation is so poor
that the  blood is liable to settle in the lower  por-
tions if  the  patient  remains in one position for a
few days.  If the patient is compelled to lie on his
back, the blood settles  in  the posterior portion of
the lungs and produces a  congestion which  results
in pneumonia.
  Although the disease is due to a bacterium, yet
it usually  follows exposure of some sort as  this
decreases the resistance  of the  system which  then
is unable to throw off the  poison.   It  is considered
that the germs  of this disease  can be found  nor-
mally  in the mouths of about sixty per cent of
healthy  individuals,  yet they are  unable to enter
the  system until it  is depleted by exposure.  Sit-
ting in wet  clothing is one  predisposing factor to
this disease.   It seldom would do  any harm for a
person to get thoroughly wet in the rain if, as soon
as he entered the house, he would remove all cloth-
ing, take a brisk rub and put  on dry, warm clothing.
It is wise, also, to take a  hot drink, as this stimu-
lates the circulation  and helps  to  prevent a chill.
Pneumonia is more  common in the fall and winter
                       H3 
THE HOME NURSE
months on account of the greater exposure at this
time.   Plethoric individuals, or  those  accustomed
to drinking heavily, are more liable to the disease
than  others  and the  fatalities  are greater.  One
attack of pneumonia predisposes to another, so a
person who has had one attack must be especially
careful about exposure.  Pneumonia  may follow
the inhalation of gases, or other irritants.   It some-
times follows the taking of an anaesthetic, as ether,
but this usually is  due to the fact that some of the
mucus from the mouth is drawn or inspired into
the lungs, so it is called  inspiration  pneumonia
This  type  frequently occurs in  the newborn  babe,
due to mucus being inspired during birth.
  Pneumonia is a  common sequence of whooping
cough or measles.   In fact, this is one of the great-
est  dangers of these diseases.
  Pneumonia usually is ushered in with a chill in
adults and by  vomiting or  convulsions in babies.
With adults, the  chill usually occurs  about  three
days  before other  symptoms and may  be very
severe and last  a  half hour.
  The disease  is divided into three stages.  First
the stage of congestion or engorgement of the lung
which lasts from  twelve to thirty-six hours.
                       114 
NURSING IN PNEUMONIA
  The second stage is called the stage of red hepa-
tization.   During this stage, the lung becomes very
solid so that no air can enter the afflicted portion.
The appearance of the lung resembles that of liver
and from this  derives its  name.
  The third stage is known as that of gray  hepati-
zation  or the  stage  of resolution.  During  this
stage  some  of  the solid matter becomes fluid and
grayish in color.  It is then thrown off by the lungs
which  thus  are  cleared gradually.
  The symptoms of pneumonia are rapid respira-
tion, the adult  sometimes breathing from forty  to
sixty times a minute and a child even faster.  The
temperature is  high, often being one hundred and
four degrees.  The pulse  rate  is increased accord-
ingly and varies  from one hundred  and  twenty
to  one hundred and forty, or even faster in some
cases.
  At first, there usually is a stabbing pain in the
side due  to some pleurisy,  while  the patient has
difficulty  in breathing.  The face is flushed.  The
patient is more comfortable if lying on the affected
side as this gives the well  lung more chance to  do
its  added work.  Cough may  be  present although
it does not always appear until the lung  is clearing
                      "5 
THE HOME NURSE
up.  The sputum is  viscid,  sticky and  of a rusty
color.   The  latter  is  due to the presence  of  red
blood cells.  On account  of its  tenacious  quality
the sputum clings to  the  side of the sputum cup.
The urine usually is scant  and highly colored.
  The  disease  usually  continues from  three  to
eleven days and then terminates  by crisis,  that is
rapid change.   The  change  commonly occurs  on
an odd number of days; thus if it  does not come on
the third day it probably will not appear until the
fifth day.  It is considered that the earlier the crisis
comes the  better the chance for recovery.
  When the crisis  appears,  if it  is favorable,  the
patient  becomes covered  with a  profuse  perspira-
tion,  the respirations  become easier and  the tem-
perature and pulse  rate  gradually decline.  If  the
crisis is  unfavorable,  the respirations become more
shallow,  the lips begin to get blue, the temperature
usually  rises and the pulse  rate  becomes weaker.
Death may not occur for several days if the  pa-
tient has considerable  reserve vitality.
  The toxines (poisons)  of the disease seem to have
a special affinity for the heart and one of the chief
dangers  of the disease is  the failure of the heart.
In  the  later stages it frequently is necessary  to
                      116 
NURSING IN  PNEUMONIA
stimulate the heart in order to tide it over the crisis.
Any added strain may prove fatal.
  The treatment of the  disease is rest in  bed, ab-
solutely.   If the patient finds  it easier  to breathe
when propped up on several pillows,  this may be
allowed.   He should lie in whatever position  makes
breathing easiest and this position may be changed
from time  to  time.  However,  he should  lie as
quietly as possible  and  not make any unnecessary
movements.  Sometimes a quick movement, by add-
ing a little extra strain to the already overburdened
heart, has proven fatal.   The patient should  be as-
sisted  in  all movements, even the  cup should be
held for him while he is drinking.  He should use
a bed pan  as the  exertion of getting out of bed
might prove fatal.
  The diet  should be light but nourishing.  Liquid
diet usually is  preferable as it  is  easily  digested
and not difficult to take.  It is  an exertion  for a
person with this disease even to chew food.   Egg
nog may be given several times a day as it is very
nourishing.
  The room should be well ventilated and the air
should be moist.  A pan of boiling water allowed to
vaporize in the  room often affords considerable re-
                       117 
THE HOME NURSE
lief.   Oil of eucalyptus or turpentine sometimes is
mixed in the water as the vapor from these is very
soothing to the  inflamed  lungs.  It has been said
that  if one wishes to kill a child with pneumonia,
the most certain way is to place its bed  in a corner
of the room away from the window, light the gas
and allow several persons in the room.  The patient
needs all the fresh air possible as one lung is trying
to do the work of two and even under the  most
desirable of circumstances it  will have  a  difficult
task.  For this reason  the windows should  be open
wide  and the patient  placed  where he will  have
plenty of fresh air although he should not be in a
draft.  As gas or oil lamps lighted in the room con-
sume considerable oxygen, they should not be al-
lowed except  when necessary.   Every extra person
in the room  deprives  the patient  of part of the
oxygen and makes the air he breathes less pure; for
this reason every one but the  nurse should be kept
out of the room.  An  open grate fire improves the
air in the room  as it creates a circulation.  A fur-
nace heated room is a poor place for a person with
this disease.
   The bowels should  be  kept open with  enemata
as it usually is not desirable to give laxatives.  The
                       118 
NURSING IN  PNEUMONIA
urine should  be measured  every day  as there  is
some diminution in the amount always and it may
be necessary to give a diuretic (medicine to increase
the action of the kidneys).
   The  patient should be given a careful sponge
,bath every morning, avoiding any exposure.  Usu-
ally it  is better  to bathe the  various  parts under
cover.  Sponging for  temperature may be  ordered
but not as frequently as in  typhoid fever.
   The mouth should be kept cleaned with a mild
antiseptic solution and the  patient  provided with
small pieces of cloth  in which to expectorate.   A
paper cone  should be  placed in a convenient place
to receive these.   They never should be allowed  to
lie on the bed and should be burned as  soon as pos-
sible.
   Sleeplessness is quite common and this sometimes
may  be relieved by an ice  bag to the  head, a hot
drink or a hot  mustard foot  bath.    Pain  in the
side usually can be relieved by the  application  of
the ice bag or of a mustard plaster.
   The  treatment varies in  regard to external ap-
plications.   Usually a cotton jacket is  ordered and
some application is made  over  the  affected area.
Turpentine  and oil or camphorated oil are two com-
                       119 
THE HOME NURSE
mon home remedies.   Other physicians  prefer to
have a poultice applied.   This sometimes is one of
the home made varieties and sometimes one of the
various  mud  poultices.
  After a  favorable crisis the  recovery usually  is
quite rapid, but if the cough persists for any length
of time the patient should have his lungs thoroughly
examined again as tuberculosis not uncommonly fol-
lows pneumonia.
120 
CHAPTER XV
              infantile  paralysis

  During the last few years the epidemics of acute
poliomyelitis  or infantile paralysis have become  so
common as  to cause  considerable alarm.   Parents
are anxious to learn how to avoid it while scientific
men are trying to find a cure, as well as a means  of
prevention.   So  far their  efforts have not been at-
tended  with  any measure  of  success.   The  mode
of contracting the disease  is not known, but it  is
supposed to  be of an  infectious nature as it occurs
in epidemics.
  The greater proportion  of the cases develop be-
fore the fifth year.   Boys are  a little more fre-
quently affected  than girls.  The majority of the
cases occur  during the  second year  of the child's
life.   On this account teething has  been ascribed
as one of the causes.   The disease is more common
during the summer months, although it may  occur
at any time  of the  year.  It sometimes  follows
some other disease, as  measles, scarlet fever, but
                      121 
THE HOME NURSE
 in the majority of cases the patient is  in the best
 of health when attacked.
   A frequent  form of the onset of this disease is
 for an apparently well child to be taken quite sud-
 denly with  vomiting, pains in the legs and general
 sensitiveness to the touch.  The temperature may
 arise to  one hundred and  one or one hundred and
 three degrees F.  These symptoms continue from
 one to three days before  the paralysis  is noticed.
 In some other cases  a child has  gone to bed  at
 night apparently as well as ever, has been a little
 restless during  the night and awakened in the morn-
 ing with some portion of  the body paralyzed.   In
 one or two cases  the child was walking along the
 street when the paralysis came on suddenly and the
 child was unable  to walk home.
   In some cases there are  pains in  the back, in the
 muscles  of the extremities and along  the spinal
-nerves.  After the paralysis appears there seems
 to  be  little change in  the child's condition  for a
 period of from one to three weeks, then it begins  to
 improve  gradually for two  or three months, then
 it again seems to be at a standstill, and the paralysis
 that remains then probably will be permanent.   The
 affected limb then begins to shrink in size and soon
                       122 
INFANTILE PARALYSIS
is considerable smaller than the other.  It does not
grow in length as fast as its fellow so that in a few
years there is a marked difference in the length of
the two  limbs.
  In the  majority of cases only one lower extremity
is involved although both lower limbs or one lower
limb and the arm on the same side may be affected.
The arms seldom are affected unless one leg is  also.
Most children with paralysis of  only one leg are
able to walk alone, but have  not the power of lift-
ing their toes.  The affected  foot drops  down and
the toes turn to one side.
  The general symptoms  of  the onset of this dis-
ease are not characteristic and no positive diagnosis
can be made until the paralysis sets in.  As the
mode of infection is not known it is impossible to
take measures to  avoid the  contagion.  However,
it is well to keep a child affected with this  disease
away from  other children during the early stages.
  There  is  little  danger to life with  this  disease.
The most important question is whether there is
to be a  permanent paralysis  or not.  Some cases
recover entirely,  but these seem to be  cases  that
have  a very light attack.
  One chief aim  of the treatment is to prevent de-
                       123 
             THE HOME NURSE

formity.  Many of the deformities common might
have  been avoided if the  limbs  had been relaxed
every day and not allowed to remain  in one posi-
tion for many hours at a time.  The value of water
to relax muscles  is shown in the treatment  of in-
fantile  paralysis  and other diseases in which the
muscles are more or less  contracted.  Exercise is
necessary in the  treatment of infantile paralysis.
The child should be placed in a  warm bath.  The
heat relaxes the muscles which are drawn  up, and
some movement will be found possible the first time.
The rigid muscles which are drawing the limbs out
of place relax with the heat and  moisture  and can
be  straightened to a  more  natural position.  At
first, a hot bath should be given three  times a day.
The body should  be immersed completely,  but the
head  should be supported  by the nurse's hand, so
that the child  never becomes frightened by getting
its  face in the water.  Often it  is better  to have
only a small amount  of water in the  tub  at first,
then after the child is in  the bath  gradually add
water until the entire body is covered.  While  in
the bath, the limbs can be straightened for a few
seconds at a time  even though they immediately re-
turn to their former  position.  After  a few days,
                      124 
INFANTILE PARALYSIS
the child  may make some voluntary movements.
In order to encourage this, it is well to place in the
water  some of the floating toys, as  ships, ducks,
fish and frogs.  There are numerous  toys that will
float on the water which can be purchased for as
low as five cents apiece.  The child will reach for
these  floating objects  and make several  desirable
movements in doing so.  An older child will en-
joy having a pair of water wings on  which to rest
the head.  This will relieve the strain  on the nurse's
arm.   All the time  the child is in  the bath,  the
nurse should massage the limbs  gently.   The child
should remain in the bath about fifteen minutes at
a time. When through, it should be lifted out into
a dry blanket and dried quickly so as to avoid a chill.
If it  then is given a drink of milk or other light
food, it probably will  drop to sleep and remain so
for some time.   This  is very  desirable  for  it is
best for the child to be as quiet as possible and to
avoid all nervous excitement.
   Another beneficial measure is to have the child as
near the ground as possible so as to get the magnet-
ism of the earth.   Whenever the sun is not too hot,
he should be allowed to play  and lie  in the sun so
as to get a sun bath.  This treatment is similar to
                       125 
THE HOME NURSE
that used in the case of Sir Walter Scott, who had
infantile paralysis  when  he was eighteen  months
old.  His grandfather, who was an eminent phy-
sician of that time, directed the treatment.  As soon
as the first stage of the disease was over, he sent the
child to his farm in Scotland where he  was placed
under the watchful care of  an  old  shepherd, who
carried him daily  out  among the rocks and crags.
He was  left to lie on the ground and soon began
to roll and finally  to  walk and climb about.  He
says, " I, who in a city probably had been condemned
to hopeless  decrepitude, now was a healthy, high-
spirited and, my lameness aside, a  sturdy  child."
Among other exercises beneficial to a child is swim-
ming, so if the afflicted child can be  taken  to the
shores of a  shallow lake where  he can swim daily,
besides climbing up the banks, he will be benefited.
  The recent reports  of  research  show that the
infection may be carried in the nasal passages; there-
fore it is well  to  spray the  nose and throat of a
child afflicted with a mild antiseptic solution.  Also,
if the disease has made its  appearance  in the neigh-
borhood, it is well to spray the  throat and nose of
all children, as  this may help to avoid the infection.
It has been found that  the  common house  fly
                      126 
INFANTILE PARALYSIS
harbors the germs of the disease in its body  for
several  hours,  although  it has  not been proven
that  it carried it to people.   However, it is a wise
precaution  to rid the  house of these dirty insects
who  are known to carry other diseases.
127 
CHAPTER XVI
           CEREBROSPINAL MENINGITIS

