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r, ^'4)6>g
Ordered medicine, I teaspoonful, at -!
f 8.30, 10.30 A. M.
Whisky, 1 ounce, at j J2 ^ 2^ ^ p M
Flaxseed poultices to chest, at j ^' „
A. M.
P. M.
The hours must be checked off as they are filled. If
the orders keep about the same, the paper will last two
days by checking the opposite way on the second day.
The day or night Report will run somewhat as follows :
Day Report.
Mrs________, Extra-uterine.
Milk, 2 ounces, 8, 9, 10, n, 12 A. M; 1, 2, 3, 4, 5, 6, 7 P. M. Total,
24 ounces.
Whisky, 2 drachms, 830, 930, io30, II30, I23" A. M.; I30, 230, 330, 430, 530>
630, 730 P. M. Total, 3 ounces.
Strychnia, gr. ^, subcutaneously, 9, II A. M.; 1, 3, 5, 7 P. M. Total,
sVhs-
Milk, 4 ounces, 1 _,
.... ... r by rectum, 10 A. M.; 2, 6 P. M. Retained.
Whisky, \ ounce, ' J
Effervescent citrate of magnesia, bottle I. Given in divided doses dur-
ing the day.
Low enema of—
Turpentine, \ ounce,
Epsom salts, 3 ounces,
Glycerin, 4 ounces,
Warm water, 12 ounces,
at 9 A. M. Was not retained. Returned
soon as injected.
High enema of—
Turpentine, 1 ounce,
Magnesia sulphate, 1 ounce,
Glycerin, 4 ounces,
Warm water, 8 ounces,
Rectal tube inserted, very little gas expelled. Abdomen very much
distended.
at 10, 11 A. M., 1 p. m. Was not re-
tained. Returned soon as injected.
THE NURSE.
27
Urinated at io A. M., 3 ounces, -w
<■■■ " 3 P. M., 6 ounces, I Total, 13 ounces.
" " 6 p. M., 4 ounces, J
Bowels did not move.
Though patient did not sleep, yet she had a comfortable day.
Night Report.
Mrs.---------•
Magnesia Sulphate, 1 drachm, |
Hot coffee, 1 drachm, j
Strychnia, gr. ^5, subcutaneously, 9, 11 P. M.; 1, 3, 5, 7 A.M. Total,
2Vhs-
Whisky, \ ounce, 8, 10, 12 P. M.; 4, 6 A. M. Total, i\ ounces.
Oxalate cerium, grs. 5, at 9, 10. Total, 10 grains.
Nourishment— \
Milk, 10 ounces, \ Total, 15 ounces through the night.
Beef-tea, 5 ounces, J
Temperature and pulse taken eveVy two hours and recorded on chart.
Urinated at 9 P. M., 2 ounces, \
" "11 P. M., 3 ounces, V Total, 7 ounces.
" " 2 A. M., 5 ounces, )
(Very good movements, character
loose; movements, though
small, were very good.
After bowels moved at 9 o'clock distention gradually disappeared; very
little distention this morning. Passed considerable gas.
Slept continuously \\ hours, \
" « \\ « I Total, 5 hours.
" at intervals 2 " J
Had a comfortable night.
Another favorite way is to rule a sheet of paper, leav-
ing spaces for the hour, temperature, pulse, nourish-
ment, stimulant, medicine, sleep, and remarks. For in-
stance :
28 PRACTICAL POINTS IN NURSING.
Date.
Hour. 6. 6 H V ~3 a 6 3 O a c « "3 S c/2 c ■3 5 "53 o 0. 55 Remarks.
7 A. M. 8 << 9 " IO " n " 12 " I P. M. 2 " 3 " 4 " 5 " 6 " 7 " 8 « 9 " IO " u " 12 midnight I A. M. 2 " 3 " 4 " 5 " 6 " 7 "
Total.
These twenty-four-hour charts, or records, are very
useful for operative cases where the treatment is con-
tinually changing. The report should be made out and
ready for the physician, and everything that has hap-
pened since his last visit be written clearly and defi-
nitely ; also what the nurse has done. This detailed re-
port will save questioning in the presence of the patient.
THE SICK-ROOM.
29
II. THE SICK-ROOM.
Selection and Preparation of the Sick-room.—The
sick-room should be on the sunny side of the house
and capable of thorough ventilation. If there is a
stationary basin in the room, it should be covered with
paper or a board, or be kept filled with water, which
must be changed often; this will prevent impure air
coming up through the waste-pipe should the pipe not
be properly trapped. The room should be as near the
top of the house as possible, for the reason that the
higher we go the purer is the air, and also that if a
room on the lower floor is used the germs of the disease
will be carried upward. If the light is too bright, the
bed should be so made that the patient will lie with the
back to the window, or a screen may be put before the
window. If the case is disease of the brain or the eye,
the room must be darkened; the curtains so arranged
that there will be no flapping when the window is open,
nor flashes of light.
Preparation of the Bed.—Probably the first thing
that will need the attention of the nurse will be the bed.
In very few families will she find the mattress protected,
which should be done both for cleanliness and expense.
Many think that in the absence of a rubber sheet or an
oilcloth an old blanket or a comforter will do to protect
the mattress, but such substitutes must not be used if it
can possibly be avoided, as it is impossible to know
where they have been or how dirty they are; they may
be filled with germs. Newspapers can always be pro-
cured, which will absorb the discharges, and which can
be burned when removed. They are to be placed be-
30 PRACTICAL POINTS IN NURSING.
tween the under sheet and draw-sheet, which, if put on
here, will keep the under sheet clean much longer.
In making the bed the under sheet should be well
tucked in at the top and sides, even if it is a little short
at the bottom, for it is easier to pull an under sheet
down from the bottom than to pull it up from the top.
Next comes the rubber sheet, oilcloth, or newspapers.
The four corners of the rubber sheet must be pinned to
prevent wrinkling. The smooth end of the draw-sheet
must come under the patient's back. The upper cloth-
ing must be well tucked in at the foot, still not too
tightly, and the nurse should guard against a weight
of clothing lying on the patient's chest; if the sheets
or blankets are very long, the surplus must be brought
down to the foot of the bed.
Changing- the Bed-clothing.—Before beginning to
change the bed- or body-linen the nurse should get
everything ready and thoroughly aired and warmed.
The patient is moved to the other side of the bed, and
the upper and under sheets are loosened; then the upper
Fig. i.—Changing the bed-sheet without removing patient from the bed (a, sheet
partly rolled ; b, sheet partly folded).
clothing and under sheets are pushed well over against
the patient's back, and the clean sheet, rubber, and draw-
sheet inserted, the under sheet being tucked in at the top
and sides, and rolled up close to the soiled sheet (Fig. i).
THE SICKROOM.
31
The upper clothing is then spread out, and the patient
moved back to the clean side, after which the soiled sheets
can be removed, and the clean sheets be well stretched
and tucked in at the top and sides. To change the
upper sheet, the spread and one blanket are removed;
over the soiled sheet put the clean sheet and blanket;
then, with one hand holding the clean sheet and blanket,
the soiled sheet and blanket are drawn down toward the
foot of the bed and removed with the other hand. In
changing the bed in this way we guard against exposing
and chilling the patient.
When the patient cannot turn on the side, the bed
should be changed from the top, the soiled sheet being
first loosened at the top and sides and pushed well
down under the pillow. Another person must assist at
the other side of the bed in working down the two
sheets ; the shoulders, back, and upper part of the thighs
of the patient must be raised with one hand, while the
sheets are worked down with the other hand. In case
of a fractured limb, one person must support the limb
above and below the fracture, taking care to raise the
limb very gently.
When arranging the pillows, the head of the patient
should be lifted and supported by the nurse's arm, her
hand supporting the back ; with the other hand the pil-
low is turned, the lower pillow being brought under the
shoulders to support the back, the upper one to support
the head without bringing it too far forward or too far
backward. The patient must be permitted to suit herself
in arranging her pillows, as every patient has a favorite
way. A pillow should never be shaken up on the bed;
the upper pillow should be removed and shaken away
from the bed, then the second pillow taken out, replacing
32
PRACTICAL POINTS IN NURSING.
it with the fresh one, so that the patient will always have
one.
Bed-making- for Different Cases.—We will now con-
sider the making of beds for the different cases which
come under the nurse's care. In private practice the
supply of bed-linen may be very limited, and for this
reason it would be well first to put on the under sheet,
then the protector, which may be of rubber, ordinary
table oilcloth, or newspapers, then the draw-sheet; by so
doing the under sheet will be kept clean much longer.
Medical and Surgical Beds.—A medical and a surgical
bed is made with an under sheet, a protector, a draw-
sheet, and the usual upper clothing. If the bed is to be
prepared for a patient with a broken limb, a wide board,
table-leaf, or small strips of board (slats) or an ironing-
board must be placed across the middle of the bed,
undepthe mattress, to make the bed firm and prevent
Egging.
Obstetric Bed.—An obstetric bed is made with an
under sheet, a protector, and a draw-sheet, then over
these a second protector and sheet; this is called a
" temporary " bed, which, after all is over, is easily re-
moved, and the patient lies on a clean bed; both beds
during labor must be pinned securely to the mattress
at each corner, the. protectors also being pinned at their
four corners. If the bed is a large double bed, then one
side of it should be prepared, or the lower part of one
side. After delivery the patient is lifted to the other
side, or to the upper part of the bed, whichever has been
prepared. Here the writer again warns the nurse not
to use old comforters or blankets, unless positively sure
that they are clean ; if there is any doubt about it, then
give way to the doubt by not using them.
THE SICK-ROOM.
33
Cross-bed.—A cross-bed is very often used for gyne-
cologic examinations and minor operations : the pillows
are arranged across the bed in the middle, which arrange-
ment brings the hips of the patient to the edge of the
bed; across the mattress under the sheet is slipped a
table-leaf or board, which will, to a certain extent, take
the place of the examining table; the patient lies upon a
hard surface, thus preventing the body sinking into the
bed. A sheet and a blanket are the upper coverings.
Divided Bed.—Some surgeons like the upper bed-cloth-
ing divided for abdominal cases. For this form of bed
there are needed two sheets and two single blankets,
which are doubled, placed over the patient, and meet in
the centre, the sheets first, then the blankets. The upper
clothing is thus divided into two distinct halves; the
bed-spread being put on as usual. When the dressing
is to be done, the spread is thrown back and the sheets
and blankets parted, so that unnecessary exposure of
the patient is guarded against.
Water-bed and Air-bed.—Water- and air-beds are used
in cases of long illness, and in cases where bed-sores are
formed or where there is a tendency to them, and where
there is much moisture. The water-bed is placed on the
bed-springs, which should be covered with rubber sheet-
ing, a comforter, or paper, to prevent rusting, and the
bed filled with water (at a temperature of about ioo° F.)
by means of a funnel and pitcher. To empty a water-
bed, it is laid in a slanting position until all the water has
run out; it is then rolled up and laid away. India rub-
ber, if unused for any length of time, becomes hard and
is apt to break, and for this reason the bed should be
filled every six weeks or oftener, the water remaining in
it three or four hours. The air-bed is filled with air by
3
34 PRACTICAL POINTS IN NURSING.
means of a pair of bellows or an air-pump ; after filling,
it is made up in the usual way. Care must be taken
that these beds are not pricked with pins, or they will
collapse.
Appliances for the Relief of Bed-patients.—In very
few families will a nurse find a bed-cradle, a screen, a bed-
rest, pads, and rings.
The cradle (Fig. 2) can be improvised by taking one or
two chairs, placing them
backs uppermost, and
securing them by tying
their two lower legs to
the sides of the bed;
to be sure, they look
clumsy, but a chair is
always to be had in the
absence of anything else.
Half barrel-hoops, with
a string fastened to each end to be tied to the sides of
the bed, make a good cradle; three halves are all that
are needed. A cradle must always be placed under the
blankets, the sheet covering the patient to prevent her
taking cold.
Bed-rest.—A straight-backed chair answers nicely for
a bed-rest; one pillow should be carried well down in
the small of the back, another (if there are only two)
is placed above for the head and shoulders.
Bed-screen.—A clothes-horse covered with a sheet, a
blanket, or a shawl makes a very good screen; it can be
made quite attractive by tying the corners of the covering
with ribbon and pinning on it photographs or pictures
cut from illustrated papers; they will help to amuse the
patient, and should be renewed from time to time: if the
Fig. 2.—Cradle for protecting patient from pres
sure of bed-clothes.
THE SICK-ROOM. 35
case is contagious, of course the pictures should be
burnt each time they are renewed.
Pads and rings (Fig. 3) to relieve pressure are made
of cotton-batting, blanket,
compress, oakum, horse-hair,
straw, or even of a sheet,
formed into a circular pad
(having a hole in the centre),
covered with compress, and
wound around with a band-
age to keep it in place.
Fig. 3.—Heel-pad or ring: a,
end of bandage.
Fig. 4.—Bed-cushion.
A cushion (Fig. 4) for the foot of the bed to prevent
FTTTTTTTT
Fig. 5.—Nightingale wrap.
the patient slipping down, or to be placed under the
knees to relax the abdominal muscles, may be impro-
36 PRACTICAL POINTS IN NURSING.
vised by putting a clean blanket or a comforter in a
pillow-case.
During convalescence the Nightingale wrap will be
found useful. It is made of two yards of flannel of
ordinary width. A straight slit 6 inches deep is cut in
the middle of one side; the points are turned back to
form the collar. The points farthest from the collar are
turned back to form cuffs. Buttons and button-holes
are added, as shown in the illustration (Fig. 5). The
wrap can be ornamented if desired.
Care of the Sick-room.—It should be remembered
that the sick-room is the home of the patient during the
time she is in it; hence great pains should be taken by the
nurse to keep the room clean, the air pure and fresh, and
herself bright, cheerful, quiet, and gentle, so that when the
illness of the patient is a thing of the past, she will look
back to the pleasant room, the systematic way in which
everything was done, the kindness of the physician and
nurse. Sweeping must be done slowly, the broom being
kept near the floor, lest the dust be thrown around and
back; the sweepings must be gathered up and burned.
A damp cloth should be used to dust with; if a feather-
duster or a dry cloth be used, the dust is thrown around
the room and settles again. If there is a fire in the room,
the coal should be wrapped in paper or placed in paper
bags before carrying it to the room; it can then be
dropped on the fire without noise.
Hygiene of the Sick-room. — Temperature.—The
temperature of the room must be kept as even as pos-
sible ; for lung troubles it should be kept about jo° F.,
but in fevers it should be lower, about 65 ° F. A point to
be remembered is that the temperature decreases at night,
and that between the hours of 12 and 4 a. m. the vital
THE SICK-ROOM.
37
powers are at their lowest ebb; the sick patient must
be carefully watched and hot drinks be given, and extra
blankets and heaters be applied if necessary. The tem-
perature must be regulated by opening or closing the
registers, and applying extra clothing, not by closing
the windows, thus shutting off the fresh air. Dry air,
which is irritating, can be made moist by keeping a kettle
of boiling water in the room, or by dropping very hot
bricks into a pail of water, or, if there is a fire or register
in the room, blankets or sheets wrung out of water may
be hung up to dry.
Air.—The air of the room must be kept pure, whole-
some, and cool. To keep a room cool in hot weather is
not always an easy matter, but good results have been
obtained by keeping the windows and blinds closed dur-
ing the day, thus shutting out the hot air and sun, and
opening them in the evening when the air has become
cooler, because, if the hot air be let into the room during
the day, it remains, and the room is hot for the patient
at night; whereas, if the windows and blinds be kept
closed during the day and opened in the evening, when
the air is cooler, the patient will be able to sleep. An-
other way, and one which also gives to the room a very
cool appearance, is to place near the window the branch
of a tree in a tub containing large pieces of ice.
Ventilation.—Ventilation is pure fresh air displacing
impure air, and it is the duty of the nurse to see that
the patient is kept supplied with fresh air. In almost
every case the window can be kept open I y^ inches at
the top without injury to the patient; hot air rises and
displaces the cold air, which becomes warmed as it de-
scends. If there is a fireplace in the room, a small fire
may be made, which will direct the impure air up the chim-
38 PRACTICAL POINTS IN NURSING.
ney; a lighted lamp or candle will also direct an upward
current. A board from 4 to 6 inches wide may be placed
under the lower window-sash, and the fresh air will enter
between the sashes (Fig. 6), thus preventing a draught.
Opening the window widely top and bottom, and cover-
ing the patient, who, if afraid of the air, may hold an open
umbrella before her or
may have a screen placed
before the bed, will air the
room thoroughly; airing
should be done for a
few minutes every morn-
ing and evening. Many
patients will object to the
window being open at
night, but the night air
is purer than that of the
day. It is said that the
air in Manchester, that
great manufacturing dis-
trict—" the workshop of
England," as it is called—
is purest after 10 p. m., as
then there is no smoke
from the immense factory chimneys, and other conditions
which tend to make the air impure are lacking. There
should always be removed immediately from the room
movements, urine, vomited matter, soiled linen, or dress-
ings, as all these make the air of the room impure. The
patient should have all the sun possible.
Fig. 6.—Window ventilation.
THE PATIENT.
39
III. THE PATIENT.
I. NURSING IN MEDICAL CASES.
In reporting to the doctor the nurse must remember
two things—namely, that he wants facts, not opinions,
and that he is dependent upon her for a faithful and ac-
curate account of the patient's condition since his last
visit; he must be told things just as they are, nothing
added to or taken from the facts. Many things which
the nurse may think too simple to report may, to the
doctor, be very important, and may considerably help
him in making his diagnosis. The temperature, pulse,
and respirations must be taken and be recorded on the
chart.
i. General Observations in Medical Cases.
The Pulse.—The pulse, temperature, and respiration,
which are called the " three vital signs," are so closely
connected that whatever affects one generally affects the
others. Every time the heart contracts blood is thrown
into the arteries (see p. 287), which are distended on re-
ceiving the blood ; it is this distention, this rising up of
the wall of the artery at regular intervals, which corre-
sponds with the beatings of the heart, that is called "the
pulse."
By taking the pulse we know the number of times
the heart beats per minute, its fulness, and its regular-
ity. Position and action alter its rate; for instance, it is
generally faster when standing than when sitting, and
faster when sitting than when lying; it is slower in sleep
and faster when dying; it is slower in old age than in mid-
40 PRACTICAL POINTS IN NURSING.
die life, slower in men than in women, faster in children than
in adults, faster, again, during excitement or exercise.
Frequency and Varieties of Pulse.—We notice the fre-
quency of the pulse—that is, how fast or how slow it is;
when we say a pulse is frequent, we mean that it beats
about from 105 to no times per minute; a rapid pulse
is from 120 to 140; and a running pulse is above that.
A pulse is regular when the beats come at regular in-
tervals and are of the same strength ; a. full pulse is when
the beat is strong and long. In an irregular pulse the
intervals between the beats are unequal, or some beats
are feebler than the others. A pulse is intermittent when
a beat is dropped out every few beats, the pulse being
generally otherwise regular; this pulse may occur in
health or may be due to some heart trouble or to ex-
haustion. A pulse is compressible when it is easily
stopped, and incompressible when it is very hard to
stop; of high tension when the artery seems to be full
of blood between the beats, and the force of the beat is
increased and is incompressible; in a low-tension pulse
the beat is easily compressed. The dicrotic pulse is one
in which there seems to be two beats, the second beat
being smaller than the first. There really is only one
beat, the first one which is counted; the second must
not be counted, as it is called " the dicrotic wave," or a
secondary wave in the blood-current, not another beat
of the heart. This fact is very important for the nurse
to remember; the large beat is to be counted, and not
the small wave which comes directly after it. If there
be any difficulty in making the distinction, place one
hand over the heart, the other at the temple or the wrist,
and the difference will at once be noticed.
Taking the Pulse.—The. way to take the pulse is to
THE PATIENT.
41
place two or three fingers on the artery at the wrist or
the temple, and count by tenths of one minute, then mul-
tiply. The thumb must not be placed on the artery, be-
cause there is an artery in the thumb, and the nurse
would thus be taking her own pulse.
The pulse in the fetus is about . . from 130 to 160 per minute.
In the infant at birth...... " 120 to 150
At I month............120
At 1 year...........from 120 to 130
At 2 years........... " 90 to 115
At 3 "........... " 80 to 110
At 7 " ........... " 72 to 90
At 12 " ........... " 70 to 76
This latter rate is the average normal pulse.
At puberty the pulse is from 80 to 85, because at this
time the nervous system is more or less excitable; in the
prime of life, from 70 to 75 per minute; in old age, from
60 to 65. In very old age it rises until it is almost as
high as that of an infant. The normal pulse of some
persons is rather high, while that of others is as low as
from 60 to 40.
Body-temperature.—The normal temperature of the
body is from 98.5° to 98.60 F., though it may, like the
pulse, be slightly higher or lower, and be the normal
temperature for that person. The temperature is higher
after meals, on account of the activity of digestion; it
is increased by exercise or by emotion ; in children
or in hysterical patients it is accelerated by excitement.
Alcoholic drinks will lower the temperature, as will
also profuse perspiration. It is lowest between 12 and
4 A. m., and highest between 5 and 8 p. m., because dur-
ing the night we are resting, and the temperature natu-
rally lowers, while during the day food, exercise, and
42 PRACTICAL POINTS IN NURSING.
excitement all tend to increase it. A temperature
above 1080 or below 95° F. is generally fatal. The
temperature of
Algid collapse is below 95° F.
Collapse is from 95° to 970 F.
Subnormal, " 970 to 980 F.
Normal, " 98.40 to 98.60 F.
Subfebrile, " 99.5 ° to 101° F.
Moderate fever is from 10.10 to 10.30 F.
High fever, " 1030 to 105° F.
Hyperpyrexia, " 1060 F. and above.
Hyperpyrexia generally indicates approaching death,
when the temperature has been known to rise as high
as 1 io° F. In a case of tetanus recently seen the ther-
mometer just before death registered a temperature of
1090 F., one hour after death in0 F., and two hours
after death 1120 F. In sunstroke the temperature may
be 1120 F. or above. Hysterical patients have been
known to put the bulb of the thermometer in a cup of
hot milk or tea, or a hot-water bag, and to shake the.
mercury up, when the attention of the nurse has been
called to other things, thus producing an alarmingly
high temperature.
Subnormal temperatures are observed during conva-
lescence after typhoid fever and pneumonia, when the
temperature may be subnormal for a few days. It may
also result from hemorrhage from the lung, stomach, or
bowel, perforation of the bowel, and from shock.
The temperature of a child is normal after the first
week; at birth it is about 990 F. The pulse generally
rises from eight to ten beats with each degree of tem-
perature; for instance—
THE PATIENT.
A temperature of 980 F. 99° generally correspond it a
" IOO° u tt
u IOI° it «
a 102° tt a
a 103° u «
it IO40 a it
" 105° tt n
" 106° « «
43
70.
80.
90.
" 100.
" no.
" 120.
" 130-
" 140.
Taking the Body-temperature.—The temperature of the
body is taken with a clinical thermometer (Fig. 7) in the
mouth, the axilla, the groin, the vagina, or the rectum.
The temperature of the axilla is about half a degree lower
than that of the mouth. The temperature of the rectum
and vagina is about half a degree higher than that of
the mouth, because these cavities are constantly closed.
For convenience the temperature is generally taken in
Fig. 7.—Clinical thermometer.
the mouth. The thermometer is washed in cold water
and wiped dry, the mercury is shaken down to 95°, and
the bulb of the thermometer is placed under the tongue
and the lips kept closed for five minutes. The patient
must be told not to open the lips while the temperature
is being taken, or cold air will enter the mouth and
the instrument will register a temperature lower than it
should. Hot or cold drinks given immediately before
taking a temperature in the mouth will make the re-
corded temperature higher or lower than it really is.
The temperature of very weak patients, unable to
keep the mouth closed, and of unconscious and delirious
patients, should be taken in the axilla or the rectum.
44 PRACTICAL POINTS IN NURSING.
The clothing is removed from under the arm, the arm-
pit is dried from perspiration, the bulb of the thermome-
ter is placed between the folds of the skin of the armpit,
the elbow is bent, and the arm is held close to the side,
the hand touching the opposite shoulder. The ther-
mometer should remain in the axilla from seven to ten
minutes. Before taking the temperature in the rectum
the latter must be emptied if full, or the thermometer
will become imbedded in the fecal matter and will not
come in contact with the mucous membrane. The ther-
mometer is oiled and inserted for about \\ inches, and is
allowed to remain five minutes. The same length of
time is allowed for taking the temperature in the va-
gina.
Fevers are said to end by lysis or by crisis. By lysis
the temperature falls gradually, as in typhoid fever, while
crisis is a sudden fall to normal, as in pneumonia. A
sudden rise or fall must always be reported promptly, as
some complication has probably set in, though with hys-
terical patients the temperature may rise to 1030 F. or
above, and fall, without indicating anything serious. The
same is also true of children. Very little things will
often cause in a child a rise of temperature, which falls
in a short time, so that a high temperature in a child is
not so serious as that in an adult.
Respiration.—The normal number of respirations in
an adult are 16 to 18 per minute; we breatrie once to
four beats of the heart. With man the breathing is
abdominal, and with women it is thoracic. When taking
the respirations one should notice if they are regular or
irregular, frequent, quiet, deep, shallow, thoracic, or
abdominal. The respirations can be counted by watch-
ing the rise and fall of the chest after having taken the
THE PATIENT.
45
pulse, the fingers being still on the wrist. The most
accurate way is to lay the hand lightly on the chest, but
there is the danger of the patient breathing slower or
faster when he knows they are being counted. It is
always best to count the respirations when he is asleep,
as they are then slower, but natural; excitement and
exertion increase them. The respirations in
Infants are about..........from 30 to 35.
At the fifth year.........." 20 to 25.
" " eighth year . . . the same as those of an adult.
The Cheyne-Stokes respiration is a very peculiar form of
breathing. The respirations gradually increase until they
reach a certain height; then they gradually decrease until
they entirely cease for a few moments, when they begin
again in the same order. The Cheyne-Stokes respiration,
which usually occurs in certain diseases of the heart, brain,
or kidneys, is a fatal symptom.
The pulse, temperature, and respirations must accu-
rately be recorded on paper or on a chart; when there
is any doubt as to their correctness, a question-mark
should be made, so that the attention of the attending
physician will be drawn to the record. A patient must
not see her temperature chart or even be informed of
the run of her temperature, because if the fever con-
tinues the patient becomes depressed. If unusual symp-
toms have developed, it is a good plan to leave a note
downstairs for the doctor informing him.
Observation of Symptoms.—The accurate observa-
tion of symptoms in the cases which a nurse will have
under her care is of the utmost importance, so that she
may know how to give the doctor a faithful and accurate
account of everything that has happened since his last
visit.
46 PRACTICAL POINTS IN NURSING.
Position.—Notice must be taken of the position the
patient assumes when lying in bed, because he always
takes a position which gives him the most comfort. A
patient ill with peritonitis lies on the back with the knees
drawn up, to relax the muscles of the abdomen; one ill
with pleurisy or asthma will breathe much easier when
propped up. If one lung is affected, the patient will
generally be found lying on the affected side, so that the
sound lung can work better. Again, when a patient has
been very ill, and has been lying on the back continually,
it is a good sign when he turns over on the side.
Nausea and Vomiting.—Under all circumstances nau-
sea and vomiting must be reported, and the following
symptoms of the condition be noted: Is the patient con-
tinually nauseated without vomiting, or does the vomit-
ing occur soon after taking medicine or nourishment ? is
the color of the ejected matter green, as it may be in
any case where there is straining ? does it contain blood,
as in hemorrhage from the stomach ? is it fecal or dark
like coffee-grounds, such as we get in intestinal obstruc-
tion ? or are the contents of the stomach rejected with-
out any distress or nausea ?
Food.—A record should be kept of the exact amount
of food the patient takes: Does he like or dislike it ? is
there a craving for other food than that he is taking ? is
there any difficulty in swallowing ?
The Mouth.—The state of the mouth should be ob-
served : Is there any pain ? is the mouth hot ? are the
teeth decayed or unclean ? The condition of the gums
should also be examined: are they a normal red or very
pale, swollen, bleeding, or rather blue ?
The Tongue.—The condition of the tongue should be
noted : Is it coated ? if so, is the color light, the coat gray,
THE PATIENT.
47
dry, and brown, as seen in typhoid fever, or is the tongue
red like beef, or of the so-called " strawberry-tongue"
type, which is rather peculiar, having a white fur through
which project bright red dots or points ? This form is
seen in scarlet fever. Another condition of the tongue
to be noticed is the trembling which accompanies typhoid
and other fevers.
Pain.—In reporting pain,.which is a condition that can
neither be heard nor seen, the nurse can tell the doctor
only what the patient says respecting the location of the
pain and its character—throbbing, steady, or a shooting
pain, and so on.
Facial Expression.—The expression of the face must
carefully be watched: Is it anxious and pinched ? does
the patient seem to take an interest in what is going on ?
or is he dull and listless ? Are there hot flushes of the
face, paleness, blueness (commonly called "cyanosis,"
which is caused by insufficient oxygen in the blood)?
or does the color come more in one cheek than in the
other ?
Cough and Expectoration.—The nature of the cough
and expectoration must be determined: Is the cough
hard and dry, without expectoration, or moist, loose,
or hacking? does it tire the patient to cough? and does
he cough more when lying upon his back than upon his
side ? and upon which side ? or does the attack come on
in paroxysms or fits of coughing ? The expectoration
may be frothy and watery, rusty, and adhere to the vessel;
it may be the color of prune-juice, as is seen in gangrene
of the lung, and have an offensive odor; it may also re-
semble pus; it may be streaked with blood, or be thick
and yellow. The expectoration should always be saved
for the doctor's inspection and its character and quantity
48 PRACTICAL POINTS IN NURSING.
noted. Line a sputum-cup (Fig. 64) with paper, which
can be taken out and burned and the cup boiled. This
should be done at least three times a day, especially in
infectious diseases, such as pneumonia and consumption,
where the germ leaves the body through the expec-
toration.
The Breath.—The character of the breath should be
observed: Is its odor sweetish like chloroform ? or has
it a fetid odor caused by decayed teeth, dyspepsia, con-
stipation, etc. ?
Sleep must be noted: Is it quiet and restful ? or does
the patient sleep all night and awake very tired, entirely
unrefreshed ? at what time did she fall asleep, and how
long did she sleep? was it in the first or the latter part of
the night ? or would she fall asleep and awake at intervals,
and remain awake for a few minutes, an hour, or a few
hours, then drop off to sleep again? was she restless
when asleep? Notice whether the patient is hard to
waken; is there twitching of the muscles during sleep,
muttering, or any sign of delirium ?
The character of the breathing-. Was it quiet, deep,
shallow, rapid, regular, irregular, or snoring (stertorous),
with flapping out of both cheeks, or of one cheek more
than the other ? This condition must always be reported
promptly, as it generally denotes unconsciousness.
Delirium.—Note the kind of delirium : is it quiet and
busy; muttering; picking at the bed-clothes or at
imaginary objects; or violent; if so, when is it most
violent ? Patients are very often quiet during the physi-
cian's visit; indeed, they seem to know the instant he
enters the house. They are, as a rule, very cunning,
and must not be left alone for a single moment, no mat-
ter how mild the delirium, as they may get out of bed
THE PATIENT.
49
and harm themselves, or may even jump out of the win-
dow. Terrible accidents have happened through delir-
ious patients being left alone; hence the nurse should
always remain near a delirious patient until some one
can relieve her.
Chills.—In reporting a chill there should be given the
time it occurred, how long it lasted, and the temperature,
pulse, and respirations. As very many diseases and com-
plications begin with a chill, it is very necessary that
a chill should be reported at once. It may vary from a
mere chilly feeling to a violent shivering or chattering of
teeth; even the bed may be shaken. A chill may be
divided into three stages: first, the cold, shivering
stage; second, the hot stage, during which, if the tem-
perature be taken, one will find it elevated, often in se-
vere cases from 1040 to 1060 F. The second stage passes
into the third, the stage of perspiration. For the first
stage the nurse should apply heaters well covered,
extra blankets, and give hot drinks of any kind—hot
milk, tea, coffee, or cocoa; for the second she should
gradually remove the heaters and extra covering; and
for the third the patient should be wiped dry under
the bedclothes with warm towels. If the perspiration
is very profuse, the clothing may be changed, but the
nurse must be sure that it is thoroughly aired and
warmed before changing, thus guarding against another
chill.
The Skin, etc.—The color of the skin must be noted,
its pallor, blueness, or yellowness; any discoloration,
hardness, or edema, which is a watery swelling caused
by a collection of serum in the cellular tissue, and
which pits on pressure; note if the skin is hot and
dry, or if there are hot flushes of the head and face, suc-
4
50 PRACTICAL POINTS IN NURSING.
ceeded by creeping chills down the spine alone or over
the whole body; also, the condition of the nails: are they
discolored, blue, dry, and brittle? Is there any dis-
charge from the nose, the ears, or the eyes ?
The Bowels.—The condition of the bowels must care-
fully be watched, noting if there is constipation or
diarrhea; also the color of the movements. Black
movements follow the use of certain medicines, such
as bismuth, iron, charcoal, and tannin. When hemor-
rhage has taken place and the blood has been retained
in the bowels, as will sometimes occur in typhoid fever,
the movements are then of a black or tarry color, but
when the hemorrhage has occurred and the blood passes
immediately from the bowels, the color is very little if
any changed, and the movements are of a red color. It
should be noticed if the feces contain mucus or pus,
undigested food, or even pills which may pass through
the bowels without being dissolved. The patient may
have diarrhea accompanied by the so-called " packed "
feces—that is, the bowels are packed with small, round,
hard lumps like marbles; the movements are then fre-
quent and watery or contain these small lumps, and still
the bowels may not be emptied. This condition must
be reported, and whether the movements are attended
with pain. Pain, tenderness, and distention of the abdo-
men, also flatulence, must be reported. The passage of
gas by the rectum after an abdominal operation is a very
good sign.
The Bladder: Urine.—The condition of the bladder
must be recorded : is the normal amount of urine passed,
or is the amount decreased or increased ? is there reten-
tion, suppression, or a constant dribbling of urine (incon-
tinence) ? is there a constant desire to urinate, and is the
THE PATIENT.
51
urine passed with difficulty or pain ? Anything abnor-
mal in the color, odor, etc. of the contents of either
bowels or bladder must always lead the nurse to save
a specimen for inspection.
A specimen of the morning urine should always be
saved for examination, because the secretion has not
generally been influenced by food or medicine, and a
better knowledge is obtained as to its specific gravity
and the amount of solids excreted. The urine must be
drawn with a glass catheter into a clean bottle or a
tumbler, and be labelled with the name, date, quantity,
and hour that it was drawn. The bottle must be cov-
ered tightly and placed in a cool place, because warmth
increases the acidity of the urine, the color becomes
high, and the normal cloud settles to the bottom. In
hot weather the reaction may change to alkaline and
the color become pale.
The general points to be noted about the urine are the
amount passed during the twenty-four hours; its odor,
color, and appearance; whether perfectly clear or cloudy;
the time the urine was passed, its reaction and specific
gravity. It must be noticed whether there is retention
or suppression of urine: is the urine passed with pain or
in very small quantities ? does it contain blood or pus ?
To record the twenty-four hours' amount, the excretion
should be taken from 6 a. m. to 6 p. m. and from 6 p. m.
to 6 a. m., and both amounts be added together. When
the bladder is very full, it must not be emptied at once,
but one part must be drawn off, and the other later on,
as sudden emptying of the bladder would bring the walls
together, and inflammation or cystitis might set in.
Hiccough and the periods of its occurrence must be
reported. It is a spasmodic contraction or movement
52 PRACTICAL POINTS IN NURSING.
of the diaphragm, and may come on after eating or drink-
ing, on account of nervousness, or when there is great
exhaustion following acute diseases. Sometimes hot
drinks, or holding the breath for a few seconds or as
long as possible, will relieve hiccough.
Menstruation.—Report menstruation, the amount and
regularity: does pain come before, with, or after the flow
begins? and does it last a few hours, one or two days,
or does it last all through the period ? Also report the
locality and character of the pain; the character of the
flow, whether it is of a normal color and odor, or scanty,
dark, or pale, and, if clots come away with it, their number
and size. If there is any leucorrhea, the character and
quantity should be noted : is it profuse, thick, and stringy,
or does it resemble the white of an egg ? Leucorrhea is
not a disease, but is generally a symptom of inflamma-
tion of the vagina or the lining membrane of the uterus.
2. Bodily Care of the Patient.
Changing the Clothing.—To change the nightdress
and undershirt, they are loosened at the neck and wrists,
and brought well up under the shoulders on one side of
the patient; the arm is taken out of the soiled garments,
and the corresponding clean sleeves are put on, and both
sets of garments slipped over the head; this slips the
soiled shirts off and the clean shirts on. The nurse
now goes to the other side of the bed, removes the
soiled clothing, and puts on the sleeves of the clean
clothing, raising the patient slightly and pulling the
clothing down smoothly at the back. It is generally
well to have the body-linen open all the way down
the front, and to button or tie it with tapes. Where
one side is injured or paralyzed, the clothes should be
THE PATIENT.
53
taken off at the sound side first, and be put on at the
injured side first; this will save the patient a good deal
of unnecessary pain. Should one or both arms be frac-
tured, the sleeves can be opened from wrist to neck and
tapes be stitched on either side from 4 to 6 inches
apart; the arm is then raised, the sleeve placed under,
and the tapes tied.
Toilet of the Patient.— The Hair.—The hair must be
combed every day, and be braided in two braids: if it is
done up in a tight knot at the back of the head, the
patient has a hard lump to lie on. If the hair is much
matted through neglect, it must be gently combed, a little
at one time, not jerked. The nurse will find it easier to
comb upward. She must not tire herself and the patient
by trying to comb it all at one time, but must do one part
and leave the other until later in the day. If vermin are
in the hair, tincture of larkspur, which is about the best
exterminator to use, or carbolic acid (1 :40), or kerosene
oil, should be rubbed into the hair, and the head be
wrapped in a towel or cloth for two or three days.
When the hair is dry, the nits can be destroyed by
very thoroughly rubbing it with alcohol.
The Mouth.—The patient's mouth should be attended
to each day punctually. The mouth, to be kept perfectly
clean, should be washed at least three times a day, and
the teeth carefully brushed. Nothing is more refreshing
in illness than a clean mouth and well-brushed teeth. If
the patient has no tooth-brush, a piece of cotton wrapped
around the end of a toothpick or a matchstick will serve
to clean the teeth with.
The nails must be cleaned and trimmed if necessary.
The hands and face should be bathed and the teeth
brushed just before settling down for the night.
54 PRACTICAL POINTS IN NURSING.
The Body.—The nurse should be careful to keep the
bed- and body-linen perfectly dry and free from wrinkles,
and the bed free from crumbs, and should guard against
bed-sores, which are generally the result of careless
nursing in allowing continued pressure upon the promi-
nent parts of the body, except in cases such as those
of fractured spine resulting in paralysis, and where the
nerve-supply is injured, when bed-sores will form under
the best of care. It must not be forgotten that a bed-
sore is a disgrace to a nurse, except, of course, in these
exceptional cases, and every good nurse will do all in her
power to prevent it. She must not wait for redness to
appear before beginning to bathe the back. Alcohol in
any form, cologne, vinegar, or lemon-juice, may be used
to harden the skin; and there may be used to powder
the back oxid of zinc, powdered laundry starch, corn-
starch, baby-powder, bismuth, or borax. In the absence
of alcohol and powder the sheets should be kept perfectly
dry and free from crumbs and wrinkles, the parts be kept
clean, and pressure be removed by pads and rings made
of oakum, muslin, sheet-wadding or compress, and wound
round with a bandage (Fig. 3). The patient's position
should frequently be changed. If there is much moisture,
the back may be rubbed with any kind of oil, sweet oil,
mutton-tallow, lard, or even melted candle, any one of
which will prevent the moisture from being absorbed.
There are some patients so very thin and emaciated that
bed-sores form notwithstanding all the care that can be
taken. Should one form, the pressure must be removed
with a ring, the part painted with the white of an egg,
which will be the next best application to collodion and
will exclude the air, or be dressed with oxid-of-zinc-
ointment. If the nurse is at a distance from an apothe-
THE PATIENT.
55
cary store, and has oxid-of-zinc powder and pure lard,
four parts of the lard should be mixed with one part of
powder; the regular ointment is prepared with benzoated
lard, but the nurse may use common lard in an emergency.
Baths.—Foot-bath.—It is only the work of a few min-
utes to give a foot-bath: everything should be made
ready, the upper bed-clothes then loosened at the foot
of the bed, and across the lower part is spread a rubber,
newspapers, or a soiled sheet, on which the foot-tub or a
large basin is placed. The patient puts her feet in the
tub, and the nurse draws the upper clothing around the
limbs to protect them from cold. After the bath the
nurse should see that the feet are properly dried; if they
are cold, a well-covered hot-water bottle may be put to
them.
Sponge-bath.—To give a sponge-bath to a patient in
bed, the nurse first gets everything ready, and sees that
the fresh clothing is thoroughly aired; the patient is then
wrapped in a blanket, the clothing removed, and one
part bathed at a time. She begins with the patient's
face and neck, then the chest, abdomen, and arms, then
the back, bathing the lower extremities last of all. The
water should be changed at least three times, and the
patient have the full benefit of the water as far as possi-
ble ; the arms, the legs, and the feet placed in the basin
and bathed thoroughly. Care must be taken not to
expose more than one part at a time.
It will be found that some of the patients in private
practice will take a sponge-bath every day, while others
will take one only once a week. The nurse must go
according to the inclinations of the patient, unless, of
course, the physician should otherwise order.
Tub-bath.—When a tub-bath is ordered, and there is
56 PRACTICAL POINTS IN NURSING.
no bath-tub, a wash-tub will answer, the patient being
seated in it and pailsful of water poured over the body.
The Bed-pan.—When inserting a bed-pan the patient
should be requested to raise herself a little; the nurse then
puts her hand under the patient's back and inserts the
pan : if this method is followed, the pan will rub against
the back of her hand, thus preventing the patient's back
becoming irritated and a bed-sore forming. The nurse
should raise the patient when removing the pan; it must
not be dragged out: if the patient is very heavy, some
one may be asked to assist in lifting her on and off the
pan, which must first be warmed, to prevent chilling the
patient, either by holding the pan over a register or by
pouring over it warm water.
Feeding of the Patient.—Serving the Meal.—At
meal-times the nurse should have the napkin and tray-
cloth spotless, and the china, glassware, and silver of
the best that the house affords ; hot food should be
served hot, not lukewarm, and cold food and cold drinks
cold. It is better to serve too little than too much, and
there should be a variety. Plenty of time should be
allowed for the meal; the patient must not be hurried,
so that the food can be thoroughly masticated and mixed
with the digestive juices. The liquid must not be spilled,
nor must a tumbler or cup be held at the rim where
the patient is going to drink, but it should be held at the
bottom. The tray must be removed when the meal is
over, and if the patient has left anything to eat later,
it should be put away, and on no account be left in the
room. It is perhaps needless to add that the nurse's
hands must be washed before preparing the food, also
the hands of the patient before each meal.
Feeding Feeble Patients.—The principal thing to ob-
THE PATIENT
57
serve in feeding a feeble patient is to feed often and a
little at a time. One will be astonished at the end of the
day to find how much nourishment a patient has taken
by giving it in small quantities eveiy ten or fifteen minutes,
gradually increasing the amount of the food and length-
ening the intervals between the meals. Milk (which must
be fresh and pure, and to which can be added the white of
an egg), gruel, beef-tea, oyster-broth, raw oysters (which
are very nourishing and easily digested), and eggnog, may
all be given (see Dietary, p. 315); as the patient gains
strength the food may be gradually changed to soft solids.
When feeding an unconscious patient pass the spoon far
back into the mouth, empty it slowly, and then close the
lips and nostrils; the patient will involuntarily swallow.
Milk and brandy dropped on the tongue will be absorbed.
When feeding an unconscious patient by rectum the
enema should be given as high up into the intestine as
possible, so that the fluid will be injected into the colon
rather than into the rectum, because, according to some
authorities, absorption goes on very slowly from the
rectum, but very rapidly from the colon itself. Both
the colon and rectum must be free from feces before
the enema is injected.
When supplying a patient with ice to suck, a piece of
flannel or of cotton should be laid over the top of a
tumbler, and a dent made in the centre in which to put the
small pieces of ice; then as the ice melts the water drops
into the tumbler, and the ice keeps much longer than it
would if allowed to stand in the water.
Moving of the Patient.—The nurse should never
attempt to lift a helpless patient alone: she should ask
some one to help, nurse and assistant standing at the same
side of the bed. The nurse places one arm under the
58 PRACTICAL POINTS IN NURSING.
neck of the patient; this brings the head resting on her
arm, her hand being passed under the arm on the other
side; the other hand and arm are'passed under the
middle of the back. The assistant passes one arm under
the lower part of the back and the other under the knees,
and both lift the patient toward the head of the bed. If
a limb is injured, a second assistant will be needed to
support the limb above and below the seat of injury.
A patient can be moved from one side of the bed to
the other by the nurse placing one hand and arm down
the patient's back, thus supporting the head and shoul-
ders, and by passing her other hand over and slipping it
under the upper part of the back; the upper part of the
body can then be moved to the fresh side of the bed.
The nurse's hands are then placed, one under the lower
part of the back and the other under the knees, and the
lower part of the body is lifted over. Or the under sheet
can be secured to the mattress with safety-pins, the draw-
sheet loosened, and the patient on the draw-sheet be
drawn to the fresh side of the bed; the draw-sheet being
then replaced. The best way is to have two beds of equal
height, one for day and one for night, each having its own
set of bedding; when changing the patient the beds are
placed side by side, the nurse taking the sheet at the
head, an assistant at the foot; the patient in this way is
lifted to the fresh bed without jarring. If the patient is
very heavy, an assistant will be needed at each corner, or
if there are broken limbs, other assistants will be needed
to support the limbs. If alone, the nurse should loosen the
under sheet, gather in her hands the side nearest to her
top and bottom, and draw the patient to the fresh bed.
When two beds cannot be obtained, a sofa or a lounge
may be used for the daytime. If the patient is in a large
THE PATIENT.
59
double bed, one half of it should be kept for the day, the
other half for the night.
It needs two persons to carry a patient, and this is
done by each grasping the forearms of her companion
at the patient's back and under the knees, thus forming a
chair, the patient resting an arm on the shoulder of
each; but a much better way is to improvise a
stretcher by rolling two long broom-handles or poles
tightly in each side of the under sheet; in this way, with
an assistant at the head and foot, the patient may be car-
ried steadily to any part of the room or the house. The
nurse must first make sure that the under sheet is good
and stout, or she may have an accident by the sheet
tearing and the patient falling.
To carry a baby, one arm is passed downward under
the shoulders, with the head resting on the upper
part of the arm; the other arm is passed under the
knees, the lower part of the back resting on the hand.
A child should never be carried with one arm around
the neck, the other under the knees, thus allowing the
body to sink between the arms and the head to hang
down over the arm. One will readily see that by carry-
ing a child in this way the blood is apt to leave the brain
and go to the abdomen. The head must always be
supported.
3. Relief of Functional Disturbances.
Enemata.—An enema is a liquid preparation for in-
jection into the rectum, and is given to relieve constipa-
tion or to check diarrhea; to give nourishment, stimu-
lants, or medicines when they cannot be retained by the
stomach; to relieve the bowels of flatulence; and for
other purposes. For all large enemata a Davidson or
60 PRACTICAL POINTS IN NURSING.
a fountain syringe should be used, and a hard-rubber
syringe for small enemata. After being used the syringe
must be cleansed by running hot soapsuds, and after-
ward hot water, through it, the outside wiped dry, and
the instrument hung up to drain. If a hard-rubber
syringe leaks and is not tight enough, filling it with
water and leaving it full will cause the washer to swell
and fit tightly; it always shrinks when not in use, and
for this reason it is always well to soak rubber syringes
every other day or so, that they may always be ready
for use.
Evacuant Enema.—A simple enema, to relieve the
bowels, is of soapsuds, made with castile or brown soap;
the amount of warm water varies from one to three
pints. A sheet or rubber sheet should be placed under
the patient, who should lie upon the left side with the
knees drawn up, or upon the back. Both ends of the
syringe should be put in the water, and the air expelled;
the tube is oiled, and also the first finger of the nurse's
left hand, which is passed under the clothes to the rec-
tum, the finger acting as a guide. With the right hand
the tube is inserted, as gently as possible, upward and
slightly backward, following the natural curve of the
rectum; the tube is held in place with the left hand
and the injection slowly made with the right. If there
is any difficulty in inserting the tube, it should be re-
moved. No force is to be used; the resistance may be
caused by the rectum being packed with fecal matter
(which can be removed with the fingers), or obstructed
by hemorrhoids (piles) or other obstacles.
Should the enema give pain to the patient, the nurse
should rest a few moments until the pain has passed
away; then the injection can generally be continued
THE PATIENT.
61
until all the fluid has been given. The tube is gently
removed, and to the anus is placed a folded towel,
which will apply pressure and help the patient to retain
the enema a few minutes. The result must always be
accurately reported. If there is no result from one
enema, it is safe to repeat it in half an hour.
High Enema.—A high enema is an injection of fluid
high up in the bowels in cases of obstinate constipation.
There are needed a rectal tube and a soft-rubber catheter,
or a piece of rubber tubing which is connected with the
tube of the syringe and inserted up the rectum about 8
inches. If there is no rectal tube or rubber tubing, and
the nurse has a fountain syringe, the hard-rubber or
metal tip can be taken off, and the soft tubing will
answer. If the syringe is a Davidson, the patient's head
is lowered, the hips raised by placing a pillow under them,
and the foot of the bed is also raised as high as possi-
ble on chairs. This position of the patient will send the
flow higher up in the bowel, as will also the knee-chest
position (Fig. 34; seep. 140). When the tubing is used
there is always the possibility of its coiling up inside the
rectum. Should the nurse suspect this, she should insert
a finger, and if a coil is found, the tubing should be
drawn out a little, then inserted again.
Purgative Enemata.—An enema of olive oil or castor
oil is to soften the feces. Six ounces of oil are warmed
and injected as high as possible, this injection being
followed in half an hour with an enema of 1 quart of
soapsuds.
For a glycerin enema from \ an ounce to 2 ounces of
glycerin are mixed with the same amount of warm soap-
suds. In many poor families the nurse may not find
olive oil, castor oil, nor glycerin, in which case either
62 PRACTICAL POINTS IN NURSING.
vaselin, butter, or lard melted and strained before inject-
ing may be used.
If a turpentine enema is ordered, I ounce of turpen-
tine added to 3 ounces of warm water, is given first,
followed with an enema of 1 pint of soapsuds.
Rochelle salt and Epsom salt (sulphate of magnesia) are
each given as a purgative enema, 1 ounce of the salt and
1 ounce of turpentine being mixed with 1 pint of warm
soapsuds.
Molasses is an excellent purgative: from 2 to 10
ounces are mixed with 1 pint of soapsuds, or the mo-
lasses heated will readily pass through the syringe, the
molasses enema being followed in half an hour with a
soapsuds enema.
Enemata that have been used with success are—
1. Glycerin, 4 ounces,
Turpentine, 1 ounce,
Warm soapsuds, 8 ounces.
2. Molasses, 2 ounces,
Glycerin, 4 ounces,
Magnesia sulphate, 1 ounce,
Turpentine, 1 ounce,
Warm soapsuds, 8 ounces.
3. Rochelle salt, 2 ounces,
Turpentine, 1 ounce,
Warm soapsuds, 1 pint.
Astringent Enema.—A starch-and-laudanum enema is
to check diarrhea. The starch is prepared as for laundry
use, except that it should be thin enough to pass through
the syringe; then the quantity to be used is measured,
which is usually l\ or 3 ounces, and there is added 30
drops of laudanum, this being the usual quantity or-
THE PATIENT.
63
dered. The enema is to stand until lukewarm before
being injected.
Bland Enemata.—Barley, flaxseed, oatmeal, and Indian-
meal enemata are very soothing to an irritated membrane.
They are each made thin enough to pass easily through
the syringe, and must be strained before being injected.
Stimulating Enemata.—A salt enema is given for a
stimulating effect: 1^ teaspoonsful of common salt are
dissolved in 1 quart of hot water. Other stimulating
enemata are black coffee, half a pint (to be strained be-
fore injected); plain hot water; or whisky or brandy, 1
ounce added to 2 ounces of hot water. If there is no
brandy or whisky at hand, but there is pure alcohol,
only one-half this amount should be given, because the
spirits are only half as strong as pure alcohol, but of the
same strength as diluted alcohol, the wines, port and
sherry, being still weaker; so where the nurse is di-
rected to give 4 teaspoonsful (half an ounce) of brandy
or whisky, she should give the same amount of diluted
alcohol, or 2 teaspoonsful of pure alcohol, or 1 ounce of
the wines.
If the pulse becomes nearer normal, the temperature
lower, the patient quieter, and an improvement takes
place, the nurse will know that the stimulants are doing
good ; but if the face becomes flushed, the pulse full and
bounding, and the restlessness increased, she will know
that they are not doing good, and must be stopped and
the physician be notified.
A stimulating nutritive enema generally consists of—
■ Milk, 4 ounces,
Whisky, ^ ounce,
Tincture digitalis, 10 or 15 minims,
the enema being injected high up in the bowel.
64 PRACTICAL POINTS IN NURSING.
Rectal Feeding.—Nutritive enemata must be injected
as high up into the intestine as possible, because the colon
absorbs more quickly than the rectum, and if the enema
is not given high it is very apt to remain in the lower
bowel, and is incompletely absorbed when the second
one is given; as a result the second and part of the first
are rejected.
A nutritive enema consists of—
Milk, 4 ounces,
Whisky, \ ounce,
White of egg.
Or, Milk, 4 ounces,
and one egg.
Beef-tea, beef-juice, liquid foods, extracts of beef,
cream, and oyster-broth are given per rectum. Stimu-
lants are very irritating to the mucous membrane, and
for this reason they should not be put into every enema,
but only into every other one. The nurse should report
whether the enema is or is not retained, also as to the
presence of food in the movements.
A nutritive enema must not be given oftener than once
in every three or four hours, and must not exceed from
4 to 6 ounces each time, unless differently ordered by the
physician. A cleansing enema of warm water must be
given first, to clean the bowel and to prevent irritation
of the mucous membrane.
If the patient is very weak and does not retain the
enema very well, it is a good plan to plug the bowel
with soft linen or gauze, the end inserted having first
been oiled. This measure will prevent the enema from
being returned.
THE PATIENT.
65
Douches.—A douche is a stream of water directed
against a part for cleanliness, for stimulation, and to re-
lieve inflammation or hemorrhage. Three of the com-
monest douches are the aural, the vaginal, and the rectal.
Vaginal Douche.—The vaginal douche is generally for
cleansing purposes and to relieve inflammation. The
Fig. 8.—Apparatus for vaginal douche.
surgical antiseptic douche is for cleansing purposes,
from 1 to 3 quarts of warm water being used. The
gynecological hot douche is to relieve inflammation.
The amount of water used is from 5 to 6 quarts, begin-
ning with a temperature of 1100 F., and gradually in-
creasing it each day until it reaches 1190 F. The tem-
perature must always be tested with a bath-thermometer.
The Baker douche apparatus (Fig. 8) is the best to
use, as the pail and pan each hold five quarts of water,
and the patient can lie in the proper position for the
fifteen minutes required for the water to run out of the
pail.
5
66 PRACTICAL POINTS IN NURSING.
When taking a douche the patient should lie on her
back, with the hips raised by means of a pillow and the
knees drawn up. In this position the water comes in
contact with the whole vagina, for it is for the womb and
ovaries that a douche is given, and if taken sitting over
a vessel the water runs down by the side of the tube as
fast as it runs in, the water reaching only as high as the
nozzle.
The fountain syringe, when used, must be hung high
enough over the bed for it to take fifteen or twenty min-
utes for the water to run out of the syringe. Air must
be expelled, the tube oiled, and the water must run warm
before the tube is inserted into the vagina.
The vagina being a curved and not a straight canal,
the tube must be inserted slightly downward, then up-
ward. Again, the injection does not flow into the womb,
as many think : if one will study a vaginal tube with the
three small holes pierced in its sides, it will be seen that
the injection is not intended to enter the womb, but is for
the surrounding parts; if a few drops of water should
accidentally enter the uterus, there would follow a severe
attack of uterine colic. A hard-rubber tube is the best,
as glass or metal will burn the parts, though a glass
nozzle can be rendered aseptic more thoroughly than
one of any other material.
All have noticed how red and swollen the hands be-
come on putting them into hot water, caused by the
blood-vessels dilating and bringing more blood to the
parts; then after a while the vessels contract and the
blood is driven away, and the hands have a wrinkled
appearance, commonly called "washerwoman's hands."
A vaginal douche given to relieve inflammation has ex-
actly the same effect. The hot water dilates the blood-
THE PATIENT.
67
vessels and brings more blood to the parts; then, on
continuation of the hot water, the vessels contract, the
blood is driven away from the parts, and the inflamma-
tion is subdued. The nurse will therefore see why she
must be faithful in keeping up the douches as ordered,
giving them at the proper time and temperature and
length of time. A patient should lie quietly for half an
hour after taking a douche; if she is taking only one a
day, it is best to give it at night, because then the womb
is most congested and needs the hot water most, and
the temporary weak feeling which follows a douche will
be gone before morning. However, the nurse should go
according to the orders given by the physician.
Many patients object to taking douches, and will
neglect them on account of the inconvenience, especially
if they live in apartments and there are children in the
family; but this can be overcome by taking them in the
bath-tub. Halfway across the bottom of the tub there
is made to fit a piece of board, on which the patient can
lie. Douches are easily taken in this way, which obvi-
ates a great deal of annoyance.
Antiseptic Douches.—Corrosive sublimate, carbolic acid,
creolin, and boric acid are used for antiseptic douches.
Corrosive sublimate and carbolic acid are very poisonous.
Creolin is irritating, and to prevent absorption and irrita-
tion a plain water douche is often ordered to follow any
of these antiseptics when a strong solution has been
used.
Rectal Douche.—Rectal douches are for cleanliness
and to relieve inflammation. Hot rectal injections to
relieve inflammation are given with a fountain syringe
and a rectal tube. The patient lies on her back with the
knees drawn up, and a small pillow is placed under the
68 PRACTICAL POINTS IN NURSING.
hips to direct the flow upward. The physician will give
directions as to the amount of water to be used, its tem-
perature, etc.
Douches to the external genitals, to the perineum, or
to the anus for the relief of inflammation or hemorrhoids
may be given with the patient in the sitting position and
with an ordinary rectal tube. The force of the stream
and the temperature of the water are decided by the
physician.
Catheterization.—Before catheterizing a patient great
care must be taken in cleansing the hands, the catheter,
and the parts, as there is danger of infecting the bladder,
and thus causing septic poisoning by passing a dirty
catheter or in neglecting to wash the hands and parts.
Germs are in this way introduced into the bladder, and
produce septic poisoning. The catheter should be of
glass or of silver, and be boiled five minutes before being
used; then be put in a solution of carbolic acid (i : 20).
If a gum-elastic or a rubber catheter is to be used, it
should be soaked in 1 : 1000 corrosive sublimate for half
an hour, then put it into very hot water until needed.
Glass catheters are the best; they are easily rendered
aseptic, and show whether they are or are not perfectly
clean. Besides the catheter, which is taken to the bed-
side in a basin of very hot water, there are needed a basin
of corrosive-sublimate solution (1 : 1000), sterilized gauze
or cotton, a vessel to receive the urine, and a lubricant of
sterilized oil to render the entrance of the catheter as easy
as possible. Gynecologists prefer that no lubricant should
be used, and when one is necessary it should be a mixture
of carbolic-acid solution (1 :40) and glycerin.
The Operation.—The patient lies on her back with the
knees drawn up and separated, the upper clothing being
THE PATIENT.
69
divided over each knee to guard against unnecessary
exposure. The labia are separated with the thumb and
fore finger of one hand, and the parts washed with the
corrosive solution. The catheter is inserted into the
urethra, the opening just above the vagina (PI. 8). If
there is any difficulty, the catheter should be withdrawn
a little, and gently pointed a little downward or upward,
to the right or to the left. If the flow should cease
before enough urine has been drawn, the catheter is
withdrawn a little or is inserted a little farther than be-
fore. Before removing the catheter a finger should be
placed over its end to prevent any drops of urine wetting
the bed. After the operation the parts are again washed,
and the catheter boiled and placed in a bottle containing
a solution of carbolic acid (1 : 20), unless the catheter is
of rubber; carbolic acid ruins rubber.
A bladder very full of urine must be emptied grad-
ually. Cystitis is due to many causes, one being the
introduction of germs into the bladder by means of a
dirty catheter, and the nurse who passes the catheter is
always blamed.
Washing out the Bladder.—To wash out the blad-
der there are needed a fountain syringe, which must
have boiling water and a disinfectant run through to
cleanse it, and a glass catheter, which is cleansed in the
same way as for catheterizing; the parts are also bathed.
The patient is first catheterized; the catheter is then
rinsed with boiling water and attached to the rubber
tubing of the syringe which contains the ordered solu-
tion, its temperature being about 1000 F. The solution
must run warm before the catheter is inserted. A pint
of the solution is allowed to run gently into the bladder;
then the tubing is disconnected from the catheter and the
70 PRACTICAL POINTS IN NURSING.
fluid is drawn off If a double catheter is used, the tub-
ing is not removed. This operation is repeated until the
fluid returns clear.
Washing out the Stomach.—A fountain syringe is
also used in the absence of a stomach-pump to wash out
the stomach. The hard-rubber nozzle is removed, the
syringe is cleansed and filled with lukewarm water, the
tubing is oiled and passed far back in the mouth, and
the patient is told to swallow. The syringe is raised
and the fluid poured into the stomach; when the latter is
filled there will be retching; the bag is then detached, and
the tubing placed over a basin or pail, and the contents of
the stomach removed. This washing is continued until
the fluid returns clear, after which the tube must be
removed quickly to avoid retching. Liquid food is gen-
erally given directly afterward. Should there not be a
fountain syringe at hand, a piece of rubber tubing and a
small funnel may be used, or the patient may drink large
quantities of lukewarm water until the water is returned
clear (lavage).
4. Administration of Medicines.
The five ways of introducing medicine into the system
are by the stomach, the rectum, the cellular tissue (sub-
cutaneously), the skin (inunction), and the lungs (inhala-
tions).
Rapidity of Absorption of Medicines.—The rapidity
of absorption depends upon the parts to which the med-
icine is applied, the state of the circulation, the solubility
of the medicine, and the power it has of passing rapidly
through a living membrane. Absorption takes place
more rapidly when the medicine is given subcutaneously,
it taking only about five minutes for the drug to act|
THE PATIENT.
71
because it enters directly into the circulation; it is more
slowly absorbed by the vessels of the mucous mem-
brane of the stomach, and slower still by the intestines.
Absorption through the lungs is rapid on account of
their large blood-supply.
It takes about twenty minutes for a drug to act when
given by the stomach, and about three-quarters of an
hour when given by the rectum. It is absorbed more
quickly if given on an empty stomach and if given
in solution, because it then comes in contact with all
parts of the mucous membrane of the stomach, and is
not impeded by the presence of food. Pills and powders
are absorbed more slowly; they require to be first dis-
solved. There are some medicines—for instance, iron
and arsenic—which must be given after meals, so as to
be diluted with the food, to avoid irritating the stomach.
Action of Medicines.—Sometimes a drug produces
symptoms or affects the patient in a way entirely differ-
ent from the ordinary: this is called an " idiosyncrasy,"
which means an individual peculiarity in regard to the
action of certain drugs. Some drugs have what is called
a "cumulative" action; that is, the excretion of the
drug is so very slow that one dose is not excreted
from the body when the next one is given; the drug
thus accumulates in the body, and after a while symp-
toms of poisoning may develop through cumulative
action.
When patients have been taking a drug for some time
the system becomes accustomed to it, so that after a
while it takes a larger quantity to produce the desired
result. This may continue until the habit of taking the
drug is formed, when the patient not only craves it but
thinks he cannot do without it.
72 PRACTICAL POINTS IN NURSING.
Some medicines act as tonics, some as stimulants
and sedatives—heart and nerve stimulants, heart and
nerve sedatives ; others as narcotics, hypnotics, astrin-
gents, etc.
Tonics.—A tonic is a medicine which increases the
strength and vigor, and gives tone to the whole body.
There are many kinds of tonics, all of which act upon
and improve the tone of the organs upon which they
have a special effect.
Stimulants are to prevent some depressing effect, as in
shock, collapse, or in typhoid fever, when the heart's
action is depressed. To do good, they should strengthen
and slow the pulse and respirations, lower the tempera-
ture, moisten the tongue, cool the skin, lessen delirium,
and induce sleep. An opposite effect would show that
the stimulants were doing harm instead of good, and
that they must be stopped and reported.
Sedatives lessen the force and frequency of the heart's
action; they have a soothing influence on the system,
and lessen pain to a certain extent.
Cerebral stimulants are drugs that increase the activity
of the brain. They are also called exhilarants. Cerebral
sedatives lower the activity of the brain. Vascular stim-
ulants are substances that cause dilatation of the periph-
eral vessels, and thus render the flow of blood through
them more rapid. Vascular sedatives contract the vessels,
lessening the flow of blood through them.
Narcotics are at first excitants, and afterward produce
profound sleep characterized by stupor.
Precautions to be Observed in Handling and Ad-
ministering Medicines.—Medicines must be kept out of
the reach of patients, especially children and delirious
THE PATIENT.
71
patients; what is left of the medicine when it is discon-
tinued must always be disposed of. The nurse should look
at the label three times before giving the medicine—before
measuring it, afterward, and when putting the bottle on
its shelf; this rule must not be departed from, we hear
of so many sad mistakes being made. She should also
be sure that the one who is to have charge of her patient
while she is absent fully understands how to give the
medicine.
Medicine-glasses (Fig. io) and medicine-spoons (Fig.
12) must be thoroughly washed after
being used, the nurse having sepa-
rate ones for strong-smelling medi-
cines and for oils. When ordered
before meals, medicines should be
given half an hour before, and those
to be given after meals should be
given about half an hour after, unless
Fig. 9.—Medicine-dropper
Fig. 11.—Double-scale minim- ■
glass (natural size).
otherwise ordered. An unconscious patient must have
the medicine dropped far back on the tongue, and it will
74 PRACTICAL POINTS IN NURSING.
be absorbed, if not swallowed. Powders must not be
given an unconscious patient by the mouth, as with a
patient in this condition they may cause suffocation.