  As much dreaded as infantile paralysis is another
disease, which has a similar  onset and which may
result in paralysis, known as cerebrospinal menin-
gitis.   This disease is due to a germ, called the dip-
lococcus intracellularis, which is not very communic-
able, although the disease occurs in epidemics.  The
epidemics are more  common in  winter and  early
spring  and may  occur  in quite  isolated localities.
  The  onset  of  the  disease usually  is sudden, the
child being taken with a chill, followed by a severe
headache, vomiting and convulsions.   The tempera-
ture rises to about one hundred and two degrees  F.,
the neck  becomes stiff, the  body rigid  and bent
backward so  that a child lying  on its  back  rests
almost entirely on its head and heels, the center of
the body being  arched.  The eyes  may develop
strabismus (cross eyes) and  photophobia, or dread
of light, usually occurs.
  There are two forms of the disease, one the hyper-
                       128 
      CEREBROSPINAL MENINGITIS

acute form in which death occurs in from twelve to
thirty-six  hours.  The following is an  illustration
of this:  A little girl of ten years was well enough
at two p. m.  to carry  a bundle of clothes several
blocks.  Returning home, she complained of intense
headache,  vomited frequently, and was so weak she
had to go to bed.   In  a few hours she became un-
conscious with a high fever and died at eleven p. m.
  The usual form of the disease is not so severe as
the case described.  In the  more severe  form there
usually is an eruption which resembles flea bites and
has given the disease  the name of  spotted fever.
These eruptions may occur in the less severe form
but are not common.  The duration of the  usual
form is from three to six weeks.  During this time
the symptoms  vary  in severity.   At times the child
may seem much better, then the next day be worse
than  ever.  There   may  be  delirium  at  times.
There are numerous  attacks of vomiting.   Some-
times there is considerable  difficulty in  feeding.
There usually  is rapid  loss  in weight and the pros-
tration increases.   In cases that get well, the  tem-
perature gradually  drops, the mind  becomes clear
and  the other  symptoms gradually disappear.   In
fatal  cases, the patient usually passes into a  deep
                      129 
THE HOME NURSE
stupor, the breathing becomes irregular, the abdo-
men sunken and death occurs from exhaustion.
  During the course of the disease, one of the most
striking symptoms  is the pain  in the back of  the
neck and along the  spine.   The body is so sensitive
that any movement  causes pain and the patient cries
out in agony.
  In cases that recover, it unfortunately is common
that some defect remains.   It is not uncommon for
the child to be left mentally deficient.   Sometimes
this is so slight as not to be noticed for months, but
as the child grows older it becomes  more  notice-
able.  There also may follow various types of par-
alysis,  some of which are only temporary while
others are permanent.  Of the special senses, deaf-
ness is quite common, while the power  of speech
also may  be lost.   Nearly seventy per cent of the
cases end  fatally.
  The treatment has been highly unsatisfactory, as
is  proven by the large  death rate.  All measures
possible to make the patient comfortable, to keep up
the nourishment of the body and to quiet the irri-
tated nervous system should be employed.  Among
others, ice to the back of the head and along the
spine has proven to  be agreeable and soothing to the
                      130 
      CEREBROSPINAL  MENINGITIS

patient.   Warm sponge  or  tub baths  sometimes
prove very soothing and help to relax the muscles.
The patient should be kept in a quiet, darkened
room, away from the remainder of the family.  He
should be urged to take all nourishment possible.
  When there is paralysis following the disease, the
same treatment  as that given for infantile paralysis
often gives good results.  As yet, no way has been
discovered to prevent the disease nor its  disastrous
consequences.
131 
CHAPTER XVII
        NURSING IN CONTAGIOUS DISEASES

   The nursing in contagious diseases presents some-
.requirements that are not  found in  other diseases.
 Not only must the  patient be considered but the
 remaining members of the family must be protected
 from the contagion.  The nurse finds  that' she is
 much  more confined and that she must take pre-
 cautions to protect herself from the disease.  For
 the trained nurse there is one compensation: a nurse
 usually receives about ten dollars a week more when
 caring for a contagious case than when nursing any
 other case.   This is only  just,  on account of the
 extra work and close hours required.
   Isolation.  In  any contagious  disease,  the  pa-
 tient should be isolated and  no  one  allowed in the
 room except the  nurse and the doctor.   The room
 preferably is at the top of the house and separated
 as far  as possible from the remainder of the rooms.
 A sheet moistened with  some disinfectant solution,
 as chloride of lime, should be hung in the doorway
                       132 
  NURSING IN CONTAGIOUS DISEASES

leading from the room.  The room should be well
ventilated, as fresh air is a great aid in recovery.
  Disinfection  During  Illness.  All  secretions, as
that expelled when the patient coughs, should be
burned.  It is better to have the patient expectorate
in small pieces  of cloth which may be burned than
to use a sputum cup.  The urine, the feces and even
the water in which the patient is bathed should be
disinfected  before disposal so  as  to prevent the
germs  of the disease being scattered  about.  Chlo-
ride of lime or a five per cent carbolic acid solution
may be used for this purpose.  No articles should
be carried from the sick room to other parts of the
house.  The patient should have  separate dishes
and these may be washed in the room.  They never
should be washed with the family dishes.   The bed
linen and night clothes should  be  allowed to soak
several hours in  a five  per cent carbolic acid  solu-
tion before being sent to the laundry.  Then they
should be  boiled  thoroughly  and  dried  out of
doors.
   Exposing Children to Disease.   There is a com-
mon superstition that all children must have all the
so-called children's diseases and that the sooner they
are over with the better, for then all  worry is past.
                       133 
THE HOME NURSE
 Some mothers have been known to deliberately ex-
 pose their children to the  contagion of  measles or
, whooping cough.  Such a proceeding should be con-
 demned  in no uncertain language.  It is no more
 necessary for all children to have these diseases than
 it is  for all  adults to have  smallpox or  typhoid
 fever.   Indeed, the after  effects  of these  diseases
 may not be nearly as serious as those from  a seem-
-ingly mild attack of measles.
   When to Call the Doctor.   As so  many of the
 diseases  of children commence with  similar symp-
 toms, as cough, vomiting and fever,  it is better to
 call a physician at the  commencement  because in
 many cases the severity of the disease may be les-
 sened by early treatment.  Many  deaths are due to
 the fact  that the child was not considered ill and a
 doctor was  not called  until   a few  hours before
 death, when it was too late.
   Measles.   This apparently  mild disease so often
 is regarded more in the  light  of a joke that it does
 not receive  proper  attention. In  many  of  the
 smaller towns, no  quarantine  is enforced and chil-
 dren are allowed to return to school before they
 have fairly recovered from the disease.  As a re-
 sult, the other children in  the room are exposed to
                       134 
  NURSING IN CONTAGIOUS DISEASES

the contagion.  This should not be allowed, for the
after effects of measles frequently are serious.
  Measles is an extremely contagious disease.  The
contagion may be present in any of the secretions
of the patient.  It may be carried in the clothes of
a third person.   One attack usually protects  from
subsequent attacks although  recurrences have been
known  in the same person.  However, the second
attack usually is very mild.
  The disease appears from seven to fourteen days
after exposure.   It is ushered in by a feverish cold;
the eyes are watery, reddened and very sensitive to
light.   The nose "runs," there is  loss of appetite
and general feeling of chilliness  and disinclination
to  exertion.   The  fever  gradually rises to about
one hundred and two degrees  F. and  may go one
or two degrees higher while the eruption is appear-
ing.
i   The  eruption  (breaking out) makes its appear-
ance on the fourth day, usually  occurring first on
the forehead, then spreading to the remainder of
the face and other parts of the body.   At first this
resembles small red papules or pimples.   Later the
face  becomes  blotchy-looking and swollen.  The
papules appear to be raised slightly.  At times there
                       135 
THE HOME NURSE
are hemorrhages into the skin producing  what is
known as " black measles."   Desquamation, or peel-
ing, usually commences at the end of the first week.
It appears fine and bran like.   About the time the
eruption appears on  the face small bluish white
spots  surrounded by a red area appear  on  the mu-
cous membrane of the cheeks  and lips.   These are
called " Koplik's sign " and are regarded as positive
evidence of measles.
  The complications of  measles  are more  serious
than  the  disease.  Bronchopneumonia  not  in-
frequently  occurs.  Otitis media  or inflammation
of the  middle ear is not  uncommon.   Following
measles tuberculosis may  make its appearance.
  The child with measles should be kept in bed for
about  a week and  quarantined  for four weeks.
Milk, broth,  gruel and  eggs  should be the chief
articles of  diet.   The body  should be rubbed with
oil or fresh lard every day to allay the  itching and
also  to prevent  the scattering of the desquamated
skin.   While  the  eyes  are  sensitive to light, the
child should be kept in a darkened room or should
wear  dark glasses.  The eyes should  be  cleansed
frequently  with a solution  of boric acid.   If the
rash is delayed, hot drinks  and hot baths may be
                       136 
  NURSING IN CONTAGIOUS DISEASES

given.   A  dry cough may be relieved by keeping
a steaming tea-kettle in the room.
  Scarlet Fever.  How frequently we hear a person
say,  " I have had trouble with my ear ever since I
had scarlet fever," or " I am unable to do any hard
work since I had scarlet  fever.  My heart troubles
me so much at times."  These are very common
experiences and the worst  phase of them  is that
many of them might have been avoided  by careful
management or nursing.
   The most mild case of scarlet fever may result
in very grave complications or sequelae.  For this
reason, the mild cases must be as carefully looked
after as are the severe cases.
   The nurse who takes care of a scarlet fever case
must resign herself to be isolated  for at least six
weeks.   During that period she will  be alone with
her patient most of the time, and must be prepared
not  only to nurse the  patient during the height of
the disease but, also, to  entertain him during con-
valescence.   The latter period is one of the most
trying with a restless child and the nurse with inge-
nuity enough to  devise a variety of entertainment
is best fitted for this class of cases.
   The  specific cause of  scarlet fever is unknown,
                       137 
THE HOME NURSE
that is, the bacterium that causes the disease has not
been discovered as yet.  However, scarlet fever is
known to  be  highly contagious,  usually occurring
in epidemics.  The disease is more common  in the
fall and  early winter months, although it may ap-
pear at any time.  The contagious element is very
tenacious and  has been known to exist in  clothing
for twenty  years.
  The onset of this disease is sudden.   A child who
has seemed to be perfectly well may begin to  vomit
suddenly without any apparent cause.  If the child
is old enough, he may complain  of a  severe  head-
ache.  An  examination will reveal that the throat
and posterior part of the mouth are fiery red.   The
temperature is quite  high  and the pulse  rate in-
creased.
  The second day the rash appears, first on the neck
and chest and then  spreading to other parts of the
body.  The rash is  punctate,  that is, dotted with
points.  The tongue is coated white with enlarged
papilla giving it the typical appearance known as
the " strawberry tongue."   As soon  as  the rash
appears, the temperature begins to drop.  The rash
will disappear upon pressure, leaving a white line.
The rash lasts from five to seven days.   As soon as
                      138 
   NURSING IN CONTAGIOUS  DISEASES

the rash begins  to disappear,  the desquamation, or
" peeling," begins.  This may last from two to six
weeks.
   This desquamated skin carries the contagion of
the disease.  This may be carried to others on the
clothing of people who have been near the patient.
It may be carried in the food, especially milk.   Epi-
demics  have  been traced to dairies  where a single
case had contaminated the milk.
   There are three forms of scarlet fever, the simple,
the anginoid, and the malignant.  The latter is so
severe that death has been known to occur within
twenty-four hours, and even before  the appearance
of the rash.
   In the treatment of this disease, the first require-
ment is isolation.  A  well ventilated,  light,  airy
room should be  chosen.  This  should  be stripped
of all except the necessary articles of furniture,
even the rugs.   The patient and nurse  should re-
main in this room and no visitors should be allowed
except the physician.  In the doorway leading from
this room to  other parts of the house, there should
be hung a sheet which should  be  kept moistened
with an antiseptic solution, as a solution of chloride
of lime or a five per  cent carbolic acid solution.
                       139 
THE HOME NURSE
Arrangements should be made so that the meals can
be brought to the door of the room and the waste
taken away.  It is not well for the nurse to use the
same bath room as is used by other members of the
family, as she may scatter the contagion  from her
clothes.  Separate dishes should be set aside for the
patient  and these should not be  placed  with the
dishes  used  by the family.  The night gowns and
bed linen used by the patient and the nurse should
be put to soak  in a five per cent solution  of car-
bolic  acid before  being  removed  from the room.
They should  be boiled  then but  should  not  be
washed with  the family washing nor  sent  to  a
public  laundry.
  The diet of a  patient should be light, but nourish-
ing.   During  the  height  of the disease, the diet
should be liquid  and, even after the patient is appar-
ently well, very little meat should be allowed for
several weeks.
  Besides the general care  of the patient and the
special directions given by the physician,  the  nurse
should rub the patient's  entire body with olive oil
or lard morning and  evening.  This  oiling  tends
to prevent the  severe itching which sometimes  is
almost  intolerable after  desquamation commences.
                      140 
  NURSING IN  CONTAGIOUS DISEASES

It also keeps the skin softened and helps to prevent
the  desquamated skin  from floating about on  the
air.
  The patient should remain  in bed until all evi-
dences of the rash  have disappeared and afterwards
if there are any complications.
  The complications and sequelae may be numerous
and  severe.   A  false membrane may  form which
resembles that of diphtheria and may cause unneces-
sary alarm.
  Malignant, black or bloody scarlet fever is a very
severe form.  In this form, there are hemorrhages
into  the skin.   These form black spots which give
the  disease the characteristic name.
  Cervical adenitis, or enlargement of the glands of
the  neck,  is common.   As a  rule,  these return to
normal in a few days but, in some cases, may break
down, leaving large ulcers which require  consider-
able  time to heal.
  Nephritis, or inflammation of the kidneys, is  one
of the most common sequelae. It may not appear
until the child is apparently well and has been play-
ing  with other children  for several days.  It  fre-
quently is very  severe and may cause death.  All
during the course  of the disease, the urine should
                       141 
THE HOME NURSE
 be watched closely.  It should be measured every
 day even after the child is well enough to be playing
 out of doors.   The danger is not past for several
 weeks.  If there is any diminution of the quantity
 passed in twenty-four  hours,  this  should be  re-
 ported to the physician at once.
   Otitis media, or  inflammation of the middle ear,
 is not uncommon.  It is due to an infection through
 the Eustachian tubes.   This usually can be avoided
 by spraying the mouth, throat and nose  several
 times  a  day with a mild antiseptic solution.  The
 child should not be allowed to blow his nose  se-
 verely, as this may force  some  of the  infected
 material from the  throat into the passages to the
 ears.
   The toxines of this disease seem to have an affin-
 ity for  the heart  muscles  and may injure them
 severely.   For this  reason,  the patient should  re-
 main in  bed even though the attack is mild.   Re-
 maining  quietly in bed  relieves the strain  on the
 heart and makes it  better able to resist the toxines.
 If the pulse should become rapid or irregular at any
 time, the attention of the physician should be called
to this condition.
   Headache and sleeplessness often can be relieved
                       142 
  NURSING IN  CONTAGIOUS DISEASES

by a warm sponge bath and a cold cloth to the head.
Pain in the  throat may be relieved by  an icebag
or hot external applications.
  The patient should be kept quarantined until all
evidences  of  desquamation have disappeared.  The
palms of the  hands and the soles of the feet are the
last to peel usually.  It also is advisable to keep the
patient isolated until all discharges have  ceased, as
these may carry the contagion.
   After the  patient  is pronounced ready to  be let
out  of quarantine, he  should be  given a full bath
(including a  shampoo  of the  hair) and  be dressed
in clean clothing that has not been in the  sick room.
The  nurse should take a similar  bath and change
of clothing.   The room should be fumigated thor-
oughly.   Everything  possible should   be  boiled.
The  woodwork should be washed with  a  five per
cent carbolic solution and the entire room and con-
tents  fumigated with  formaldehyd.   During  this
process all dresser drawers and closet doors should
remain open, the bed clothing should be hung about
the  room in  such  a  manner that the gas will reach
every portion.  The doors and windows should be
calked carefully and the room remain closed for at
least twenty-four hours.  Books are best burned
                       H3 
THE HOME NURSE
 as it is hard to fumigate them thoroughly.   If there
 is any  question as to  whether anything has been
 fumigated thoroughly, it had better be burned as the
 loss of anything is better than the risk of a life.
, The  nurse,  during  the  course  of  the  disease,
 should take precautions that she should not contract
 the disease.  She should spray her  throat, mouth
 and nose with a mild antiseptic  solution  several
 times a day and  should take frequent baths and
 change  her  clothing.   She  should  keep  the sick
 room well ventilated and be at the  open window as
 much as possible.   She should arrange her bed so
 that the patient is not between  her and the open
 window.
  The nurse who is willing and fitted for this class
 of cases is rare and in demand.   Many good nurses
 are afraid of contracting the disease and so  refuse
 such  cases,  others  are not fitted  to care  for the
 child  during convalescence as they have not the gift
 nor training  that fits them to entertain  the peevish
 child.
  Diphtheria.  This is an acute contagious disease
 accompanied by moderate  fever, great  prostration
 and the formation  of a false membrane upon cer-
 tain parts, especially the throat and adjacent parts.
                       144 
  NURSING IN CONTAGIOUS DISEASES

The exciting cause is the Klebs-Loffler bacillus, al-
though the contraction of the disease is favored by
damp houses and unhygienic  surroundings.
  Three-fourths of the cases occur in children be-
fore the tenth year.   The disease commonly begins
with fever,  sore throat and a general tired feeling.
The fever, as a rule,  is not very high but the pros-
tration is  great.  The child  complains of difficulty
in swallowing.  Examination shows the presence of
a false membrane, a grayish white coat which when
stripped off leaves a raw bleeding surface.
   Absolute rest must be  enforced during the course
of  this disease.   It is better that the atmosphere be
,kept moist  by generating  steam in a kettle or by
slaking quicklime  in the room.  The  mortality
,from this  disease has decreased wonderfully  since
the introduction of antitoxin.  The best results are
obtained when this is  given in the early stages of the
disease.  Aside  from  this,   stimulation may be
necessary at times.  One great danger is heart  fail-
ure.  The danger is  not past when the child is ap-
parently well.  In many cases, anemia,  or lack of
good blood, follows this  disease and must be treated
by tonics, fresh air and nourishing food.   Paralysis
of some portion of the body  sometimes follows, but
                       145 
THE HOME NURSE
this usually disappears within a few months.  The
.voice may be lost  entirely  for  a  time, but as the
child increases in strength, it usually returns.
i   Whooping  Cough.  Spring   housecleaning and
whooping  cough  seem  to  be  boon  companions.
Whenever moving days and housecleaning come, the
lay of the whoop is heard on all sides.  We might
wonder at the coincidence if we did not know that
whooping cough was a contagious disease and that
the germs of  the disease would live  from year to
year.  They  find lodging places in the rugs,  the
curtains and the furniture where they remain in re-
pose until disturbed from their rest by the zealous
housewife.   As they are driven  out of their dwell-
ing they ride on air currents until finally they find
a  resting place in some  little child's air passages.
Here they  begin  to  grow and produce  various
symptoms.
   Probably the first symptom noticed by the mother
is  a slight  hacking cough.   This gradually  is pro-
longed and  increases  in  severity.   It does not re-
spond to the ordinary home remedies.   The child's
sleep is disturbed  at night,  for the paroxysms  of
coughing seem to be worse when the child is lying
down.   The general health  is  not much  impaired
                      146 
  NURSING IN  CONTAGIOUS DISEASES

although a paroxysm of coughing may be  followed
by  vomiting.  Usually  the  typical whoop  is not
heard until  about  three weeks.   This is  a long
drawn,  shrill,  whooping inspiration due to a spas-
modic closure of the glottis.  The number of pa-
roxysms varies from twelve to fifty in twenty-four
hours.   The duration of this stage of whooping is
about three  weeks, but the cough may continue for
some time afterwards.  The entire  course  of the
disease extends over a period from a  few  weeks  to
several  months.   The  chief dangers are from the
complications  or sequelae.  Pneumonia or tubercu-
losis may be  the closing chapters of this disease.
Indeed the latter especially is a danger for it makes
its appearance so insidiously that the parents do not
realize that  another disease has appeared until it is
too late to save the child's life.
  The treatment consists first in isolation and quar-
antine to protect others, followed by thorough dis-
infection so that the germs may not remain until
the next year.
  A tight binder pinned around  the abdomen will
be found to lessen the severity of the paroxysms  of
coughing, and, also, will tend to  prevent vomiting.
  Fresh air, sunlight and protection from exposure
                      147 
THE HOME NURSE
to  inclement  weather  are necessary.   The  room
should be well ventilated, for rebreathing of the in-
fected air prolongs the duration of the  disease.   In
the later stages, sea air is especially beneficial.   If
the coughing  period is prolonged, the lungs should
be tested  at intervals so that tuberculosis may  not
become established without the  knowledge of  the
parents.
  The diet should be light and nutritious.  On ac-
count of the vomiting,  it is better to feed a small
amount at frequent intervals instead of limiting the
child  to the regular meals.
  In  the early stages the severity may be lessened
by spraying the mouth, throat and nose with a mild
antiseptic  solution.  This  should be done several
times a day.
  Mumps.  One of the most  painful disorders  of
childhood is mumps.  This is  an acute, contagious
disease the chief characteristic of which is the in-
flammation of the parotid and, perhaps, other sali-
vary glands.
  The mother may notice  that the child's neck  ap-
pears to be swollen.   This swelling is below and in
front of the ear,  is pyriform  in shape and has a
doughy feel.   An older child may complain of an
                       148 
  NURSING IN  CONTAGIOUS DISEASES

inability  to swallow, especially acid food  giving
excruciating pain.   The  jaw is moved with diffi-
culty.  The swelling may be on one or both sides.
Usually it appears  on one side first and  then a few
days later on the other.   The mouth is dry as the
saliva usually is lessened.  There may have been
symptoms previous to the swelling,  such  as head-
ache, vomiting or pains in the back and limbs.
  Inquiry usually  reveals that the child has been
exposed to the mumps one to three weeks previously.
The disease usually is acquired through direct con-
tact and probably from the secretions of the salivary
and parotid glands.   It is contagious from the be-
ginning of the symptoms and for about three weeks
after the swelling first appears.   For this reason the
patient should be isolated and not allowed to come
in contact with other children.   The disease very
rarely  is  fatal  although  there may be death from
complications if the patient is not given good care.
One attack  confers  immunity  from later  expo-
sures.
  The patient should be kept in bed and the chief
treatment should be measures to relieve the aching
pain.  One of the  quickest and most effective reme-
dies is hot fomentations.   The skin over the affected
                       149 
THE HOME NURSE
area should be rubbed with a mixture of turpentine
and olive oil (one part of turpentine to about eight
of olive  oil), then flannel cloths should be wrung
out of hot  water and applied  to the parts.  Over
these should be placed  a dry cloth and the whole
held in place by bandages.  The  hot, moist  heat
seems to penetrate better than dry heat and so is
more effective.   Flaxseed, or  linseed,  meal poul-
tices are excellent.  If  a little olive oil  is added
after the mush  is  prepared, the poultice  will  not
become hard and dry so easily.  Hot salt bags, or
hot water bags may  be  used if it  is impossible to
apply the hot moist heat, in fact, any hot application
affords considerable relief.
  The diet  should  be light and nourishing.  As it
often is painful and difficult to chew the food, it is
better to give a liquid diet  for a few days.  This
may be taken through a tube.
  The bowels should be kept open.  A warm  bath
or alcohol rub morning and evening is very refresh-
ing and restful, and relieves the aching limbs.
  In young children  there seldom  are  any serious
complications, as there are  in  older people.  In a
few  cases  deafness has followed  but  this  is  not
common.  In older people,  especially with adoles-
                       150 
  NURSING IN  CONTAGIOUS DISEASES

cent boys, there is danger of extension to the tes-
ticles.  This may result in sterility.
  Disinfection in all Contagious Diseases.   After a
child has recovered, it is necessary to prepare the
room so that it may be used again by the family.
As  a rule, quarantine should be continued until all
desquamation has ceased.  The palms of the hands
and the soles of the feet usually are the last to peel
so these should be examined.  If the peeling  has
ceased but  there is a discharge from the nose or
ears, there still is danger.  When the quarantine is
to be raised, the patient should be given a full bath,
the  hair washed and clean clothing, which has not
been in the sick room, provided.  The room should
be made air tight by sealing all openings around the
windows and  doors.  The closet  doors should be
opened, as  well as the dresser drawers.   The bed
clothing  should be  spread around the room and
formaldehyd  gas set free  in the room.  This may
be done by different methods.  Regular formalde-
hyd generators frequently are used.   In some  cases,
wet sheets are  sprinkled with  formalin, which is  a
forty per cent  solution of formaldehyd, and hung
about  the room.  The  room  then should be left
closed  for twenty-four hours.
                      151 
THE HOME NURSE
  All books and papers  that have been in the sick
room are better burned as  it is difficult to disinfect
them sufficiently.   Everything possible should be
boiled.  All  toys  should  be  burned or  boiled.
When the child is recovering from a contagious dis-
ease, there is a period when he feels well but must
be quarantined.  This period is one  of  the  most
trying for the nurse who  must devise amusement
for the little one.   The making of paper dolls and
dresses is one of the most desirable occupations, for
these can  be  destroyed afterwards.  It  is better
that the child should not  know of the destruction of
the toys, for she will  not  understand  the necessity
of this act, and will have  a  feeling of resentment.
New  dolls and toys can  be substituted for  the old
ones, and the child  probably will not notice the dif-
ference.
  Precautions for  the Nurse.  The nurse should
take precautions to avoid  contracting  the  disease.
She should sleep near an open window, never with
the patient between her  and the  window.   She
should be out of doors as much as possible when off
duty.  She should  bathe and change  her clothing
frequently and spray  her  mouth, throat  and nose
with an  antiseptic solution.  Her dishes  should be
                      152 
  NURSING IN  CONTAGIOUS DISEASES

separate from those used by the patient.  After the
patient is well she  should bathe, wash her hair and
put on clean clothing.
153 
PART III
  MINOR DISORDERS,  AND ACCIDENTS

              CHAPTER XVIII
      TONSILITIS, SORE THROAT AND COLDS

  Tonsilitis.  Seldom a week  in winter goes by
without some person in every large office being con-
fined at home with tonsilitis.  This trouble seems
to be more particularly common in youth, although
it may occur at any age.   Those who have  a pre-
disposition to rheumatism  are  especially prone to
be attacked.  Exposure to  wet  and  cold usually is
the exciting cause, and such exposure is especially
effective if the system is debilitated or the  throat
is congested from improper use or over use  of the
voice.   For this  reason there   are apparent  epi-
demics  after  many  large and  exciting  football
games.  Lack of ventilation, either  during the day
or night, may be another factor  in the cause.
  The chief symptoms are  chilliness, headache and
                      154 
   TONSILITIS, SORE THROAT, COLDS

backache, high fever, pain in the throat, difficulty in
swallowing and pain and swelling behind the angles
of the jaw.  In the simple or catarrhal form the
tonsils are swollen uniformly and covered with  a
tenacious mucus.  In the suppurative form, which
commonly  is  called  quinsy,  the tonsils are  ex-
tremely swollen, often  so  much  that they  almost
meet, the pain is intense and of  a throbbing char-
acter.  The voice is lost and breathing is difficult.
One tonsil soon becomes larger than the other, fluc-
tuates (wave-like  motion because of fluid formed
in the gland),  a yellow spot appears  which, if not
opened, breaks of its own accord in  time and dis-
charges bloody  looking pus.  The relief is almost
instantaneous  but complete  recovery often is slow.
   In many  instances a severe case may be avoided
by prompt  attention to the first symptoms.  One
who is subject to tonsilitis should be especially care-
ful about exposure, and if by chance he does be-
come chilled should take a hot bath, hot drink and
,go to bed.   At the first appearance of any irritation
of the throat some local application should be  used.
In many cases  a cold compress applied at night will
,so relieve the congestion that no further results will
appear.  For  such a compress a towel wrung out
                       155 
THE HOME  NURSE
of cold water should  be  put around the neck  and
over this a dry towel.
  There are many local applications that afford con-
siderable relief in tonsilitis.  One of the most con-
venient, and also most effective, is turpentine  and
oil  or lard.  One  part of turpentine  to eight of
olive  oil will not cause a blister.  This should be
heated and then rubbed  in well and covered with
absorbent cotton or a soft flannel cloth.   Hot vine-
gar is another excellent application.  Cloths wrung
out of hot water afford considerable relief.   These
may be applied  over the turpentine and oil.
  Spraying or  gargling the throat with some mild
antiseptic  is of decided  benefit.  Diluted alcohol
makes an excellent gargle.
  The Prevention of Colds.   It has been said that
a clean person never has a cold.   When we consider
cleanliness as relating to  the internal body as well
as to the  external this may be  given as a fact.
Certainly  one whose  intestinal tract is  not clogged
is less liable to take cold  than one whose tract con-
tains all manner of fermenting material.   One great
way to avoid colds is to keep the bowels open at all
seasons of the  year.   Never let a  day  go by with-
out an evacuation.  At the first suggestion of a cold
                       156 
   TONSILITIS, SORE THROAT, COLDS

clean out and keep clean.  It is not uncommon for
a patient to tell the physician that she has not had a
bowel movement for  five, six or even seven days.
No wonder the system became so poisoned with  its
own waste material  that disease germs  found  it
easy to do their work!
  Another  preventive of colds  is fresh air laden
with oxygen.   When  the cold days come  the tend-
ency is to shut out all the cold air and, incidentally,
all the fresh air.  As  a consequence, the living and
office rooms become hot and stuffy.   Disease germs
thrive well under these conditions and colds follow
readily.   So, to avoid  colds, keep the rooms well ven-
tilated even during the coldest weather.  It even is
better to shiver a little than to breathe impure air.
  To avoid colds, take some  exercise in  the  open
air every day.   No matter what the weather, one
will be  benefited by a brisk walk.   Dress for the
day and walk  quickly; do not loiter.   The move-
ment of walking stirs up  the  sluggish circulation
and  helps  the  body  to  throw  off  all impurities.
Even though the day be dark, dreary, perhaps rainy,
the exercise will be beneficial.  Colds usually are
not contracted from getting wet but from  sitting in
the wet  garments after going indoors.
                      157 
THE HOME NURSE
  Keep the pores of the skin clean by frequent bath-
ing, for when the pores of the skin become clogged
they cannot do their work and colds result.
  Mouth breathing is one cause of colds.  Nature
did not intend that one should breathe through the
mouth.  The nose was  so constructed that cold air
passing through it would become warmed before
reaching the lungs.   Besides, the mucous membrane
of the nose is so planned that it acts as  a sieve and
will strain  out the particles of dust and irritating
material from the air.  The mouth  is not so  con-
structed and the air breathed in through the mouth
reaches the lungs almost as  cold and dust laden as
when it entered the mouth.   This cold air taken into
the lungs may chill  them suddenly and produce a
congestion.
  How to Cure a Cold.   The cures  for a cold are
almost  as  innumerable  as the sands  of  the  sea.
Every one  has a seemingly different prescription.
A person afflicted with  a cold can go through the
day and meet a dozen persons each of whom will
offer a different remedy in all good faith.  Perhaps
faith has considerable to do with it, for what acts
like magic with one person may have no effect upon
his  neighbor.
                       158 
   TONSILITIS, SORE THROAT, COLDS