Fig. 12.—Medicine-spoons.
1. Medicines by the Mouth.—The nurse should
always give minim doses when minims are ordered, and
drops if drops are ordered, because of the tinctures
two drops are equal to one minim, but of fluid extracts
the minims and drops are equal.
Drops may be given upon a piece of lump sugar or in
a little water.
Powders may be given dry upon the tongue and be
swallowed by drinking water, or may be dissolved in
Fig. 13.—Wafers or cachets: a, small wafer closed; b, large wafer closed; c, showing
two sections of the wafer (&); d, cross-section of a wafer filled.
water or hot milk. Powders that are unpleasant to take,
such as quinin, are now enclosed in wafers (Fig. 13) or
THE PATIENT.
75
in gelatin capsules (Fig. 14). The wafers, which are
made of rice paper, may be obtained from most chemists,
Fig. 14.—Empty hard capsules.
and are from 1^ to if inches in diameter. One is moist-
ened, and the powder is laid in its centre, another wafer is
laid over the powder, and the two secured together by firm
pressure. The wafer is then laid on the patient's tongue,
and swallowed by drinking water. Or a spoon containing
the wafer may be filled with water and the mass swallowed.
Pills should be placed at the back of the tongue and
be swallowed with water. For children, who find it
very hard to swallow a pill, the pill may be finely
crushed and given with a little preserve, molasses,
honey, or sugar. Powders may also be administered in
this form.
Acids, which injure the teeth, should be taken through
a glass tube and the mouth thoroughly rinsed afterward.
Oils may be taken in coffee, hot beef-tea, milk, ale, or
brandy, or in lemon- or orange-juice. Oily medicines
are sometimes given in gelatin capsules.
Purgatives must be given early in the day, so that the
patient will not be disturbed at night, but laxatives should
be given late in the evening; a result is then had the
next morning.
Many medicines of unpleasant flavor are given in
wafers and capsules.
Should a patient vomit directly after, or in five or ten
76 PRACTICAL POINTS IN NURSING.
minutes after, taking a medicine by the mouth, or if the
medicine is returned when given by rectum, tt is safe to
repeat the dose in from fifteen to twenty minutes.
2. Medicines Administered per Rectum.—Medi-
cines given by the rectum are in the form of supposi-
tories or of enemata, which latter should be given high
up in the bowel (see p. 59).
Suppositories.—Suppositories are drugs incorporated
Fig. 15.— Different forms of suppositories : a. vaginal suppository; b-e rectal sup-
positories ; /, urethral suppository (Thornton).
with cacao-butter and then made up into conical shapes
(Fig. 15) for their convenient introduction into the rec-
tum, the vagina, or the urethra. The finger is first oiled;
then the suppository is inserted, and pushed well up in
the rectum until it cannot be felt by the finger, a cloth
being applied and pressed against the part. The patient
is in the same position as that for giving an enema.
3. Hypodermatic Injection.—A hypodermatic or
THE PATIENT.
77
subcutaneous injection means the injecting of a medicine
under the skin for a more rapid and certain effect than
we would get if given by stomach or the rectum. The
most convenient places for the injection are the outside
Fig. 16.—Hypodermic syringe.
of the arms, the forearms, the thighs, the chest, and the
abdomen, the injection being made into the fleshy part,
avoiding the large blood-vessels, nerves, and bone. The
syringe (Fig. 16) is cleansed by drawing through it sev-
eral times a i : 20 solution of carbolic acid, followed by
very hot water. The needle is boiled in a large spoonful
Fig. 17.—Method of giving a hypodermatic injection.
of water over a gas-flame. The syringe is loaded with
the ordered solution, the needle is screwed on tightly,
making sure that it does not leak at the junction, and
the air is expelled.
After cleansing the part a fold of skin is pinched up
between the thumb and finger (Fig. 17), the needle
quickly and slantingly inserted, then withdrawn slightly,
and the fluid is slowly injected. A gentle friction over the
78 PRACTICAL POINTS IN NURSING.
part will distribute the fluid and aid the absorption. The
needle is quickly removed, and the friction is kept up for
a few moments. If a large quantity, half a drachm or
more, is to be injected, it is better to inject deep in the
muscle, to avoid irritation.
The syringe must afterward be thoroughly washed, by
drawing through it the carbolic-acid solution and hot
water, and the thin wire kept constantly in the needle to
keep it clear. If not often used, the syringe should be
soaked every few days in hot water to prevent the pack-
ing from shrinking. Abscesses following hypodermatic
injections are generally caused by the syringe and needle
not being thoroughly clean and the solution not fresh or
pure. If the syringe is in constant use, it should be kept
in a solution (i : 20) of carbolic acid. Hypodermic syr-
inges hold from 20 to 30 minims.
Intravenous injection, which is the injection of solutions
into a vein, is only practised in cases of emergency, as,
for instance, the injection of blood or of salt-solution
when there has been an excessive hemorrhage.
4. Inunctions.—Inunction is the rubbing of an oil
or an ointment into the skin for medicinal purposes, as
in the application of mercury.
Mercurial Inunction.—When applying mercurial oint-
ment, it must be rubbed on some part where the skin is
thin,- such as the inner sides of the thighs; absorption
will then take place much quicker. The order of appli-
cation differs somewhat. One way is for the patient to
take a full bath the first evening, and put on fresh under-
clothing. The second evening a piece of ointment, about
the size of a small nut, is with the hand rubbed in on the
inner side of the right thigh. The third evening the left
thigh is taken, then on successive evenings the left arm-
THE PATIENT.
79
pit and the right are taken. In this way one part is taken
each evening, and irritation on account of excessive fric-
tion on the same part is avoided. The rubbing should
take about fifteen minutes, the ointment being thor-
oughly rubbed in. The application is to be omitted on
the sixth evening, and on the seventh the patient takes
a warm bath, changes the underclothing, and resumes
treatment. Dr. W. H. Devine in his lectures on medi-
cines gives the following order:
First evening, the buttocks ;
Second " the thighs ;
Third " the side of the chest, but not the armpit;
Fourth " the internal surface of the arms and
forearms;
Fifth " the back and abdomen;
Sixth " omit treatment;
Seventh" bathe, change underclothing, and re-
sume treatment.
This method of applying mercury to the skin is
resorted to when the stomach will not bear any mer-
curial, and also to obtain the general action of mercury.
The mercury passes through the skin without producing
any irritation, and is absorbed into the general circula-
tion, where the general effects of the drug are produced.
The symptoms of mercurial poisoning are an increased
amount of saliva, a fetid breath, swollen and spongy
gums, with a bluish line along their margins, and a
metallic taste in the mouth; any one of these symptoms
must promptly be reported.
Children are not easily salivated, but when the breath
becomes fetid the mercury must be stopped at once.
When applied to children, it is a good plan to put the
80 PRACTICAL POINTS IN NURSING.
ointment on a piece of flannel and fasten the flannel
to the part with a bandage. There is then no danger
of the child getting the ointment over other parts of the
body. Fresh ointment is put on the flannel every day,
even if the latter does look soiled. The nurse should
wash her hands thoroughly after each application, or
absorption may take place through the skin of the hands.
5. Inhalations.—Inhalation is the administration of a
drug in the form of a vapor, whose action is on the air-
passages.
Moist Inhalation.—In the absence of a steam-inhaler
the vaporized substances may be inhaled from a tea- or a
coffee-pot standing over an oil or a spirit lamp by the
bedside, the spout being directed toward the patient; or
the solution may be put into a pitcher or a tin pan, cov-
ered with paper, which is perforated, and through which
the patient can inhale the vapor. The patient must breathe
quite naturally, taking in the vapor through the mouth,
then closing the mouth, and letting it escape through the
nose, breathing five or six times in succession before
withdrawing the face for a few moments; then the pa-
tient begins again, and continues in the same way for
the length of time ordered. If the patient is not in
bed, he should inhale the vapor before going to bed; if
done in the daytime, he should not go out for about an
hour after. The inhalation of moist air may be obtained
by means of kettles of boiling water in the room or by
placing small pieces of unslaked lime in pans of water.
Dry inhalations may be taken from a heated shovel or
a plate. The drug is placed on the shovel, and a paper
cone is made; one end of the cone is put over the drug,
which is lighted, the vapors being inhaled from the nar-
row end of the cone and taken into the lungs.
THE PATIENT
8l
5. General and Local External Applications.
Baths.—Temperature. — The temperature of baths
varies, and the water must be tested with a bath-ther-
mometer (Fig. 18).
A hot bath varies from 98 ° to 1 io° F.
A warm " " 85 ° to 980 "
A tepid " " 700 to 85° "
A bath must never be given earlier than two hours
after eating, for the reason that after eating the digestive
organs, as a rule, are congested, owing to the increased
activity with which they are obliged to do their
work in the process of digestion.
Action of Baths.—A hot bath stimulates
the nervous system through its action on
the cutaneous nerves, which are connected,
in a manner too varied and difficult for us to
trace out, with the main nerves of the heart
and with the respiratory and digestive sys-
tems. The nerves being already in a state of
increased activity, a bath would lead to over-
stimulation and might lead to shock, fainting,
vomiting, etc. In simpler words, food increases
the circulation, and a bath stimulates and ex-
cites the nervous system, hence one might get
a shock through over-stimulation if a bath
was given directly after a meal. A patient
should never be left alone while in the bath-
tub, as faintness may come on, the patient
may lose consciousness, slip under the water,
and be drowned.
Vapor-baths also act as stimulants to the nervous sys-
tem and induce perspiration. A warm bath acts as a seda-
Fig. 18.—Bath-
thermometer.
82 PRACTICAL POINTS IN NURSING.
tive ; it relieves inflammation, stupor, and delirium. The
vessels of the surface of the body are dilated, but not so
much as by the hot and vapor-baths; the blood is drawn
from the brain, its activity is lessened, and the patient
falls asleep. The warm and the hot sitz-bath, also the hot
foot-bath, increase the circulation in the pelvic organs.
They relieve retarded menstruation by dilating the ar-
teries, so that the supply of blood is increased in the
pelvic organs. Mustard, being a powerful stimulant,
increases the effect of the hot bath. The amount used
is \\ teaspoonsful to i gallon of water.
Tepid and cold baths reduce inflammation and fever,
and act as tonics and sedatives. The first effect of a
cold bath is chilliness, through contraction of the blood-
vessels ; but later they relax, and the warm blood comes
to the surface, and if the patient be rubbed, the circulation
will be increased. To reduce the temperature the patient
must have the full benefit of the bath. If in bed, each
part must be bathed separately; each limb must be put
into the water and well bathed by pouring the water
over it, using a sponge or a wash-cloth; the other parts
of the body must be well bathed with a very wet cloth,
then mopped with towels, and allowed to dry. As
above stated, cold water contracts the small blood-ves-
sels ; therefore, in sea-bathing or cold baths we apply
cold water to the head to prevent a rush of blood to the
brain, because, as the lower limbs are the first to be
placed in the cold water, the blood-vessels of the legs
are the first to contract, sending the blood upward.
It will be found that cold and tepid bathing will relieve
thirst. When one is thirsty, it is a sign that the system
is in need of water, though one feels the thirst only in
the mouth and throat; but if the body is bathed, the
THE PATIENT.
83
skin will absorb the water, and the system will get
enough water to satisfy its demands. Water when in-
jected will also relieve thirst. After an abdominal ope-
ration, when nothing is given by the mouth for several
hours, the bathing of the hands and face greatly relieves
the extreme thirst. Hunger, which is felt in the stomach,
may also be relieved otherwise than by the mouth. If
nourishment be given by rectum, it will be absorbed by
the intestines, and the hunger be alleviated to the same
extent as though nourishment had been taken by mouth.
Cold tub-baths are much used in the treatment of fevers.
The tub is half filled with water at a temperature of 68°
F. The patient, wrapped in a sheet, is gently lifted and
gradually lowered into the water. While in the bath
friction is applied to the limbs and the body, but not
over the abdomen. Cold is applied to the head, which
is kept raised. After the bath the patient is lifted out,
laid in bed on a large rubber sheet covered with a dry
sheet, and mopped dry. Should the patient complain of
persistent coldness, heat may be applied. The pulse and
temperature must be taken before and after the bath. The
duration of the bath is from ten to twenty minutes.
Hot Baths.—Hot baths and vapor-baths are given to
produce perspiration. When the kidneys are not work-
ing properly and the waste material is not carried away
from the body, hot baths and vapor-baths dilate the super-
ficial blood-vessels (those near the surface of the body),
causing the patient to perspire profusely and a large
amount of the waste material to be thus thrown off. If
a tub-bath is ordered, the tub may partly be filled with
warm water, the patient be lifted in, and then the tem-
perature gradually increased by adding very hot water.
At the end of fifteen minutes the patient is taken out,
84 PRACTICAL POINTS IN NURSING.
put to bed, and wrapped in blankets, which are tucked
in very securely about the neck and body so that no air
can enter. Cold cloths are applied to the head, and
water is given to drink, because when there is a large
quantity of water in the body the perspiration becomes
much more profuse, and consequently the impurities
thrown off are larger in amount. After the bath is com-
pleted the blankets are removed and the patient is
sponged with warm water or with alcohol and water.
Hot Foot-baths.—When giving hot foot-baths the nurse
must remember to keep the temperature of the water
even by adding hot water. The bed-clothes at the foot
of the bed are loosened, newspapers or a rubber cloth
is spread across to prevent the bed from getting wet,
the patient's knees are drawn up, the feet are placed in
the tub, and the clothing is drawn around the limbs to
prevent chilling. When taken out the feet are to be
wiped dry, and care be taken that they are comfortably
warm by either wrapping them in a blanket or applying
heaters.
Hot-air Bath.—To give a hot-air bath, a rubber cloth
or an oilcloth and blanket are put on the bed (the pa-
tient being turned on one side, as is done in changing
the bed); the patient's clothing is removed, and he is
then wrapped snugly in the blanket, the upper cloth-
ing being supported by means of a cradle. The
clothing should be well tucked in about the patient's
neck and the sides of the bed, under the mattress, to pre-
vent the escape of air, and another oilcloth put over all
will make the covering much more air-tight. Under the
clothing, at the foot of the bed, is inserted the spout of
a kettle of boiling water, which can stand over a gas-
or an oil-stove or a spirit-lamp placed on a chair or a
THE PATIENT.
85
table, the whole being covered with a blanket to direct
the steam under the blankets (Fig. 19). If the bed has
Fig. 19.—Simple arrangement for giving a hot-air bath.
a high footboard, the steam can be directed from one
side of the foot of the bed. The nurse should guard
against fire. The doctor will give orders as to the
length of time the patient is to remain in the bath. He
may order a thermometer to be placed in the bed, and
the steam continued until the thermometer registers 1200
F. or above, when the steam is stopped and the patient is
treated as after the hot bath. As the water in the kettle
boils down it must be replaced with boiling water, not
with hot or cold water, or the steam will stop until the
water boils again. Careful watch must be kept over the
patient's pulse, which can be taken at the temples.
In the absence of an oil-stove or a spirit-lamp, very
hot bricks, smoothing-irons, or plates may be wrapped
in wet flannel or cloths; the hot bricks in contact with
the wet cloths will make steam. The cloths must be
placed about the patient on plates or in dishes to prevent
wetting the bed, and care be taken not to burn the patient.
86 PRACTICAL POINTS IN NURSING.
If able to sit up, the patient can be seated on a cane-bottom
chair, the clothing being removed, and surrounded with
blankets or comfortables, which must be fastened from the
neck down (Fig. 20). A kettle
of boiling water over a spirit-
lamp or an oil-stove, or a pan
or pail of boiling water, is
placed under the chair. The-
feet may be put into a pail of
hot water to increase the effect,
because the blood-vessels of
the surface of the body are
dilated, and remain so while the
heat or vapor is continued; in
this way the activity of the skin
fig. 2o.-Arrangement of blankets is increased, the pores of the skin
in giving a hot-air bath to patient in are opened, and perspiration is
sitting position. (Thornton).
produced. Ine nurse should be
sure that the blankets or coverings are fastened closely
around the patient's neck and about the chair to prevent
the steam escaping. Cold is applied to the head, and
water is given to drink, for the same reason as that given
in describing the hot baths, and the after-treatment is the
same.
Acid Steam-bath.—An acid steam-bath, which is a
valuable application in rheumatism, is given by prepar-
ing the patient in the usual manner, and placing around
her very hot bricks wrapped in flannel which has been
steeped in vinegar. The bath is continued for fifteen
minutes, after which the body is wiped over with a towel
wrung out of cold water, then thoroughly dried.
Shower-bath.—A shower-bath is given by directing
the water from an ordinary watering-can, a pitcher, or a
THE PATIENT.
&7
pail elevated a few feet above the patient. To douche the
head the patient generally lies upon her stomach, her
head hanging over the side of the bed, or the bath may
be given her lying in bed. The patient lies on her side
or back ; the pillows are removed, the clothing loosened
and pushed well down under the shoulders to prevent
wetting; a pad is made with rubber cloth, oilcloth,
or newspapers, by rolling the cloth at each side and
at one end; the pad is put under the shoulders of the
patient, her head resting on it, and the unrolled end
hangs in a pail. The pad will prevent the water from
running down the patient's back and the sides of the
pad, and will also keep the bed dry. The water is poured
upon the patient's head from
a pitcher elevated a little dis-
tance above. After the
douche the patient's head
and shoulders are raised
and wiped, the pad is slipped
down into the pail, and the
clothing and pillows are re-
placed.
Sheet-bath {Drip-sheet).—
The sheet-bath, or drip-sheet,
which is frequently applied in
nervous diseases, is generally
given in the following way:
The patient, with clothing
removed, stands in a tub
which contains enough warm
water to cover the feet to the
ankles to prevent chilling (Fig. 21). A sheet wrung out of
tepid water is thrown over the patient from behind, and
21.—Application of the sheet-
bath (drip-sheet).
88 PRACTICAL POINTS IN NURSING.
covers the head and entire body. The patient is then
gently rubbed (over the sheet) with both hands to pro-
duce friction and bring the blood to the surface. As the
sheet becomes warm it can be re-wet by pouring water
on it from a cup or a bowl. The doctor will always give
directions as to the length of time the patient should be
in the sheet. After being dried some physicians like the
patient to be put to bed for a certain length of time, while
others will leave orders for the patient to dress and go
out for a short walk or to sit by an open window.
Cold Douche.—The cold douche, or affusion, is given
by wrapping the patient in a sheet, placing him in the
bath-tub, and pouring pailsful of water over the body.
The first pailful should be tepid, and be poured rather
slowly, to prevent shock. Exhaustion must be watched
for, and after the affusion the patient should be put to
bed and wrapped in blankets. Another way, one often
employed in nervous diseases, is to stand the patient in
the bath-tub, and direct the water to the spine or to the
part to be treated by a piece of hose-pipe attached to the
faucet.
Cold Pack.—The cold pack is ordered for reducing
the temperature in many acute diseases. A rubber, an
oilcloth, or a newspaper is first put on the bed, and
over this one or two blankets; then a sheet or a table-
cloth which has been dipped in tepid water and wrung
out is placed on the blankets. The patient is laid upon
the sheet (the patient's clothing having first been re-
moved), and every surface of the body is covered by
pressing the folds of the sheet down between the arms,
body, and lower extremities. The sheet is tucked well
in at the neck and feet; the blankets are then folded over
and tucked evenly under the patient on both sides. The
THE PATIENT.
89
feet are lifted up and the corner ends of the sheets and
blankets are tucked under them (Figs. 22 and 23). A
wet towel or compress is applied to the head. The
patient should be kept in the pack ten or fifteen min-
utes. It will be found that, besides lowering the tem-
perature, the cold pack will relieve nervousness and
induce sound sleep.
Hot Pack.—The hot pack is given in the same way as
the cold pack, with the exception that the blanket, the
sheets, or tablecloth is wrung out of boiling water by
placing the blanket in a sheet, and pouring the boiling
water over them ; two persons, each taking an end of the
sheet, wring in opposite directions. More coverings are
placed over the patient than in the cold pack. Should
Fig. 22.—Application of the cold pack (pressing the sheet between the patient's arm
and body).
the nurse not have anything with which to prevent the
mattress from getting wet, a table may be arranged with
blanket and sheets ; in the absence of a table the floor
near the bed may be prepared. Towels, tablecloths,
90 PRACTICAL POINTS IN NURSING.
and old linen may be used where there are but few
sheets. After the pack the sheets and blankets are
removed, the patient is wiped dry with soft towels, the
clothing is put on, heat is applied if necessary, and the
Fig. 23.—Application of the cold pack (patient completely covered, with wet towel on
the head).
pulse and temperature are taken. Partial packs are
compresses applied to different parts of the body, and
covered with a flannel or a cotton bandage to prevent
the patient's clothing becoming damp.
Inflammation.—Blood is made up of three parts: a
watery, almost colorless fluid, called "plasma," and
red and white corpuscles, which give to the blood its
rich red color; there are more red corpuscles in the
blood than white. The plasma contains a substance
called " fibrin," which is an albuminoid, and which is the
nourishing part of the blood. Blood in its normal con-
dition is perfectly fluid, but when drawn from the body
into a basin the fibrin causes the blood to coagulate or
clot; the corpuscles, which are heavier than the plasma,
sink to the bottom of the basin and are bound together
by the fibrin, the whole forming a red semi-solid mass,
covered with a clear yellowish liquid called " serum."
THE PATIENT.
9'I
The clot is the corpuscles, together with the fibrin, which
has now left the plasma, and the serum is the plasma
without the fibrin. It is thus seen that when the blood
is fluid there are two parts—the plasma and corpuscles ;
when it is clotted or coagulated there are two parts—
the serum and clot, the clot being made up of the cor-
puscles and fibrin, the serum consisting of the plasma
without the fibrin.
Symptoms of Inflammation.—The four symptoms
of inflammation are heat, redness, swelling, and pain—
heat, due to the abnormal conditions of the blood in the
inflamed area; redness, due to increased hematin in the
blood of the part; swelling, due to increased blood-
supply ; pain, due to pressure on the end-organs of the
sensory nerves. We can feel heat when the inflam-
mation is on the surface, as in the case of an inflamed
finger, but where the inflammation is hidden, as in the
lungs, the brain, or the bowels, or in any of the internal
organs, we ascertain it by taking the temperature with
the clinical thermometer.
Treatment of Inflammation.—If heat or cold is
applied at the beginning of inflammation, the latter may
subside; but should it continue, it may terminate in
an abscess. The poultice or fomentation which is gen-
erally ordered softens and relaxes the skin and tissues,
dilates the blood-vessels, quickens the circulation in the
part, so that the fresh, pure blood can pass through, and
the tight, painful feeling caused by the blood-pressure to
the part is relieved. Ice contracts the capillaries, and
thus lessens the amount of blood flowing to the part, and
pus-formation may be prevented. When pus has formed
poultices are again ordered to bring it up to the surface,
bringing it to a head, as it is termed.
92 PRACTICAL POINTS IN NURSING.
Bleeding.—Leeching.—Leeches are used in inflamma-
tion when it is necessary to remove a small quantity of
blood. The part must be washed very clean, shaved if
necessary, and be wiped dry; the leech is taken be-
tween the folds of a towel and applied. If it does not
bite, a drop of blood extracted from a pricked finger
will generally cause the leech immediately to bite.
Another very successful way is to put the leech in a
very small wineglass or cup filled with water, in which it
should remain for a few minutes; the edge of the wine-
glass is then held to the part we wish the leech to bite,
and it will come up out of the water and generally take
hold; should it move around, it can be guided to the right
spot. As a leech is always hot and uncomfortable after
being shut up in a box, it should be put into water (the
glass or cup having a perforated paper cover) until we
are ready to use it; being then in its natural element, it
becomes cool and good-natured.
After the leech has taken hold a piece of cotton should
be slipped between it and the skin, because the move-
ments of the leech give a very unpleasant sensation to
the patient, and tend to make some patients nervous. A
leech generally holds from i to 2 teaspoonsful of blood,
and when full it will drop off. If necessary to remove
leeches after being on a certain length of time, a little
salt sprinkled on their heads will make them drop off;
they must riot be pulled off, or they may leave their
teeth in the wound and cause inflammation. The bleed-
ing can further be encouraged by the application of hot
poultices or fomentations. To stop the bleeding pres-
sure is the best—a pad of graduated compress-cloth; or
cold may be used—a small lump of ice. The patient must
not be left for the night until the bleeding has stopped.
THE PATIENT.
93
Leeches should not be applied over an artery, a vein,
nor over loose cellular tissue where pressure cannot be
applied, but, if possible, over a bony surface. It should
also be known that the odor of tobacco, vinegar, or dis-
infectants in the room will often prevent a leech from
biting. All cavities must be filled with cotton if leeches
are to be applied near; should a leech get into one, it
can be removed with an injection of salt and water.
Leeches must always be disposed of after being used by
putting them into a very strong solution of salt and water
or into dry salt, and covering the vessel tightly. The
nurse must be sure they are dead before throwing them
away. The American leeches are best for children ; they
draw less blood. In case the patient is a child, the leech
should be well covered, so that the child will not be
frightened.
Cupping.—Cupping is to relieve pain and congestion,
and to prevent absorption. Dry cupping draws the
blood to the surface of, and wet cupping draws blood
from, the body.
For dry cupping there will be needed two or three
tumblers, or wine-glasses, or medicine-glasses ; alcohol;
a candle, a lamp, or a spirit-lamp; matches; towels.
The part is washed with warm water, the glasses rinsed
with hot water, and thoroughly dried. A few drops of
alcohol are poured into a glass and shaken around; the
edge of the glass is wet with the finger or is oiled, which
prevents the fire reaching the patient's skin; the alcohol
is then lighted with a match, and the glass turned over
on the part, which must be an even surface. All this is
done very quickly. The skin is seen to rise almost im-
mediately in the interior of the glass, and the blood is
drawn toward the surface. To remove the glass the
94 PRACTICAL POINTS IN NURSING.
skin is pressed down with the thumb or finger. The
air will then enter the glass, which can be taken off
Care must be taken to avoid getting too much alco-
hol in the glass or getting the edges of the glass too
hot.
Wet cupping is done with a scarificator. In addition
to the things needed for the dry cupping, the nurse
should prepare for the wetting operation some disinfec-
tant and a dry dressing of gauze or compress. The
part is washed with soap and water and a disinfectant;
incisions are then made with the scarificator, and a dry
cup is applied, which draws the blood. After the re-
quired amount has been drawn the cup is removed and
the dressing is applied. Sometimes poultices are ordered
to increase the effect. The nurse must have everything
prepared for the physician, and stand ready to hand what-
ever he needs.
Fomentations.—Moist heat is applied to the body in
the form of warm or hot baths, poultices, and fomenta-
tions (stupes). For a hot-water fomentation coarse flan-
nel or two or three thicknesses of old blanket is the
best. White flannel is preferable, as the dyes of colored
flannels are apt to be poisonous. The flannel is placed
in the middle of a towel, and both dipped in a basin of
boiling water for a fev. moments, the ends of the towel
being twisted in opposite directions until all the water is
wrung out; the fomentation is then carried to the bedside,
the towel untwisted, and the flannel shaken out, before
applying, to let in the air; it will then retain the heat
much longer. The fomentation is covered with dry flan-
nel or towels and a piece of rubber cloth (both flannel
and rubber being larger than the fomentation), and a
bandage is applied to keep it in position. This proce-
THE PATIENT.
95
dure will retain the heat of the fomentation longer and
also keep the patient dry. When renewing the fomenta-
tion the fresh stupe must always be ready before the
cool one is removed.
Laudanum and turpentine stupes are prepared in the
same way as the preceding: when the flannel has been
wrung out of the water, from 15 to 20 drops of laudanum
are sprinkled over it. For the turpentine stupe about
30 drops of turpentine are sprinkled over the flannel, or
to 1 pint of boiling water there are added 3 teaspoonsful
of turpentine; this solution is well mixed and the flannel
put in, stirring all the time. The flannel is then taken
out, wrung, and applied, the turpentine being then more
evenly distributed over the flannel.
Mustard fomentation consists of flannel wrung out
of veiy hot water (not boiling), about 1 pint, to which
has been added I tablespoonful of mustard. It is pref-
erable to make a paste of the mustard before adding it
to the hot water; there will thus be less danger of it
forming lumps. Mustard must not be added to boiling
water, or the action of the volatile oil which the mus-
tard contains, and to which it owes its value, will be de-
stroyed.
Fomentations to the eyes and neck are changed every
few minutes. Flannel, old cotton handkerchiefs, or
sponges may be used, all of which can be put in boiling
water and be pressed out with a lemon-squeezer, which
is very handy for these small stupes.
When stupes are discontinued the part must be dried
and covered with absorbent cotton, flannel, or a towel
for a while, and afterward be bathed with alcohol, which
will be a preventive against cold.
Poultices.—A flaxseed-mcal poultice is made by rap-
96 PRACTICAL POINTS IN NURSING.
idly stirring the meal little by little into boiling water.
When the mixture is of the consistency of mush, stiff
enough to drop away from the spoon, it is well beaten
with the spoon to remove the lumps. This flaxseed
paste is spread smoothly and evenly half an inch thick
on a piece of old cotton, cheese-cloth, mosquito-netting,
or even on paper, of the desired size, leaving a margin
to turn in of about \\ inches all around the poultice.
Another layer of muslin is put over the face of the poul-
tice-; the edges are turned well under to prevent the flax-
seed escaping. The poultice should be rolled in a towel
and carried on a plate to the patient. When applying
the poultice the nurse places her hand under it, the back
of her hand resting on the part to which the poultice is
to be applied, and slowly removes her hand; this will
get the patient used to the heat, and is far better than
suddenly putting a hot poultice on an already tender
and sensitive skin, as repeated applications make the
part very tender. This fact applies also to children:
if once a child is frightened by too hot a poultice, the
nurse will probably never be able to put on another.
The poultice should be covered with flannel and rub-
ber cloth or with newspapers, and be fastened with a
bandage; the heat will thus be retained and the patient
kept dry.
Large poultices should be changed every four hours,
or if well covered they will last five or six hours; the
smaller ones must be changed every one or two hours.
A poultice must never be removed until a fresh one is
made and ready to be applied; then the old poultice is
removed and the part wiped dry with a piece of soft cot-
ton, for the reason that the air acts as an irritant to a
moist surface and causes an itching sensation. A poul-
THE PATIENT.
97
tice once used must never be reheated: it is valueless:
hence poultices must be freshly made each time they
are needed. If, for some reason, the nurse has to wait
before applying a poultice, it can be kept hot by placing
it between two plates over a pan of boiling water; if it
is put in an oven, it will bake.
When applied for the removal of a slough, the poul-
tices must be discontinued as soon as the slough is re-
moved, as further poulticing will prevent the healing of
the part by making the skin too moist and flabby.
facket-poultices.—A jacket-poultice, which is a poultice
to encircle the whole chest, is readily made by taking
four large pieces of muslin, old linen, etc., that will reach
from the neck to the waist-line, and sloped out to fit
under the arms; the poultice is then made in the usual
way, one poultice being applied to the back and one to
the chest, and fastened together over the shoulders and
down the sides with safety-pins to keep them in posi-
tion ; then the usual coverings and bandages are applied.
The jacket-poultice must not be renewed until the fresh
poultice is ready to be applied; then the bandage is
unpinned, the patient turned on his side, the cold
poultice removed, the back wiped dry, and the fresh
poultice and coverings applied; then the patient is
turned on his back and the fresh poultice applied to the
chest and fastened with safety-pins. It is an expert act
to remove a poultice or a fomentation without awaken-
ing a sleeping patient: it can be done on almost any
part of the body excepting the back, and even here it
may be accomplished if the nurse has the confidence of
her patient, who will wake up just enough to turn over
and have the poultice renewed, and then drop off to
sleep again.
7
98 PRACTICAL POINTS IN NURSING.
A bran-jacket is made by placing bran between two
pieces of muslin, which are cut the same as for the
jacket-poultice, and stitching them all round and in dif-
ferent places after the manner of quilting, to keep the
bran in place. The bran-jacket may be applied dry after
heating it in an oven, or it may be placed in boiling
water for a few minutes, then wrung out, laid on the
part, and covered with rubber cloth or flannel and fast-
ened with a bandage. When cold it is again wrung out
of boiling water and reapplied. There should be two
jackets made.
Bread Poultice.—Bread poultices are applied to very
tender parts, and are milder than flaxseed, but they do
not retain the heat as long. The poultice is made by
stirring stale bread-crumbs into boiling water, and beat-
ing the mixture well to remove the lumps; then the
water is drained off and fresh boiling water is added,
which will remove the alum found in some bread; the
second water is drained off, the poultice being then
spread and applied.
Mustard Poultice.—A mustard poultice is made by
adding to very hot water two parts of mustard (all
the lumps being thoroughly dissolved) to four parts
of flaxseed meal, and the poultice is spread and ap-
plied in the usual way. If the mustard be sprinkled
over the flaxseed poultice, there is danger of burning
the patient in patches; we avoid this by first dissolving
the mustard in the water.
1 Charcoal Poultice.—A charcoal poultice, which is a
very dirty poultice to prepare, is generally made with
one part of charcoal and two parts of flaxseed meal,
mixed and made in the usual way, a little additional
charcoal being sprinkled over the surface of the poul-
THE PATIENT.