  The cure of a cold can be summed up in the one
word eliminate.  Eliminate by the skin,  by  the
lungs, by the kidneys and by the intestines.
  To produce elimination by the intestines it usually
is necessary to  take a laxative, for one is liable to
be constipated when taking cold.   At this  time all
the secretions of the body are more or less locked
up and unable  to do their work, therefore it fre-
quently is necessary to aid them.  It matters little
what form of laxative is  taken so that the bowels
are well cleaned out.
  Elimination by the skin is produced by some rem-
edy that induces sweating.  The old-fashioned plan
of taking a hot mustard foot-bath, a drink of  hot
lemonade  and going to bed with extra covering is
not outdone by any of the more modern remedies.
The good old-fashioned  sweat taken in this way
often will throw off a severe  cold.  Care must be
taken not to chill in the morning.  It is better to
throw off the coverings gradually, then take  an alco-
hol rub as soon as out of bed.
  Elimination by the kidneys is produced by drink-
ing plenty of water.  The hot lemonade  also has
some effect here and is much better than hot water.
  Elimination by the lungs is vastly important.  In
                      159 
THE HOME NURSE
the early stages many a cold may be cut short  by
taking long draughts  of pure air.   Breathe deeply
and hold the breath for a  few seconds.   At night
when taking the sweat be  sure there is plenty  of
fresh air in the room.   Do not  breathe through the
mouth unless  it is unavoidable.  Force the air to
come through the nose.  Keep the nasal passages
clear  by spraying the nose with some mild anti-
septic solution.  The same  effect was derived from
the older method of " snuffing " salty water up the
nose.  The virtue of nearly all the inhalations is
that they keep the air passages free so that fresh
air can enter the lungs.
   Above all, in the treatment of colds do not " dope
up " with all varieties of remedies.  The majority
of the patent " cold cures " are composed of a laxa-
tive  and some drug  to  induce perspiration.  Un-
fortunately  the majority  contain  some harmful
drug, as phenacetine or acetanalid.  Watch out for
these drugs on the label, for they are depressing to
the heart and may cause  considerable damage if
used freely.  The more simple the remedy the bet-
ter,  for the after effects of many drugs  are more
harmful than  the conditions they cure.
160 
CHAPTER XIX
TUBERCULOSIS AND THE CARE OF THE AIR PASSAGES

  Of all  diseases known to man the most deadly
and most widely spread is tuberculosis, or consump-
tion, as it commonly is called.   As has been correct-
ly stated,  other diseases  have caused more dismay,
more panic, and, occasionally, for short periods, even
wider  destruction, but tuberculosis  has been the
most constant and the most pestilential  of all; the
worst scourge of  mankind.
  Tuberculosis kills men and women in their prime.
Its  victims are mostly of the  active working  age.
They die during their period of greatest  usefulness.
Many  leave  families  to be supported  by others.
During the first two decades of a man's life, he is
an  expense to his parents and to the state.  It is
expected that he will repay this during the next two
decades.   But  tuberculosis deprives the state of
these workers just as they have acquired independ-
ence.
  Fully one-seventh of  all mankind die from this
                       161 
THE HOME NURSE
disease.  It is estimated that one million lives are
lost by this disease annually throughout Europe and
that one hundred and fifty thousand persons die each
year in the  United States  of some form of tuber-
culosis.
  Tuberculosis is  a communicable disease caused
by a germ or bacillus.   It is not inherited as  was
once thought.  The tubercular mother may indeed
bequeath to  her child a weak  constitution  which
causes it to be a ready prey to the germ of this dis-
ease, but the disease itself  usually is  contracted by
association with some one afflicted with the disease.
Thus a daughter might  easily contract the disease
from her mother by her constant association.   She
even may contract  the disease years  before she  is
aware of it.  The germs may be in the system but
may not become active until some indiscretion, over-
work or exposure causes the body to be a good field
for the cultivation of the germs.  Then the disease
takes on a more active form, may even  be what is
termed " quick consumption."
  Tuberculosis is so prevalent that it is estimated
that one in every twenty  has the disease in some
form or  other.  It  may be that  the only  manifesta-
tion of the disease is in enlarged glands of the neck,
                       162 
TUBERCULOSIS
— tubercular  glands.  Frequently  these  are  neg-
lected, with the result that the disease spreads to
other parts of the body.
  Any organ or tissue of the body may be affected
with  tuberculosis.   The   form  most  commonly
recognized is tuberculosis of the lungs, or consump-
tion,  as  it  commonly is called.  However, there
may be tuberculosis  of the bones.  " Hip disease "
is  tuberculosis of the hip.  " Potts'  Disease" is
tuberculosis  of the spine.   This is the form of the
disease which not unfrequently attacks young chil-
dren  and, if  neglected,  causes  them  to  grow  up
" hunchbacks."  During the process of this disease
a part of the structure of the spine is destroyed so
that it is bent out of shape and allows the body to
become deformed.
  " Lupus " is tuberculosis of the skin.  There may
be tuberculosis of the intestines and of various other
vital organs.  Our grandmothers used to speak of
"scrofula"  in children.   This was shown by the
enlarged glands of the neck and the child was con-
sidered delicate, but these  glands were not consid-
ered related to the  dread disease consumption, yet
now we know that these glands are an indication of
tuberculosis.
                      163 
THE HOME  NURSE
   Tuberculosis is a curable disease, but the best cure
 is prevention.  The disease makes  its approach so
. insidiously that a great many do not  realize its ex-
 istence until too late.  It is a very common sequela
 for in no other way is it possible to tell if the child
 should be examined by  a competent  physician at
 least  every two weeks if the cough continues long,
 for in no other way is it possible to tell if the child
 still is coughing  from whooping cough or if tuber-
 culosis has become enthroned.
   Girls working in offices and stores and men work-
 ing in factories frequently contract tuberculosis from
 some fellow worker and do not realize the fact until
 the disease has made considerable  progress.  If a
 person is losing weight, feels tired all the time and
 has little appetite, he should have his lungs examined
 even  though there is no noticeable cough.   If taken
 in this early stage, tuberculosis can be  cured readily.
   The great preventive,  as  well as cure, of tuber-
 culosis is fresh air both day  and  night.
   The disease is not  contracted directly from an-
 other person, so a consumptive need not be shunned
 as would a smallpox patient.  The disease germ is
 thrown into the air with the sputum during cough or
 expectoration; it then becomes dried and is distrib-
                       164 
TUBERCULOSIS
uted through the air.  Hence the  reason for state
laws against spitting in public places.  If the sputum
of every tubercular patient could be destroyed there
would  be  few germs  to be distributed around and
the disease  soon would  become a memory.  The
tubercular patient will be of little menace to his as-
sociates if he uses a pocket sputum cup or paper
napkins in which to  expectorate,  either of which
may be burned.  He  also should hold a paper nap-
kin in front of his face when coughing.   The use of
handkerchiefs for this purpose is not advised as it
is  hard to disinfect them and the  one who washes
them is exposed to the danger.
   Sunlight destroys the germs; hence there is not
much danger of contracting the disease on the street,
but in  a close room the germs accumulate.  Then,
too, they may be brought in from  the street on the
soles of the shoes.   For this  reason babies  should
not be  allowed to play on the floor in public places,
as they take the germs on their hands.  Even in the
home it is much better to have a blanket  for  the
baby to sit on when playing on the floor.  If germs
are tracked  in from  the street they are distributed
about the room when the floor is swept energetically
with a  broom.   For this reason, a vacuum  cleaner,
                      165 
THE HOME NURSE
or at least a broom moistened with some antiseptic
solution, is better to use than a dry broom.  In dust-
ing, the cloth should be damp or moistened with oil.
A feather duster is an abomination and a distributor
of disease germs.
  In olden times it was thought that tuberculosis
was an incurable disease.   Its existence was not dis-
covered until the patient  was in an advanced stage,
and  then  the custom was to shut him in a closed
room to which no  sunlight and little air were ad-
mitted.   Especially at night, there was not a particle
of fresh air allowed to penetrate  the room,  for the
"night  air"  was  considered deadly.   Naturally
under such treatment the patient  continued to grow
worse until finally he succumbed.   Then it was not
considered necessary  to  disinfect the  room, hence
the germs were allowed to remain to inflict some
future occupant. '
  The fact is now  well established that if taken in
time the majority  of cases of tuberculosis are cur-
able.  But a cure  requires time,  a determined will
and  constant supervision.  Tuberculosis cannot be
cured by drugs or medicine nor by any easy route.
The most successful treatment has been found to be
the open  air  cure,  the essentials of  which are
                      166 
TUBERCULOSIS
fresh air night and day, summer and winter, plenty
of good nourishing food, rest, a disposition to cease
worrying and a determination to get well.  All this
is  much  more readily  accomplished  if the patient
places himself under the supervision of a competent
physician who will direct the details of his  daily liv-
ing.
   The prevalence of this dread disease has led  to
the  formation of  a  great many "get-rich-quick"
companies who achieve fortunes from the gullibility
of the unfortunate.  The  poor  man  (or  woman)
who thinks he has this disease seems  to be a ready
victim to the wiles of the unscrupulous.  Every day
we  may read  advertisements  of  " consumption
cures"  which are absolute fakes.  Often the suf-
ferer is beguiled into sending his last dollar for a
bottle of medicine which is worse than useless.  The
majority of the so-called cures contain a large per-
centage of alcohol which gives  the patient  a tem-
porary stimulation, but leaves him worse off than
before.   There  absolutely is no medicine  which
cures consumption and the man who buys the most
lauded " cure "  might  better throw his money into
the fire.  This does not mean that no consumptive
should take any medicine, for often it is  necessary
                       167 
THE HOME NURSE
for the patient to be given a tonic or a remedy for
some accompanying disorder, but this remedy should
be prescribed for the individual to meet his special
requirements.   What would be  beneficial to  one
might be poison to  another.
  Outdoor life is the chief essential.  Change of
climate is beneficial  in many cases if the patient can
have the best of care under the new conditions and
be surrounded by friends so as not to be lonesome.
But to send a patient off to the mountains with barely
enough to  keep a well  man alive, is murder; the
patient  simply is sent to die among strangers.  So
well  known has this fact become that the  citizens'
committee from one western state recently  sent out
circulars to physicians requesting them not to send
any more tubercular patients there unless they have
sufficient means to live in comfort.  These residents
have seen the hopeless misery and loneliness of those
who  have been sent  to die among strangers.  There
is no miracle in the mountain air, and unless a per-
son has sufficient means to purchase the comforts
and some luxuries of life, he is better off at home
among friends.
  The  patient at home  can be taken care  of  with
little expense.   Arrangements  should be made so
                       168 
TUBERCULOSIS
that he can be out of doors at all hours, either on a
porch or in a shack.   He may, indeed, sleep in a
warm room if his head is out of doors by means of a
window tent.   If he  has any  rise of temperature
(fever) he should rest absolutely, even having his
meals brought to him.   This means  mental rest, as
well as physical,  so he should  not be consulted re-
garding business  or the affairs of the  house.  The
mind should be at ease as well as the body.
  At least six meals a day should be provided.  Be-
sides the regular  three nourishing meals, he should
be given egg nog or similar diet at about ten in the
morning,  three  and eight in  the afternoon.  He
should sleep from eight to ten hours at night, and
also will be benefited by a nap or two in the daytime.
  Sanitarium treatment is excellent  for those who
can afford it, for here  are the facilities for carrying
out the routine of treatment exactly as prescribed.
Every patient is under constant medical supervision
and his diet, exercise and other treatment are varied
to meet any changes.   One disadvantage with treat-
ment at home is  the inclination to neglect some of
the seemingly minor regulations, but in a sanitarium
it is the  entire  business of the  nurses  and phy-
sicians to see that every detail is attended to.   Then,
                       169 
THE HOME NURSE
 too, in the home it is hard for the patient not to
 kiss or fondle other members of the family and so
 expose them to the disease.
   The routine treatment  that  is advised  for the
 tubercular patient is beneficial in many other condi-
 tions of ill health.  When an individual is run down
 or exhausted nervously, this treatment will be ex-
 cellent.  The under-developed or nervous child will
 be greatly benefited by  the same treatment, espe-
 cially  the  out-of-door sleeping  and the extra diet
 between meals.
  One preventive of consumption is to keep the en-
 tire body and especially the air passages in a healthy
 condition.   Do not neglect  colds and coughs, no
 matter how slight they may be.   A  child with ade-
 noids is liable to contract tuberculosis, for  there is
 an interference with the free entrance of fresh air
 into  the lungs.  In the same way, enlarged tonsils
may predispose  to the disease.  Slightly  enlarged
 tonsils often can be reduced by treatment, but those
which  are much  enlarged  are  better  removed.  A
child with enlarged tonsils  is much more prone to
sore throat and colds, and these may be a precursor
 of tuberculosis.   The  teeth  never should be  neg-
                       170 
TUBERCULOSIS
lected,  for a  cavity in  a tooth often is  a resting
place for germs of tuberculosis and other diseases
which later find their way to other parts of the body.
171 
CHAPTER XX
           ACCIDENTS AND EMERGENCIES

   In all accidents or emergencies the first essential
 is to keep cool, to decide what is best to be done and
 not waste  time by aimless movements.
   If the accident is at all serious a physician should
 be summoned at once.  Unless a telephone is handy
 it is best to send a written note, for frequently when
 a child carries the message he  becomes so excited
 that he is  unable to give the physician any definite
 information.  In  some cases he even is unable to
 tell the address.  All that is necessary to be written
 is the  name and address of the patient with a few
 words telling the nature of the accident.
  The next consideration  is to place the patient in
 as quiet and comfortable a position as possible and
 to keep the by-standers  at  a distance.   Unless the
 head is injured, place it on the same level as the re-
 mainder  of the body.  Loosen the collar  and  belt,
 stop all bleeding as quickly as possible.  If the pa-
tient vomits, turn his head to one side.
                       172 
     ACCIDENTS AND EMERGENCIES

  Hemorrhage.   Hemorrhage  from  any  portion
calls for absolute rest  and elevation  of the parts
with the addition of ligatures or ice when possible.
If of the lungs,  the patient should be propped  in
a semi-sitting position so that he will not become
choked with the blood.   Ice should be applied to the
chest.  If from the nose, the patient  should stand
or sit.   Ice  applied to the back  of  the  neck often
will  help.  If very severe, it may  be  necessary  to
pack the nostril.   Hemorrhage of an arm  or leg
can be controlled by a tight ligature.  A large hand-
kerchief  tied tightly around the arm above the cut
will stop an arterial hemorrhage.  Keep the  patient
quiet in a reclining position.
  Cuts  and Bruises.   Cuts and bruises are daily
occurrences  among children as well  as their elders.
Children will  go  barefooted and cut  their feet on
pieces of glass.  Men  will sustain injuries while
working in shops  and  factories.   Many times a
small cut will give much more serious results  than
a larger injury because  of the fact that it is  neg-
lected.   A   large  injury usually is  dressed  and
treated by a surgeon who understands his business
but a small cut frequently is wrapped tightly  to stop
the bleeding and then neglected.
                       173 
             THE HOME NURSE

   The great danger of cuts is that they are liable
to become infected, that is, some disease germs get
into the wound and produce trouble.  The parts
become red and swollen and filled with pus.   Some-
times the germs work their way along the lymph
channels and may travel several feet.   Such a con-
dition ordinarily is called blood poisoning, although
a physician would  say that the wound had  become
infected.  If the wound is on the hand, faint  red
lines may be seen running up the arm and the glands
of the elbow and axilla may become enlarged so that
they feel like little kernels.  This shows that  the
germs are traveling and prompt measures are neces-
sary.   When such a condition occurs, it is necessary
to allow an opening  for the escape of the pus.  If
the original wound  has closed up it must be  re-
opened.  Then a hot, wet dressing must be  applied.
Gauze should be wrung out of hot boric acid solu-
tion and wrapped around the injured parts.  This
should  be covered with oiled paper to keep the heat
and moisture in.  A  layer  of cotton held in place
by a bandage will  aid in keeping the parts warm.
The gauze must be kept warm and moist by chang-
ing it frequently or by pouring some more solution
on to it.  A small opening may be made through
                      174 
     ACCIDENTS AND EMERGENCIES

the bandage, cotton  and oiled  paper  and a table-
spoonful of the boric acid solution be  poured on to
the gauze every half hour or even more often.   The
solution should be as hot as can be borne.
  When a cut first occurs it usually can be  kept
from   becoming  infected  by  first  cleansing  it
thoroughly with water  that has been boiled,  then
wrapping it in a piece of sterile gauze or clean white
cloth.  A few drops  of  carbolic acid may be added
to the water.  Boric acid powder  may be  dusted
on the wound, but salves or ointments never should
be applied as they tend to seal the wound and  keep
in any  germs that may  have  gained entrance.
Bruises usually require no  treatment except  rest,
but if there has been a tiny break  in the skin,  they
may become infected and must be treated the same
as an infected cut.  If any wound, no matter  how
small,  becomes red,  swollen  and painful, no  time
should be lost until treatment  is applied.  Arms and
even lives have been lost as the result of neglecting
a very small cut on the finger.
  Burns and Scalds.   Often we  read in the daily
papers  an  instance of  some little baby becoming
badly burned or scalded by  falling against a hot
stove or into a pan of water.  In a number of in-
                       175 
THE HOME NURSE
 stances, serious results might have been averted by
 prompt attention.
   Many mothers  become panic stricken whenever
i an accident occurs and do the worst thing possible.
 For instance, if the baby's clothing has caught fire,
 many a frightened mother runs to the neighbors,
 while every  second  the baby  is  becoming  more
 burned.   The better way would have  been for her
 to  grab the nearest heavy  cloth,  a coat, a heavy
 skirt, a portiere, even a  rug,  anything she can find
 in  which to wrap the baby quickly.  Fire cannot
 burn without air, so if the air can be kept from the
 fire it will go out immediately.  Throwing water
 on burning clothing often only spreads  the fire more.
 Smothering it with a blanket or clothing is the best
 means of quenching it.
   Then  as soon as  the  fire is out, not a moment
 should be lost until a remedy is applied.   In a case
 of  a burn the remedy should be of such a nature
 that  it will keep out the air and, also, allay the in-
 tolerable  burning.  One of the best remedies  is
 Carron oil.  In every home where there are chil-
 dren, there should be an  emergency remedy chest  in
 some convenient location.   In this chest should be
 a bottle of lime water and  another of raw linseed
                       176 
      ACCIDENTS AND EMERGENCIES

oil.   Equal parts of these two make what is known
as Carron oil.   This always  should be mixed fresh
as needed.  Pieces of soft cloth, pr better still, a
package of sterile gauze also should be in the emer-
gency chest.  Strips of the  gauze should be satu-
, rated with the Carron oil and applied to the burned
places immediately.   They may be held  in place by
bandages, but first all the  burned surfaces should be
covered.
   In the absence of Carron oil, lard  and baking
soda form a good  preparation.   In  the  absence of
any remedies, immerse the burned portions in water
until a remedy  can be procured.  The water keeps
the air from reaching the burn and is preferable to
 something that will cling to the raw  surface, as
flour and water.
   The dressings should  be renewed once a  day.
 The old dressing should be removed carefully and,
 if it sticks in  places, should be soaked off with a
 little warm water.
   If the  burn  is at all extensive, the doctor should
 be called at once as some complications  may result.
 In extensive burns the kidneys are liable to become
 affected and these must be watched carefully.  The
 urine should be measured daily.
                       177 
THE HOME NURSE
  The child should be kept as quiet as possible.   It
may be necessary for the physician to give some
medicine  that  will dull the pain.  This  is  much
better than to have a  child suffer so severely that it
cannot rest and is tearing off the dressings contin-
ually.  After a few days, the pain will be lessened
and the medicine should not be continued.
  Foreign Bodies  in the  Eye.  Foreign bodies,
such as particles of dust, bits  of steel and emery,
frequently get  into  the  eyes.  On  a windy day
dust from the  street is liable to blow into the eyes
and at once set up an irritation.  The natural tend-
ency is to rub the eye  and this only adds fuel  to
the fire and causes more irritation.  If the foreign
body  happens to be a bit of steel  or other  sharp
substance, the rubbing may cause it to become im-
bedded in the conjunctiva.
  In many cases if the eye is left alone for a few
minutes the irritating material will  be washed out
by the flow of tears which its presence causes.   If
not washed  out by the tears,  it usually may be
found under the upper eyelid and its removal is not
a difficult task  for one who has had some practice.
  The patient should be directed to look downward,
then the upper eyelid should be everted.  This can
                      178 
ACCIDENTS AND EMERGENCIES
be done by pressing a match or small pencil against
the lid  and then,  catching hold  of the eyelashes,
rolling the edge of the lid back.  Usually this will
bring the foreign body into view and it can be re-
moved by  touching it with a bit of cotton or the
corner of a clean handkerchief.
   In a few cases the foreign body lodges under the
lower lid.  From  this position it can be removed
readily  by causing the patient to look upward and
then everting the  lower lid.   After the body  has
been removed, there  may be  some pain for some
time if much irritation  has been set up.  Rubbing
the eye  only increases  the  inflammation.  A few
drops of a solution of boric  acid dropped into the
eye will be  found soothing.   If the  irritation is
extensive, a cloth wrung out of hot water may be
laid over the eyes to relieve the pain.
   In some cases in which steel has become imbedded
in the conjunctiva it may be  removed by holding a
small magnet near it.  In other cases it may be so
firmly  imbedded that it  will be necessary  to have
a surgeon  remove  it.
i   Good eyesight is so essential to comfort and suc-
cess that one never should neglect the eyes.  Pain
and redness are signs of irritation.   If not due to
                      179 
THE HOME NURSE
a  foreign  body that can be removed, a physician
should be  consulted and  the cause removed.  The
irritation may be due to disease germs which have
entered  the eye.  One kind is so virulent  that it
can destroy the  eyesight in a few days.
   Sprains, Dislocations and Fractures.   A fracture
is  a broken bone.   The limb should be placed in as
comfortable a  position as possible.   Ice or  cold
cloths applied over  the injured  parts will relieve the
pain  and  prevent  early  swelling which so often
prevents the immediate setting of the bone.
   In a Dislocation the bones are pulled out of place.
The first treatment  is the same as for fracture.
   In  a  Sprain the  muscles are torn  and  strained.
Rest  is essential.   Either hot  or cold applications
may  relieve the pain.  Tight  bandaging  prevents
muscular movement and so prevents pain and  aids
in  repair.
   Drowning.  When a person  has  been rescued
from  drowning,  the first considerations are to empty
the lungs of any water  and then to maintain respi-
ration by  artificial  means if necessary.   For  the
former, the patient may be turned face  downward
over a barrel, the mouth being kept open and  free
from  fluid.  All clothing should be loosened about
                       180 
ACCIDENTS AND  EMERGENCIES
the neck and waist and the neck and chest bared to
the breeze except in severe weather.  If the patient
has not swallowed  any considerable  quantity  of
water, he should be laid on his back with the shoul-
ders  elevated  so that the  head hangs  downward.
The tongue should be brought forward by means of
a forceps if necessary.   Artificial respiration should
be performed.  One method of doing this is to fold
the patient's arms over his stomach, then raise them
over the head to a perpendicular  position.  Draw
them  straight, then forward to a folding  position
again, at the same time pressing the arms against
the sides of the chest.   This procedure produces a
bellows-like  movement  and should be done about
fifteen times a minute.
   Smelling  salts or  aromatic spirits of ammonia
may  be held near the  nostrils.   On signs of  life
returning, the patient should be wrapped in a warm
blanket  and a few drops of brandy  may be given.
Artificial respiration should be  kept up for three
hours if necessary, for  persons have been restored
to life after that length  of time.   It is best for sev-
eral persons to take turns with  the work, so that it
may  be  kept up continuously.
   Electric Shocks  are treated in a similar manner
                       181 
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by  artificial  respiration.  In  these  cases  also  one
should not stop efforts too soon.
  Suffocation,  as  from inhaling gas or by  smoth-
ering,  also is treated by artificial respiration.   In
many cases a mustard plaster  over the heart will be
beneficial.
  Unconsciousness may result  from  many causes
and it  often  is  difficult for an inexperienced person
to distinguish between the different varieties.
  Fainting is one of the most common forms of
unconsciousness.   In this case  there  is a  lack of
blood in the  brain, therefore  the  patient should be
placed  with the head low so that the blood will flow
toward the head.  All clothing should be loosened
at neck and waist.   Fanning the patient or holding
a bottle of aromatic spirits of ammonia  near the
nose will aid in restoring consciousness.  The pa-
tient needs  all  the  fresh air possible; hence  by-
standers should be kept  at  a  distance so as not to
interfere with the  free circulation of air.
  Apoplexy  or Stroke.  The  patient  usually is
found  with the face flushed (which is an opposite
condition to  that  in fainting).   The  arm  and leg
on  one side usually are helpless and devoid of  sen-
sation.   In many  cases  the pupils  are  of  unequal
                       182 
ACCIDENTS  AND EMERGENCIES
size.  In this case, there has been a hemorrhage of
one of the blood vessels of the brain and it is de-
sirable to have the blood flow away from  the brain.
The patient should be placed  with  his head raised
slightly.   Stimulants must not be given.   Rest and
quiet are absolute necessities.  The patient should
be wrapped in blankets and cold cloths  should be
applied to the head.
  Alcoholism  so frequently is confused  with apo-
plexy that many a person with apoplexy has been
taken to the police station and treated wrongfully.
In alcoholism the breath smells strongly of alcohol,
the pupils of the eyes are of equal size and the pulse
is strong and full.   In this case also the patient may
be  wrapped in  blankets with  a cold  cloth to  the
head.  An emetic may be  given.
  Poisoning  by  Opium  or  Morphine.   In  this
case the patient becomes  drowsy,  hard to arouse,
the pupils are  contracted to pin point size, the respi-
rations become very  slow.  Activity  is  necessary
in  this  case.   Keep the  patient walking  around,
give him hot black coffee and,  if necessary, dash
cold water into his face.
  Heat Exhaustion and Sunstroke are two  opposite
conditions that may result  from practically the same
                       183^ 
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cause.   However,  sunstroke usually  results from
prolonged exposure to the sun's rays and heat ex-
haustion follows a continued remaining in a warm,
close  room.  Heat exhaustion may  occur  in  the
winter time as well as in the summer.  It frequently
occurs among stokers for the  furnaces.
  Following  sunstroke the patient's temperature is
high, often as high as  1060 or in° F.  The face is
flushed,  the breathing deep and labored, and the pa-
tient unconscious.   In heat  exhaustion, the symp-
toms may be  almost the opposite and resemble those
of shock.   The temperature is subnormal, the feet
and hands cold, the pulse weak  and rapid, while
the patient may or may not  be unconscious.
  In sunstroke, the treatment consists in the appli-
cation of  ice  to the head, followed  by a cold bath.
If possible a tub bath  should be given; otherwise
the patient may be laid on the  ground and cool
water poured over  him. Care must be taken that
the head is kept wet and cold all the  time, otherwise,
with the  pouring of water  on other parts  of the
body, the  blood would rush  to the head.
  In heat exhaustion, the patient should be laid flat
on the bed or floor in a darkened room if possible.
A cold cloth  should be applied to the head and heat
                       184 
     ACCIDENTS  AND EMERGENCIES

to the feet.  Stimulants should be given,  such as
strong coffee or brandy.  A hot bath may be given,
but quiet and stimulation are the essentials.
  During the very  hottest days  of  the summer,
everyone should take precautions to avoid these dis-
astrous conditions.   Keep out of the  sun, if possi-
ble, otherwise, wear a light  weight hat.   If obliged
to work in a warm room, have as much ventilation
as possible, then keep a cold wet cloth on the head.
Those  who  are  obliged to  be out  in the  sun
should keep a wet cloth on their heads  under the
hat.
  Whenever it is possible,  it  is better to arise a
little  earlier in the  morning  and accomplish the
day's work during the  cooler morning hours, then
rest during the hottest part of the day.  Do not try
to do any more work than is necessary.   Leave the
extra work until  the days become a little cooler.
  Eat very little  during the middle of the day and
yet do not fast, for one who is faint from lack of
food  will  be a  more  ready victim  of the  heat.
Learn a lesson from the deaths recorded every hot
day and avoid unnecessary exposure.   Stay at home
in  the  shade.  Do not go  bargain  hunting  when
the thermometer is  striving to  reach a hundred.
                       185 
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All the bargains in the world are not worth the risk
to life.
  Poison Ivy.  During the summer and fall months
when people love to roam the woods, to get close to
Mother Nature, one of their worst enemies is poison
ivy or poison oak.   The two plants vary consider-
ably in appearance but are similar in effects and in
their  poisonous propensities.  The latter is a short
stocky plant  while the former  is a climbing shrub
whose stem often rises to a great height upon trees,
rocks and  other objects to which  it  adheres  by
strong rooting fibers.   The leaves of the poison ivy
usually are divided  into three leaflets  each  about
four  inches  long.   The  leaves  are pointed  and
coarsely  notched along the edge while  the surface
is  more  or  less downy.  In  some instances  the
leaves are five lobed, so the plant is more liable to
be confused with other varieties of ivy.
  The leaves contain an oil which is very irritating
and poisonous to the skin.  There are a few persons
who are  immune to the effect of this  poison  and
can handle the leaves  or chew them with no  bad
effects, but these people are rare.   The majority
are easily affected by  contact with the leaves.  It
is claimed  by some that they become  poisoned by
                      186 
ACCIDENTS AND EMERGENCIES
being in the vicinity of the vine without actually
touching it.  It is probable  that these people really
did come in contact with some leaf, although it is
possible that the poisonous matter could be carried
by dust that had first settled on the poisonous leaves
and then been blown to the  person's skin.
  The effect of the poison is to produce an eruption
of the skin which resembles eczema or even erysipe-
las.   Minute vesicles appear and the parts become
red and swollen.  There is considerable itching and
burning.  In some cases there are  systemic effects,
as  abdominal  pain, nausea  and  vomiting.  The
eruption may appear in a few hours after contact
with  the plant or  not until  after a lapse of several
days.   The face and hands are the parts usually
affected first, probably because they are more liable
to contact with the leaves.   The poison may spread
to other parts of the body by contact.   A  person
with  his hands affected is liable to  carry the poison
to his eyes or any part of the body.
   The treatment  is first to get  rid of  the  poison
, clinging to the parts.  As the poison is contained in
an oil, water will not wash it off.  The parts should
be bathed with alcohol  or with an alkaline solution,
as ammonia water.  After bathing, some soothing
                       187 
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 lotion should be applied, as a boric acid solution or
 a weak solution  of  carbolic acid.  Lead water is
 one of  the best known remedies.  Ointments  and
 oily applications should not be used, as they tend to
 dissolve the poison and will spread it to other parts
 of the  body.   The eruption and other  symptoms
 usually disappear within ten  days with no bad after
 effects.
   Poison ivy sometimes is used as a drug and is
 very useful in indicated conditions in small doses.
   Ptomaine  Poisoning.  During recent  years  we
 have heard a great deal about poisoning by food.
 Probably there  were many cases in  the past that
 were not recognized.   However, the  increased  use
 of canned food, especially meats, no  doubt has  in-
 creased the amount of illness of this nature.
  Canned meat  that has been opened long always
 should be regarded with suspicion.  When a can of
 meat is  opened  it should  be  emptied immediately
 into  an earthen  vessel.  It should not be left even
 for a few minutes in a  tin  container.
  Many  too  economical  housewives  have  poi-
 soned  their   families  by  their  would-be-saving
methods.  Meat is kept from day to day, served
perhaps in different styles  as  recommended by the
                       188 
     ACCIDENTS AND EMERGENCIES

teachers of domestic science.  Perhaps the last day
it is served it has become  tainted, but the house-
keeper, not realizing the danger,  thinks it will be
all right if well seasoned.  In warm weather it  is
better to buy only enough  meat for the  day even
though one does have a good ice box.  There is too
much risk in keeping meat  to be warmed  over for
several days, as even  prolonged  cooking fails to
destroy  the  toxic  action  of  certain  ptomaines
(poisons)  in infected meats.
  The symptoms of meat poisoning usually are ex-
cruciating pain  in the abdomen, frequently accom-
panied by  nausea  and  vomiting.  There  may  be
considerable rise in temperature.   These symptoms
often are followed by great prostration, sometimes
by collapse and death.  In other cases the symp-
toms resemble those of typhoid fever.
  As soon as the symptoms develop a  physician
should be called, as the death rate is about thirty
per cent.   Prompt  action  gives  a  much  greater
chance of  recovery.   If  there  is  any  delay  in
obtaining the physician, some measures may be em-
ployed in  the meantime.  The  stomach   may  be
washed out by drinking several glasses  of water
and  then  producing  vomiting.   Warm   mustard
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water is excellent, as besides producing vomiting, it
acts as a stimulant.   A dose of salts, together with
an enema  (injection into the bowels), will help to
rid the intestines of  the poison.   Hot, clear tea also
has a beneficial effect and usually  is borne well by
the stomach.
  The patient,  although recovering from the attack,
may feel the results in the form of digestive troubles
for several months.
190 
CHAPTER XXI
   MINOR DISORDERS AND DISORDERS OF GROWTH