99
tice before applying. This poultice, which is ordered
for wounds which have an offensive discharge, acts as
a deodorant by absorbing the odor and promoting a
healthy condition. Another method of making this
poultice is to add \ an ounce of charcoal to 4 ounces
of flaxseed meal and bread-crumbs, mixing all together
and making the application in the ordinary way.
Starch Poultice.—A starch poultice is made by taking
ordinary laundry starch, mixing it with cold water, and
then adding boiling water to make it into a thick paste.
A starch poultice is used in skin diseases to relieve irri-
tation. Very often belladonna or laudanum is sprinkled
over the surface of both starch and flaxseed poultices to
act on the nerves of the part and allay the pain. The
effects of the drug must be watched for; this is very im-
portant, especially in the case of children.
Spice Poultice.—A spice poultice is made by placing
in a bag equal parts of cloves, cayenne pepper, ginger,
and cinnamon. The bag is sewed up and submerged in
hot alcohol or in vinegar for a few moments, when it is
wrung out and applied. Another way is to mix the
spices with about 1 ounce of flour and enough hot alco-
hol to make a paste, and to spread this between two
layers of muslin or linen. If the skin is tender, the
proportions of cloves and pepper should be decreased.
In the absence of the spices flannel may be wrung out
of hot whisky or pure alcohol and applied to the part.
The action of a spice poultice is that of a mild counter-
irritant.
Yeast Poultice.—To make a yeast poultice, which is
used as a stimulant to slow-healing wounds, take 3
ounces of fluid yeast and hot water, and stir in a quarter
of a pound of either flour, oatmeal, flaxseed, or Indian
IOO PRACTICAL POINTS IN NURSING.
meal. This mixture is heated, stirring it all the time
until it is hot; or it is set by the fire until it rises;
it is then spread on muslin the same as a flaxseed-
meal poultice is prepared, and is applied while fer-
menting.
Slippery-elm Poultice.—A slippery-elm poultice is made
by mixing slippery elm with very hot water; they should
be mixed slowly or the poultice will become lumpy, and
be well beaten before spreading it on the linen.
Hop Poultice.—A hop poultice may be made in the
same manner as a bread poultice, or by filling a bag
about half full with hops and wringing it out of boil-
ing water when needed.
Antiseptic Poultices.—Corrosive sublimate is used for
antiseptic poultices, the strength varying from I : 5000 to
1 : 10,000. A towel, absorbent cotton, or gauze is wrung
out of a hot solution, applied to the part, and covered
with a dry towel, oil-silk, or paper, and a bandage. Car-
bolic acid is used for poultices in strengths varying from
1 :60 to 1 : 100. Both carbolic acid and corrosive sub-
limate are very easily absorbed, and the general effects
of the drugs must be watched for. Creolin, which is
not so poisonous as the preceding, is used in strengths
of from 2 to 5 per cent. For boric-acid poultices a 4
per cent, solution is generally used.
Green-soap Poultice.—A green-soap poultice is a thin
layer of green soap spread over a pad of gauze, ab-
sorbent cotton, or a towel, and covered with a dry towel
and a bandage.
Ice Poultice.—An ice poultice is to relieve hemor-
rhage, or pain due to neuralgia or inflammation, and
is made of crushed ice, mixed with salt and sawdust,
flaxseed, bran, or oatmeal, and sewed up tightly in
THE PATIENT.
IOI
rubber cloth, a coarse towel, or in paper, so as not
to wet the patient and the bed.
It is not at all difficult to apply poultices or fomenta-
tions in a railway car: all one needs is a pint tin-cup,
flaxseed meal, a spoon, paper, and a spirit lamp. In
cases of sudden illness of an adult or a child attacked
with croup, where fomentations will give great relief,
hot water can generally be had, and handkerchiefs be
wrung out of it and applied.
Dry Heat.—Dry heat is applied with hot bottles,
bricks, plates, or smoothing-irons, well covered to pre-
vent burning the patient. Hot flannel and bags filled
with salt or bran or sand are used in aural surgery to
relieve pain in the ear: the bags are made of old mus-
lin or gauze, cut half-moon shape, and applied around
the ear, never over it, as there would be danger of the
heat causing the walls of the aural canal to swell; this
would bring the walls together, and if the Eustachian
tube were closed and there was an abscess in the mid-
dle ear, the nurse would have a sad state of affairs.
Two bags will be needed—one being in the oven or
in a farina-boiler heating, the other being on the pa-
tient. When using a hot-water bag the contained air
must be expelled before putting in the stopper; the
bag will then lie flat.
Application of Cold.—Leiter Coil.—Cold is applied
to a part to relieve pain, to relieve inflammation, to ar-
rest hemorrhage, and as a local anesthetic to freeze
the tissues and allow slight operations to be performed
painlessly; also as a stimulant, as when cold water is
dashed on the face of a fainting person. It relieves
pain by reducing the feeling of sensation, acting as an
anesthetic; it relieves inflammation by contracting the
102 PRACTICAL POINTS IN NURSING.
blood-vessels, so that the amount of blood flowing to
the inflamed part is considerably lessened and pus-
formation is prevented.
The Leiter coil (Figs. 24, 25), which is used to apply
continued cold to a part, is made
of coils of pliable metal through
which ice-water runs continually.
Coils are made to fit the head,
the ear, the abdomen, and differ-
ent parts of the body. Two long
pieces of rubber tubing are at-
tached to the coil; the end of
one tube being put in a vessel
containing ice-water; the water
Fig. 24.-Leiter coil applied to runs to the coj] an(J after cjr.
the ear.
culating through it the water
passes out of the second tube into a pail on the floor
to receive it (Fig. 25). The ice-water pail, which should
be a few feet above the patient's head, may stand on a
hassock or a small chair placed on a table, or it may
hang from the knob of one of the bedposts; the reser-
voir must not be too high or the water will run through
the coil too rapidly. If the tubing is large, the second
tube which conveys the water to the pail may be made
smaller by tying it a little tightly at different parts
along its length, thus preventing the water running out
too rapidly. The supply-pail must be kept filled with
water and ice. Should there be any difficulty in get-
ting the water to run, or should the water stop run-
ning, by putting the end of the lower tube in the mouth
and making slight suction the water will generally begin
to circulate. These coils are fastened to the part by
tapes passed through slits at each end and tied around
THE PATIENT.
103
the part. Should the patient complain of the intense
cold, a piece of compress first put between the part and
the coil will make it more bearable ; this applies also to
ice-bags.
Ice-bags.—Ice-bags must carefully be watched : if the
nurse has only one ice-bag, ice-cold compresses must be
much harm. When applying an ice-bag to the back or
to any part of the body that will lie upon the bag, two
things must be remembered : first, that there is air in the
bag, and second, that the heat of the part to which it is
applied very rapidly melts the ice in the upper portion of
the bag, the water becomes warm, and the ice lying at
104 PRACTICAL POINTS IN NURSING.
the bottom of the bag does no good. To remove the
water and air, one end of a piece of small rubber tube
is placed in the mouth of the bag, the other end in a pail
on the floor. In this way the water will be drained off as
the ice melts, and continuous cold will be applied.
To fill an ice-bag the ice is wrapped in a coarse cloth
or a towel and crushed with a hammer, or the ice may
be broken into small pieces with a strong pin or a darn-
ing needle. Fill the bag half full, and press out the air
before sealing it.
When cold is applied to the head and spine or to
the head alone, heat is generally applied to the feet
and other parts of the body to avoid any depressing
effect on the circulation.
Counter-irritants.—Counter-irritation relieves a deep-
seated inflammation by irritating the ends of the sensory
nerves and dilating the blood-vessels of the part so that
the circulation of the blood through them is increased;
the blood is brought to the surface, thus relieving the
inflamed part beneath. There are three classes of
counter-irritants. Counter-irritants of the first class
are rubefacients, which redden the skin by distending
the small blood-vessels. Friction will also do this, as
it tends to send the blood out of the small blood-vessels
through the veins ; the circulation of the part is increased
and the swelling is removed; other counter-irritants of
this class are mustard poultices and turpentine and
mustard fomentations (stupes).
Counter-irritants of the second class act more strongly:
they, too, are rubefacients, but of a stronger kind; for
example, a mustard plaster, which is stronger than a
mustard poultice. The blood-vessels are dilated, the
circulation is greatly increased, and a certain amount of
THE PATIENT.
105
the blood is brought to the surface; the blood in the
inflamed part is lessened and the pain is relieved.
A counter-irritant of the third class is vesication, or
blistering, which produces true inflammation by drawing
the blood from the inflamed part directly to the surface,
and there is an outpouring of the serum (the water of
the blood) between the cuticle and the true skin.
Counter-irritants are generally applied a little distance
from the inflamed parts, for the reason that if the vessels
of these parts are dilated more blood is brought to them.
For instance, in cases of meningitis, severe headaches,
and other affections of the head a blister is sometimes
applied to the nape of the neck: the blood-vessels here
being dilated, more blood is brought to them, and the head
is relieved. It is the same when a hot-water or a mustard
foot-bath is given to relieve headache: it causes greater
dilatation of the blood-vessels in the limbs, so that more
blood is drawn to them, thus relieving the head. If the
blister was applied directly over or too near the inflamed
part, there would be danger of the accumulation of blood,
or the " congestion," increasing and doing more harm
than good.
The reader may have had an inflamed finger, and have
noticed that when the hand was hanging down by the
side the throbbing and pain were increased ; this was due
to the blood rushing down to the hand, thus putting
more pressure upon the finger; but on raising the
hand the pain was relieved, because the pressure of blood
became less. It is for this reason that rest is ordered
for inflammation. The part is kept quiet and elevated;
the arterial blood is thus prevented from rushing to the
part, and the venous blood can better return to the
heart.
Ib6 PRACTICAL POINTS IN NURSING.
Mustard Plaster.—A mustard plaster is made of mus-
tard and flour, equal parts, or of all mustard, mixed into
a paste with warm water and spread between two layers
of muslin or soft linen rag. When mixed with flour
the action of the mustard is slower and it is not so liable
to blister. The plaster is covered and left on from ten
to twenty minutes. When it is removed a little vaselin
is rubbed over the part, which is covered with a soft
cloth. While the plaster remains on the patient a corner
should be raised from time to time, to see that it is not
blistering; especially is this necessary with unconscious
and paralyzed patients. For children four parts of flour
are mixed with one part of mustard; when the skin is
red the plaster is removed and a flaxseed-meal poultice
applied. The action is slower, but blistering is prevented.
White of egg and mustard make also a non-blistering
plaster.
Tincture of Iodin.—Tincture of iodin is a counter-
irritant ; it is painted over the part with a swab or a
camel's hair brush, a little of the tincture being poured
into a cup or a saucer. Two coatings will be sufficient.
The iodin stains the skin a dark yellowish-brown color,
and may cause a painful, smarting sensation, which can
be relieved with alcohol or ammonia, though some pa-
tients prefer olive oil. The swab or brush must never
be put into the bottle after being used on the patient.
There should be a separate brush for each patient.
Croton Oil.—Croton oil is a powerful counter-irritant;
3 or 4 drops are sprinkled on a small piece of flannel
and rubbed into the skin; this gives rise to a vesicular
eruption.
Blisters.—Cantharidism.—A blister is raised with either
cantharidal plaster (Spanish-fly), cantharidal cerate (blis-
THE PATIENT. . 16/
tering cerate), or cantharidal collodion. The part must
be washed, and shaved if necessary, and be wiped per-
fectly dry; the plaster is cut the desired size and shape
(Fig. 26) and applied. If the cerate is used, it should be
spread on a piece of cotton and be kept in place with a
bandage. If adhesive plaster is used to keep either of
these plasters in place, there will be no room for the
blister to rise, and it will cause a dragging pain. Before
applying the cantharidal collodion the parts to be blis-
tered must be outlined with vaselin or with oil, which will
prevent spreading of the blistering solution. The collo-
dion, which is painted on with a swab or a brush, causes
an itching sensation when first applied; patients must be
told of this to guard against scratching.
The action of the cantharis must be watched for. It
is a powerful irritant and affects the kidneys, and some-
times causes painful urination or suppression of urine.
108 PRACTICAL POINTS IN NURSING.
For children and very weak persons the plaster should
be kept on just long enough to start the blister, then a
poultice be applied to make the blister rise, otherwise a
slough may be formed. It generally takes from four to
eight hours for a blister to rise (collodion acts more
quickly). If at the end of that time the blister has not
risen, the application of a flaxseed poultice will hasten
this result.
Should the physician leave to the nurse the time of
applying the irritant, she should apply it during the early
part of the day, so that the blister will rise before even-
ing. If applied in the evening, the patient is kept awake
through the night with the pain caused by the rising of
the blister. When the blister has risen, the lower part
should be snipped with a pair of scissors, and the fluid
discharged on a towel or a piece of cotton to prevent
irritation of the skin, and then be dressed with vaselin.
It must be remembered that the cuticle, or skin, of the
blister must not be removed without orders; the skin is
only removed when the blister is to be kept open. In this
case it is called a "perpetual" blister, and is dressed with
some irritating ointment. If the physician wishes the
fluid to be reabsorbed, care must be taken that the
skin is not broken.
Chloroform Blistering.—A ready way to produce a
blister is to pour a few drops of chloroform or of strong
ammonia into a watch-crystal, which is then placed over
the part; the blister will rapidly rise.
A blister must not be produced over a bony part, be-
cause here the circulation is less active, and a slough
may be the result.
Massage.—Massage consists of a series of movements
which give to the muscles and the whole system strength
THE PATIENT
IO9
and vigor, and in a certain sense takes the place of active
exercise, but it is entirely different from rubbing. The
work is done by the ball of the thumb, the fingers, and
the palm of the hand. Some of the movements are
stroking with the finger-tips, followed by deep stroking ;
kneading, which is grasping a muscle or group of mus-
cles between both hands or between the thumb and fin-
ger, and pressing, rolling, and squeezing it, beginning at
the extremity of a limb and working upward. Then
there is the deeper kneading, as in treating an arm or
limb, followed by rolling or fulling, which is a to-and-
fro movement with the limb between the palms of the
hands, the limb being rolled back and forth; deep pres-
sure with the knuckles, used when a part is either hard
or flabby and we want to reach a deep-seated nerve;
twisting of the muscles, followed by vibration, which
stimulates the capillary circulation ; percussion, which is
striking or beating the surface with the palm of the hand
(clapping) or the side of the hand with the fingers held
very loosely (whipping), and with the fingers held stiffly,
which is true percussion. All this is followed with light
friction. On the abdomen the kneading is begun at the
ascending colon, then is continued on the transverse and
descending colon. The tissues are rolled, not rubbed;
a firm grasp of the muscles should be taken, and a con-
siderable amount of force be used, but not too much.
Repose of touch should be cultivated, and work be
done from the wrists, or the movements will be jerky
instead of being even. Tender parts should be gone
lightly over at first: later on more force may be used.
It will be found, if done skilfully (and skill can only
be acquired by constant practice), that massage is a
nerve sedative, relieves neuralgia and also some chronic
IIO PRACTICAL POINTS IN NURSING.
affections. In order that the student may have a perfect
knowledge of massage and its application, it is absolutely
necessary that she should first take a complete course in
anatomy, and familiarize herself with the bones, muscles,
and organs of the body, their form and location.
Liniments.—Liniments are for external use, to relieve
pain or to produce local stimulation. They must be
applied to the skin with friction until the part is en-
tirely dry. A cloth must not be used, or the effect will
not be so good.
Lotions.—A lotion is a medicinal application, and may
be evaporating or non-evaporating; it is used externally
for cooling purposes and for the relief of pain. Where
evaporating lotions, such as alcohol, vinegar, or camphor,
are used, one single thickness of cotton, saturated with
the selected lotion, is applied and left uncovered. Lotions
must be changed often, and not be allowed to become
warm or dry. Non-evaporating lotions are applied with
two or three thicknesses of compress wrung out of the
ordered solution and covered with rubber tissue or cloth,
and a bandage to keep it in position.
Gargles, Sprays, etc.—To gargle the throat the solu-
tion is taken into the mouth, the head being thrown back
and moved from side to side. The fluid in this way is
brought in contact with the back part and sides of the
throat, and is more beneficial than by causing the fluid to
bubble up in the throat. If the gargle is an acid, the
mouth must afterward be rinsed with water, so that the
teeth will not be injured. Sprays are much better than
gargles when the throat is ulcerated; a patient can seldom
gargle thoroughly. A spray will reach all the parts.
When spraying or painting the throat the nurse should
stand a little to one side, so that the patient will, not
THE PATIENT.
Ill
cough in her face. When painting, the rule is to paint
from down up, because the patient will always gag; by
beginning to paint at the bottom of the throat one can
paint upward, bringing with one sweep the brush or
cotton-stick out of the mouth. A roll of paper answers
nicely for blowing powder into the throat; the paper roll
is placed back in the throat with the powder inside, and
is blown in by the nurse or is inspired by the patient.
All instruments used in the throat must be very clean
and warm, also be free from odor, so as not to nauseate
the patient. The back part of the throat is connected
with the Eustachian tube, which is about i^ inches long,
and passes from the ear to the back of the throat, and
which in order to hear perfectly should be kept open;
but when one has a cold in the throat the mucous mem-
brane which lines the back of the throat and this little
tube is swollen, and a temporary deafness results.
Gargling the throat with veiy hot water is very bene-
ficial when the soreness is first felt, and will very often
prevent its extension. The nose also calls for special
attention; its passages must be kept open and clean.
We breathe through the nose, and by so doing the cold
air becomes warmed in passing through the nasal cavities
to the lungs, and dry air is moistened; but if we breathe
through the mouth, as when the nostrils are inflamed,
the cold air goes directly to the lungs, the mouth and
throat become dry, and the throat becomes sore. Certain
diseases of the nose call for special treatment and special
directions. When spraying the nose it should be sprayed
down on a level with the roof of the mouth, and not up
to the roof of the nose; this mistake is often made.
The patient must be instructed to close the mouth and
draw the fluid into the throat, then to cough it out; if
112 PRACTICAL POINTS IN NURSING.
this is not done, the fluid will run out the nose as the
spray is applied.
Eye-drops.—To put a drop in the eye the patient
should look up, the lower lid be drawn down, and the
drop be put in with a dropper or a quill on the centre of
the lower lid; it will then flow over the surface of the
eye to the duct next the nose. A mistake often made is
that of putting drops in the eye in the inner corner, next
the nose.
The interior of the eyelids and front of the eyeball are
covered with a mucous membrane called the "con-
junctiva," and in the orbit on the outer side of the eye-
ball is a gland called the " lachrymal gland," which
secretes the tears and keeps the eye moist. The tears
pass over the surface of the eyeball, and those not used
are carried off into the nose by a small canal called the
" lachrymal duct," which passes down from the orbit into
the nose. This secretion of tears is going on day and night,
but we do not notice it until either the conjunctiva is irri-
tated by a foreign body in the eye or by strong vapors, or
when we are affected by strong emotional feelings of sor-
row or of happiness, when the secretion of tears by the
lachrymal gland exceeds the drainage-power of the duct
and they overflow on the face. When we try not to cry
the tears pass down through the duct to the nose, and
pass out through the nose; then we get the " blowing of
the nose," commonly thus called when people try not to
cry. So we see that the gland which secretes the tears
is at the outer part of the eye, and the duct which re-
moves them from the eye is in the inner corner. It
must now be clear why a drop should be put in the cen-
tre of the lower lid, so that the solution will pass over
the surface of the eye to the duct next the nose.
THE PATIENT. 113
Ointment should also be applied in the centre of the
lower lid, either with a small spatula used for the pur-
pose, with the handle of a small teaspoon, or with any-
thing that has a smooth, flat, narrow surface.
A medicine-dropper may be used to syringe the eye,
which must be done from the inner to the outer corner.
Syringing the ear must not be done with too much
force or the drum-membrane may be ruptured. A foun-
tain syringe (Fig. 27) is the
best to use, as with it we get
a continuous flow, and injec-
tion of air into the ear is
prevented ; still, an ordinary
Davidson syringe will answer
if the nurse has not a fountain
.... . Fig. 27.—Fountain syringe.
or a hard-rubber syringe.
The necessary things for syringing the ear are a foun-
tain or a hard-rubber syringe, a bowl for the water to be
used (unless the nurse uses a fountain syringe), a bowl for
the return flow, a towel for the patient's shoulders, and
one for the assistant. The syringe is filled, the air ex-
pelled, and the tip of the ear is pulled backward and
upward to straighten the canal, which is then syringed
gently. The patient may hold the small bowl beneath
the ear, but if not able an assistant will be necessary.
Warm water is used for ordinary syringing.
For an ear-douche to relieve inflammation the tempera-
ture of the water is about 1000 F. The douche is continued
for fifteen or twenty minutes, unless the patient should
complain of dizziness, which is often due to the water
being directed to one spot or to too much force being
used. When syringing for the removal of discharge, the
nozzle of the syringe should be moved around, directing
8
114 PRACTICAL POINTS IN NURSING.
the stream against the sides of the auditory canal and
not in the central axis. This procedure is also necessary
when syringing to remove a hard collection of wax. By
syringing thus the water will pass between the sides of
the canal and the plug of wax, and, reaching the space
behind, will bring out the wax with the return current.
Many persons syringe their own ears, which operation
is easily done if one has a fountain syringe. The head
is held over a bowl; one hand is passed over the back
of the head to hold the auricle and straighten out the
canal, while the other hand directs the stream of water
into the ear.
An ear-bath, which may be of plain water or of water
to which is added a small quantity of sodium bicarbonate
is used to soften an accumulation of wax that cannot be
removed by syringing. The head is laid on the unaf-
fected side, the tip of the ear is pulled slightly backward
and upward to straighten the auditory canal, and the
ordered solution is poured into, and remains in, the ear
about fifteen minutes, when the mass will be softened
sufficiently to be removed by syringing. A piece of
cotton should be worn in the ear for a while after the
operation to prevent chilling.
No liquids should be dropped into the ear without
direct orders from a specialist. Laudanum, oil, glycerin,
lard, and other applications that we hear of as ear-drops
are all injurious, though they may alleviate the pain for
the instant. Pain should be relieved by heat until an
aural specialist can be consulted. The nurse is justified
in putting oil into the ear only when it is invaded by an
insect; then the oil must be warmed and poured in, and
the insect will float to the top and fall out. If no oil is
at hand, warm water will do—the insect will thus be
THE PATIENT.
"5
drowned. Beans and other things likely to swell with
water must not be interfered with, but a surgeon should
at once be consulted. The ears must not be picked with
pins; the drum-membrane is often perforated through
this habit. Before washing the patient's head it is always
well to put cotton in the ears, the ends of the pledgets
having first been dipped in oil or in vaselin. If cotton
alone is used, the water will soak through; but as water
and oil do not mix, the water cannot get beyond the oil
into the ears.
II. NURSING IN OBSTETRIC CASES.
Pregnancy: Signs and Symptoms.—The probable
■ signs of pregnancy are—stoppage of menstruation, morn-
ing sickness (though with some women this is entirely
absent or may come on regularly every evening), en-
largement of the abdomen at the end of the third month,
a sense of weight and fulness in the breasts, and darken-
ing of the skin around the nipples. Still, these symp-
toms are uncertain. Nurses having experience in gyne-
cologic wards know that the abdomen may be en-
larged by a tumor, and that the blue color of the vagina,
due to dilatation of the veins from congestion of the cir-
culation, may be caused also by the presence of a tumor.
Menstruation may cease from cold and from anemia; or
a change of climate and of living will many times stop
the menstrual flow for a few months, as will also an
attack of any of the acute fevers, until the nervous sys-
tem .regains its normal condition. In some womb dis-
eases the breasts have increased in size and contained
milk, and the nausea and vomiting may be caused by
some disease of the stomach. None of these symptoms,
taken singly, is a positive sign of pregnancy.
IIO PRACTICAL POINTS IN NURSING.
The positive signs of pregnancy are the fetal pulse,
which can be heard about the sixth month, and the fetal
movements, which are felt between the fourth and fifth
months. There are other signs, but they belong to the
obstetrician.
Duration of Pregnancy.—The average length of
pregnancy is two hundred and eighty days—nine cal-
endar months, or ten lunar months.
Conception and Date of Confinement.—Conception
may take place just before or very soon after a menstru-
ation. We begin to count the probable date of confine-
ment from the last menstruation. The way to date is to
find out on what day the last menstruation began, count
forward nine months or three months backward, and add
seven days, which is the probable duration of the men-
struation ; when the date of the last menstruation is
uncertain, add four and a half months to the date of
quickening, which will give the probable date of confine-
ment. There is always a possibility of a mistake, because
conception may take place just before or soon after a men-
strual period; that is, if conception did not occur soon
after a menstruation, it probably took place just before
the date of the next occurring period.
As pregnancy advances the abdomen becomes larger
(Fig. 28). About the fourth month the abdomen begins
to enlarge, and the top of the womb can be felt above the
brim of the pelvis; at the fifth month it is halfway to the
navel; at the sixth month it is on a level with the
navel; at the seventh month it is between the navel and
the point of the breast-bone; at the eighth month it
reaches the sternum ; and at the ninth month it gradually
sinks into the abdomen, the pressure upon the organs
within the chest is removed, and the woman breathes
THE PATIENT.
117
easier, though pressure at the same time is now put
upon the lower organs, and it is difficult for her to
Fig. 28.—Abdominal enlargement of pregnancy, showing varying heights of the
fundus marked in weeks (Schaefer).
walk. At the end of nine months the child is fully
developed and labor takes place.
The Fetus.—The fetus receives its nourishment from
the mother through the blood-vessels of the placenta,
which, when fully formed, consists of two portions, a
fetal and maternal. These two portions are connected
118 PRACTICAL POINTS IN NURSING.
so closely that waste material from the child is carried
to the mother, and nourishment from the mother is car-
ried to the child very easily without there being any
direct blood-communication between the mother and
fetus; the blood is carried from the placenta to the fetus
by the umbilical vein, and the two umbilical arteries carry
the waste substance from the fetus to the mother. The
umbilical cord is connected with the navel of the fetus
and the placenta. When fully developed the cord is
about 20 inches long, and is covered with a gelatinous
substance called " Wharton's jelly," which acts as a pro-
tective. The cord contains two arteries and one vein.
The arteries twist around the vein, which carries the
blood from the placenta to the fetus, and it is returned
by the arteries. After a while the fetus is enclosed in a
membrane which gradually fills with what is called the
" amniotic fluid," which is water containing albumin and
certain salts. In this bag of waters the child floats, it
being thus preserved from all injury. The bag of waters
at the beginning of labor acts also as a wedge to dilate
the mouth of the womb, and usually when it is fully
dilated the membranes give way and the waters escape.
Petal Movements.—The movements of the fetus are
felt between the fourth and the fifth month, and they gen-
erally occur two weeks later in a woman who has been
pregnant before. The supposition that the child—or
" fetus," as it is called while in the womb—has no life
until between the fourth and the fifth month, when its
movements are felt by the mother, is entirely wrong.
The child is living from the moment of conception, but
its movements are not felt because, up to the first four
and a half months, the womb, which is not sensitive, is
not large enough to come in contact with the inner sur-
THE PATIENT.
119
face of the abdominal wall, which is fully endowed with
sensibility.
Disorders of Pregnancy.—Some of the disorders
which may arise during pregnancy are—nausea, vomit-
ing, constipation, diarrhea, leucorrhea, retention or in-
continence of urine, salivation, swelling of the veins of
the legs and thighs, swelling of the external parts, heart-
burn, neuralgia, etc. The constipation is due to the
pressure of the enlarged uterus on the intestines. The di-
arrhea may be caused by the constipation, as there is then
the packed feces. Pressure on the bladder is the cause
of the constant desire to urinate, as the pressure inter-
feres with the distention of the bladder and there is little
room for the urine to accumulate. The pressure of the
enlarged womb on the nerves of the pelvis, which supply
the stomach, causes the nausea and vomiting. This dis-
order disappears about the fourth month, when the womb
rises out of the pelvis into the abdomen, but may appear
again during the last month, and then is probably due
to renal inadequacy. The swelling of the limbs and
external parts is due to the amount of pressure put upon
some of the blood-vessels, thus causing distention of
other blood-vessels.
Convulsions during pregnancy may be hysterical or
epileptic, though they are generally uremic, caused by a
disease of the kidneys, owing to the waste material of
the body, which is disposed of by them, being retained
in the body. The urine should be watched carefully;
the increase or decrease in its amount, and its paleness or
deepness of color, etc., must be reported. The premon-
itory symptoms which announce the convulsions in the
majority of cases are — edema of the face, feet, and
ankles, dull headache, dimness of vision, bright flashes
120 PRACTICAL POINTS IN NURSING.
before the eyes, ringing in the ears, a confused condition
of the mind, and the presence of albumin in the urine.
The convulsions of pregnancy are treated in the same
manner as uremic convulsions.
Hemorrhage.—Should there be hemorrhage from the
womb during pregnancy, the patient should be put to
bed; the foot of the bed should be elevated and the
head of the patient be lowered. The physician must
then be sent for. The clots should be saved for the
physician's examination. Cold may be applied to the
abdomen and the genitals.
Termination of Pregnancy and Nurse's Preparations
for the Confinement.—We will now suppose that a nurse
has been called to a confinement case. What is the first
thing to be done ? She should find out if the patient is
really in labor—if the pains are true pains or false pains.
\ifalse, the pains will be irregular and short; if true,
they will be regular, first felt in the lower part of the
back, and gradually increase to a certain intensity, then
gradually subside. If the pains are the true labor-pains,
the nurse should ask the patient at what time they
began. The physician in charge of the case should then
be notified. When the dilatation of the os is complete
the physician is again notified.
Preparation of the Patient.—The patient's bowels should
be emptied with soap-and-water enema, which will both
clear the bowels and make labor easier by removing
the fecal obstruction. If this is not done, the pressure
put upon the rectum during the second stage will cause
the bowels to empty of themselves, to the great annoy-
ance of all in the room.
A full bath is to be given if possible; if there is not
time for the bath, the external parts should be washed
THE PATIENT.
121
thoroughly. The hair of the patient should be braided
in two braids. During the first stage she maybe allowed
to walk about; but if it is night-time, she may lie down
and try to get a little sleep between the pains.
Preparation of the Bed.—The nurse should prepare the
bed as follows: A large rubber sheet should be tightly
pinned over the mattress, and covered with a sheet and
a draw-sheet tightly tucked under the mattress; over
these should be placed another rubber sheet and a draw-
sheet, which must be tightly pinned at the four corners,
so as not to be pulled out of place. If rubber sheets are
not at hand, one may use newspapers, which can be
burned afterward. The patient's napkins should be
soaked in a solution (i : iooo) of corrosive sublimate,
and when dry folded in a towel and so kept until needed.
Accessory Preparation.—Antiseptic pads can be made
with cheese-cloth and common cotton-wool. The
cheese-cloth is to be washed with soap and water,
boiled, dried, and then cut it into as many pieces as the
required number of pads (the number should be about
thirty), each piece being about 16 inches square; into
each piece is folded the cotton-wool, which should first
be cut about 8 inches square; the cotton-wool is then
doubled, which will make it 4 inches wide and 8 inches
long, so that when the pad is made it will be 4 inches
wide and 16 inches long. These pads are soaked thor-
oughly in corrosive sublimate (1 : 1000), then dried, and
kept in an antiseptic towel. When the pads are applied
they should be pinned to the abdominal bandage back
and front; when removed they must be burned. Prepa-
rations should also be made for sterilizing the doctor's
aprons and instruments. Plenty of hot water should be
at hand.
122 PRACTICAL POINTS IN NURSING.
Other things that will be needed are—a pail, a fountain
or Davidson syringe, safety-pins, scissors, a glass cath-
eter, vaselin, stimulants, a fan, ergot (fluid extract), cor-
rosive tablets, carbolic acid (i : 20); a binder of stout
cotton about \\ yards long and from 16 to 18 inches
wide; a basket for the baby if there is no crib (a clothes-
basket, even a foot-tub, has been brought into use, lined
with a blanket or comforter and provided with a pillow);
a blanket or a receiver for the baby; clothing for the
baby; boiled vinegar, ice, cold water, a minim-glass, an
ounce graduate, a spoon, a feeder; a basin for the after-
birth, basins for solutions for the hands ; a bed-pan, soap,
towels, a nail-brush, a hypodermic syringe, some old soft
linen (old handkerchiefs answer nicely), and very strong
thread or fine string for tying the cord. The string
should be cut into twelve lengths, each 12 inches long;
these pieces are divided into threes, which will give three
four-strand pieces, each four to be knotted together at
both ends. This gives three separate lengths, which,
with the scissors, must be put into carbolic solution, and
placed ready for the physician when he needs them. A
word of caution to the nurse before proceeding: she
should be scrupulously clean—she cannot be too clean.
Septic material is carried by unclean hands and dirty fin-
ger-nails, by clothing, instruments, or anything that is
used about the patient that is not perfectly clean and
sterilized. Hands must be washed in antiseptic solution
each time anything is done for the patient before and
after delivery. After birth the womb is like one large
wound; even the most minute portion of septic material
will be absorbed, and may cost the patient her life.
Labor.—In a normal labor the head is born first—
" head presentation," as it is called—but there are other
THE PATIENT.
123
presentations, such as breech, brow, face, etc. For this
reason the nurse must never attempt to take the respon-
sibility of the case alone. She is not justified in so
doing, because in large cities and country places a phy-
sician can always be called in time. She does not know
what complications may exist, and by undertaking the
case alone she might lose the lives of both mother and
child. Neither is she justified in making an examination
to ascertain the presentation without orders from the at-
tending physician.
Under no consideration should a nurse take a case if
she has been tiear a contagious case (medical or surgi-
cal), typhoid fever included, to say nothing of having
attended one.
Stages of Normal Labor.—Labor is divided into
three stages : First stage, from the beginning of the pains
to the dilatation of the mouth of the womb; second stage,
from the complete dilatation of the mouth of the womb
to the birth of the child; third stage, from the birth of
the child to the birth of the placenta.
First Stage.—The pains, which are caused by the con-
traction of the muscles of the womb, are very severe,
and they increase in intensity and duration as labor ad-
vances. The first sign of labor is pain in the lower part
of the back, which pain gradually comes forward to the
front of the abdomen, extends down the thighs, and is
of a bearing-down character. The pain at first is slight,
but it increases until it reaches its height, then gradu-
ally disappears. When the pain is at its height the
mouth of the womb is stretched, and as the pain passes
off it closes and the membranes recede. These pains at
first occur regularly, about every twenty minutes or half
hour, and this regularity helps to distinguish true labor-
124 PRACTICAL POINTS IN NURSING.
pains from colic-pains, which are irregular. During the
dilatation the mouth of the womb may be very slightly
torn and the discharge of mucus be slightly tinged with
blood; this is called the " show," and the physician must
at once be notified. When the dilatation has reached a
certain extent the bag of waters breaks. In this, the first
stage, the patient may sit down or walk about, but she
must be instructed not to bear down.
Second Stage.—At the beginning of the second stage
the nurse must put the patient to bed, roll up under
the arms the night-dress and under-vest, fasten them
with safety-pins, and pin a sheet around the waist, leav-
ing it open at the right side. This arrangement will
guard against exposure and keep the night-dress and
under-vest clean. The nurse, in the absence of the
physician, should remind the patient from time to time
to urinate. Stimulants must not be given without the
physician's orders. When the pains come a roller-towel
or a sheet may be tied around the foot of the bed, and
the ends be given to the patient to pull upon.
The stage of expulsion now begins: the pains change;
they are stronger, are more frequent, and force the child
out of the womb through the vagina. At the end of
each pain the head of the child goes back, or " retreats,"
and the patient may think that something is wrong; but
finally the head reaches a point where it does not retreat,
and at last slips out. There is then a little rest, during
which time the nurse can wipe the eyes of the child with
a cloth wet with sterilized (boiled) water and cleanse
its mouth. Another severe pain now comes, and the
shoulders and the rest of the body are born, accom-
panied with a rush of amniotic fluid and of blood
from the placenta. This discharge may cause faintness
THE PATIENT.
125
due to the blood leaving the brain, for, the pressure upon
the abdominal organs being removed, the blood-vessels
are dilated, and the blood rushes to them; there may
also be a chill, owing to a certain amount of nervous re-
action. The womb now contracts on the placenta, which
accomplishes its separation, thus shutting off the supply
of oxygen to the child. This causes the child to gasp,
and respiration is started.
Ether is sometimes given during the second stage to
lessen or dull the pain. The cone, sprinkled with a small
quantity of ether, is held over the mouth and nose when
the pain begins, and taken off as the pain subsides.
Third Stage.—After the birth of the child there is
usually a rest of about fifteen or twenty minutes, when
the pains begin again, and the after-birth and membranes
are expelled. This is the third stage. When the child
is born the womb contracts, and it can be felt like a
round hard ball. The physician may ask the nurse to
hold the womb; this is best done with the left hand.
The abdomen is depressed so as to allow the womb to
rest in the palm of the operator's hand, the fingers being
then behind and the thumb in front of the womb; in
this way the womb is firmly grasped. After the phy-
sician has tied and cut the cord he generally holds the
womb until the placenta comes away; after the bed has
been cleaned the pad and binder are applied. If the baby
is all right, it is wrapped in the receiving blanket and put
away and the nurse attends to the mother.
After all is over the womb gradually decreases in
size and returns to its normal condition {involution),
which usually takes from six to twelve weeks; but
when involution is not complete, when the womb re-
mains large and does not return to its normal shape, this
126 PRACTICAL POINTS IN NURSING.
condition is called subinvolution, which may result in
inflammation of the lining membrane of the womb.
Duration of Labor.—The duration of an ordinary
normal labor is from seventeen to twenty-four hours for
a first child, but is less long for a second. The pains, as
a rule, begin in the evening, the larger number of births
taking place during the small hours of the morning.
Conduct of Normal Labor.—Now, one may not
always get a favorable state of affairs. The baby may
be born before the physician comes, which accident is
not uncommon with women who have borne children
before.
The patient should be put to bed on her left side;
the perineum should be supported to prevent the head
emerging too suddenly, which support will relieve the
strain upon the perineum and lessen the danger of its
being torn. This regulation of the expulsion is done
by the nurse standing behind the patient at the left side
of the bed and laying her right hand on the external
genitals, which will bring the fingers on the left, the
thumb on the right side, and the palm of the hand
pressed against the perineum (Fig. 29). The head is to
be pushed rather upward, so that
the chin of the child will rest
against its chest and relieve the
strain on the perineum. When
f.g 29.-Reguiating^d. the head is bo™ the nurse should
sion of the head with the fin- see if the cord is wound around
gers of one hand against the ,1 , ., ., , ._
occiput. trie child s neck; if so, it should
be slipped over the head from
behind; if this is not done quickly, the circulation of
blood in the cord will stop and the child will die.
If there is a membrane over the child's face, it must be
THE PATIENT.
127
torn immediately or the child will suffocate. This is known
as being born with a veil or " caul," which is due to the
child being born with high rupture of the membranes.
The eyes, nose, and mouth of the child must be cleared
of mucus. The perineum must again be supported when
the shoulders are being born, because it is stretched
more than when the head passes through, and there is
more danger of its being torn. Moreover, if it was
slightly torn when the head was born, the tear may be
made considerably larger. If the child does not cry
and its mouth and nose are perfectly clear, it may be
patted on the back with the hand or some stimulant may
be rubbed on its back; if this does not make it cry,
then the cord may be tied tightly in two places—the
first ligature being 1^ inches from the child, and the sec-
ond 1^ inches from the first—and cut between the two
ligatures. The child should then be put first into hot
and then into cold water, or artificial respiration may be
practised by placing the child upon the bed with its back
slightly arched by means of a folded towel or sheet.
The nurse grasps a forearm in each hand, presses the
arms lightly against the lower part of the chest to effect
expiration, the arms are then slowly lifted above the
head, which movement causes inspiration by raising the
ribs and expanding the chest. These movements should
be repeated ten times a minute. This is Sylvester's
method, but it is of little value here.
Schultze's method is very good. The child is held
by the upper arms and shoulders, with its back to
the nurse. It is then swung upward with the head
downward above the nurse's head; the child is held in
this position while the nurse counts five, when the first
position is resumed. The first movement tends to ele-
128 PRACTICAL POINTS IN NURSING.
vate the ribs, while in the second they are depressed.
When the baby begins to breathe it must be wrapped in
a warm blanket and be put in a warm place.
We will now suppose that the birth has been perfectly
normal and that the nurse is still alone. As soon as the
baby is born the nurse should grasp the womb firmly
with the left hand and keep it contracted. When the
pulsation in the cord ceases she must tie and cut the
cord. She should then wrap the child in the receiver,
lay it away, and attend to the mother, having first wiped
the hands of the child to prevent any substance on them
being carried to the eyes.
When the after-birth (placenta) is being expelled, the
nurse can assist by pressing the womb evenly on all
sides; as the placenta passes out, the nurse should turn
it around so as to make a twist of the membranes, which
procedure will prevent them from tearing and will bring
them all away together. The placenta should be put in
a basin and kept for the physician's inspection, after which
it can be burned or buried. The patient may be given a
teaspoonful of the fluid extract of ergot, which will con-
tract the blood-vessels of the womb and keep up the
contraction, thereby preventing hemorrhage. When the
womb is hard and firm the patient may hold it while the
genitals are bathed with an antiseptic solution. The pa-
tient is then turned on her side and her back bathed.
The soiled sheet and rubber cloth are removed by
folding one side as closely as possible up to the back
of the patient; the binder is arranged on the bed, the
farther end being rolled up and placed next the patient,
so that when she is turned over on the other side she
rests on the clean permanent bed and the binder. The
soiled sheet and rubber are removed and the binder
THE PATIENT. 129
straightened out. The nurse should keep up the con-
tractions of the womb for about an hour longer, when
it will be safe to pin the binder tightly about the hips,
beginning at the bottom and working upward. The pin-
ning should be done evenly, the pins being about i-L
inches apart. The binder may be fitted to the waist by
taking in darts at the sides, and perineal straps may be
applied to prevent it slipping up. The binder should
extend from the hips to the waist-line. An antiseptic
napkin should be laid over the genitals. The patient
may be given a drink of milk or a cup of weak tea,
which is generally preferred; when everything 13 quiet
the patient will probably go to sleep. The nurse should
move about the room quietly, keep out visitors, and,
lastly, watch for hemorrhage.
Management of the Puerperium.—The room should
be kept bright and cheerful, the air fresh and pure. The
nurse should keep a record of the temperature, pulse,
respirations, sleep, amount of diet the patient takes, and
the condition of the bladder, bowels, and lochia.
The length of time that the patient remains in bed
depends upon the amount of progress made and whether
or not there is any blood in the lochia. The sitting up
in bed will be gradual. Some physicians have the
patient propped up in bed on the third day, though as a
rule she does not leave her bed until the second week.
The return .to the customary mode of living is gradual.
The period of lying-in is usually about four weeks. The
patient must not be allowed to sit up in bed without the
physician's orders, because sitting up or excitement of
any kind may bring on a hemorrhage.
Catheterization.—The nurse should see that the patient
urinates six hours after labor; she should not wait for
9
130 PRACTICAL POINTS IN NURSING.
the patient to express a desire to do so, but should
remind her. There may at first be a little difficulty in
urinating, but before passing the catheter the nurse
should try any of the means usually resorted to in in-
ducing the urine to flow—hot water in the bed-pan, the
sound of running water from a faucet or a pitcher, or
allowed to run down over the parts (cold water succeeds
with some women), or hot cloths placed over the lower
part of the abdomen; or the patient may turn over on
her hands and knees: if these means fail, the nurse must
then resort to the catheter.
Lochia.—The lochia are the discharges that follow
childbirth; for the first few days they are a bright red,
which gradually becomes paler and paler until they are
almost transparent, and finally cease. The lochia may
last two weeks or longer, the length of time differing
with each patient. Any odor or departure from the
normal must be promptly reported.
Napkins.—The napkins must be changed during the
first few days every three hours, taking care that they
have previously been soaked in some antiseptic solution.
If is very easy at this time, if strict antiseptic precautions
are not used, for germs to enter the uterine cavity or
peritoneum, the result being puerperal septicemia. The
parts must be kept clean and must be washed with anti-
septic solution three times a day.
Douches must not be given without direct orders from
the attending physician.
Diet.—The diet should be liquid for the first twenty-
four hours; after that there may be given soft, light,
easily-digested food. The bowels must be moved by
the third day.
Temperature and Pulse.—The temperature may rise
THE PATIENT.
131
slightly during the first twenty-four hours after child-
birth ; then it should descend to normal, and so remain.
A rise of temperature after childbirth may be due to
constipation, exhaustion after labor, nervousness, or
threatened abscess of the breasts; or it may indicate
sepsis. Should sepsis be indicated, other symptoms,
such as decrease of the lochia, offensive odor from the
discharges, and distention of the abdomen, will be pres-
ent. The pulse may, on the contrary, be found very
low, sometimes as low as 50 beats. A low pulse is not
at all serious, but must be noted.
After-pains are caused by the womb contracting, and
they generally last four or five days. Nursing will often
produce severe pains, because of the sympathetic rela-
tion between the breast and uterus, and by putting the
child to the breast involution is hastened.
Lactation.—The child must be put to the breast six
or eight hours after birth, after the mother has rested.
The milk does not generally appear until the third day
after delivery, but the breast contains a secretion called
" colostrum," which acts as a laxative and clears the
bowels of the child; putting the child to the breast early
also teaches him to nurse and assists in forming the nip-
ples. The breasts must be nursed alternately regularly
every two hours during the day, and the nipples must be
washed before and after each nursing with water to which
a little borax has been added. If the nipples are soft
and tender, they may be hardened by bathing them with
equal parts of alcohol and water.
Care of the Breasts.—If the breasts are sore and pain-
ful, this condition must be reported to the physician: in
the mean time the nurse may rub the breast with warm
sweet oil and apply gentle massage, massaging from the
132 PRACTICAL POINTS IN NURSING.
base toward the nipple. The pulse and temperature
should be taken. A cracked nipple must promptly be
attended to, the child nursing from the other breast; the
nipple must be kept perfectly clean; the milk must be
drawn from the sore-nipple breast with a breast-pump,
and the breast massaged gently to relieve the tight feel-
ing. The nipple usually heals after a rest of one or two
days. The bowels must be kept open. If the milk-
secretion is scanty, the mother's diet should be a mixed
one, milk entering very largely into its composition. Al-
cohol, such as beer or porter, does not make milk, as is
commonly supposed, but tends only to fatten the mother.
Breast-bandage.—The breast-bandage most commonly
used is made with three toilet napkins or with two pieces
of muslin. The two napkins are pinned together to form
a V, and are fastened to the middle of one end of the
third napkin (Fig. 30) after the manner of the Y-bandage.
The single napkin is passed across the back, which
brings the V-shaped napkins directly to the side of the
breast; these two napkins are carried
across the chest, one below the breasts,
the other above, and pinned to the free
end of the napkin crossing the back.
This bandage holds up the breasts. The
muslin compress is arranged in exactly
the same way, though only two pieces
are needed (each folded and about 6
inches wide), one small piece to pass
under the back, the second piece large enough to go
twice across the chest in the shape of a double V ( o),
and pinned to the ends of the small piece. If the baby is
nursing, this bandage is left open; if not, a pad of cotton
is placed between the breasts, and the edges are pinned
THE PATIENT.
133
together with small safety-pins. Straps of muslin passed
over the shoulders and pinned back and front will keep
the bandage in position.
Pathology of the Puerperium.—Some of the com-
plications which may arise after childbirth are hemor-
rhage, puerperal insanity, eclampsia, and phlegmasia
dolens.
Hemorrhages.—Hemorrhage after childbirth is called
" post-partum hemorrhage," and is due to the womb re-
laxing. The symptoms of post-partum hemorrhage are
restlessness or tossing of the patient in bed, faintness,
pallor, a demand for air, a sense of dizziness, shortness
of breath, and a weak, rapid pulse. The restlessness
alone should put the nurse on her guard and lead her
to investigate. The nurse should put one hand on the
abdomen and feel for the womb by pressing on the ab-
domen ; if the womb is found, grasp and squeeze it hard,
squeezing out the clots; the womb may not be found,
owing to its relaxed condition, or it may be found large
and firm, owing to the formation of a blood-clot which pre-
vents the womb contracting and keeps the blood-vessels
open. The nurse should call for assistance and send
some one for the family physician. If he lives at a dis-
tance, the nurse is justified in sending for the nearest
physician. The assistant should be directed to elevate
the foot of the bed (to send the blood back to the heart
and brain) and to bring the basin of antiseptic solution,
vinegar, gauze, or a clean handkerchief. The nurse
should wash her free hand in the antiseptic solution and
clean out the clots from the womb ; then the gauze or
handkerchief should be soaked in the vinegar, be carried
well up into the uterine cavity, and squeezed. The vin-
egar will flow back over the walls of the womb and the
134 PRACTICAL POINTS IN NURSING.
vagina and cause the blood-vessels to contract. This
treatment should be continued until the bleeding stops.
Ergot may in extreme cases be given hypodermatically, in-
jected either into the upper part of the thigh or the abdo-
men. A hot douche of water and vinegar, equal parts, its
temperature being about 118° F. or 1200 F., will also con-
tract the blood-vessels. The nurse should see that the blad-
der is empty; she should also watch for collapse and give
stimulants. Morphia {^ grain) may be given to secure
rest. Kneading of the womb must be kept up all the
time with one hand. The application of ice is not ad-
visable, because ice is not clean, and it may be the means
of introducing septic material into the cavity of the
womb. Vinegar is the best; it is an astringent, it can
always be had, it is readily applied, and its action is
generally very prompt.
When the bleeding has stopped the kneading must
still be continued until the womb is firm and small.
The foot of the bed and the hips should be kept elevated,
and the patient should not be left alone for a moment.
This is one of the cases where prompt action, a calm
and collected mind, and a steady hand are absolutely
necessary. It is always a safe plan to have close at hand
vinegar, very hot water, a syringe, and gauze or clean
soft rags which have previously been sterilized in the
oven for a number of hours after delivery, in case this
accident should happen. The nurse is then prepared for
prompt action, for it does not take long for a patient to
bleed to death.
Septicemia.—Puerperal septicemia is caused by neglect
of antiseptic cleanliness on the part of the attendant (see
p. 165). It begins with a chill or a continued chilly feel-
ing, followed by a rise of temperature and accelerated
THE PATIENT.
135
pulse, a bad odor from, and probably suppression of, the
lochia, cold, clammy sweat, anxious expression, and dis-
tention of the abdomen. The smallest rise of temper-
ature should make the nurse watchful; she should notify
the physician, move the patient's bowels, give a vaginal
douche of 1 : 5000 corrosive sublimate, and apply tur-
pentine fomentations to the abdomen. The patient
should be stimulated if necessary.
Insanity.—The treatment of puerperal insanity or mel-
ancholia lies in keeping the patient perfectly quiet and
preventing her from harming herself. The air of the
room must be kept fresh and pure; the patient's strength
supported with nourishing food; baths may be given
to promote activity of the skin; the bowels must be
kept open; and any article or any person that tends to
excite the patient must be removed from her sight. The
baby is taken from the breast when the symptoms first
appear, and must be taken from the room. Bed-sores
must be guarded against, and a strict watch must be
kept over the patient; if allowed to be up and around,
she must not be permitted to go out of the nurse's sight.
With a little tact the nurse can manage this surveillance
without letting the patient think that she is being
watched. The causes of puerperal insanity are many,
and a good recovery depends chiefly upon the nursing.
Eclampsia {Convulsions).—In event of convulsions the
nurse must send at once for the attending physician, and
put something in the mouth of the patient to prevent
her biting her tongue. A hot pack or a vapor-bath may
be given, and ice be applied to the head. Morphia (^
grain) will stimulate the heart's action, induce perspira-
tion, and quiet the patient.
Phlegmasia Dolens.—Phlegmasia dolens, or milk-leg, is
I36 PRACTICAL POINTS IN NURSING.
due to a blood-clot forming in a vein. There is swelling
of the affected limb and pain, and its surface is white and
drawn. The disease may be ushered in with a chill or a
chilly feeling and a rise of temperature and pulse. The
patient must be kept on her back, and the limb be ele-
vated and kept warm by wrapping it in cotton-wool.
Recovery takes place with the absorption of the clot.
Thrombosis.—Thrombosis is. a clot of blood in a vein
obstructing the circulation. It is generally caused by
the patient walking, or even standing, too soon after an
illness. Clotting may also take place after childbirth.
There is swelling of the part, which swelling goes down
as the clot is absorbed. But if absorption does not take
place, if the clot is swept onward in the circulation of
the blood to the right side of the heart, sudden death
results from the obstruction of the pulmonary artery.
This clotting is called embolism.
Extra-uterine Pregnancy.;—Extra-uterine pregnancy
is development of the ovum outside the womb, either in
the Fallopian tube, the ovary, or the abdominal cavity,
but generally in the Fallopian tube. As the ovum grows
the walls of the tube become very weak and thin, until
at last, about the fifth, eighth, or twelfth week, they rup-
ture. There is then sudden pain in the affected side,
together with all the symptoms of internal hemorrhage
and collapse.
Cesarean Section.—Cesarean section is the removal
of the child from the womb by abdominal incision. This
operation is performed to save the life of the child should
it be living after the death of the mother, or in case
there is some pelvic deformity or tumors complicating
natural delivery.
THE PATIENT.
137
III. NURSING IN GYNECOLOGIC CASES.
Preparation for Gynecologic Examination.—To pre-
pare a patient for examination the genital parts should
be cleansed and the bladder and bowels be emptied.
The womb lies between the bladder and the rectum, and
the distention of either of these organs will alter the
position of the womb. A douche must not be given
before an examination, because the surgeon will want
to see the character of the discharge. All bands around
the waist and the corset must be loosened; a single tight
band around the waist will crowd down the contents
of the abdomen and displace the uterus. Around the
patient is thrown a sheet, beneath which she can raise
her clothing above the waist, and then step upon a chair
and thence to the edge of the operating-table without
there being the slightest exposure.
For the examination there is needed a small table cov-
ered with a shawl, a rug, and a comfortable or blanket;
over these a sheet is spread and a pillow is placed for
the patient's head. There should be at hand a sheet to
cover the patient; a chair by the table for her to step
upon ; a table, covered with a towel, on which are placed
two bowls, one containing corrosive-sublimate solution
(1 : 1000), and the other containing warm water; a piece
of soap (castile) or vaselin; and towels.
Positions for Examination.—The four positions for
examinations, and also for operations, are the dorsal, the
Sims, the knee-chest, and the upright.
Dorsal Position.—The patient lies upon her back with
the knees drawn up and separated; the hips are brought
down near the edge of the table, leaving sufficient room
I38 PRACTICAL POINTS IN NURSING.
for the heels to rest together comfortably, 8 or 10 inches
apart, without slipping from the table. The clothing is
pushed above the knees and the sheet hangs in front,
Fig. 31.—Dorsal position, with patient arranged for examination (Codman and
Shurtleff).
completely covering the patient's legs and avoiding all
exposure (Fig. 31).
Sims Position.—In the Sims position (Figs. 32, 33) the
patient lies on the left side of her chest, with her head
and left cheek resting on a low pillow, and the left arm
is drawn behind the body or hangs over the edge of the
table. The hips are brought down to the left-hand cor-
ner of the table, so that her body lies diagonally across
it, the head and shoulders being at the right-hand side,
with the right hand and arm hanging over the table
edge. The thighs are flexed upon the body, the right
knee being so bent that it lies just above the left, and the
THE PATIENT.
139
feet rest upon a board extending from the right-hand
corner of the table (Fig. 32). The patient is covered with
a sheet, and the buttocks are covered with two towels,
one to cover each side, their
upper ends being tucked
under the clothing, the
lower ends being tucked
between and under the legs,
thus simply exposing the
entrance to the vagina (Fig.
33). This position is one
in which a practical illus-
tration is needed before one
can fully understand how
to place the patient, and
also how to arrange the
towels. The Sims position
causes the vagina to be
filled with air and places
the mouth of the womb
Within easy reach, SO that it F'G' 32--S>ms's position for tamponing and
curetting Dickinson).
can more clearly be seen.
Kncc-chcst Position.—In the knee-chest position (Fig.
34) the patient first kneels on the edge of the table, then
bends forward and rests her chest on a low pillow, her
head lying just beyond, so that her back slopes down
evenly, her arms clasping the sides of the table. The
clothing is drawn above the waist, and the patient is
covered with a sheet. In this position the abdominal
organs are thrown down toward the diaphragm; the
air enters the vagina and balloons it out, so to speak,
so that there is an unobstructed view of the canal and
the cervix.
140 PRACTICAL POINTS IN NURSING.
Upright Position.—In the upright position the clothing
of the patient is drawn up, and around the waist is pinned
Fig. 33.—Arrangement of the towels for examination with patient in the Sims
position.
a sheet extending to the floor. The patient stands with
limbs separated, one foot resting on a stool or the rung
of a chair.
Fig. 34.— Knee-chest position.
Preparation for Operation.—For gynecologic opera-
tions the nurse makes her preparations in the same
THE PATIENT.
141
manner as for abdominal operations, using the same
antiseptic precautions. In an emergency, when a slight
operation is to be performed with the patient in bed,
there will be needed a table or a chair covered with a
Fig. 35.—Table equipped with basins, brushes, antiseptics, etc. for the physician's
use (Dickinson).
sterilized towel or sheet for the instrument-tray, bowls,
hot and cold water, a fountain syringe filled with cor-
rosive-sublimate solution (1 : 3000) and a wide board
or an ironing-board for insertion between the mat-
tress and sheet (thus making a hard surface for the
142 PRACTICAL POINTS IN NURSING.
patient to lie upon), a chair for the surgeon, soap, and
a nail-brush.
A piece of rubber cloth, or oilcloth, or newspapers
will serve for the pad. The material used is folded at
the top and sides, covered with a towel, and the unfolded
end draped into a pail or a wash-tub. When the patient
is etherized the bed is turned toward the window to
afford the surgeon a good light—the northern light if
possible. A bay window must be avoided, because it
gives cross lights.
The limbs are flexed, the hips are brought down to
the edge of the bed, and the pad is placed under them,
so that the water used in bathing the external parts is
conducted by the cloth into the pail or the tub. When
holding the patient's limbs the nurse should let the heel
of one foot rest in the palm of her hand; the knee of
Fig. 36.—Arrangement of towels for examination, showing introduction of the specu-
lum with patient in the Sims position.
the patient will then rest against the chest of the nurse,
whose free hand is passed over and holds the other
limb in position at the knee. If the patient is in the
Sims position and the nurse is asked to hold the specu-
THE PATIENT.
H3
!um, it should be held with her right hand in the exact
position in which the surgeon has placed it (Fig. 36),
her left hand, being passed over the patient's thigh,
should raise the right buttock.
After-care.—The after-care of gynecologic cases lies
mainly in procuring absolute rest and quiet. The pa-
tient must see no visitors without permission from the
surgeon. The limbs are generally tied together for
the first few days, especially after an operation on
a lacerated perineum, to prevent the external stitches
(sutures) giving way in case the patient should toss
about.
The genital parts must be kept perfectly clean, and
strict antisepsis must be observed, as septic material
readily finds access. After passing the catheter the nurse
should be careful that when removing it the urine does
not drop on the stitches; the parts are afterward sprayed
with the ordered solution and dried. When giving
douches the nurse must insert the tube carefully and
away from the stitches, and after the douche is over
she should softly wipe the vulva dry with sterilized
gauze or cotton. The same care must be used when
giving enemas, so that the rectal and vaginal stitches
are not broken by the tube. The patient must be
instructed not to strain when the bowels are being moved,
or the stitches may break. If the uterus is packed with
gauze, the pulse and temperature are taken every two
hours; should the temperature rise to 1010 F.,the pack-
ing is removed.
Diet.—The diet is liquid until after the third day,
when the bowels will have been moved; then, if all is
well, the amount of food is increased.
Vaginal Tampons.—A vaginal tampon is made of
F44 PRACTICAL POINTS IN NURSING.
absorbent cotton, lamb's wool, or gauze, and is about
7 inches long, \\ inches wide, and \ inch thick, folded
and tied in the middle with strong white thread or fine
twine, leaving long ends with which to remove the tam-
pon. The kite-tail tampon is made by fastening several
of these pieces of cotton to a piece of thread about 2
inches apart. When the tampon is made the pledgets
of cotton are soaked thoroughly in water, then in gly-
cerin, after which they are put away; or they may be
sterilized and the tampon put away in an aseptic glass
jar.
Vaginal Dressings.—Vaginal dressings are made of
strips of absorbent cotton, lambs' wool, or gauze (three
thicknesses), 1^ inches in length and width. They are
prepared for use in the same way as the tampons.
Each surgeon has his favorite dressings, and after see-
ing a dressing done once the nurse should know what to
prepare for him the next time.
IV. DUTIES OF THE NURSE IN GENERAL
SURGICAL CASES.
We will now consider the preparations for an opera-
tion, and the care of the patient before, during, and after
operation.
Preparation of the Operating-room.—The directions
for the preparation for an operation will be given by the
surgeon in charge. In some houses the nurse may
have a separate room, or even the kitchen, for the
operating-room, while in others she will have to pre-
pare part of the patient's bed-room. In the latter case
the brightest end of the room should be prepared for.
the operation, to afford the surgeons plenty of light. A
screen must be put up before the bed, so that the patient
THE PATIENT. 145
will not see the preparations; some patients, however,
will take a great interest in all that is going on, while
others will be exceedingly nervous. The nurse should
remove from the room all movable furniture; lay oil-
cloth, or newspapers covered with a sheet, over and pin
securely to the carpet, and across the window fasten a
curtain or newspapers, so that the operation cannot be
viewed from the opposite side of the street. The re-
maining furniture and window-frames should be washed
with carbolic-acid solution (1 : 20), and on the morning
of the operation should be dusted with a cloth wrung
out of the solution. The things necessary for the opera-
tion can be placed on the operating-table, covered with a
sheet, and be left outside the room until the patient is
partly etherized, when they may be carried in.
If a separate room may be had, one with a northern
light is to be preferred, and, if possible, it should be far
away from the bath-room for aseptic reasons. All un-
necessary furniture being removed, the hangings must be
taken clown, the room thoroughly swept, and the walls
and remaining furniture washed with carbolic-acid solu-
tion (1 : 20) and exposed to the action of the sun and air
for about twelve hours, when the windows are to be
closed, the room thoroughly dusted with a damp cloth,
and not again disturbed. The kitchen makes the best
operating-room; it is warm, hot and cold water is close
at hand, and one is not afraid of soiling carpets or
hangings.
Operating-table.—The operating-table should not be
wider than 25 inches, nor higher than 37 inches, because
if low and wide the surgeons will have to stoop and
bend forward. A kitchen table or a dining-room table
with the leaves let down, and a small table at one end
10
146 PRACTICAL POINTS IN NURSING.
for the patient's head, will make a good narrow ope-
rating-table; or three chairs, with two planks, a leaf
from an extension table, or an ironing-board laid across
them, may suffice.
The table may be covered with rubber cloth, oilcloth,
or even with newspapers, two sheets, and a blanket. A
word of caution here: the nurse should not use any
old blanket or comfortable to cover the operating-table;
it may be filled with germs, which must be avoided.
Two wooden chairs should be at hand in case the
Trendelenburg position is necessary, and two wooden
boxes for the surgeons to stand upon when using this
position.
Preparations for the Operation.—The evening be-
fore the operation the nurse should boil a wash-boiler
full of water and set it in covered pitchers to cool, the
wash-boiler and pitchers having first been made thor-
oughly aseptic.
On the morning of the operation the nurse should
sterilize in the boiler or in an oven six sheets, two
blankets, twelve towels, and twelve sponges. She
should not take the best towels in the house, because
they are spoiled by the solutions and the blood. There
will be needed six bowls, which may be of agate-ware
or be the ordinary bed-room china bowls—one for per-
manganate of potash, one for oxalic acid, one for steril-
ized hot water, one for corrosive sublimate, one for the
surgeons' hands, and one for the vomit. If there are no
pails for the sponges, the hot and cold water may be
carried in the bed-room toilet pitchers. After the hands
have been made aseptic and the part washed the perman-
ganate and oxalic acid can be disposed of and the bowls
be used for the sponges. Two tables will be needed—
THE PATIENT.
H7
one for the instruments, the other for the assistant—which
can be improvised in the same way as was done for the
operating-table (p. 146), and covered with sheets or towels.
There will also be needed a pail or a wash-tub for the
soiled water, a tin dish or a flat bake-pan for the instru-
ments, brandy, a hypodermic syringe (which must be
placed in a bowl containing carbolic-acid 1 : 20 solution),
and the syringe be filled with the solution, strychnia tab-
lets (7^5- grain), a small tumbler, a Davidson or a fountain
syringe, common table-salt for salt-solution, sheet-wad-
ding, absorbent cotton, bandages, sterilized gauze, safety-
pins, rubber tubing for a tourniquet, two new nail-brushes,
castile soap, green soap, a razor, hot-water bottles, two
blankets, alcohol, matches, and twelve gauze sponges
of various sizes—three 2 inches square, three 4 inches
square, three 6 inches square, and three 8 inches square.
Sterilization.—Sterilization may either be dry or moist;
moist heat is preferable, because it is more thorough and
more penetrating than dry heat. For dry sterilization
the clothing and dressings are placed in covered tin
pans in the oven, the temperature ranging from 1600 to
212° F. For moist or steam sterilization an ordinary
wash-boiler is used. Water is poured in to the depth
of about 6 inches; sticks or bricks, placed crosswise, are
built up above the level of the water, and upon them rest
the clothing and dressings.
For both these methods the heat must be continued
for fully one hour before the operation. The instru-
ments are wrapped in a towel and allowed to boil for
ten minutes in a tin pail or a kettle of boiling water to
which has been added 2 teaspoonsful of washing-soda
to each pint of water, to prevent them from rusting.
There must be left hanging out of the kettle one end
148 PRACTICAL POINTS IN NURSING.
of the towel, by which to lift out the instruments. The
water must boil some time before the instruments are
placed in it.