  Back-Ache.  Of  all annoying  afflictions back-
ache seems to be one of the most common, espe-
cially with those who have passed the first flush of
youth.  The common idea  that all back-aches are
due to the kidneys is very misleading.   Many of
the advertisements  of "kidney  pills"  which are
displayed so prominently would lead the reader to
believe  that all back-aches have  their source in
some disorder of the kidneys.  The "crick" in
the back is taken as an indication of need of some
kidney remedy, so the sufferer rushes to the near-
est drug store and buys a package of pills and per-
haps a plaster.  If within a few days the back-ache
is better he becomes a devotee to the remedy which
may not have  had anything to do with his recovery.
Many a person has a back-ache  who has  perfectly
normal kidneys.
   Probably more back-aches are due  to  lumbago
than to any other cause.  This is an affection of the
                      191 
THE HOME NURSE
voluntary muscles in the lumbar  region character-
ized by pain, tenderness and rigidity.  Pain is the
chief symptom.  It  is made worse by use of the
muscles and is associated with tenderness.   Some-
times the muscles are contracted and rigid.  There
is a dull aching pain across the loins.  Turning the
body  or rising from the sitting posture causes an
exacerbation which sometimes is so severe that the
patient  cries out.
  The cause usually is exposure to cold and wet or
muscular  strain.   People who are predisposed to
rheumatism are especially inclined to be  the  suf-
ferers.
  The  treatment consists  chiefly   in rest  and the
application of counter-irritants.  The muscles  may
be put to rest by strapping with strips  of  adhesive
plaster.   The  chief  benefit  derived from  most of
the plasters sold  for this purpose  is that they  hold
the muscles at rest so that when the body is moved
there is no strain of the  affected muscles.   The ap-
plication of heat, or of a mustard plaster affords
considerable  relief in many cases.  True oil of
wintergreen (not the synthetic which often is  sub-
stituted) well  rubbed in  is an excellent remedy.
  Back-ache may be due to many  other causes, and
                       192 
MINOR DISORDERS
if one is not certain as to the cause it is well to go
to a physician and have a thorough examination
which  will reveal the cause.   It  may  be due  to
chronic constipation, to eye strain or to some other
strain on the  nerves.  In women it  frequently is
due to a displacement of some organ or to an in-
flammation, either of which conditions need to  be
corrected.  Girls who are compelled to be on their
feet several hours at a time are subject to back-ache
which should not be neglected.
  Temporary  Deafness.  Many  people  complain
that their hearing gradually is growing less  acute,
perhaps  is almost entirely lost in one ear.  One
case was particularly noticeable in a young man who
was unable to hear ordinary conversation and  so
was deprived of much of the pleasure of life.  On
examination it was found that his ear contained a
large amount of hardened  wax.  When  this was
removed his hearing was restored.
  This condition is very common and not  limited
entirely  to the  uncleanly.  Some people  who are
scrupulously clean in their personal habits have this
hardened wax.   The original cause  probably was
a slight inflammation of the ear  during the  course
of  a cold.  This might  have been so slight as to
                      193 
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pass unnoticed, but, as a result of this inflammation,
the wax stuck to the drum of the ear and to the sur-
rounding tissues  and gradually increased in amount.
As hearing is produced by the sound waves striking
the drum of the  ear, the patient would become par-
tially deaf because the sound waves could not reach
the drum.  In some cases the wax becomes partially
loosened and then the patient will  complain of a
buzzing or roaring in the ear which is  due  to the
waves of sound being compressed  behind the wax.
   The remedy for this condition, naturally, is to
remove  the wax. However, this  sometimes  re-
quires considerable time and  patience in order not
to injure the delicate drum.   First the wax must be
softened by the application of an oily spray.  It may
be necessary to apply  this several times a day for
two or three days.  Then it may be that the wax can
be washed  out with  warm water.  To do this, a
fountain syringe  is filled with warm water and hung
about a foot above the level of the  ear.  A medicine
dropper makes a very good point to be used instead
of any of the ordinary syringe  points, as it  allows
only a small stream of water to flow.   The water
should be allowed to flow very slowly into the ear.
                      194 
MINOR DISORDERS
If much force is used the operation  would be very
painful.
  In some cases it is necessary to dig the wax out
with a fine instrument.  The patient should not at-
tempt to do this himself as there is great danger of
puncturing  the  ear-drum and causing permanent
deafness.   It is necessary to have a good light so
that the canal is clearly visible.   The majority of
physicians have a very strong light which can be re-
flected into the ear.
  Good hearing is so necessary, not only to the en-
joyment of life, but  in the attainment of success in
work that it seems strange that anyone would neg-
lect a gradually increasing deafness.   Yet there are
hundreds of people who go for years with impaired
hearing  which  might be relieved by very simple
measures.
  Bunions.  A bunion  is one of  the most painful
of minor affections.   It is defined as a swelling of
the bursa mucosa at the ball of the great toe.   Every
joint is protected by  one or more sacs of fluid called
bursa.  The bursa lying between  the skin and the
head  of the bone at this joint is  exposed to pres-
sure from  the shoe and often becomes  inflamed.
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This inflammation is called a bunion, although the
same condition may be present at other joints.
  If people never  wore  shoes  they never  would
have bunions.  If they wore shoes suited to the
shape of their feet the same absence of discomfort
would  be noted.  Feet vary as much in size  and
shape as do other parts of the body, yet people with
different shaped feet try to wear  the same shaped
shoes.   Pointed  toed  shoes are  responsible  for
nearly  all the  bunions.  The natural foot does not
converge to a  point, yet, when it is encased in cer-
tain shoes, that becomes its appearance.   The foot
is drawn out  of  shape, is deformed to fit the pre-
vailing style of foot wear as truly as the foot of any
Chinese  lady  was deformed.  There really  is not
much difference between encasing the foot in band-
ages or in tight shoes.
  If one will draw the toes of his bare foot together
to try  to form a point he will notice that the last
joint of the great  toe is thrown outward.   If a
shoe is worn that holds the foot in this position the
joint receives  considerable pressure  from the shoe
which  results in inflammation.
  Understanding the  cause it is not a hard matter
to decide upon the treatment of a bunion.  First,
                      196 
MINOR DISORDERS
procure a pair of shoes that do not squeeze the toes
together.   The  inner  side of  the  sole of  a shoe
should be nearly straight, not slanting towards the
middle  at  the toe.   The " mannish " cut of  shoes
usually has this  shape sole,  and they can be pro-
cured in all weights of leather.   The next thing is
to relieve the pressure on the sore joint and also try
to replace the great toe in its original position.   The
latter can be aided by placing a piece of cotton be-
tween the great  toe and the second toe.  This tends
to throw the big toe back into a straight line with
the foot and the joint to resume its proper position.
To relieve the pressure, a small piece of cotton with
a hole cut in the center laid directly over the bunion
should be worn  during the day.  If the bunion has
not existed a great length of time nor become com-
plicated this treatment will be all that is necessary.
However, in some cases the bursa has become in-
fected and pus has formed.   Then it may be neces-
sary to remove the bursa.  In extreme cases the in-
fection has extended to the joint cavity and the end
of the bone has become necrosed (dead).  In this
case it will be necessary to remove a portion of the
bone before the  bunion can be relieved.
   The Child With Rickets.   In some of the poorer
                       197 
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localities, especially of the large cities, it is not un-
common to  see a small child whose head not only
appears too  large  for  his  body but  seems to be
square in  outline.   A further examination  usually
reveals  bow legs  or knock-knees,  while the long
bones of the arms also  may be bent.   The ends of
the bones frequently appear to be clubbed.   If the
chest is examined the sides appear to be flattened,
while the sternum or breast  bone is very prominent.
Nodules, which are  called  the " rachitic  rosary,"
may be felt  where the ribs join the  sternum.
  Such a child presents a typical picture of  rickets
or rachitis.   This is a disease characterized  by de-
fective  nutrition  of the  bony tissues.  The most
marked changes appear in the  ribs and  long bones
although the condition is general.  The condition
seldom  is seen at birth but develops during the first
or second year.   If it commences early, the mother
notices that  the " soft spot" on the top of the baby's
head does not close as soon as it should.
  This  condition is due to lack of proper food and
bad  hygienic surroundings.  For this reason  it
most frequently is  seen among the poverty stricken
who usually do not even have sufficient fresh air.
  At birth,  the framework of  the baby's body  is
                       198 
MINOR DISORDERS
composed partly of  cartilage  or gristle.  If the
breastbone of a young chicken is examined, it will
be found that the  lower portion  is not  bone but
gristle.   As the chicken grows older the gristle  is
replaced  by bony substance.  The same is true of
the bones of a baby.  As the child grows, lime salts
are deposited in the tissues and bony substance takes
the place of the gristle.   In order for this to take
place, the baby must have sufficient bone forming
food.  The mother who nurses her baby can  regu-
late  the  amount of bone forming material in the
milk by  attention to her own diet, but the  baby
brought  up on a bottle must also have this matter
attended to.   The mothers  in the poorer localities,
even though they do nurse  their babies, frequently
do not have enough nourishing food to make good
milk for the babies.  The  poor bottle  fed  babies
fare even worse.  One who has not visited the
poorer districts, cannot conceive  of  the condition
of the babies there  and cannot realize their need  of
proper food.
   While  the  bones are soft, they are easily  bent
out  of shape so that bow legs and other deformi-
ties  are  frequent in these localities.
   The child with rickets needs to be placed in the
                       199 
THE HOME NURSE
 fresh  air  and fed nourishing food.  Under such
 treatment, the bones gradually become stronger and
 some of the deformities may disappear.   However,
 if the condition has remained so long that the bones
 are badly  out of shape, the only results will be a
 prevention of further deformity.
   Adenoids.  Of recent years we hear so much of
 adenoids.  It does not seem that we ever used to
 hear of them.  They are like  appendicitis,— an old
 disease with a new name.  People used to have ap-
 pendicitis,  and die of it, but it was called inflamma-
 tion of the bowels or some similar name.
   Children used  to have adenoids in the good old
 days just the same as they do now, but they were
 not recognized then  and the troubles which they
 caused were allowed to continue.   We used to hear
 a great deal about " catarrh " and bought all kinds
 of  patent medicines for it.  The majority of these
 contained cocaine or some other dangerous drug,
 the use of which  soon created a habit.  Many were
 the troubles laid to "catarrh."  It  was a sort of
 scape-goat for all the diseases.   Mothers met and
 discussed the difficulties attributed to it.
,  All  this  is changed now.  We know something
 about this " catarrh " which causes children to hold
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MINOR DISORDERS
their  mouths  open as they are unable to breathe
through  their noses.   We know that the children
that have sore throats all the time, that  are back-
ward in  their studies, have a reason for  being so.
Now we do not buy the harmful drugs  that only
allay  the symptoms while doing more harm than
good.  We have the child examined to see if it has
adenoids.
  Adenoids are little growths in the passage from
the nose to the throat.   These growths  resemble
small bunches  of  grapes.  When they fill the air
passages  the air cannot  reach the lungs  properly.
As a result, the lungs do not receive enough oxygen,
the blood does not contain enough coloring matter,
the child becomes  pale and  tired.   Such a child is
less able  to resist disease so is constantly subject to
sore throat and colds, as well as being more liable
to contract the more serious diseases.   Besides this,
the brain is poorly nourished and the child becomes
stupid and  dull.  He falls behind  his classes  in
school and  is not able to grasp the lessons assigned
to him.   Finally his face becomes drawn and dull
looking.  Then, too, breathing through the mouth
causes the  face to become deformed, the  palate is
arched and the teeth do not have their proper con-
                      201 
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tour.   The  protruding or squirrel teeth of many
children are due to adenoids or enlarged tonsils.
   The  only  remedy  for  this condition is  the  re-
moval of  the little growths that are causing all  the
trouble.   If something were plugging up the water
main  in a town, it would not take long for the  en-
gineer to  decide to remove the obstruction.  It is
just as  reasonable to remove the obstruction that is
plugging up the air passages in the child's body.
   The  change resulting  sometimes is  surprising.
The child begins to take an  interest  in the things
around  him, he improves in  his  lessons, the colds
and sore throat are things of the  past, the child  be-
gins to take on flesh and has color in his  cheeks.
He is becoming a normal child!
   Hernia.   A rupture or hernia is so common with
babies,  especially boy  babies,  that it is surprising
that so few mothers really understand the condition.
   Try to imagine a person with a bag of coiled tub-
ing.  The bag is double, consisting of a lining and
an outer covering.  Someway a tear or rip  has  ap-
peared  in the lining.  This  allows the tubing to
come out between the lining and the outside,  making
an irregular lump.  That is just the condition with
a rupture  or hernia.   The intestines or bowels have
                      202 
MINOR DISORDERS
come out between the lining muscles and the skin
through  a little tear or  opening in the muscles,
This  opening  commonly  is  the  inguinal  canal
through which the spermatic cord passes.
  A good housekeeper would  sew up  the  rip  or
tear in the lining of the bag without  any question.
That is what a surgeon does when he operates for
hernia.   He sews up the tear in the muscles so the
intestines cannot come down.
  If the baby is very young, an operation may not
be necessary, for there is a chance that the muscles
will grow together again  if the intestines are held
in place  for awhile.   A truss is  a contrivance for
holding these  in place.  It does  not  in itself cure
the trouble.  We see many advertisements saying,
" Rupture  cured  without  a  knife."  These  are
fakes!  The most common  treatment these  adver-
tisers use is to inject a little paraffin or wax  under
the skin to plug up the tear as a cork would stopper
a bottle.  This may  keep the intestines up  for a
time and the patient thinks he is cured.   However,
it is very common for this wax to become displaced
a little and an examination will reveal that the tear
has become larger than ever.  These cases usually
have to be operated upon eventually.
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  If the hernia  is not repaired, there is danger of
what is known as a strangulated hernia, that is, the
intestine comes down between the muscles and be-
comes  caught  so that it cannot go back into place.
This is a very serious condition, for the blood sup-
ply usually is  cut off and the intestine will become
gangrenous  (dead).  This may result in death of
the patient within  a few hours.   If a rupture ever
becomes caught in this way, there is no time to be
lost until the abdomen is opened by a surgeon and
the intestine is released.
  Rupture may be congenital, that is, present at
birth, or it may be caused by heavy lifting or strain-
ing.  For this reason, a small  child should not be
allowed to strain himself by trying to lift a heavy
object.   Some children are inclined to attempt tasks
too great for their strength and must be restrained.
Violent crying and straining at stool may produce
a rupture if there  is a weak  spot  in the muscles.
This is one reason a baby should wear a band around
the navel for the first few weeks after birth.
  The  Child  With Bow-Legs.   Summer  is  the
season  of the year when the treatment of bow-legs
can be made enjoyable to the patient.
  Bow-legs are caused by allowing the baby to walk
                      204 
MINOR DISORDERS
or stand before the little legs are strong enough to
bear the weight of  the body.   During babyhood,
the bones of the legs are soft and bend easily, just
as a young tree can be bent in any direction.
  When baby first is learning  to walk,  great care
should be exercised that he does not remain on his
feet too long at a time.  If left by himself he will
sit  down  frequently and creep about.   A  baby
should not  be  urged to walk  too  young.  When
his muscles  are strong enough he will discover that
he  can  walk just as he discovered that he could
creep.   He  should not be allowed to walk until he
is too tired.  When  he goes outdoors for exercise
and fresh air he should ride in  the carriage part of
the time so as to rest the little legs.
  The baby-walkers  advertised in many magazines
never should have been invented as they are liable
to help  cause bow-legs or knock-knees.   If a  baby
is placed in  one of these walkers, he is unable to sit
or lie down  no matter how tired he may be.  As he
is unable to talk, he may suffer considerably before
released from his prison.
  As a rule, the parents do not  notice that the  baby
is becoming bow-legged until he is three or  four
years of age, then they are anxious  to have the legs
                      205 
THE HOME NURSE
straightened.  This is a tedious process, but if the
parents are persistent, much benefit can be derived.
If the child is old enough, he should be provided
with a velocipede large enough so that he will  have
to stretch his legs a little to reach  the pedals.   This
will relieve the weight from the legs and the con-
stant  stretching will  tend  to straighten them.
  Massaging the legs every night and morning with
olive oil or alcohol and gently trying to straighten
them a  little will make a gradual improvement.  It
will be necessary to continue this for several months
to obtain any results.   In extreme cases, braces may
be necessary, but these should not be used if  they
can be avoided.
  The best form of treatment is prevention.  The
growing baby should be given bone forming food.
The prevalence of bow-legs in the poverty stricken
districts among  the poorly nourished  children is  a
proof of the part that lack of proper nourishment
has in causing this condition.  The desire of  par-
ents to have their child walk at too early an age is
the next great factor in the prevalence of this pre-
ventable and unsightly deformity.
206 
                      INDEX
                                                 PAGE
Accidents and emergencies ............,......■...... 172
    Alcoholism................................... 182
    Apoplexy  or  stroke........................... 182
    Burns and scalds............................. 175
    Cuts and bruises.............................. 175
    Drowning.................................>. • 181
    Electric shocks............................... 181
    Fainting.................................... 182
    Foreign bodies in eye......................... 178
    Heat exhaustion ............................. 183
    Hemorrhage................................. 173
    Ivy poisoning................................ 186
    Meat poisoning.............................. 189
    Oak poisoning..............................• 186
    Poisoning by opium or morphine............... 183
    Ptomaine  poisoning......................---- 188
    Sprains, dislocations and fractures............. 180
    Suffocation   ................................. 182
    Sun stroke.................................. J83
    Unsciousness................................ J82
Acid steam baths for rheumatism---................  52
Acids and milk, incompatible......................  73
Action  of medicines..............................  7°
Adenoids.......................................• • 20°
    Predispose to tuberculosis..................... 17°
Administering medicine to  unconscious  person......  71
                         207 
INDEX
PAGE
Affusion or pouring on of water...................   59
Alcohol sweat  ...........,........................   57
Alcoholism......................................  183
Antitoxin  .......................................  145
Apoplexy  .......................................  182
Appliances for relief of bed patients...............   60
Arm, hemorrhage  of.............................  173
Aural  douche...................................   88
Backache.......................................  191
Back rest  .......................................   63
Baths  ...................................    49
    As  cleansing agent...........................   49
    As health  producing  agent....................   49
    Classification ..................................50
    Disinfection of bath water....................  103
    Effects   .....................................   50
        Cure headache ..........................   52
        Induce perspiration......................   51
        Induce sleep  ............................   52
        Reduce temperature  .....................   50
        Relieve kidneys.........................   51
        Relieve nervousness  .....................   51
        Relieve thirst  ...........................   51
    For  paralysis   ...............................  124
    For temperature  in typhoid...................  106
Bed, feather ....................................  26
    Obstetrical ..................................  26
    Surgical  ....................................  26
    Water and air..............................  26
Bedmaking   .....................................  21
Bed  sores  ........................................45
    Call physician's attention to...................  36
                         208 
                       INDEX
                                                 PAGE
    Prevention   .................,................  60
    To avoid  ...................................  45
Bitter taste in indigestion.........................  38
Bleeding, to relieve inflammation..................  79
Blood poisoning  .................................  174
Bowel movement recorded........................  67
Bow-legs   .......................................  204
Bread poultice or plaster..........................  83
Bronchopneumonia  ..............................  112
Bruises..................................,......  173
Bunions  ........................................  195
Burns..........................................  175
Cantharides blister  ..............................  87
Care  of patient
    Bed sores ...........................•........  43
    Care  of hair......... —.....................  44
    Feeding patient.............................  47
    Hands  and  nails.............................  45
    Morning toilet  ..............................  43
    Mouth  and  teeth.............................  45
    Moving helpless patient.......................  46
    Placing bed-pan.............................  47
Carron oil  ......................................  176
Carrying  patient................................  46
Castor oil, how  to administer.....................  73
    To prevent  bed sores.........................  46
Cerebrospinal  meningitis .........................  128
    Cause  ......................................  I28
    Deformity or defects following................  130
    Symptoms..................................  I28
    Treatment ......................>...........  13°
Chart in accident cases as testimony in court........  65
                         209 
                              INDEX
                                                          PAGE
/        Cheyne-Stokes  ..................................  34
        Chloride of lime disinfection...................... 132
        Circulation effected by baths......................  50
        Cleanliness, essential to health........,............  49
           Of bed  .....................................  43
           Of patient  *.................................  43
        Coffee-nutrient  .................................. 106
        Colds
           Cure....................................... 158
           Prevention  of  ............................... 156
        Coma-vigil  .....................................  37
        Condition of tongue as symptom...................  37
        Cone,  paper ..................................19, 102
        Constipation, enema  for..........................   90
           In  typhoid..................................  107
        Consumption (see tuberculosis)
        Contagious diseases  .............................  132
           Diphtheria.................................  144
           Disinfection during illness....................  132
           Disinfection of nurse.........................  143
           Disinfection of patient after recovery..........  143
           Disinfection of room  after  recovery.......143, 151
           Exposing children  to.........................  133
           Isolation...................................  132