Operative Position.—The most popular position for ab-
dominal operations is the Trendelenburg (Fig. 37). This
position is one in which the knees of the patient are con-
siderably higher than the head, the body slanting upward
from the shoulders; the intestines are thus thrown down
THE PATIENT
149
toward the diaphragm, giving the surgeon a clear view
of the pelvic organs. In the absence of a Trendelenburg
table the position can readily be obtained by raising the
lower end of the operating-table and placing chairs or
boxes under its feet; or a wooden chair or a high box
can be secured to the operating-table and covered with
sterilized sheets.
Preparation of Patient.—If the nurse has from
twenty-four to thirty-six hours in which to prepare the
patient for operation, she should give the patient, the day
before the operation, a full bath and a cathartic of either
castor oil, citrate of magnesia, salts, or compound lico-
rice powder. The diet must be nourishing and light.
Milk should not be given before an abdominal operation,
because the stomach does not digest it thoroughly, and
its curds may remain in the intestines and act as an irri-
tant. Gruel is best given; it is nourishing and easily
digested.
The part to be operated on must be shaved (if the
patient is very nervous it is generally well to leave this
operation until she is partly etherized). After the shaving,
the part is thoroughly cleansed with soap and water and
a nail-brush, then with ether, which removes all oily and
fatty substances, then with warm corrosive-sublimate so-
lution (1 : 1000), after which cleansing a pad of sterilized
gauze, absorbent cotton, or a towel is wrung out of the
solution, applied over the part, and held in place with a
sterilized bandage and perineal straps. This pad is not
removed until the surgeon is ready to operate. The
patient must be instructed not to put her fingers under-
neath the dressing or to disturb it in any way.
No definite rules can be laid down for the surgical
bath, as surgeons differ in their method of preparing
150 PRACTICAL POINTS IN NURSING.
patients for operation. The bath may be given in the
manner just described, while some surgeons will direct
the application of a poultice of green soap, which is re-
moved early on the morning of the operation, the part
being scrubbed with hot water and a brush to remove
the soap, and a warm corrosive-sublimate poultice (i :
iooo) applied.
On the morning of the operation the patient should
be given a simple enema to clear the bowels, and a
sponge-bath; the nurse should then put on the patient
a clean under-vest, night-gown, and stockings, and braid
the hair in two braids; she should also remove from the
patient all rings and ear-rings; also false teeth, whether
a whole or a partial set, as there is danger of their being
swallowed, and put them away in a tumbler of cold
water. Two hours before the operation the patient
should be given a stimulating enema of whisky (i ounce)
and warm water (2 ounces). This enema is to be fol-
lowed in one" hour with atropia (j^-g- of a grain), which
acts as a sedative and lessens the irritability of the stom-
ach caused by the ether; it also lessens the secretions of
the mouth and throat and prevents the throat filling up
with phlegm. Both these stimulants should be given by
enema, because if given by the mouth they might stay in
the stomach unabsorbed, and the patient would vomit
them when under ether. No food must be given after
midnight, unless the operation is to be performed late in
the day—about noon-time or in the afternoon—in which
case the patient may have, six hours before, beef-tea,
gruel, or coffee. Milk should not be given, as it is very
apt to curdle and stay in the stomach, and, should the
patient vomit while under ether, the curds may get into
the larynx and trachea and choking result. The cath-
THE PATIENT.
151
eter should be passed before etherization if the operation
is abdominal, even if the patient has urinated a few min-
utes before, and the nurse should be sure that the blad-
der is empty.
Special operations, abdominal and gynecologic, call
for special directions, which will be given by the surgeon
in charge.
Duties of the Nurse in Emergency Cases.—We will
consider the preparation for an emergency operation in a
very poor family, where there are no conveniences. We
will presume the case to be one of appendicitis, and that
the nurse has been called in the night. While the sur-
geon is making his examination of the patient the nurse
should start a fire and put on the wash-boiler, to make
sure of plenty of boiling water; she should then get six
sheets and twelve towels, if possible. There may be no
clean towels, and the nurse will have to wash some dirty
ones. After being washed clean they can be placed in a
tin pan, boiling water poured over, and allowed to re-
main in the water a few minutes, when they are wrung
out and placed in corrosive-sublimate solution (1 : 1000)
until the surgeon is ready to use them.
The kitchen should be rendered as clean as possible.
The kitchen table should be prepared for the operating-
table, and there should be procured two small tables for
the instrument-tray and the sponges. If small tables
cannot be had, chairs covered with a corrosive sheet or
towels will do. If there is no gas-light, the nurse
should get as many lamps as she can, and arrange them
near the surgeon, but not too near the ether, be-
cause ether is inflammable. The instruments are to
be wrapped in a towel and boiled for ten minutes in a
kettle of boiling water to which has been added two tea-
152 PRACTICAL POINTS IN NURSING.
spoonsful of washing-soda to the pint of water, to prevent
rusting. There must be left hanging out of the kettle one
end of the towel, by which to lift out the instruments.
After the surgeon has made the examination the part
must be shaved, washed, and a corrosive towel applied;
an enema should be given to clear the bowels, also a
stimulating enema, and the urine should be drawn.
While the patient is being etherized the nurse may
arrange the tables and wash a flat bake- or meat-pan
for the instruments. If sponges have been forgotten, a
clean sheet can be torn up and folded into flat sponges.
China basins can be used for the antiseptics, the sponges,
and the surgeon's hands; china pitchers for hot and cold
water; a wash-tub for the soiled water; and hot bricks
or beer-bottles for heaters. No matter how poor the
family, the kitchen can be cleaned and prepared as an
operating-room in a few minutes. Boiling water kills
germs on contact, and where there are no means of
sterilizing the sheets and towels, they can be soaked
first in boiling water and afterward in corrosive-subli-
mate solution (i : iooo).
Anesthesia.—Ether.—A few words about the giving
of ether, which duty may sometimes fall to the nurse,
especially in emergency cases. Unless unavoidable, ether
or chloroform must be never given on a full stomach,
because the patient may vomit, and particles of food may
lodge in the larynx and trachea and result in strangula-
tion. The bladder and bowels must always be emptied,
or they may act involuntarily. An ether cone is made
by folding a newspaper, or a straw cuff may be shaped
to fit over the nose and mouth, a stiff towel being folded
around and secured with safety-pins, and a clean hand-
kerchief or piece of cotton placed inside.
THE PATIENT.
153
Absolute silence must be maintained while the ether
is being administered, as any conversation may be heard
by the patient. Whatever is said by the patient when
going under ether or coming out must be kept abso-
lutely secret. Care must also be taken when the patient
is coming out of ether that the operation is not dis-
cussed. Many patients have been made miserable
through carelessness on this point; for, while they could
hear everything that was said by the nurses, they were
totally unable to make any sign by which the nurses
would know that they could hear. Death from ether is
slow—by paralysis of the respiration—the signs of dan-
ger being a blue and livid color of the skin, the respira-
tions being low, shallow, and gasping. Ether affects
people differently, and no definite rules can be laid
down. Ether should be given slowly; in other words,
the cone should not be filled with ether and put over
the face, entirely smothering the patient. The nurse
should show the patient how to inhale it, slowly and
deeply, and also instruct the patient to close the eyes,
because ether is an irritant to the eyes. About 2 tea-
spoonsful of ether are poured into the cone, which the
nurse should hold a little distance from the patient's face,
and as she becomes accustomed to the ether and under
its influence the cone may be brought nearer; the stran-
gling sensation of which so many patients complain is
then in a measure avoided. Ether generally first pro-
duces choking and coughing, followed by excitement;
this is followed by the muscles becoming rigid, the face
blue, and the breathing stertorous or snoring; this stage
passes away, the muscles become relaxed, and the patient
is in a state of insensibility.
The lower jaw must be kept forward by placing the
154 PRACTICAL POINTS IN NURSING.
thumbs behind the angles of the jaw. Pushing the jaw
forward and upward, which brings the upper behind the
under teeth, prevents the tongue slipping back and ob-
structing the larynx, and gives free access of air to the
lungs (Fig. 38). Should
the tongue slip back, it
may be pulled forward
with the fingers or with
a pair of forceps. Fre-
quent inspirations of
fresh air should be
given. When com-
pletely etherized only
a small quantity of the
drug is needed to keep
The mucus should be
The pupils should re-
Fig. 38.—Method of pushing the lower jaw
forward to prevent obstruction to breathing.
the patient under its influence.
wiped from the patient's mouth
main contracted all through etherization, and dilate when
the patient is coming out of ether. If the pupils are
dilated during etherization, the patient is over-etherized,
and they remain dilated until the muscles of the eyes
regain their tone, when they contract. The sudden di-
latation of the pupils is generally a sign of imminent
death. It is very important for the nurse to watch
carefully the respirations, because ether kills by suffoca-
tion, the heart usually beating long after the respirations
have ceased. The nurse should speak out if the pulse is
growing rapid, feeble, irregular, or intermittent; if the
respirations are becoming low, rapid, or gasping; if the
face is becoming pale or blue, or the pupils are grad-
ually dilating.
If the patient seems inclined to vomit, the ether should
be pushed, which will generally ward it off; should she
THE PATIENT
155
vomit, her head should be turned to one side, to allow
the matter more easily to escape from the mouth. One
will see from the above that the giving of ether requires
the undivided attention of the etherizer; no one can ether-
ize and see the operation at the same time. Nausea and
vomiting after ether may continue for two or three hours
or longer. Should it persist until the following day, it
may be due to shock or to some cause other than ether.
Very hot water will often check vomiting, or crushed
ice, black coffee, small doses of brandy, champagne and
ice, or aromatic spirits of ammonia. Cocain, \ grain
every two hours for five doses, has been successful in
severe cases ; also a mustard plaster over the stomach
and the washing out of the stomach. Patients who take
chloroform do not suffer from nausea so much as do
those who take ether.
In etherizing young children it is best to put them on
the back and at once place the ether-cone over the mouth
and nose without temporizing. If their pleadings to have
the cone taken away are listened to—and they are hard
to resist—their agony will only be prolonged and the
operation delayed. Children are quickly etherized, and
very rapidly recover from the influence of the ether.
Chloroform is similar in its action to that of ether; it is
pleasanter to take, and the patient is under its influence
quicker, though it is more depressing on the heart than
ether, and for this reason the patient is not allowed to
rise until all effects have passed off. To give chloro-
form, a few drops may be sprinkled on a handkerchief,
a towel, or a small wire framework covered with flan-
nel, or the drops may be sprinkled on a piece of absorb-
ent cotton placed in a tumbler, which is held a little dis-
tance from the patient's face. The same symptoms are
156 PRACTICAL POINTS IN NURSING.
to be watched for as those in ether. Death from chlo-
roform is almost always sudden, from paralysis of the
heart: the pupils become dilated, the face becomes pale,
and the pulse becomes flickering.
Nurse's Duties in Operating-room.—The duties of
the nurse in the operating-room are the same for all
operations. Her dress must be of cotton goods, the
sleeves being made to roll up above the elbows. Both
dress and apron must be fresh for the operation.
On first going to the operating-room the hands and
forearms of the nurse are to be thoroughly washed and
scrubbed for ten minutes, and the finger-nails thor-
oughly cleaned, thus removing the germs from the
hands. The hands are then rendered absolutely sterile
by putting them first into a saturated solution of per-
manganate of potash until they are of a deep-brown
color from the tips of the fingers to the elbow, then
into a hot saturated solution of oxalic acid until all the
permanganate stain has been removed; they are then
washed in sterilized hot water, and finally are soaked for
three minutes in a solution of corrosive sublimate (1 :
500), which reaches the corners and crevices in the fin-
ger-nails that cannot be reached by the brush.
Some surgeons prefer ether and alcohol to cleanse the
skin. After the hands have thoroughly been scrubbed
in hot soap-suds and the finger-nails cleaned, the hands
are washed in ether, which removes from the skin all
oily and fatty substances; they are next washed in pure
alcohol for one minute, and finally soaked for three min-
utes in a solution of corrosive sublimate (1 : 1000). The
patient's skin is cleansed in the same manner with ether,
alcohol, and the sublimate solution.
The nurse next puts on a sterilized gown. If there
THE PATIENT. 157
are no gowns—as in an emergency case, for instance—
three sterilized sheets (see p. 151) will answer for gowns
for surgeon, assistant, and nurse. The nurse now puts
her hands again through the different solutions, and
stands ready to get anything that may be called for.
After making her hands aseptic the nurse should not
touch her hair, her face, a door-knob, or anything that
has not been made aseptic. If any article falls to the
floor, it must not be picked up unless it is an instrument
that the surgeon will need; then it must be boiled in a
small pan which should be in the room in case this acci-
dent happens. If a sponge falls, the nurse should move
it with her foot to a position where it can be seen. The
assistant will always tell a nurse when he wants fresh
water for sponges; on no account must she take the pail
without his knowledge. If she is asked to do anything
that she does not understand, she should so inform the
surgeon," who will always be perfectly willing to make
the duty clear.
The pails, bowls, and pitchers, and the tray for instru-
ments must be washed inside and out, and filled with
sterilized hot water, which is conveyed from the boiler to
the pail by means of a perfectly clean pitcher or a tin
ladle. The pads and rubbers to be used, also the ope-
rating-table (the patient is generally etherized in bed),
must be thoroughly washed with the corrosive-sublimate
solution (1 : 1000).
If the nurse is to wash the sponges, she should first
make her hands aseptic, then count the sponges as she
puts them into the pail of water, the surgeon counting
them at the same time. She must be on the alert in
case a fresh sponge or a sponge of a certain size is sud-
denly called for; she should then take the soiled sponge
158 PRACTICAL POINTS IN NURSING.
from the surgeon with her left hand and give him the
fresh sponge with her right. She should not, while wait-
ing to hand a fresh sponge, rest her hands or forearms on
the pail; and if she has to stop to get something for the
surgeon or to get fresh water, her hands must again be
washed in the antiseptics before touching the sponges.
If she is to sponge the wound, she should wipe swiftly
and firmly. She should count the sponges before the
surgeon begins to sew up the wound, and should be
very sure that she has the exact number employed in
the operation.
Arranging the Patient for Operation.—When the
patient is brought into the operating-room and placed'on
the table, the clothes must be removed from the part to
be operated upon, to prevent their getting soiled. If the
part to be operated upon is the head or the chest, the
night-gown must be pushed well down under the shoul-
ders ; if it is a breast, an arm, or a leg, the gown should
be opened down the front and be pushed to the opposite
side; if it is the abdomen, the gown and under-vest
must be brought well up under the shoulders and the
under-vest be turned up so as to hold the arms in posi-
tion across the chest.
Sterilized blankets are tucked about the chest and the
feet, the bandage and pad are removed from the part,
and the latter is again thoroughly cleansed with soap
and water and disinfectants. Sterilized sheets and towels
are then arranged about the part. A table for the in-
strument-tray is placed at the surgeon's right side, also
a chair or table on which is placed a pail or bowl of
water for his hands. A table for the pails or bowls for
sponges is placed at the opposite side of the table, at the
assistant's right hand, and the operation is begun.
THE PATIENT.
159
After-care of Patient.—Just before the wound is
closed the soiled towels are removed and replaced by
fresh ones. After the dressing has been applied the
patient is raised, wiped perfectly dry, a bandage put on,
and is then carried to the bed, which has previously been
prepared and heated with heaters well covered to pre-
vent burning the patient. A towel should be placed
under the chin of the patient in case she should vomit,
and a small basin should be at hand, but not where she
can see it on first returning to consciousness. The pa-
tient should not be left until she is well out of the ether.
If there is a member of the family not afraid of the sight
of blood, the nurse may ask her to assist in cleaning up
the room.
Sequelae of Operation.—Shock.—After an operation
the nurse must watch for two things—shock and hemor-
rhage. Shock is great depression of the vital organs of
the body produced through the nervous system, brought
on by injury or surgical operation. The greater the in-
jur)- and the longer the anesthesia, the greater the shock.
The nearer the operation is to the trunk, the greater the
shock. An operation on the abdomen or the amputation
of a thigh is more severe and the shock is greater than
operations on remote parts—a finger or a toe, for in-
stance—because they are farther away from the heart
and the nerve-centres.
Mental shocks, such as sudden joy, grief, or fright,
may be as severe as those of the body. Age modifies
shock. In old people shock is usually more severe and
prolonged, especially if there is any organic disease.
Children recover readily from shock if there has been
veiy little loss of blood. Invalids and individuals used
to suffering stand shock better than those whose nervous
l6o PRACTICAL POINTS IN NURSING.
system is in a high degree of activity. Shock is modi-
fied by mental conditions; it is aggravated by fear, de-
spondency, or depressed mental conditions of any kind,
while it is diminished by cheerfulness, hope, joy, etc.
Two very important points to be remembered in case
of shock and of hemorrhage are the temperature and
the condition of the patient's mind. In shock the tem-
perature at first is normal or very little below normal,
and the senses are dull in proportion to the degree of
shock present; in hemorrhage the temperature is sub-
normal and the mind is bright, keen, alert, and there is
an anxious expression on the face, anticipating danger.
The symptoms of shock are a weak, rapid, and irregu-
lar pulse; sighing; rapid, irregular, shallow respiration ;
temperature normal or very little below; pale face with
a pinched look; cold, clammy skin; the mind dull.
There may be involuntary movements of the bowels and
urine through loss of muscular power; nausea and
vomiting.
The treatment of shock consists in lowering the patient's
head and elevating the arms and the foot of the bed, to
promote the supply of blood to the vital centres; in ap-
plying heat to all parts of the body—the sides, between
the legs, and to the feet—and a mustard plaster over the
heart; in administering stimulants of whisky, brandy, or
pure alcohol hypodermatically; in giving hot coffee or
salt-solution by the rectum and very high up. An enema
of \ ounce of turpentine, a raw egg well beaten up, and
3 ounces of warm water is a powerful stimulant.
It must be remembered that in severe shock the func-
tion of absorption of the stomach and intestines is almost
wholly suspended, and anything given by the rectum
must be given very high up. When the respiration of
THE PATIENT.
\6\
the patient is fast failing, everything depends on main-
taining the heart's action. To this end artificial respira-
tion must be persistently practised. When the depres-
sion is deepened by hemorrhage, transfusion must be
resorted to. External heat is the most powerful of all
heart-stimulants, and often when the heart's action
threatens to fail it may be restored by heat over the
heart and by hot fluids taken into the stomach.
Strychnia is a powerful heart-stimulant, and, if at hand,
■^5- grain should be given every half hour for four doses.
Tincture of digitalis in 15-minim doses may be given
every half hour for four doses. Ether alone, or mixed
with an equal part of alcohol, has a more rapid stimulant
action than alcohol. Recovery may be rapid or very
slow ; then we get what is called " reaction "—the pulse
becomes more full, slow, and regular, the temperature
rises, the body becomes warm, and a general improve-
ment takes place.
Collapse is an extreme degree of shock, and almost
invariably ends in death.
Hemorrhage may be caused by the slipping of a liga-
ture or the displacement of clots, due either to restless-
ness or to reaction of the circulation, and it generally
occurs within the first twenty-four hours after the
operation.
The symptoms of internal hemorrhage are restlessness,
thirst, faintness, an anxious expression, pale face, cold
skin, frequent and irregular respiration, subnormal tem-
perature, and a weak, rapid pulse (120-140), though
there have been cases of internal hemorrhage in which
the pulse has not gone above 94 beats to the minute, all
the other symptoms being very marked.
11
162 PRACTICAL POINTS IN NURSING.
Treatment of Hemorrhage.—The two things to be
remembered in the treatment of hemorrhage are position
and pressure. The part from which the blood is coming
should be elevated and the patient's head lowered, to pro-
mote the supply of blood to the vital centres. If the
nurse can apply pressure by putting her finger on the
artery, she should do so, or she may plug the wound
tightly with sterilized gauze or a compress, and hold
it there until the arrival of the surgeon, who must im-
mediately be summoned. The patient is to be kept
perfectly quiet on her back. If symptoms of shock
supervene, heat is to be applied to all parts of the
body by warm blankets and hot-water bottles. Stimu-
lants are to be given only if the pulse is failing. When
the hemorrhage has been excessive, transfusion is often
resorted to, the fluid that the body has lost being thus
replaced.
Transfusion is the injecting of blood from the vein of
one person into that of another or the injecting of a
saline liquid, for the purpose of replacing the blood lost
by hemorrhage. The most common normal saline solu-
tion used is salt-solution, which consists of i^ teaspoons-
ful of common salt to i quart of boiled water. The
amount of solution injected varies from 8 ounces to a
pint. The parts used for injection are the chest, the
abdomen, the thigh, or the arm. For transfusion there
will be needed an irrigator which has been thoroughly
sterilized with boiling water and corrosive sublimate
(i : iooo), followed by the boiling water, or a rubber
tube and a glass funnel. The needle used resembles a
hypodermatic needle, but is much larger. It must be
boiled for several minutes, and fastened to the end of the
THE PATIENT.
163
rubber tube connected with the irrigator. The tempera-
ture of the solution should be about ioo° F., and the
solution must be strained through gauze or cotton when
being poured into the irrigator. The part is washed with
carbolic-acid solution (1 : 20) before the needle is inserted.
After-treatment of Patient.—Rest.—The after-treat-
ment of every surgical operation consists in perfect rest
of the patient on the back for a certain length of time, to
prevent the ligatures giving way and to prevent irritation
of the stomach and vomiting.
The diet following operations is liquid until after the
third day and the bowels have moved; then a light diet
is given, such as cream toast, a soft-boiled egg, custard,
buttered bread with the crust removed, cocoa, etc.; solid
diet is afterward gradually resumed.
After-treatment in Amputations.—After the amputation
of a thigh the stump must slightly be elevated on a pil-
low and a cradle be used to keep off the weight of the
bed-clothes. A careful watch should be kept for hemor-
rhage. When a breast has been amputated, the arm is
confined to the side by a bandage. The arm will become
very tired; this tired feeling can be relieved by putting
under the arm a small pillow, upon which it can rest.
After-treatment in Abdominal Operations.—After ab-
dominal operations the patient cannot have anything by
mouth for a certain number of hours. The extreme
thirst can greatly be relieved by frequent bathing of the
hands and face with alcohol and tepid water or with
water alone. After operations on the abdomen it is well
to place a roll under the knees. This roll will relax the
abdominal muscles, and also remove the strain the patient
would have to make to keep up the knees.
.164 PRACTICAL POINTS IN NURSING.
The external genitals are to be kept perfectly clean,
the body is to be bathed, the bed and body-linen are to
be kept sweet and clean, the teeth are to be brushed, and
the hair is to be combed after the third day. Every
want of the patient should be anticipated, and she should
be made as comfortable and happy as possible. No
visitors are to be admitted without the surgeon's consent.
The mind of the patient is to be kept perfectly free from
worry and excitement, and the whole atmosphere of the
room should be bright, pleasant, and cheerful, no matter
what trouble is going on outside. The nurse must not
allow the patient to sit up until two weeks after the ope-
ration, as there is danger of a clot (thrombus) forming in
a vein and being carried by the circulation to the pul-
monary artery, causing sudden death.
Bladder and Bowels.—The catheter should be passed
every six or eight hours if necessary, according to direc-
tions. The passage of gas by the rectum is a very good
sign, as it shows that the bowels have regained their
normal tone and that there is no obstruction.
Drainage-tube.—If a drainage-tube is in the abdomen
and the care of it is left to the nurse, she must each time
before draining thoroughly scrub and sterilize her hands.
The syringe must be washed first with boiling water, the
water being passed through it several times, then with
corrosive-sublimate solution (1 : 1000), followed with boil-
ing water; the syringe is then to be laid in the corrosive
solution until the nurse has washed her hands a second
time and unpinned the dressing covering the tube. The
rubber tube attached to the syringe is passed down
the centre of the drainage-tube to the bottom, then with-
drawn a little, so that only the fluid will be drawn up,
and not the tissues of the pelvis. The syringe piston is
THE PATIENT.
I65
to be slowly and steadily drawn up. When removing
the syringe the nurse should be careful that the blood
does not drop on the dressing. The mouth of the tube
is to be covered while the syringe is being emptied, and
the corrosive and hot water are to be passed through the
syringe before again putting it down the tube.
Some surgeons prefer gauze drainage, a piece of twisted
gauze being put into the tube, that sucks up the fluid.
This gauze is changed at stated intervals, and the tube
is cleaned with a small piece of sterilized cotton or gauze
fastened on the end of a pair of long fine forceps; then a
fresh twist of gauze is inserted. With both these meth-
ods the amount of fluid drawn and its character must be
reported. When the drainage-tube is to be removed,
the nurse should observe the same precautions as she
would for a dressing.
Hysterectomy.—The after-care of a hysterectomy, which
is the complete removal of the womb and ovaries, either
through the vagina (vaginal hysterectomy) or through
the abdomen (abdominal hysterectomy), is the same as
after any abdominal operation. Regarding the question
of the mild form of insanity which may follow a hyster-
ectomy or the removal of a large fibroid tumor, one
must know that a large amount of blood is taken from
the body, and that the cutting and tying of the large
blood-vessels alters the circulation; the operation is also
more or less a shock to the nervous system, and may
affect the brain. Insanity is not a complication of this
operation, the recovery from which is usually rapid; but
when insanity does set in, this is commonly the cause,
and the patient generally recovers.
Septicemia.— Septicemia is blood-poisoning caused by
the entrance of germs into the body through the agency
166 PRACTICAL POINTS IN NURSING.
of unclean hands (especially dirty finger-nails), instru-
ments, sponges, towels, dressings, or the passing of a
dirty catheter into the bladder, or in not washing the
parts before catheterization. When septicemia occurs, it
is generally the surgeon or attendants who must be
blamed. In a very large majority of surgical cases the
patient is in a healthy condition, and by a conscientious
preparation of the patient for the operation, be it ever so
simple, and of the room and of everything that will be
used, the patient should and does make a good recovery.
Should a healthy patient die of sepsis, then some one is
always to blame; the germ was introduced by some one.
Death may be due to some cause such as heart-disease,
over which the surgeon has no control, the patient being
willing to take the risk when consenting to the operation.
Septicemia, or septic peritonitis, may occur any time,
from a few hours to six days after the operation. The
temperature is about ioo° F., and the pulse rises rapidly
to 115, 120, or 130 beats per minute, and is weak and
thready; then the temperature rises to 1030 F. or above,
or it may range between ioo° and 1010 F. until just
before death, when it has been known to rise to 1080 F.
The abdomen is distended" with gas; vomiting occurs
(the ejected matter having a dark-brown color resem-
bling coffee-grounds and a characteristic fecal odor); a
cold perspiration appears: the patient has a very anxious
expression and is restless and talkative; the eyes are un-
usually bright.
Treatment of Septicemia.—The nurse should send at
once for the surgeon, and in the mean time try to move
the patient's bowels with high enemata of turpentine,
glycerin, oil, salts, melted vaselin, butter, lard, or mo-
lasses, or soap and water if there is nothing else at hand
THE PATIENT. 167
The enemata should be given every two hours until
the bowels are thoroughly moved or large quantities of
gas are passed, because it is only by putting the bowels
into an active state that one can overcome threatened
paralysis of the intestines, and enable them to take up
from the peritoneal cavity whatever blood-serum may be
there. Stimulating enemata of whisky 1 ounce and warm
water 2 ounces should be given every hour and a half.
Brandy should not be used, because it is constipating.
Strychnia, being a powerful heart-stimulant, is given in
doses of grain -^ every hour until its physiological effects
are produced. It must be stopped at the first appearance
of twitching of the muscles of the face or of the limbs, and
stiffness of the neck. Vomiting may be relieved by wash-
ing out the stomach or by the application of a mustard
plaster over the stomach. If after repeated efforts the
bowels are not moved by the third day, the result is
usually fatal. All the symptoms deepen. The surface of
the body is cold and clammy; the face is pinched and
sunken and has a dusky hue; the restlessness increases,
also the thirst, which is very great, and to the last the
patient calls for water, which is vomited immediately after
being taken, but which it is cruel to withhold. The mind
is usually clear to the end.
Surgical Disinfection and Materials.—Antisepsis and
Asepsis.—Antiseptics prevent the growth of germs and
putrefaction; a disinfectant destroys germs; and a de-
odorant destroys bad odors. Although an antiseptic
may be a disinfectant and probably a deodorant, it does
not follow that because a deodorant will destroy bad
odors it will also kill germs. The best deodorant is
pure, fresh air and sunlight; next, carbolic acid (which
is both a disinfectant and a deodorant), charcoal, or lime.
l68 PRACTICAL POINTS IN NURSING.
Asepsis, or sterility, means freedom from septic germs.
For instance, before an operation the hands and fore-
arms are scrubbed with nail-brush, soap, and hot water
to cleanse them and remove the germs; then the hands
are entirely freed from germs by putting them in the
different antiseptic solutions ordered by the surgeon,
thus reaching the corners and crevices in the finger-nails
and skin that the brush could not reach; in this way
the hands and forearms are rendered thoroughly asep-
tic. The sheets, blankets, towels, gowns, instruments,
sponges, and dressings are subjected to dry or moist
heat, according to the orders of the surgeon, for a cer-
tain length of time. Everything to be used at the
operation is made as thoroughly aseptic as possible, and
only that which has been rendered aseptic must be
touched by those assisting at the operation.
Antiseptics.—Some of the commonest antiseptics in
use are corrosive sublimate, carbolic acid, permanganate
of potash, creolin, thymol, boric acid, lysol, alcohol,
peroxid of hydrogen, iodoform, and dermatol.
Corrosive sublimate and carbolic acid are the best dis-
infectants and antiseptics, but the corrosive cannot be
used for the instruments or the clothing, on account of
its discoloring properties; it is used in solutions of from
i : 500 to 1 : 10,000.
Carbolic acid does not discolor clothing or instru-
ments, it having this advantage over corrosive sublimate,
but it irritates and benumbs the hands. The strengths
of the solutions used are from 1 : 20 to 1 : 80. The acid
is bought in the liquid form, having a strength of 95
per cent. To make a solution of 1 : 20, 1 :40, 1 : 60, or
1 : 80, 1 ounce of the 95 per cent, solution is added to
20, 40, 60, or 80 ounces of water.
THE PATIENT.
169
Both corrosive sublimate and carbolic acid are very
poisonous ; for this reason many surgeons have the parts
washed with plain water after using these antiseptics, to
prevent absorption. Symptoms of poisoning have been
produced by the absorption of these drugs from surgical
dressings.
The first evidences of carbolic-acid poisoning are a
very dark coloration of the urine, giddiness, ringing or
singing in the ears, headache, and lassitude.
The first symptoms of mercurial poisoning (corrosive
sublimate) are fetid breath, excessive salivation, a metal-
lic taste in the mouth, swollen and spongy gums, with a
dark line at their upper margin, loosened teeth, and
swollen tongue. If the use of these drugs is persisted
in, all these symptoms deepen. On the appearance of
any of these symptoms the dressing should be removed.
Creolin is not so poisonous as the two above-named
drugs, but it cannot be used for instruments, because
of its yellow color, which prevents their being seen at
the bottom of the tray. For cleansing the hands or
other parts a 5 per cent, solution is used. To make a
2 per cent, solution 2\ teaspoonsful of creolin are added
to 1 pint of water.
Boric acid is an unirritating and non-poisonous anti-
septic ; a 4 per cent, solution is generally used.
Lysol as an antiseptic is much objected to by some
surgeons on account of its soapy properties. When
used for instruments it makes them slippery. The
strongest solution used is 2 per cent.
Permanganate of potash is an antiseptic used to
cleanse the hands and other parts before operation, fol-
lowed by a solution of oxalic acid to remove the stain.
The permanganate stains everything with which it comes
170 PRACTICAL POINTS IN NURSING.
in contact; it also causes pain and burns if used in very
strong solutions. The strength of the solution gen-
erally used is from 20 to 60 grains of the crystals to the
pint of warm water.
Oxalic acid will remove permanganate stain from the
skin. This method is very irritating to the skin, but the
irritation can in a measure be avoided by immersing the
hands and forearms afterward in lime-water. Oxalic
acid also removes permanganate stain from white goods,
and hydrate of ammonia will remove the stain from
black goods.
Condy's fluid, which contains 16 grains of perman-
ganate-of-potash crystals to 1 ounce of water, is both a
disinfectant and a deodorant.
Iodoform is an antiseptic that may be absorbed into
the system if applied to raw surfaces and cause iodoform
poisoning. The symptoms of absorption are headache
and loss of appetite, followed by rise of temperature,
rapid and feeble pulse, and restlessness; a bright-red
eruption appears on the face and limbs, and there may
be retention of urine.
Peroxid of hydrogen, which is the most expensive anti-
septic now in use, destroys the germs of pus. When
poured into a wound an effervescence takes place which
ceases only when the wound is rendered sterile, and
which carries off any shreds of tissue in the wound that
cannot easily be reached. It is also applied to the throat
in diphtheria to destroy and remove the false membrane.
Peroxid readily decomposes by coming in contact with
metals. If used as a spray, a glass atomizer must be
employed; the bottle must not be kept in a bright light,
nor should the mouth of the bottle remain unstoppered
any longer than necessary.
THE PATIENT.
171
Absolute alcoJiol is an antiseptic used for cleansing the
skin; it is also used for sterilizing silk, catgut, and silk-
worm-gut sutures and ligatures.
The best disinfectant is heat—either dry heat (baking)
or moist heat (steam). Water of a temperature of 212° F.
will kill germs on contact.
Suturing.—Sutures, which are used to bring the edges
of a wound together, are of silver wire, silk, catgut, or
*'&
,«•;*#«;?>'??
Fig. 39.—Interrupted suture (Bernard
and Huette).
Fig. 40.—Continued or glover's suture
(Bernard and Huette).
Fig. 41.—Button-suture (Bryant).
silkworm gut. The interrupted
suture (Fig. 39) is made by pass-
ing catgut or silk through the
skin from one side of the wound
to the other ; then both ends are
drawn together and tied in a
double knot. The continuous
suture (Fig. 40) is the ordinary over-and-over stitch from
one end of the wound to the other. The button suture
(Fig. 41) is made by passing wire across the bottom of
the wound, bringing out the ends about 1 inch from the
edge of the wound, and securing each end with a button.
Ligation.—Ligatures, which are used for tying large
blood-vessels, are of heavy twisted silk, silver wire, silk-
worm gut, or catgut.
Sterilizing Sutures.—The catgut is soaked for twelve
hours in corrosive-sublimate solution (1 : 1000), and after-
ward, for twenty-four to forty-eight hours, in oil of juniper.
172 PRACTICAL POINTS IN NURSING.
The spools are then transferred to covered glass jars con-
taining sufficient absolute alcohol to completely cover the
catgut. The alcohol is changed every two weeks.
Gauze Sponges.—The sponges most commonly used
are gauze pads, the cut edges being folded over and
loosely hemmed, and little gauze bags, made by wrap-
ping cotton waste in squares of gauze, the corners being
brought together and stitched firmly at the top. Gauze
sponges are never employed more than once. Those
used in operations are afterward destroyed; those not
used are re-sterilized, placed in sterilized towels, and de-
posited in covered glass jars which are not uncovered
until called for at an operation.
In these days of antiseptic surgery the surgeon gen-
erally attends to the preparation of the sutures, ligatures,
and sponges: when this duty is left to the nurse it is a
clear proof that the surgeon has great confidence in her,
for septic material may as readily be conveyed into the
wound by dirty sponges, sutures, and ligatures as by
the hands, instruments, and dressings.
IV. ACCIDENTS AND EMERGENCIES.
i. Surgical Accidents.
Fractures.—A fracture is the breaking of a bone into
two or more pieces. A simple fracture is a single break
without injury to the flesh. A compound fracture is a
single break with injury to the flesh. A fracture is said
to be comminuted when the bone is broken into several
pieces. An impacted fracture is one in which one frag-
ment is driven and fixed into another. A green-stick
fracture is one in which the bone is bent and partially
broken. It occurs chiefly in young children.
ACCIDENTS AND EMERGENCIES. 173
A fracture is said to be complicated when there is
other injury, such as a lung punctured from a broken
rib, or a nerve or a blood-vessel is injured, or when other
bones or joints are injured. Fractures are also trans-
verse, longitudinal, or oblique.
Signs of a Fracture.—The signs of a fracture are
loss of power, pain, swelling, crepitus (which is the
grating made by the rubbing of the ends of the broken
bone together, and which may be both heard and felt),
distortion, and deformity.
Bone-repair.—The repair of a broken bone is very
interesting. At first blood is poured out around the
ends of the broken bone and surrounding tissues. This
blood gradually becomes infiltrated with lime and thick-
ens to the consistency of jelly, which is then called " cal-
lus." The callus cements and unites the broken ends
of the bone, and by the deposit of new bone-forming
cells gradually hardens and eventually becomes bone.
The union takes about six weeks, though it is about
nine months before being thoroughly complete.
Management of Fractures.—The management of a
broken bone until the arrival of a surgeon consists in
securing perfect rest. If a leg be broken, the patient
should be laid on a stretcher, a door, or a shutter; a
splint may be improvised with an umbrella, a walking-
stick, a thin board, books, newspapers, or a coat rolled
up and tied to the side of the leg with handkerchiefs
above and below the seat of fracture. If none of these
articles are at hand, then both legs may be tied together.
The patient's clothes must be removed from the sound
side first. The clothes should not be torn, but should
be opened at the seams, which can easily be sewed up
again. To remove the boots, one hand should be
174 PRACTICAL POINTS IN NURSING.
placed at the ankle to steady the limb, and with the
other hand the boot may be removed. If the foot is
injured or if there is much pain, the seam of the boot
must be cut open. Garters must be removed before the
stockings, and the suspenders unfastened in front and
behind before the trousers are removed. Work should
be quiet and steady, as there is danger of converting a
simple into a compound fracture through the broken
ends of the bone running through the skin. If there is
shock, heat is to be applied and stimulants given.
The bed is to be made in the usual way, with a board
underneath the mattress to prevent it sinking in the
middle. A pillow should be placed around the limb
and fastened with safety-pins, and a sand-bag should be
placed on each side of the limb to keep it in position.
Sand-bags are made of stout ticking, cotton, or any
material that is sufficiently fine to prevent the sand from
escaping into the bed. They should be long enough to
extend from below the foot to above the knee, and be
about 6 inches wide. The sand must be thoroughly
dry, and the bags be filled about three parts full. The
limb should be elevated on pillows; the toes must point
upward.
Before the arrival of the surgeon the nurse must get
the part and the patient as clean as possible. She
should have ready cotton or gauze bandages of different
widths (from 3 to 6 inches); sheet-wadding bandages
(about 4 inches wide), which, if a plaster-of-Paris band-
age is applied, will be put on first to protect the skin;
sheet wadding; plenty of warm water; towels; corro-
sive-sublimate solution (1 : 1000) or carbolic-acid solu-
tion (1 : 20); sheets to cover the surgeon and to protect
the bed and the floor. If sheets cannot be had, news-
ACCIDENTS AND EMERGENCIES. 175
papers may be used for the bed and floor and a large
apron for the surgeon.
A patient with a broken leg is generally in bed from
four to six weeks, and one with a broken thigh from
eight to ten weeks. Bed-sores must not be allowed to
form, and will not form if proper care be taken, unless
the spine is broken or the nerve-supply is injured, in
which case they will form even with the best of care.
A broken arm after being dressed (Fig. 42) should be
put in a wide sling (Fig. 43) made with a large handker-
Fig. 42.—Splint for a fractured arm.
chief folded diagonally, the ends tied around the neck,
the point turned up above the elbow and fastened with
safety-pins.
For a broken jaw the mouth should be closed firmly
and bandaged with a folded handkerchief or a four-tailed
bandage (Fig. 44).
Fig. 43.—Handkerchief sling Fig. 44.—Four-tailed bandage
for a broken arm. for the jaw.
When the collar-bone is broken a pad of cotton should
be put under the arm and the arm be bound across the
chest.
176 PRACTICAL POINTS IN NURSING.
Dislocations.—A dislocation is the displacement of the
bone or bones of a joint by some external violence, such
as a fall or a blow. A compound dislocation is one in
which there is a wound connecting with the joint. The
patient should be put to bed on his back, the part band-
aged, and ice applied to prevent inflammation.
Dislocation of the lower jaiv, which is sometimes
caused by yawning, can generally be overcome by the
nurse wrapping her thumbs in a handkerchief and placing
them in the patient's mouth on the lower back teeth and
pressing down and back, when the bone will generally
slip into its place.
Sprains.—A sprain is the wrenching of the ligaments
of a joint; there may also be rupture of the fibres and
blood-vessels. The limb should be placed first in mod-
erately hot water, and the temperature gradually be raised
until it is as hot as the patient can bear, the limb remain-
ing in the water for about half an hour; or hot fomenta-
tions may be applied and the limb be placed in a com-
fortable position.
Surgical Dressings.—Surgical dressings are divided
into dry and moist; the latter is commonly called a
" water-dressing." Ordinary cheese-cloth (prepared by
being boiled for two hours in water to which has been
added some washing-soda, after which the cloth is wrung
out and washed in plain water to remove the soda, and
again boiled for two hours in plain water, then taken out
and dried), absorbent cotton, or the ordinary cotton-
wool, pads of graduated compress, iodoform gauze, and
permanganate gauze, are all used as dressings, though in
an emergency old sheets, linen or cotton, cut to the de-
sired size and sterilized in an oven, make very good ster-
ilized dressings.
ACCIDENTS AND EMERGENCIES.
For a water-dressing several thicknesses of gauze are
wrung out of the ordered hot solution, applied over the
part, and covered with two layers of sheet-cotton and a
single piece of oil-silk or oil-paper, the whole being kept
in place by a gauze bandage.
A dry dressing consists in covering .the wound with
several thicknesses of sterilized gauze, over which is
placed two or three layers of sheet-cotton, both dress-
ings being secured by a bandage. Many surgeons first
powder the wound with iodoform or a preparation of
boric acid and iodoform or dermatol powder, to prevent
irritation and chafing and to absorb the moisture.
Tents are small strips of rolled gauze and are used to
keep wounds open for the escape of pus.
Management of Surgical Dressings.—Before beginning
to do a surgical dressing the nurse should see that every-
thing is ready. She should try to remember the favorite
dressings for the different surgeons: this is sometimes
rather difficult; still, after seeing a dressing done once
she should, if quick and intelligent, know what will be
needed the next time. Besides the dressings there will
be needed a basin of warm corrosive-sublimate solution
(i : iooo) for the hands, a basin of carbolic-acid solution
(i : 20) for the instruments, towels, and a pail or a basin
for the soiled dressings and discharges. If asked to pre-
pare a wound for the surgeon's inspection, the nurse
must wash her hands with soap and water and corrosive-
sublimate solution, having first covered any cut or scratch.
She should then remove the bandage and dressing, which,
if it adheres to the wound, may be wet with corrosive-
sublimate or carbolic-acid solution, after which it will
easily come off The nurse should wash toward, not
away from, the wound, and cover it with a cloth wet in
12
178 PRACTICAL POINTS IN NURSING.
carbolic-acid solution until the surgeon is ready to
inspect it. To remove a plaster begin at each end and
work toward the wound. Putting one hand on the skin
and pressing firmly down will prevent the peculiar tear-
ing feeling of which a patient will complain. The marks
of the plaster can be removed with alcohol, ether, tur-
pentine, or soap and water, care being taken that the
solution used does not enter the wound.
Bandages.—Bandages are to retain dressings and
splints in position, and also to apply pressure. Almost
any kind of household muslin or gauze may be used for
a bandage. Gauze is the best, on account of its elasti-
city ; it can be applied to any irregular surface, and it
is not necessary to reverse a gauze bandage. Shaker-
flannel cut on the bias is used where greater strength is
required and to make firm pressure.
Rubber Bandage.—Rubber or elastic bandages are to
prevent hemorrhage and to prevent or reduce swelling.
The rubber bandage is put on from below upward, with-
out reverses. It must not be drawn too tight nor be
left on too long, or paralysis from pressure on the nerves
of the part may result, or the circulation will be interfered
with or entirely cut off. Rubber bandages should be
rolled up quite loosely and be kept in a dark, moist
place, or they become brittle and break into pieces.
Roller-bandages.—Roller-bandages are from \ inch to
6 inches wide and from 2 to 8 yards long. The selvage
must always be removed, the bandage rolled very tightly
and evenly by hand or on a regular bandage-roller, and
the loose threads of the edges trimmed off.
In applying a bandage the nurse should hold the
bandage in one hand, and, taking the loose end in the
other hand, should so apply it to the part to be bandaged
ACCIDENTS AND EMERGENCIES. 179
that the outer surface may be against the skin, and that
the bandage will lie close to the limb (Fig. 46). All band-
ages must lie smoothly and their pressure be uniform. A
Fig. 45.—Bandaging an ankle. Fig. 46.—Bandaging aleg, showing meth-
od of reversing the bandage.
bandage should always begin from the inner side of a
limb, and thus bring the turns to its outer side (Fig. 45).
A bandage must not be put on too tightly, as there is
considerable danger of inflammation or of gangrene
through the circulation being interfered with or being
entirely cut off. It should fit snugly to the part, and an
equal amount of pressure should be maintained. Inflam-
mation and gangrene (death of a part) are often caused
by tight bandaging. The fingers or the toes must be
left exposed, so that one can see if the circulation is car-
ried on all right. They should feel warm to the touch,
and the color should disappear upon pressure and reap-
pear when the pressure is removed. If they are cold,
numb, swollen, or have a livid appearance, the bandage
should be loosened. If in compound fracture the patient
has pain, the pulse and temperature should be taken and
the surgeon be notified. The bandage or dressing must
not be removed unless the splints are pressing unevenly
or displacement has occurred, or the fingers and toes are
congested or swollen and there is danger of gangrene.
l8o PRACTICAL POINTS IN NURSING.
When taking off a bandage it should be rolled up
loosely in the hand as it is unwound, thereby keeping it
all together.
The simplest forms of bandaging are the spiral and
the figure-of-8 bandage.
The spiral bandage consists in covering a limb by a
series of spiral turns, each turn overlapping the one
below for about one-third its width. In most limbs the
enlargement at the upper part prevents the application
of a spiral bandage without making a reversed turn in
it. Without this turn only one edge of the bandage
would come in contact with the part, the other would
stand freely away from it. The reverses are made by
placing a finger on the lower edge of the bandage to
hold it firmly in position, and folding the bandage down-
ward upon itself (Fig. 46). The turns should not be
made over the prominence of a bone, and where possible
should be made on the outer side of a limb. At the
moment of making the turn the bandage should be held
quite loose, and after the turn has been made it can be
Fig. 47.-Figure-of-8 bandage. Fig. 48.-Bandaging a wrist.
pulled as tight as necessary. In making the turn the
hand should be held a little above the limb, and care be
taken not to unroll more bandage than is necessary.
ACCIDENTS AND EMERGENCIES. l8l
The figure-of-8 bandage (Fig. 47) is the one most fre-
quently used; it is easier to apply and it fits better. It is
applied alternately above and below, each succeeding
turn overlapping its neighbor by one-third its width.
The figure-of-8 bandage needs very few reverses; still,
they must be employed should occasion require them.
The Desault bandage (Fig. 49) is applied in the treat-
ment of fracture of the clavicle.
Fig. 49.—Desault's bandage : a, first roller; b, second roller; c, third roller.
Divided Bandages.—The four-tailed bandage (Fig.
50) is useful for dress-
S
E
Fig. 50.—Four-tailed bandage.
ings about the face (Fig.
44), the scalp (Fig. 58),
and the knee. A many-
tailed bandage (Fig. 51)
is applied to a limb
which requires frequent
dressing, and consists of
a piece of linen or muslin
the length of the limb
and wide enough to go
one and a half times
around. The muslin is torn from each side, in strips
about 2 inches wide, to within about 3 inches of the
Fig. 51.—Many-tailed bandage.
182 PRACTICAL POINTS IN NURSING.
middle. The central part of this bandage is placed under
the limb, and the tails are drawn to the front over the
dressing and tied; beginning at the lowest pair, the ends
are brought up and the next pair tied over them.
The Scultetus bandage (Fig. 52) is used for bandaging
the abdomen, and is made by taking two pieces of flan-
nel or of cotton, each 1 yard long and 4 inches wide,
the two pieces being placed 4 inches apart; across them
are sewed five other pieces of the same length and width,
each piece being overlapped by the one above it by one-
half its breadth. This bandage is placed under the pa-
tient's back, the cross strips are folded over the abdomen
from below upward, and the lower ends of the vertical
Fig. 52.—The Scultetus bandage. Fig. 53.—T-bandage.
strips are brought up between the thighs and pinned to
the front of the bandage. This keeps the bandage from
wrinkling and retains it in position.
T'-bandage.—The T-bandage (Fig. 53), which is to
secure dressings on the anus or the perineum, is made
of two strips of bandage, each about 5 inches wide. To
the middle of one strip, which is to go around the waist,
the end of the other strip is sewed, and is passed be-
ACCIDENTS AND EMERGENCIES. 183
tween the thighs and fastened in front to the waist band-
age with safety-pins.
HandkercJiicf Bandages. — Handkerchief bandages
(Figs. 54-58), which are very useful in emergencies,
Fig. 54—Handkerchief Fig. 55.—Three-cornered Fig. 56.—Four-cornered
bandage for perineum and bandage for arm. bandage for arm.
hip.
consist of large handkerchiefs or of pieces of linen or
muslin, each about 32 inches square. The triangle is
Fig. 57 —Various forms of handkerchief bandages : a, for the chest: b, for the shoul-
der, hand, and arms ; c, double bandage to prevent motion of the arm.
made by cutting the square diagonally, so that two
three-cornered pieces is the result. A cravat is made by
folding in the sharp corner toward the base of the tri-
angle until a bandage about 3 inches wide is formed.
184 PRACTICAL POINTS IN NURSING.
Muslin cut in the form of a Maltese cross is used to
apply a dressing snugly over an amputation-stump.
Fig. 58.—Four-tailed bandage for the head.
Plates 1 and 2 give a very good idea as to the
various applications of roller-bandages.
Plaster-of-Paris Bandage.—Plaster-of-Paris bandages,
which are intended to prevent all motion in a part, are
made by sprinkling gauze or cotton bandages with
dentists' plaster of Paris; these bandages are loosely
rolled and kept in a covered jar or a tin box to ex-
clude the air.
When needed the rolled bandages are placed in warm
water to which has been added a little salt, to help the
plaster to set more rapidly; they remain in the water
until the water-bubbles cease, when they are wrung out
by holding the bandage at each end, thus preventing the
plaster coming out at the sides, which happens if the
bandage is taken in the hand and squeezed in the middle.
A little plaster cream should be prepared, to be applied
over the bandage after its application to fill up any crevices.
The cream must be constantly stirred or it will gradually
thicken and become hard. The limb is first enveloped
in a thick layer of sheet wadding, then the prepared
bandages, after having been thoroughly wet, are applied
in the usual manner. After the bandage has been ap-
mandating.
F'LATK I.
i. Demi-gaunllet bandage; 2. Gauntlet bandage; 3. Spica of the thumb; 4. Spiral reverse
bandage of the upper extremity ; 5. Recurrent bandage of a stump; 6. Spiral reverse bandage of
the lower extremity (from An American Text-Book 0/ Surgery).
bandaging.
Plate 2.
1. Figure-of-8 bandage of the ankle; 2. Method of covering the heel; 3. Recurrent bandage of
the head; 4. Crossed ngure-of-8 bandage of both eyes; 5. Barton's bandage, or figure-of-8 of the
jaw; 6. Yelpeau's bandage (from An American Text-Book 0/ Surgery).
ACCIDENTS AND EMERGENCIES. 185
plied the dressed limb is exposed to the air until the
bandage is dry and hard; after this the limb is placed
between sand-bags, covered with the upper bed-sheet,
and the weight of the blankets is supported by a cradle.
Another method of making the plaster bandage is to
shake the plaster into cold water until the mixture is of
the consistency of cream; the plain muslin or gauze
bandage is unrolled in a basin of water, re-rolled in the
basin containing the plaster cream, and then applied; but
this method is only resorted to when the powdered band-
ages are not prepared. The cream must be constantly
stirred or it will gradually thicken and become hard.
If the bandage is applied to the upper part of the
thigh, where it is likely (especially with children) to get
wet with urine or soiled with fecal discharge, it may be
kept clean by giving it a coat of varnish.
Silicatc-of-soda Bandage.—A silicate-of-soda dressing
consists in protecting the limb as in the case of a plaster-
of-Paris bandage, after which bandages saturated with
silicate of soda are applied. Another way is to bandage
the limb with muslin bandages and paint each layer with
the silicate. From three to five layers of bandage are
generally applied. The disadvantage of this dressing is
that it takes too long for it to dry thoroughly; it is
readily removed with water.
Starch Bandage.—A starch bandage is made by mix-
ing starch in the way it is ordinarily prepared for laundry
purposes, applying a bandage over the limb, and painting
the starch over the bandage; strips of pasteboard are
soaked in the starch, laid along the limb for support, and
another starch bandage is applied over the pasteboard.
Chalk-and-gum Bandage.—A chalk-and-gum bandage
is applied in the same way as the starch bandage. The
186 PRACTICAL POINTS IN NURSING.
mixture is prepared by taking equal parts of gum-arabic
and precipitated chalk, and adding boiling water until
the admixture becomes of the consistency of thick
cream. This mixture dries more quickly than starch,
which takes two or three days to dry, and the bandage
is also stouter. The plaster-of-Paris bandage has the
advantage over all other bandages in being more durable
and in the rapidity with which it can be applied and with
which it sets.
Splints.—Splints are used to keep a broken bone in
its proper position. A splint should fit above and below
the seat of fracture, care being taken that it does not
press upon any prominent part. There are a large
variety of splints which are adapted for every part of the
body, but perhaps the commonest are the coaptation
splint, which can be adjusted to any part, and the plaster-
of-Paris splint.
Splints may be improvised with cardboard, gutta-
percha, leather, felt, tin, wood, an old hat, a coat rolled
up, an umbrella, a walking-stick, or newspapers, The
cardboard, leather, or gutta-percha is first soaked in hot
water, after which it will easily mould to the part; such
splints are perforated to allow the escape of perspiration.
They should be covered with a compress or with sheet
wadding of three or four thicknesses, brought smoothly
over the edges and stitched firmly or held in place with
strips of adhesive plaster.
Plaster-of-Paris Splint.—A plaster-of-Paris splint is
made by taking flannel, linen, or muslin (folded to three
or four thicknesses) to envelop the limb, and stitching
through the middle of the folds after the manner of
stitching the leaves of a book. The folded material is
soaked in the plaster-of-Paris cream, laid on a board,
ACCIDENTS AND EMERGENCIES. 187
opened out, and applied over the limb, which is first cov-
ered with sheet wadding. Plaster of Paris must be kept
covered, as it absorbs moisture from the air; if it is
moist, it can be dried in the oven.
This bandage is readily removed by making a line
with a knife and dropping water along the line from a
medicine-dropper or a spoon to soften the plaster, after
which the bandage can be cut with scissors and removed.
Extension.—Extension (Fig. 59) is used to prevent
the shortening of a limb. To prevent the extension-
apparatus gradually pulling the patient's body to the
Fig. 59.—Extension apparatus.
foot of the bed, the foot of the bed must be raised on
two blocks of wood (8 or 10 inches high), thus obtaining
counter-extension by the weight of the patient's body,
everything being taken away from under the patient's
head except a small pillow. The materials required for
extension are two strips of adhesive plaster 3 inches wide
and long enough to reach from above the knee to below
the foot, leaving a loop. A piece of wood (4 inches long
and 1 inch thick), having a hole pierced through its cen-
tre, is inserted in the loop beneath the foot and fastened
in place. The adhesive-plaster strips are placed along
188 PRACTICAL POINTS IN NURSING.
the sides of the leg to above the knee, and further se-
cured by a bandage. One end of a stout cord is passed
through the hole in the wood and knotted. The cord is
carried over a pulley attached to the foot of the bed and
fastened to a weight. Smoothing-irons, bricks, or sand-
bags may be used as weights: these must first be
weighed, so that the surgeon will know the number of
pounds he is putting on.
Wounds.—A wound is defined as a solution of con-
tinuity of the tissues—a separation of the continuous
parts by violence. There are different kinds of wounds
—incised, contused, lacerated, punctured, gunshot, or
poisoned. An incised wound is a cut made with a sharp
instrument. Contused and lacerated wounds are made
with a blunt instrument, the tissues being torn and
bruised. A punctured wound is made with a pointed
instrument, such as scissors, a nail, etc. Gunshot wounds
are caused by firearms. A poisoned wound is caused by
an agent which carries with it into the wound a poison.
Wounds may also be aseptic or septic. An aseptic
wound is one which is free from and is preserved from
all poisonous bacterial products. A septic wound is one
in which the bacteria are present, they having gained
access either through injury and exposure before treat-
ment or during the treatment.
Healing of Wounds.—Wounds heal by first intention
or by second intention. Wounds heal by first intention,
or primary union, when the edges are brought together
and rapidly heal without granulation or suppuration.
Wounds heal by second intention, or granulation, when
the edges are separated and the wound is large and
deep, and the granulations, which are soft, bright-red
elevations, fill up the wound from the bottom and sides.
ACCIDENTS AND EMERGENCIES. 189
Occasionally the granulations grow too rapidly and pro-
ject above the surface of the skin. This condition is
commonly called " proud flesh," which is removed either
with nitrate of silver or with the knife. Granulations are
sometimes pale and flabby and have to be stimulated.
Occasionally a wound healing by granulation will heal
from the top instead of from the bottom and sides.
When this process of repair occurs the wound is kept
open with gauze packing, a little of which is removed
each day as the wound heals up from the bottom. Only
an incised wound heals by first intention; other wounds
heal by granulation. Healing under a blood-clot, of
which we so often hear, occurs when an aseptic blood-
clot remains in a sterile wound. The blood-clot grad-
ually becomes organized and serves as a scaffolding for
the new tissue which is thrown out from the surround-
ing parts. When the wound heals the surface clot breaks
up, is brought away with the dressings, and a firm scar
is seen. If the wound has become infected, the clot may
be swept away with the pus, and the wound then heals
by granulation. Suppuration, which is the end of infect-
ive inflammation, consists in the formation of pus, which,
if absorbed into the system, will result in erysipelas or
pyemia. Both these terms mean blood-poisoning; the
former is septicemia without abscesses, the latter, septi-
cemia with abscesses, and is the severer disease.
Erysipelas.—Erysipelas is due to the entrance of germs
into a wound either during or after an operation, and is
generally caused by the instruments, the sponges, the
dressings, or the hands not being properly sterilized.
The symptoms are a chill, a rise of temperature, and
swelling and pain : the skin around the wound is of a
bright-red color, which disappears upon pressure.
190 PRACTICAL POINTS IN NURSING.
Pyemia.—Pyemia is blood-poisoning together with the
formation of abscesses. The symptoms are severe chill,
followed by profuse perspiration, rise of temperature and
pulse, nausea, vomiting, and diarrhea, and pain at the
point where the abscess is forming.
The treatment for both these diseases consists in iso-
lating the patient, in sustaining the patient's strength
with nourishing food and stimulants, and in observing
thorough asepsis. Each surgeon has his own method
of treatment, and his directions must faithfully be carried
out.
Tetanus.—Tetanus is an infective disease which almost
always originates from wounds, particularly those of the
extremities. The infecting germ may enter a wound,
large or small, at or a few days after the time of injury.
The earliest symptom is stiffness of the neck, after which
the muscles of the face and jaw become rigid, so that the
patient cannot open his mouth. This condition is com-
monly called " lockjaw." Gradually the other muscles
are affected by spasms, which are very severe, and the
face has a peculiar grinning expression. If the body is
bent forward, the condition is called " emprosthotonos;"
if the head is stretched backward and the spine arched,
it is called " opisthotonos."
The treatment of tetanus consists in keeping the pa-
tient perfectly quiet in a darkened room, care being taken
to disturb him as little as possible. Nourishment, stimu-
lants, and medicine may be given by the rectum if nec-
essary. Morphia may be given subcutaneously. The
bowels must be kept open, and retention of urine may
be relieved by catheterization. The number of spasms
must be counted and the degree of their severity be
noted. The pulse is rapid and weak, and the temper-
ACCIDENTS AND EMERGENCIES. 191
ature is slightly elevated. The exhaustion is extreme,
due to loss of food and sleep. An acute attack may
result in death from asphyxia or exhaustion in from
three to five days, the mind, as a rule, being clear to
the end.
Gangrene is the mortification or death of a part, pro-
duced by the stoppage of the circulation in that part by
cold or frost-bites; a severe form of inflammation in a
weak part may also lead to gangrene. The germs de-
stroy the vitality of the part, and spread until they meet
with parts strong enough to resist their action; then a
line of demarcation is formed. There are two forms of
gangrene, moist and dry.
Moist gangrene may be produced by an accident when
the injury is extensive and the supply of arterial blood
is cut off, or it may be caused by an obstruction to the
return of venous blood. The symptoms are first pain and
intense burning in the part; red skin-coloration which
changes to a purple or a greenish-black; there is a fetid
odor; the part is swollen and soft; the skin is raised in
blisters; there is a watery discharge; and the line of
demarcation marks the living from the dead part.
Dry gangrene, or " senile gangrene," as it is called, is
due to an impaired condition of the circulation in parts
at a distance from the heart, such as the toes, where the
circulation is not very vigorous, or to a diseased condi-
tion of the arteries.
The symptoms are numbness and tingling in the part;
the color of the skin gradually changes to a dark red,
then to purple, and finally the part destroyed becomes
black, dry, wrinkled, and resembles in appearance the
limb of a mummy. When the progress of the disease
is arrested a line of demarcation is formed. The de-
I92 PRACTICAL POINTS IN NURSING.
pressed and lowered condition of the patient must be
met with stimulants and nourishing food, and thorough
antisepsis be observed.
Abscess.—An abscess is a collection of pus occurring
in any of the tissues or organs of the body, and is one
of the terminations of inflammation. It may be acute or
chronic (cold), circumscribed or diffused.
Boil.—A boil (furuncle) is a localized inflammation of
the skin and subcutaneous tissues, frequently about a
sebaceous gland, forming a small painful swelling with
pus-formation and ending in the expulsion of a necrosed
centre or " core." A blind boil is a non-suppurating swell-
ing that gradually subsides, the contents being absorbed.
Carbuncle.—A suppuration of the subcutaneous tis-
sue, most generally situated under the thick skin at the
back of the neck, is a carbuncle. It is distinguished
from a boil by being larger and of longer duration, in
having no central core, in having several points of sup-
puration, in being less defined and prominent, but more
extensive in its sloughing.
The treatment is surgical, antiseptic dressing, and
good nourishing food.
Ulcer.—An ulcer is an open sore, attended by dis-
charge, generally due to certain difficulties obstructing
the healing process.
Fistula.—A fistula is an abnormal opening between
an internal part and the surface of the body, or between
two organs of the body, such as the bladder and vagina
or the vagina and rectum.
The treatment is surgical; fresh air, good food, and
tonics are essential.
Sinus.—An opening upon the surface of the skin,
ending in the cavity of an abscess, is a sinus. It is gen-
ACCIDENTS AND EMERGENCIES.
crally caused by the failure of the abscess to heal, by the
presence of a piece of dead bone, by inability of the walls
of the cavity to come together, or by a diseased condi-
tion of the walls of the cavity.
2. Common Emergencies.
Under this head will be considered the emergencies
apt to be met with in every-day life.
Hemorrhages.—It is impossible to be too thoroughly
prepared to meet the emergency of hemorrhage, as the
care and responsibility of the patient rest entirely upon
the nurse until the arrival of the surgeon.
Hemorrhage may be external or internal. The bleed-
ing may come from the arteries, the veins, or the capil-
laries. Arterial blood is bright red, and bursts out in
spurts with each beat of the heart. Venous blood is
dark; the stream is steady, flowing to the heart. Cap-
illary blood is of an intermediate shade, and oozes.
Capillary hemorrhage is dangerous only when a num-
ber of capillaries give way at one time.
Hemorrhage is also primary, recurrent (intermediate),
or secondary. Primary hemorrhage is that which takes
place when an incision is made. Recurrent or intermedi-
ate hemorrhage is that which takes place during the first
twenty-four or forty-eight hours after an operation, and
which is due to the force of the circulation of the blood
after reaction has set in, to the displacement of clots
through restlessness, or to the slipping of a ligature.
Secondary hemorrhage takes place between the first day
and the complete healing of the wound, about the time
the ligatures or sloughs separate. It is generally caused
by diseases of the walls of the arteries, by a ligature not
being strong enough or being tied too loosely, or by the
13
I94 PRACTICAL POINTS IN NURSING.
too rapid absorption of a catgut ligature, or by sepsis,
the germs eating their way through the walls of the
blood-vessels, which become so thin that they cannot
stand the force of the blood pumping through them, and
finally burst. Children do not stand the loss of blood
well, but they rapidly recover as a rule. Adults in
health stand the loss of blood well; old people do not,
neither do they quickly recover.
Symptoms.—The symptoms of hemorrhage are rest-
lessness, faintness, demand for air, weak and rapid pulse,
subnormal temperature (960 or 970 F.), anxious expres-
sion, pale face, cold extremities, feeble, sighing respira-
tions, sometimes a mist over the eyes, and a roaring in
the ears.
Treatment.—The treatment of hemorrhage consists
of position and pressure. The bleeding part should
be elevated to promote the supply of blood to the
vital centers; pressure may be applied with the finger
on the artery, or the wound may be plugged with
sterilized gauze or with a handkerchief; morphia (gr. I)
may be given to secure rest and quiet, stimulate the
heart, and contract the blood-vessels. The patient is to
be kept perfectly quiet, to allow the blood to coagulate
in the vessels, and plenty of fresh air should be given.
Alcoholic stimulants must be given very cautiously, as
they excite the heart's action and increase the hemor-
rhage ; hence they must not be given without orders
from the surgeon, unless the pulse is very weak and in-
dicates heart-failure. If hemorrhage should occur from
the stump of a limb after the amputation, the nurse should
elevate the part and make firm pressure with her finger
on the artery until the surgeon arrives.
Flexion, or the bending of a limb, is another way to
ACCIDENTS AND EMERGENCIES. 195
stop hemorrhage. A pad of cotton is put in the joint—
the hollow of the elbow, under the knee, or in the groin;
against this pad pressure will be made when the limb is
bent. Ice and very hot water are also used in hemor-
rhage, heat being the better, as it stimulates the blood-
vessels and causes the blood to coagulate, while ice par-
alyzes the vessels, stopping the hemorrhage for a while;
but when the ice is removed and reaction from the cold
sets in, and the circulation is restored, the blood-vessels
dilate wider than before and the bleeding begins again.