           Measles  ....................................  134
           Mumps  .....................................  148
           Nurse — precaution  to  avoid  contracting  dis-
                   ease   ............................144, 152
           Scarlet fever  ................................  137
           Whooping  cough  ............................  146
        Convalescence   ..................................  109
       Convalescent,  entertaining.......................   13
                                2IO 
INDEX
PAGE
Conversation in sick  room........................  13
Cotton pad  ......................................  61
Cough  .........................................  40
    Croupy  .....................................  41
    In pneumonia  ............................... 115
    Whooping ..................................  41
Counter irritant for relief of inflammation..........  78
Cradle to relieve  pressure.........................  61
Crumbs and wrinkles causing bed sores............  46
Cumulative effect of medicine.....................  76
Cupping........................................  80
Cuts........................................... 173
    Infected  .................................... 174
Deafness  caused by wax..........................  88
    Temporary  ................................. 193
Death  Cross  ....................................  30
Delirium,  as symptom............................  38
    In typhoid.................................. 106
    Overcome by baths...........................  52
Diarrhoea in typhoid.............................. 107
Diluting  medicine  ...............................  72
Diplococcus intracellular is  meningitis.............. 128
Diphtheria  .........................,........... 144
    Antitoxin in ................................ 145
    Definition  .................................. 144
    Heart failure in.............................. 14S
    Paralysis  following .......................... 145
    Symptoms .................................. M5
    Treatment .................................. 145
Directions for giving baths.......................  53
Dishes, care of in infectious diseases.............. 102
    Disinfection during  illness.................... 132
                         211 
                      INDEX
                                                 PAGE
Dislocations ..................................... x8o
Doctor, when  to call............................. *34
Douches, Enema, Injections.......................  88
Douche, aural...................................  88
    Deafness,  partial, due to wax.................  88
    Definition  ..................................  88
    Forms of ...................................  88
    Rectal ......................................  88
    Uses   .....................................88, 94
    Vaginal   ....................................  94
    Variety   ....................................  88
Dram   ..........................................  66
Draw  sheet .....................................  22
Drowning  ...................................... 180
Ear, cleansing method of.........................  89
    Douche....................................  88
    Inflammation of .............................  88
    Troubles  relieved by irrigation................  88
    Wax  in external canal........................  88
Electric shocks  .................................. 181
Elimination of waste by skin......................  49
Enema.........................................  89
    Astringent  ..................................  92
    Definition  ..................................  89
    Evacuant ...................................  89
    For hemorrhoids ............................  93
    Nourishing   .................................  92
    One,  two, three..............................  91
    Position   during  .............................  9°
    Stimulating  .................................  93
    Turpentine  for  diarrhoea......................  92
    Uses of.....................................  89
212 
                       INDEX
                                                 PAGE
Eruption  (as symptom)..........................  35
Evaporation  reduces temperature..................  54
Examination of feces.............................  39
Excretions  ......................................  39
    Disinfection of ..............................  39
    Disposal of ................................39> l9
    Recording nature,  quantity time of voiding.....  39
Expectoration,  quality  of.........................  41
Expression of face (symptom)....................  36
Eye, as symptom.................................  3^
    Foreign  bodies in...........................  178
Fainting  ........................................ l&2
Feces,  disinfection of............................ 133
    Disposal of .................................  *9
Feeding, patient .................................  47
    Stubborn patient  ............................  47
    Unconscious patient .........................  47
Flies in patient's room............................ 103
Foot-baths  ......................................  55
Fractures  ....................................... *8o
Gas in intestines................................. I07
General condition, of body........................  35
    Of skin  .....................................  35
Glands of skin...................................  49
Habit  forming drugs.............................  77
Hair  of patient..................................  43
Hands and nails, care  of..........................  45
Heat  exhaustion  ................................ J°3
Heat  to  feet to reduce fever......................  52
Heel  pads  ......................................  6l
Hemorrhage  .................................... *73
    From  intestines .............................  39
                         213 
                      INDEX
                                                 PAGE
    In typhoid .................................. 107
    Observations  in .............................  42
Hemorrhoids ..................................  93
Hernia  ......................................... 202
Hip  disease ..................................... 163
Hot  foot baths...................................  56
Hot  fomentations................................  85
Hot  pack .......................................  58
Hot  stupes  ......................................  85
Hunch backs  ................................... 163
Hypodermic medication ..........................  75
Ice Pack .......................................  58
Idiosyncrasy to  drugs............................  77
Inflammation, treatment ..........................  78
Infantile  paralysis  (see poliomyelitis, acute)........ 121
Injured limb (cradle)............................  63
Inunctions   ......................................  76
Ivy poisoning ................................... 186
Kidney  pills .................................... 191
Knee-chest position for enema.....................  90
Laxatives,  administration  of......................  74
Leeching.......................................  79
Leg, hemorrhage of.............................. 173
Linen, air and warm bed.........................  25
    Changing bed ...............................  22
Lobar pneumonia ................................ 112
Lungs — hemorrhage of .......................... 173
Lupus (see tuberculosis)......................... 163
Mattress, care of.................................  21
Measles  ........................................ 134
    Black   ...................................... 136
    Care of eyes................................. 136
                         214 
INDEX
                                                 PAGE
     Complications............................... 136
     Desquamation  ............................... 136
     Eruption   ................................... 535
     Koplik's sign  ................................ J36
     Symptoms  .................................. j-je
     Treatment  .................................. j-jg
 Measles, followed  by pneumonia................... 114
 Meat poisoning ................................. !gn
 Medicine, bottles and glasses......................  19
     By inhalation  ...............................  74
     By mouth  ...................................  72
     By rectum  ..................................  74
     Ounces in measuring.........................  66
     Pouring ....................................   yl
     Precaution  in  handling.......................   70
     Recorded   ...................................   66
 Melancholia as  symptom..........................   38
 Mercury by inunction............................   76
 Milk curds in  feces...............................   40
 Mind as symptom................................   38
 Minor disorders and disorders of growth...........  191
     Adenoids  ................................... 200
     Backache  ...................................  191
     Bow legs  ................................... 204
     Bunions .................................... iog
     Hernia  ..................................... 202
    Rickets  ..................................... 197
     Temporary  deafness  ........................ 193
Morphine  poisoning ............................. 183
Mouth and  speech as symptoms...................  37
Mouth and teeth of patient.....................45, 105
Moving helpless patient...........................  46
215 
                       INDEX
                                                  PAGE
Mumps  ......................................... 148
    Sterility resulting  ........................... 151
    Symptoms  .................................. 148
    Treatment  .................................. 150
Mustard,  foot  baths..............................  56
    Fomentations  ...............................  87
    Plasters   ....................................  83
Nervousness, baths relieve........................  51
Night  air  ....................................... 166
Nose,  hemorrhage  of............................. 173
Nourishment,  recorded  in ounces..................  66
Nurse, attitude to  physician......................  14
    Care of, in infectious diseases................. 103
    Dress   ......................................  12
    Personal appearance  .........................  12
    Prescribing medicine  ........................  77
    Requirements for ............................  12
    Responsibility for substitute...................  13
    Shoes......................................  12
    Sleep  and exercise...........................  12
Oak poison ..................................... 186
Olive oil  enema..................................  90
Opium poisoning ................................ 183
Pain   ...........................................  42
    Of hysterical cases...........................  42
    Varieties of  .................................  42
Perforation ..................................... 109
Perspiration, importance of  as  symptom............  35
    Reduced by  baths............................  51
Physician's orders  carried out exactly.............  43
Piles   ...........................................  93
Pillows, changing of..............................  25
                         216 
                      INDEX
                                                PAGE
Pills,  administration of...........................  73
Placing bed pan..................................  47
Plants and flowers in sick room...................  18
Pleurisy accompanying pneumonia................. 115
Pneumococcus  .................................. II2
Pneumonia..................................... II2
    Bathing in .................................. "9
    Bowels ..................................... IJ8
    Broncho .................................... II2
    Cause   ...................................... I12
    Cough  ..................................... "5
    Crisis   ...................................... Il6
    Following measles ........................... IJ4
    Following whooping cough.................... 114
    Forms  ..................................... II2
    Heart  failure in.............................. 116
    Inspiration   ................................. II2
    Lobar  ...................................... "2
    Lobular  ....................................  II2
    Pleurisy accompanying  .......................  iJ4
     Sleeplessness   ...............................  IJ9
    Sputum  .....................................  XI5
     Stages of
         engorgement  ............................  IJ4
         gray hepatization  ........................  XI5
         red hepatization.........................  "5
     Symptoms  ..................................  IJ5
     Treatment  ..................................  JI7
     Tuberculosis following  .......................  I20
     Ventilation  .................................  ll7
 Poliomyelitis, acute ..............................  I21
     Fly carries  germs............................  I2(>
                         217 
                       INDEX
                                                 PAGE
    Mode  of contraction.........................  121
    Prevention  ..................................  126
    Symptoms  ..................................  122
    Treatment  ..................................  124
Position, in abdominal trouble.....................   41
    In heart trouble..............................   41
    In lung  affection.............................   41
    In nervous  condition.........................   41
    In pain  .....................................   41
    Near death  .................................   41
    Of  patient changed frequently...............46, 60
    Of patient in bed.............................   41
Positions, descriptions  of.........................   95
    Fowler's  ....................................   95
    Knee chest  ..................................   95
    Prone ......................................   95
    Sim's  ....................................   94
    Trendelenburg  ..............................   95
Pott's Disease  (see tuberculosis)..................  163
Poultice   ........................................   81
    Bran  .......................................   82
    Charcoal  ..............'.....................   81
    Essentials of ................................   81
    Flaxseed  ...................................   81
    Hop  ........................................   81
    In pneumonia ...............................   81
    Jacket ......................................   81
    Onion ......................................   83
    Slippery  Elm ...............................   82
    Spice  ......................................   82
    Starch   .....................................   82
    Yeast ......................................   82
218 
                       INDEX
                                                  PAGE
Poultices, effect  of...............................  79
Powders, administration of........................  74
Prone  position for enema.........................  90
Prune  juice  sputum..............................  41
Ptomaine poisoning   ............................. 188
Pulse rate  recorded...............................  66
Purgatives,  administration  of.....................  74
Quinsy......................................... 155
Rapidity of absorption of medicine.................  70
Record out of sight of  patient.....................  67
Report, essential  of nurse's........................  67
    The nurse's written...........................  65
Respiration  .....................................  34
    Abdominal breathing  ........................  34
    Counting respirations  ........................  34
    Recorded  ...................................  66
    Shallow, regular, free or labored...............  34
    Thoracic  breathing..........................  34
Rickets  ......................................... 197
Rigors  or  chills..................................  42
Rubber air cushion to relieve pressure..............  61
Rubber sheet  ....................................  22
Rug or pad to prevent bed sores..................  46
Rupture ........................................202
Salt bags  .......................................  83
Salty taste in pulmonary tuberculosis..............  3&
Scalds  .......................................... 175
Scarlet fever  .................................... 137
    Cause...................................... 137
    Contagion in milk............................ 139
    Desquamation ............................... 139
    Diet   ....................................... 140
219 
                    "INDEX
                                                 PAGE
    Forms of ................................... 139
    Headache  .................................. 142
    Heart  complications ......................... 142
    Itching relief of............................. 140
    Kidneys, inflammation of......................141
    Malignant or black........................... 141
    Nephritis  ................................... 141
    Rash   ....................................... 138
    Strawberry tongue .......................... 138
    Symptoms  .................................. 137
    Throat ..................................... 138
    Treatment  .................................. 139
Scrofula  (see tuberculosis)....................... 163
Sick room,  choice of.............................  16
    Furniture ...................................  16
    Keeping cool ...............................  17
    Light   ......................................  16
    Moisture  ...................................  17
    Sweeping ...................................  19
Sim's position for enema.........................  90
Sitz  baths  ......................................  56
    For dysmenorrhoea ..........................  56
Skin irritations overcome by baths.................  52
Sleep as symptom................................  38
Sleeplessness and nervousness relieved by  baths....  52
Sordes  ....................................37,45
Spice plaster ....................................  83
Spitting in public (see tuberculosis)............... 165
Sponge baths ...................................  53
Sponge, bath for nervousness.....................  54
    For cleanliness  ..............................  55
    For temperature .............................  53
                         220 
                       INDEX
                                                 PAGE
 Sponging in typhoid.............................. 106
 Sprains  ......................................... 180
 Sputum  .........................................  19
 Starch  baths....................................  52
 Sterility following mumps......................... 151
 Strawberry tongue...............................  37
 Stroke  .......................................... 182
 Stupe wringer...................................  85
 Suffocation ..................................... 182
 Sun Stroke ..................................... 183
 Symptoms  .......................................  28
    Cough  ......................................  40
    Excretions  ..................................  39
    Eyes  .......................................  36
    Face  .......................................  36
    General conditions of body....................  35
    General conditions of skin....................  35
    Hemorrhage ................................  42
    Mouth and  speech............................  37
    Of  inflammation ............................  78
    Observation .................................  28
    Pain ....................................... 42
    Position of  patient in bed....................  41
    Pulse  .....................................34,  35
    Respirations  ...............................34>  35
    Rigors or chills.............................. 42
    Sleep  ...................................... 38
    Taste and appetite........................... 37
    Temperature  ..............................34. 35
    The  mind ................................... 38
    Vomiting  ................................... 4°
Taking medicine in dark.......................... 71
221 
                       INDEX
                                                 PAGE
Taste  and appetite...............................  37
Taste of medicine disguised.......................  73
Tea-nutrient  .................................... 106
Teeth, decayed  .................................. 170
Temperature  ....................................  31
    After and during chill........................  42
    Care  of thermometer.........................  33
    Crisis   ......................................  33
    How  to  take.................................  32
    Increase as  death approaches..................  31
    In  infants  ..................................  31
    In  old age...................................  31
    In  sunstroke  ................................  31
    Lysis .......................................  33
    Nervous temperature ........................  31
    Normal   ....................................  31
    Of sick  room................................  17
    Per axilla  ..................................  33
    Per mouth  ..................................  32
    Per rectum  .................................  32
    Recorded ...................................  66
    Reduced by  baths.............................  50
    Reduced by ice  pack.........................  58
    Sudden  rise or fall...........................  34
    Variation during day.........................  32
    Variation with individual.....................  31
Thirst relieved by baths..........................  51
Toe nails, care  of................................  45
Tonsilitis  ....................................... 154
    Causes   ..................................... 154
    Prevention  .................................. 155
    Symptoms  .................................. 154
                         222 
INDEX
PAGE
    Treatment  .................................. 155
Tonsils  enlarged  ................................ 170
Tub baths ......................................  57
Tuberculosis  .................................... 161
    Babies exposed  ............................. 165
    Communicable  .............................. 162
    Curable  .................................... 164
    Cure  ....................................... 166
    Diet in ..................................... 169
    Feather duster as distributor.................. 165
    Following pneumonia ........................ 120
    Following whooping cough................147, 164
    Forms  ..................................... 162
    Medicine cannot cure......................... 167
    Method of conveyance........................ 164
    Of  bones  ................................... 163
    Of  glands  .................................. 163
    Of  lungs  ................................... 163
    Of  skin ..................................... 163
    Prevalence of disease......................... 162
    Prevention ..............................164, 170
    Quick consumption  .......................... 162
    Sanitarium treatment ........................ 169
    Sunlight  destroys germs...................... 165
    Tubercular glands ........................... 162
Turpentine stupes ...............................  86
Tympanites in typhoid............................ 107
Typhoid fever ....................................98
    Cause ......................................  99
    Constipation in .............................. 107
    Convalescence  .............................. I09
    Curative  treatment  .......................... 104
                         223 
                      INDEX
                                                 PAGE
    Definition  ..................................  98
    Delirium  ................................... 106
    Diarrhoea  ................................... 107
    Diet in ..................................... 105
    Eberth's  bacillus ............................  99
    Flies  as  carriers............................. 103
    Gas in intestines............................. 107
    Hemorrhage  ................................ 107
    Method of contracting........................  99
    Perforation  ................................. 107
    Prevention  ................................. 101
    Relapse  .................................... 109
    Sordes in ...................................  37
    Sponging  ................................... 196
    Symptoms  ..................................  99
    Temperature  ................................ 106
    Visitors  .................................... m
Unconsciousness  ................................ 182
Urine, disinfection of............................. 102
    Disposal  of .................................  19
    Recorded  ...................................  67
    Saving specimen ............................  40
Vomiting  as  symptom............................  40
Whooping  cough ................................ 146
    Dangers  .................................... 147
    Diet   .....................................  47
    Duration  ................................... 147
    Followed by pneumonia....................... 114
    How  carried ................................ 146
    Symptoms  .................................. 146
    Treatment .................................. 147
    Tuberculosis  following ....................... 147
                         224 
publishers' note
  The reader will be interested in other
books by Dr. Lowry described in the fol-
lowing pages;
  Dr. Lowry is  famous as the author of
the only books on sex hygiene which have
received  the  endorsement of the leading
medical, educational and religious authori-
ties, who declare they are the first books
to meet the standards and requirements of
the present great world-movement for sex
education.
  The books are  written  with scientific
accuracy and with directness and unpre-
tentious clearness.
  There  is  nothing  morbid  or mawkish
about Dr. Lowry's books — they lead to
better health, to sex  purity, and to a high,
practical morality. 
               By E. B.  Lowry,  M.D.

               HERSELF

    TALKS WITH WOMEN CONCERNING
                  THEMSELVES

  This  book contains truths vitally important to every
woman.  The health and  happiness of mothers and  their
children depend upon their  knowledge of the  facts here
given with great clearness and conciseness by a physician
of national reputation in the scientific care of  women.

  " Herself " is superior to all books on its subject.— The
Independent.
  It stands alone in the literature of the subject and I am
losing no opportunity to commend  it.—The Rev. Lyman
P. Powell.
  Well written, skillful and  conscientious.— Margaret E.
Songster.
  A book the world has long needed.— Mrs. W. N. Hutt,
National Chairman, School Hygiene, General Federation
of Women's Clubs.
  A very excellent book that will save many from physical
and mental suffering.— Iowa Medical Journal.
  Should be recommended by physicians to all their female
patients.— The Lancet-Clinic.
  It is a book for the reading of which almost any woman
would  be the better and  give thanks.— Chicago  Record-
Herald.
               Illustrated.   Cloth, l2mo.

            Price, $1.00 net; by mail, $1.10

     For sale by  all booksellers  and the publishers

FORBES & CO.,  443  S.  Dearborn St.,  CHICAGO 
By E. B. Lowry, M.D.
               HIMSELF

      TALKS WITH  MEN CONCERNING
                  THEMSELVES

  This is regarded by all authorities as the best book on
sexual hygiene for men.   No man knowing its contents
would be without this important  book.  It tells plainly
all of the facts about sex and leads to health,  happiness
and success.   A book that points the way to strong vitality
and healthy manhood.
  Every man ought to read this excellent, reliable book.—
Philadelphia Telegraph.
  The best book on sexual hygiene  for men and we highly
commend it.— Baltimore American.
  The more  widely  this splendid book is read the better
it will be for men and women.— Boston Globe.
  Every  youth and man who can  read the English lan-
guage should  study this book.— Portland Oregonian.
  A rare book that  treats  its subject  in a common-sense
fashion.— Pittsburgh Post.
  This is a storehouse of knowledge that should be in the
hands of every man.— United States Medical Journal.
  It is utterly free from hysteria and sticks straight to the
unadulterated truth.   A valuable  addition  to any man's
library.— Spokane Chronicle.
  It is as good a book as a physician could recommend.—
Northwest Medicine.
  Clear, accurate, easily understood.— Chicago Journal.

              Illustrated.   Cloth, i2mo.

           Price, $1.00  net; by mail, $1.10
     For sale by all booksellers and the publishers

FORBES  & CO.,  443 S.  Dearborn  St.,  CHICAGO 
By  E.  B.  Lowry,  M.D.
           CONFIDENCES
TALKS WITH A YOUNG GIRL  CONCERNING
                     HERSELF

  A book explaining the  origin and development of life
in language intelligible to young girls.  The author, who
is a physician of wide experience and  a  pleasing writer,
has very delicately and adequately treated this important
subject.
  Carefully written and should be  given to every young
girl.— American Motherhood.
  A sweet and wholesome book and  we are glad to recom-
mend  it.— Y. W. C. A. Monthly.
  Every physician should  read  and  circulate this book.—
Journal of  Therapeutics.
  It will prove a boon to  all mothers.— Woman's Era.
  The reading of " Confidences " will open the heart of a
girl as sunshine the petals of a rose.— Vegetarian Maga-
zine.
  A book like this has a great mission before it.— Health.
  Dr. Lowry's books are excellent and they can be safely
recommended.— Journal of the American Medical Asso-
ciation.
  Delicate and adequate.— The Christian Guardian.
  The author's  tribute to motherhood is a masterpiece.—
Chicago Inter Ocean.
           Neatly bound in  cloth.  i6mo.
         Price, 50 cents net; by mail, 55 cents
    For sale by  all booksellers  and the  publishers
FORBES &  CO.,  443 S. Dearborn  St., CHICAGO 
By E. B. Lowry, M.D.
                 TRUTHS

TALKS WITH A BOY CONCERNING HIMSELF

  A book containing the simple truths of life development
and  sex which should be given to every boy approaching
manhood.  His  future welfare demands it.  This is the
first book to adequately and delicately present these truths
in language intelligible to boys from ten to fourteen years
of age.

   " Truths " is  the first  satisfactory book  on the subject.
— Health Culture Magazine.
   Straightforward and modest, it is the best book on the
subject.— The American Friend.
   Many a mother will be glad  that such a book is within
reach of her child.— Seattle Post Intelligencer.
   We wish it might be read by all the boys in the world.
— Eclectic Medical Journal.
   The knowledge most essential to a  growing boy is told
with scientific accuracy and in such a  careful manner that
it will not be found objectionable by thinking  parents.—
Life and Health.
   It is becoming more and more recognized that instruc-
tion in sexual hygiene is  a  necessary part of the education
of every  boy and girl,  and this book helps to solve the
problems.  We  recommend it to parents.— Chicago  Med-
ical Recorder.
            Decorated cover.   Cloth, i6mo.

         Price,  50 cents net;  by mail, 55 cents

     For sale by all booksellers and the  publishers

FORBES &  CO.,  443 S. Dearborn  St., CHICAGO 
By E.  B. Lowry, M.D.
        FALSE  MODESTY

  THAT  PROTECTS VICE BY IGNORANCE

  The most thorough and  convincing appeal ever  made
for the proper education of  the young in matters pertain-
ing to sexual hygiene by  the foremost writer on the sub-
ject.  A  book of vital, helpful  interest to every parent,
teacher, physician and minister.
  All parents  and teachers  should  read this  very impor-
tant book.— Boston Globe.
  Dr.  Lowry  covers the case completely and in such a
manner that all can understand.— Portland Telegram.
  Dr. Lowry has rendered signal service to perplexed and
anxious parenthood.— Los Angeles Herald.
  An eloquent, effective and important book, it deserves
the same high  praise  as  Dr. Lowry's other volumes.—
Philadelphia Evening Telegraph.
  Will take a place of deserved prominence in the litera-
ture devoted to the elevation of the race.— Chicago  Jour-
nal.
  Dr. Lowry is doing a noble work in shedding light on
the folly of bringing up children in ignorance of  many
things vital to their welfare.— The Medical Missionary.
  Dr.  Lowry's books combine medical knowledge,- sim-
plicity, and purity in an  unprecedented way. They are
chaste and  void of offense  to the most delicate natures.
The volumes  are  written  with scientific accuracy and
clearness.— The Journal of  Education, Boston.
                    Cloth, i6mo.
         Price, 50 cents net; by mail, 55  cents

    For  sale  by all booksellers  and the publishers
FORBES  & CO., 443  S.  Dearborn St., CHICAGO 
 
 
 
The New York Academy of Medicine
  Due in two weeks unless  renewed.
    Not renewable after e  weeks
DATE BORROWED	BORROWER
	
	
	
	
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