Moreover, with the application of ice, which is seldom
clean, there is the danger, if it be put on a raw surface,
of introducing germs into the system. Fainting has a
tendency to check hemorrhage, as it permits the blood
to coagulate.
Venous hemorrhage is checked on the side of the
wound that is away from the heart. The limb should
be elevated slightly and pressure applied.
A tourniquet made of a piece of compress or a knotted
handkerchief tied and twisted with a stick, the knot or
some round smooth object being over the artery (Fig.
Fig. 60.—Impromptu tourniquets for compressing an artery with a handkerchief and
a stick.
60, a and b) will stop the circulation to a part, but it
cannot remain on longer than half an hour or the part
may die. Position, pressure, and morphia are the best
196 PRACTICAL POINTS IN NURSING.
remedies for hemorrhage. The first two can always be
had, and morphia sustains the heart's action, secures rest
and quiet, and contracts the blood-vessels.
The other methods of stopping hemorrhage—tor-
sion, ligation, cauterization, acupressure—belong to the
surgeon.
When much blood has been lost the patient suffers
greatly with thirst, which is often extreme on account of
the amount of fluid that has been taken from the body.
For this reason there may be given to drink, in small
quantities, cold water, which will relieve the thirst and
also make up for the amount lost by resorption. The
patient should be fed well and often and in small quan-
tities.
Bleeding from the palm of the hand may be controlled
by clasping a clean handkerchief and holding the hand
high above the head.
Hemoptysis.—In hemorrhage from the lungs (hemopty-
sis) the blood is bright red, and frothy from its admixture
with air. In treating hemoptysis the head and shoulders
are elevated and an ice-bag or an ice poultice is applied
to the chest; crushed ice may be given the patient to
swallow. Equal parts of vinegar or lemon-juice and
water, given in teaspoonful doses, or a quarter of a tea-
spoonful of dry salt, will contract the blood-vessels.
Rest and quiet will be obtained by the administration of
morphia (gr. \), chloral (gr. x), or bromid of potassium
(gr. xx).
Hematemesis.—Bleeding from the stomach (hemateme-
sis) is treated in the same way as that from the lungs.
The blood in this case is vomited, is of a dark-red color,
and contains particles of food. The feces are of a very
dark color, through the blood having passed into the
ACCIDENTS AND EMERGENCIES. 197
intestines. It is always well to examine the nose and
throat, because the bleeding may not come from the
stomach, but from the nose, the blood having passed
down the throat into the stomach.
Epistaxis.—For nosebleed (epistaxis) the head and arms
should be elevated, and pressure with the fingers should
be made on the nostril from which the blood is coming,
or a small piece of lemon or a small piece of cotton
wrung out of vinegar and inserted will contract the
blood-vessels. The patient should not blow the nose,
as it will disturb the formation of clots. Ice may be
applied to the back of the neck and to the forehead.
Burns and Scalds.—Burns and scalds are the same in
effect. A burn is caused by dry heat—fire or heated
metals; a scald is caused by moist heat—heated fluids
or steam—and is apt to be extensive, because the fluid
spreads over a larger surface than a burn; a burn, how-
ever, is deeper. Burns are of three degrees :
1. Inflammation without blisters, or destruction of the
epidermis without penetrating the true skin.
2. Inflammation of the skin resulting in the formation
of blisters, the latter caused by an outpouring of the
water of the blood, that lifts the outer skin from the
true skin.
3. Partial or complete destruction of the nerves and
blood-vessels of the part. Their vitality is destroyed.
A burn of the first degree may result in death if two-
thirds of the body is burned, because, although there is
only a mere reddening of the skin, the action of the skin
is lost, consequently the power of perspiration or excre-
tion is lost; extra work is thus thrown upon the kid-
neys, which become inflamed, and death may occur from
nephritis, which is inflammation of the kidneys.
198 PRACTICAL POINTS IN NURSING.
Burns of the second degree may end fatally if exten-
sive, because the superficial blood-vessels are destroyed ;
consequently, more blood is driven to the internal or-
gans of the body, which become very much congested,
and acute inflammation sets in, which may result in death.
Death from burns of the second degree may occur from
shock, exhaustion after long-continued suppuration, which
follows the separation of the sloughs, also septicemia or
tetanus (lockjaw).
The result of a burn of the third degree is nearly
always fatal in the old or the young, and is determined
by the part affected and by the age and health of the
patient. Burns of the abdomen, the head, and the chest
are more severe than those of the extremities, because
they are nearer the vital organs.
Shock is always present in burns of the first degree,
though not so great as in those of the second and third
degree, and the reaction after shock may result in in-
flammation of any of the vital organs.
Pain is severe in slight burns, because the nerve-end-
ings are exposed; it is less severe in deep burns in which
there is total destruction of the part.
Edema of the Glottis.—Edema, or dropsy of the glottis,
is caused by the inhalation of steam or the drinking of
scalding liquids. Edema is a pouring out of the watery
part of the blood into the tissues, and the effusion may
increase with great rapidity. Death by suffocation may
occur within a very short time. The symptoms of edema
are gradual loss of voice, difficulty in breathing, and
blueness of-the surface of the body (cyanosis) from in-
sufficient oxidation of the blood, gasping respirations,
and a flickering pulse. Tracheotomy or intubation is
generally performed. There may be inflammation with-
ACCIDENTS AND EMERGENCIES- 199
out edema, and this may develop into bronchitis and
pneumonia.
The treat me tit of burns and scalds consists in first at-
tending to the shock by the application of heat to the
body, or, if possible, in giving a hot bath (temperature
iOO° F.), the administration of stimulants (alcohol or
black coffee), and the application of a mustard plaster
over the heart. The clothing is to be removed gently,
being cut if necessary. If the burn is slight and no blis-
ters have formed, the part is to be dressed with a satu-
rated solution of ordinary baking-soda or dusted with
either baking-soda, flour, or starch, and the air excluded,
because air is an irritant. If blisters have formed, they
should be opened, the fluid being allowed to run on to a
piece of cotton, and then dressed with either carbolic-
acid solution (1:40), sodium-bicarbonate water, sweet
oil, vaselin, zinc ointment, or Carron oil (equal parts of
linseed oil and lime-water), and the air excluded.
A raw surface should not be dusted with flour, starch,
or any other powder, because these substances harden
and form crusts, which are painful to remove. The
dressing should be removed only when really necessary,
on account of the extreme pain, and only one part at a
time should be exposed and dressed. If the dressing
adheres to the part, it should not be pulled off, but
should be wet, so that it will come off without causing
the patient much pain. The bed should be made up
with old sheets and old pillow-cases. The patient's
strength should be maintained with a nutritious diet
and stimulants, and the thirst relieved with crushed
ice. The bowels should be kept open, and the nurse
should watch for retention of urine.
Complications of Burns and Scalds.—Some of the
200 PRACTICAL POINTS IN NURSING.
complications are delirium, meningitis, ulceration of the
duodenum (the first part of the small intestine near the
stomach), which may result in perforation of the intes-
tine and cause peritonitis, inflammation of the lungs and
kidneys or intestines, and retention or suppression of
urine. Great distortion or deformity is often caused by
contraction of the healing skin. The scars are densely
white. To prevent deformity, the parts are put in splints
in the best possible position ; skin-grafting is often re-
sorted to, and in some cases amputation is performed.
Sunstroke.—The symptoms of sunstroke are a tem-
perature of from 105 to 1120 F., sometimes higher, a
flushed face, stertorous breathing, and unconsciousness.
The patient should be put into a cold bath and rubbed
with ice. If at the seaside, he may be carried to the
beach and put in the water; the head may be kept cold
by bathing it, or by the application of handkerchiefs
wrung out of the water. If a cold bath is impossible,
the patient may be douched with cold water from a
hose-pipe or from pails, and cold cloths be kept on the
head. Enemata of ice-water are very good. The cold-
water treatment must be continued until the temperature
has fallen, after which the patient should be put to bed,
and, if there is depression, be given stimulants moder-
ately. Should the temperature begin to rise, the above
treatment should be renewed.
Heat-exhaustion.—Heat-exhaustion is caused by too
long exposure to a very high temperature; the blood
leaves the brain and the surface of the body, and goes
to the large blood-vessels of the abdomen. The symp-
toms are those of shock. The treatment is the same as
that for shock : hot bath if possible, or heat applied to all
parts of the body; stimulants of alcohol or strong coffee.
ACCIDENTS AND EMERGENCIES. 201
Lightning-stroke.—For a lightning-stroke the treat-
ment is the same as that for shock.
Fainting.—The head of a person in a faint should be
lowered and the feet raised, the blood being thus sent
back to the brain. Plenty of air, the clothing loosened
about the neck and chest, and a little cold water dashed
over the face, are usually sufficient to restore conscious-
ness. A method often practised is to place the patient
on a chair, and to push the head down between the
knees, the hands hanging down by the side. The pa-
tient is kept in that position until the face becomes red,
being then able to rise and walk about. This position
restricts the abdomen and shuts off the blood-supply to
the lower extremities, the blood going to the brain.
Strong ammonia should not be held to the nostrils of
an unconscious patient, as it is very irritating. The
pulse should be watched, and if consciousness does
not soon return, heat should be applied and a physician
be sent for. Little can be done for loss of conscious-
ness from heart-failure, beyond stimulating a flagging
pulse, until the arrival of medical assistance.
Drowning.—In asphyxia from drowning, if the person
when taken from the water is breathing, he should be
removed, if possible, to a near-by house, and put into a
hot bath, which will act as a stimulant; or heat may be
applied directly over the heart and other vital organs,
the head and shoulders be raised, stimulants given, and
the body briskly rubbed. This can be done until the ar-
rival of a physician. In all cases of suffocation the throat
must be cleared, so that fresh air can reach the lungs.
Artificial respiration is the imitation, as nearly as possi-
ble, of natural breathing. We breathe from sixteen to
eighteen times a minute; this number of chest move-
202 PRACTICAL POINTS IN NURSING.
ments must not be exceeded, or the lungs cannot ex-
pand to fill thoroughly with air nor contract to expel
the air.
To produce artificial respiration in case of drowning or
of suffocation, the patient's clothing is first removed and
Fig. 6i.—Artificial respiration, first movement.
the body is quickly dried. The mouth, the throat, and
the nose should be cleared and the tongue be pulled
forward to facilitate access of air to the windpipe; a roll,
Fig. 62.—Artificial respiration, second movement.
a pillow, a rolled-up coat, or a piece of wood should be
placed under the shoulders. The arms near the elbows
should now be grasped and be swept around horizon-
tally, away from the body, until the hands meet over the
head (Fig. 61); this movement raises the ribs and ex-
pands the chest as in inspiration; the arms should then
be brought down to the sides, the elbows meeting almost
ACCIDENTS AND EMERGENCIES. 203
over the pit of the stomach (Fig. 62); pressure is then
made against the chest-wall, producing contraction of
the chest; the arms are to be held in the latter position
a few seconds, and then the movements are repeated.
Twelve or fifteen respirations will be sufficient. The
mouth must be kept open and the tongue be held
forward.
Accidents from Fire.—If clothing catches fire, the
person should be thrown down and rolled in a rug,
shawl, blanket, or coat. Any one may at some time be
compelled to pass through sulphur fumes or smoke, and
it can be done by holding a wet towel, a large wet hand-
kerchief, or a wet cloth over the nose and mouth. Some
persons who have been through this experience never
retire without first placing at their bedside a large hand-
kerchief or a towel and a bowl of water, in case this
emergency should arise.
Retention of Urine.—Retention of urine is due to the
patient's inability to pass urine, owing to shock, paralysis,
hysteria (commonly known as hysterical retention), or
other causes, which, if not relieved, may result in rupture
of the bladder or uremic poisoning through resorption.
The patient should be put into a hot bath if possible,
which will act as a stimulant, relieve the pain, contract
the muscular coats of the bladder, and also produce per-
spiration. If the bath is impossible, a hot poultice or
fomentation should be applied over the bladder, or cath-
eterization may be practised and a simple enema be
given.
Head-accidents.—For all accidents to the head, the
part is to be bathed with warm water and firm pressure
with a clean compress be made until the arrival of a
physician.
204 PRACTICAL POINTS IN NURSING.
Concussion of the brain is the sudden interruption of
the functions of the brain brought on by severe blows
on, or by other injury to, the head. In the simple form
of concussion the patient is partly insensible; the pupils
are contracted, and the face is pale. In a few moments
he may regain consciousness; there is nausea and vom-
iting- and headache. In a severe case of brain-concus-
sion death may very soon occur.
Compression of the brain is due to tumors, to depres-
sion of the skull from fracture, and other causes. The
symptoms closely resemble those of apoplexy. In both
these injuries, until the arrival of a physician, who should
be sent for at once, the patient should be placed in bed
with the head slightly raised; the room should be dark-
ened and cold applied to the head. If there is shock, heat
is to be applied, but stimulants are not to be given with-
out orders from the doctor.
Cuts and Bruises.—For a cut or a bruised finger, the
part is to be washed thoroughly with an antiseptic solu-
tion or with boiled sterilized water, then with dilute alco-
hol or with hamamelis (witch-hazel), and the part bound
up with clean cotton and a bandage.
Foreign Bodies.—A foreign body in the ear should
be removed at once. If the obstruction be an insect,
the patient should lie on the side with the affected ear
upward, the aural canal being straightened by pulling
the auricle upward and slightly backward; the ear is
then filled with warm water or with olive oil. The insect
will then float to the top and fall out. No other liquid
should be put into the ear without the consent of an ear
specialist. The ear is a very delicate organ, and will be
injured by unskilful treatment. If the foreign body is a
bean or any object likely to swell, the ear must not be
ACCIDENTS AND EMERGENCIES. 205
syringed. If the obstruction is a button, a stone, or cot-
ton, one may try to syringe it out; but nothing else
should be attempted, or the obstruction may be pushed
farther in. A foreign body in the nose, if it can be seen,
may be removed with a bent hair-pin or with forceps.
An obstruction in the throat may be removed by the
drinking of water, the swallowing of a piece of bread,
or by a hard blow between the shoulders; if these
measures fail, an emetic of mustard and water or of salt
and water may be given.
A foreign body in the eye may be removed by having
the patient look down; a pencil or some similar thin
body is then placed across the upper lid, and the lashes
are seized and the lid turned over; the exposed particle
is then wiped off
Insect Bites and Stings.—Insect or mosquito bites
are treated by bathing the part with dilute or pure vin-
egar or with a solution of carbolic acid (1 :4o).
Dysmenorrhea.—Dysmenorrhea, or painful menstrua-
tion, very often calls for prompt treatment, which consists
in hot mustard foot-baths, rest in bed, the application of
hot flaxseed poultices, or turpentine or mustard fomenta-
tions to the lower part of the abdomen, and a hot-water
bottle to the back and one to the feet. Drinks of hot
ginger-tea or of gin will increase the circulation. It may
be mentioned that painful menstruation is often the re-
sult of tight lacing: the abdominal organs are crowded
down upon the womb, the bladder, and the rectum, and
the womb is forced down out of its normal position, the
free escape of the blood thus being prevented. Expo-
sure to cold during menstruation is another cause. A
normal menstruation should be painless.
Vomiting.—To relieve vomiting a mustard plaster or
206 PRACTICAL POINTS IN NURSING.
an ice poultice over the stomach is very good. If the
vomiting is caused by constipation, a Seidlitz or a Ro-
chelle powder will generally stop it.
Flatulence.—Flatulence is relieved by io drops of
the oil of peppermint or 5 drops of the oil of turpentine
on sugar every three hours, or by drinking very hot
water.
Toothache.—Toothache may be relieved by oil of
cloves, oil of peppermint, or creasote applied on cotton
and inserted in the cavity of the tooth.
Insomnia.—Insomnia, or sleeplessness, considered as
an emergency, may be relieved by the application of
heat to the abdomen, and to the feet if they are cold.
Should the patient sleep the first few hours of the night,
then awake, and remain so during the early morning
hours, a light meal, such as a cup of hot cocoa and a
cracker, or even a glass of hot milk, will induce sleep
by drawing the blood-supply from the brain to the stom-
ach, and at the same time the blood will be replenished
by substances formed in the process of digestion, that
have a soothing effect. Wakefulness is increased if there
is a light in the room, because the brain cannot rest un-
less there is darkness : to procure this the room should
be darkened as much as possible and a handkerchief
folded over the patient's eyes.
Sunburn.—Sunburn is painful, and may be relieved
by any kind of oil or by a wash made of sodium bicar-
bonate, and by excluding the air.
Burns by Acids and Alkalies.—A burn by an acid
should be treated by pouring over the burn a solution
of sodium bicarbonate and water or plain water to dilute
the acid; the part is then dressed as for an ordinary
burn. For a burn by an alkali, for instance, quicklime,
•
ACCIDENTS AND EMERGENCIES. 207
an acid is applied, such as lemon-juice or vinegar. For
burns of the eye with an acid or an alkali the eye should
be washed immediately with warm water to dilute the
substance and to prevent its being absorbed; vaselin or
any of the oils then should be applied.
Frost-bite.—Frost-bite is due to extreme cold. The
vitality of the part is lowered and the circulation in it
ceases. Exposure to intense cold may cause death,
owing to the action of the skin and the superficial blood-
vessels being cut off; as a consequence, the internal
organs are very much congested, which condition is
followed by congestion of the brain, causing drowsiness,
stupor, and coma, and ending in death.
The treatment of frost-bite consists in rubbing the part
with snow or with ice-water, which will gradually dilate
the contracted blood-vessels and start up the circulation
in the part. The patient must be kept in a cold room.
As the temperature of the part and of the body rises, the
patient should be rubbed gently with equal parts of alco-
hol (or vinegar) and water, and the temperature of the
room be slowly increased; or the patient may gradually
be removed to a warmer room. The part should be
exposed to the air for a while and then covered. Hot
drinks and stimulants are to be given if necessary.
The return to heat must be gradual, as the sudden
reaction of the circulation in the part may result in
intense inflammation and gangrene. Should inflamma-
tion set in, cloths wet in equal parts of alcohol (or vine-
gar) and water may be applied.
Chilblains.—Chilblains are caused by exposure to
cold, followed by a sudden return to heat. The treat-
ment is the same as that for frost-bite. Patients after
one attack should wear woollen stockings and gloves.
208 PRACTICAL POINTS IN NURSING.
3. Accidental Poisoning.
Poison Denned.—A poison is a substance which, when
taken into the body, produces either disease or death.
Any substance causing death when taken into the stom-
ach is a poison. Poisons may also enter the circulation
through the broken skin.
Classification and Action of Poisons.—Poisons are
divided into two classes—irritants and narcotics. The
irritant poisons act on the stomach and bowels, and the
symptoms of all such poisons are generally the same.
Coming in contact with the lips, mouth, throat, and
stomach, they produce a burning sensation and give rise
to vomiting and pain in the stomach and abdomen, the
pain being increased upon pressure, and by purging.
The effects of the poisons are chiefly upon these organs,
which they irritate and influence. After all irritant poi-
sons, demulcent drinks, such as flaxseed tea, white of
eggs, glycerin, sweet oil, starch-water, or warm milk,
should be given to soothe the inflamed mucous mem-
brane. Neurotic poisons act upon one or more parts of
the nervous system, producing headache, giddiness,
numbness, stupor, and paralysis, and often convulsions
and death. They have not the burning taste of irritants,
and rarely give rise to vomiting and purging.
What to Do in Case of Poisoning.—The first thing
to do in all cases of poisoning is to ascertain what kind
of poison has been taken, either from the symptoms pro-
duced or from the vomited matter. If this detection is
impossible, the stomach is to be emptied—that is, if the
drug has been taken by mouth—to prevent the poison
being absorbed; the antidote (a remedy to counteract
the effect of the poison) is then to be given. If the
ACCIDENTS AND EMERGENCIES.
209
poison has been absorbed, medicines are given to coun-
teract its effect on the temperature, the respiration, or
the circulation. Vomiting may be induced by giving
mustard and warm water, salt and warm water, tepid oil
and water (a tablespoonful to a cup of water), warm
water, or by running the finger down the throat, or by
tickling the throat with a feather. Vomiting is gener-
ally easier if the stomach is full of food or of fluid.
Should the stomach be empty, a quantity of fluid should
be given before the emetic.
When emetics are administered, they should be given
quickly and not more than half a pint at a time, or the
walls of the stomach may become paralyzed through
over-distention. After vomiting, the patient should drink
plenty of milk or water, and the bowels should be
cleared, in case the poison has entered the intestines.
A few of the most common poisons and their anti-
dotes are the following:
Irritant Poisons. — Carbolic Acid.—Milk and lime-
water, equal parts; stimulants; no oil, as it will help
absorption; flaxseed tea, hot applications to the extrem-
ities, and counter-irritation upon the abdomen.
Carbonic-acid Gas.—Removal of patient from the
room; artificial respiration ; bathing with alcohol and
water; application of heat to the feet; cold douching,
friction, and stimulants.
Oxalic, Acetic, and Tartaric Acids.—Chalk or plaster
scraped from the wall and dissolved in water or in milk
(in an emergency); soapsuds; emetics; stimulants, and
heat externally.
Prussic Acid {Hydrocyanic Acid, Cyanid of Potassium).
—Apply smelling-salts to the nose; an emetic; black
coffee. Action should be prompt; often there is little
14
210 PRACTICAL POINTS IN NURSING.
time for anything but hot and cold affusions to the head
and artificial respiration.
Sulphuric, Phosphoric, Nitric, and Hydrochloric Acids.
—Magnesia, whiting, chalk, sodium bicarbonate, milk,
white of egg, or plaster scraped from the wall; external
heat.
Ammonium.—Vinegar, lemon-juice or orange-juice,
milk, oil.
Ammonia, Caustic Lime, Potash, and Soda, and the
Carbonates of Sodium and Potassium, are alkalies, and are
treated with acids, such as vinegar and lemon-juice, and
milk, and olive or any bland oil to soothe the mucous
membrane.
Arsenic and Paris Green.—Emetics; oil and lime-
water ; milk; raw eggs; flaxseed tea; powdered charcoal
in water (half an ounce to a cup of water); heat over
the abdomen.
Corrosive Sublimate.—White of egg, which, being an
albumin, will render the corrosive insoluble, or milk or
flour and water will answer; then an emetic is given to
remove the poison. Poisoning by copper or lead is
treated in the same way.
Ergot.—Stimulants ; strong tea.
Iodin.—Emetic; flour or starch and water; white of
egg in milk ; sodium bicarbonate.
Phosphorus.—Emetics and purgatives; no oil, as it
aids absorption ; poultices to stomach.
Poison ivy when brought in contact with the skin is
capable of exciting inflammation of its tissues. It is an
acid, and is treated with an alkaline. Plain cold water,
baking-soda (saleratus) and water made into a thick
wash, lime-water, or soapsuds will help to relieve the
inflammation. The applications should be continued
ACCIDENTS AND EMERGENCIES. 211
faithfully for twenty-four hours. The parts should after-
ward be dusted with powdered starch.
Narcotic Poisons.—Aconite.—Emetics; purgatives;
stimulants of alcohol, digitalis, or atropin to restore the
heart's action; heat to the body.
Atropin and Belladonna.—Emetics; black coffee and
stimulants; hot and cold water alternately to the head;
lemon- or orange-juice and water. The patient should
be aroused from stupor.
Chloral.—Emetics; heat is to be applied and strong
coffee given; hot mustard foot-baths; artificial respira-
tion should be practised if necessary. The patient
should be aroused as in opium-poisoning.
Digitalis.—Emetics; strong tea and perfect quiet in
bed; also cathartics.
Opium and Morphia.—Emetics (the stomach may be
washed out with warm water); black coffee by the mouth
or the rectum; vinegar and water; lemon- or orange-
juice and water. The patient should be aroused from
stupor and kept awake by being walked about the room
and flicked with a wet towel; a hot- and a cold-water
douche may be given. Mustard plasters may be applied
to different parts of the body. Blistering should be
guarded against; the patient should be kept warm all
through the treatment.
Nux Vomica and Strychnia.—The stomach should be
emptied before the convulsions begin. If an emetic is
impossible, inhalations of ether or of chloroform should
be given, and the stomach be washed out; chloral or
bromid of potassium be given subcutaneously to quiet
the convulsions; also a hot bath. Heat and friction
are to be applied and artificial respiration is to be
practised.
212 PRACTICAL POINTS IN NURSING.
Nitrate of Amyl.—Artificial respiration ; hot and cold
affusions.
Quinia.—Emetics ; purgatives ; strong tea or coffee;
hot stimulants ; artificial respiration.
Mushrooms.—Emetics; purgatives; poultices to abdo-
men ; stimulants.
Poisoning by tainted meats or fish or by mushrooms
is treated with emetics and purgatives. Heat and stim-
ulants should be employed if there is shock.
Bites of Rabid Animals.—Poisoned bites by a mad
dog or by serpents should be treated by having the
poison sucked out of the wound (unless there is an
abrasion on the nurse's lip), and the wound afterward
washed with plain warm water. The patient must be
taken at once to a physician, who will cauterize the
wound. The patient must be given stimulants in mod-
erate quantities to sustain the system. The state of the
pulse must be taken as a guide to indicate when the
proper amount of stimulation has been reached.
In all emergencies the nurse must keep perfectly calm ;
she should think what has happened and what should
be done, and then do it quietly. If she gets excited and
loses her presence of mind, the life of the patient may
be lost. When notifying the physician or surgeon
she should send a written, not a verbal message, and
should state clearly what has happened, so that he will
fully understand and come prepared: he should also be
informed of what is being done by the nurse.
NURSING IN SPECIAL MEDICAL DISEASES. 213
V. NURSING IN SPECIAL MEDICAL
DISEASES.
1. Infectious and Contagious Diseases.
Infectious Diseases.—Infectious diseases are caused
by the introduction into the body of a living poison,
which has the power of producing a disease if it can
find therein conditions suitable for its development.
Every infectious or contagious disease is caused by a
specific germ—a germ which produces that disease and
no other. Exposure to an infectious disease does not
always produce that disease in a healthy person, because
its germs cannot find conditions suitable for their devel-
opment, so that the mere presence of the active cause in
itself is insufficient to produce the disease. In diphtheria
it will usually be found that the attack of the disease has
been preceded by a local inflammation of the throat,
thus making a suitable place for the specific action of
the diphtheria germs. In typhoid fever the germs re-
quire a suitable condition of the bowels before they can
produce the disease. Healthy lungs are not a suitable
location for the development and activity of the germs
which produce consumption. On finding these conditions
it takes the germs some days to develop and produce the
disease; this explains what is meant by the period of in-
cubation. All germs—or bacteria, as they are called—
have their favorite seat in the body, and they leave the
body through the lungs, the skin, the kidneys, or the
bowels. The germs of diphtheria leave the body through
the breath and the discharges from the nose and throat;
those of pneumonia and of consumption (which is tuber-
culosis of the lungs) leave the body through the expec-
214 PRACTICAL POINTS IN NURSING.
torations, which are charged with them; those of scarlet
fever and of measles, through the breath, skin, and dis-
charges from the nose and throat; those of whooping
cough, in the same manner as those of diphtheria; those
of small-pox, through all the discharges; and those of
typhoid fever, through the bowels.
Contagious Diseases.—Contagious diseases spread by
contact with a patient or with the corpse of one dead of
a contagious disease, articles of clothing, etc. Some-
times the disease will be communicated by a single ap-
proach to a patient, though persons who have once had
a contagious disease rarely ever have it a second time:
this is what is meant by immunity. A child that never
had scarlet fever if placed in the same room with one
who has the disease will take it because of this ex-
posure. The " acute exanthemata" are the eruptive
diseases—scarlet fever, measles, small-pox, and chicken-
pox.
Another term very often heard is miasmatic disease.
Intermittent fever and malarial fever come under the
head of miasmatic diseases, the poison of which is found
in the low, marshy districts. These diseases are infec-
tious, but not contagious; one cannot take them by
contact with the patient, but must get them from the
low marshy regions supposed to be favorable for the
propagation of these germs.
We guard against the spread of contagious diseases
by isolating the patient in a room at the top of the
house, because the air there is purer, and because if the
patient be on any of the lower floors the poison might
spread upward through the house ; by the utmost clean-
liness, by keeping the air pure, by the faithful use of dis-
infectants, and by hanging a sheet wet with some disin-
NURSING IN SPECIAL MEDICAL DISEASES. 215
fectant, or even with plain water, before the door of the
room, so that when the door is opened the germs in the
air coming from the room will come in contact with the
wet sheet and cling to it; by having separate dishes
and utensils for the room and the patient, and separate
bed- and body-linen, and by thoroughly disinfecting the
movements and expectoration before disposing of them.
The very best way to treat the latter is to mix them with
sawdust and then burn them.
Typhoid Fever.—Typhoid fever is an acute infectious
disease due to the entrance into the body of a special poi-
son by drinking impure water or milk, through bad air or
drainage, or from a previous case of typhoid fever where
no precautions were taken against the spread of the dis-
ease. It is also called enteric fever, slow fever, low fever,
and nervous fever, and is characterized by ulceration of
certain parts of the bowels. In mild cases the stage of
ulceration may not be reached. The period of incuba-
tion is from two to three weeks.
Symptoms.—Some of the symptoms are headache,
aching pains in the back and the limbs, loss of appetite,
increasing weakness, nausea, sleeplessness, depression,
a chilly feeling, nose-bleed, slight diarrhea, gradual rise
of temperature and increase of pulse, coated tongue,
stupor, and delirium. There may be coma vigil, the
patient lying perfectly quiet with his eyes open, but
paying no attention to what is going on around him.
The temperature gradually rises morning and evening
until it reaches 1040, sometimes 1050 F., with a corre-
sponding increase in the pulse-rate. During the second
week the temperature is high and varies very little; it
begins to descend gradually during the third week, the
morning temperature being one or two degrees lower
2l6 PRACTICAL POINTS IN NURSING.
than that of the evening. During the fourth week the
temperature is almost normal in the morning, and rather
irregular. A sudden drop would indicate hemorrhage
or perforation of the bowels. The pulse is generally
rapid, and in severe cases may be dicrotic.
About the second week rose-colored spots appear on
the chest, the back, and the abdomen. These spots are
slightly elevated and disappear upon pressure. Each
spot lasts about three days, a few fresh ones appearing
every day or two until the third week, when they dis-
appear. The eruption may be absent in the old and the
very young. The third week is an anxious week, as then
very often the symptoms are at their worst. The patient
may have a relapse, which is another course of the fever;
but generally the duration of the disease following a
relapse is not so long as the first attack. It is, however,
a very serious time, the patient's strength being very low.
The nursing consists in keeping the patient quietly in
bed, the bed- and body-linen sweet and clean, the air of
the room fresh and pure, and the temperature 65° F. The
typhoid germ is eliminated from the body through the
discharge from the bowels, and the smallest portion of
fecal matter can produce the disease in another person.
There may be diarrhea, the movements being loose and
yellowish in color, with an offensive odor, or there may
be constipation. After a recent hemorrhage the move-
ments are dark red, containing blood; but if not passed
for some time after the hemorrhage has taken place,
they will be black, resembling tar.
The excreta must be thoroughly disinfected with
chlorid of lime (1 pound to 4 gallons of water, 1 quart
being well stirred in each dejection), or with whitewash
or a solution of carbolic acid (1 : 20). Corrosive subli-
NURSING IN SPECIAL MEDICAL DISEASES. 21J
mate is not so good, as it hardens the albuminous mate-
rial which covers the outside of all fecal masses, and
thus protects the inside from its action. In the absence
of all disinfectants boiling water may be used, or the
movements may be mixed with sawdust and burned.
The feces must not be emptied near a well nor any place
where the water-supply would become contaminated. A
disinfectant should be poured into the bed-pan before it
is carried to the patient, and on its removal it should be
covered with a cloth wet in carbolic-acid solution. Bed-
and body-linen soiled with fecal matter must be thor-
oughly boiled.
Sometimes there is a constant dribbling of urine
through over-distention of the bladder. This trouble is
easily remedied if the catheter be passed. There may
be retention or suppression of urine. Retention exists
when the bladder is full of urine, the patient being
incapable of urinating; in suppression the bladder is
empty, no urine having been secreted by the kidneys.
The nurse should report any cough, the character of
the expectoration, and nose-bleed; also delirium, which
very often occurs, and which may be mild, active, or
violent. She should be very kind and gentle, but firm;
she should not leave the patient alone for a single mo-
ment, but should wait until some member of the family
can relieve her or bring what she needs. She should
report any symptoms of pain in the ear, discharge from
the ear, or deafness, which is not uncommon. The
mouth of the patient must be kept perfectly clean; it
should be washed at least three times daily to prevent
the collection of sordes, a dark-brown accumulation on
the teeth, gums, lips, and tongue.
The diet will be liquid food, which is easily digested;
2l8 PRACTICAL POINTS IN NURSING.
a more solid diet would irritate the intestines and cause
perforation. Milk will probably be ordered. For an
adult two quarts should be given in small quantities
every one or two hours during the twenty-four hours;
the milk may be flavored with tea, coffee, cocoa, vanilla,
or any flavor for which the patient has a fondness.
Should the milk not digest, as will readily be deter-
mined by the presence of milk-curds in the dejections,
this fact should be reported to the doctor.
A few words may be said here about the drinking of
milk. Many patients will drink half a glass, and often a
whole glass, of milk at one time, and soon afterward will
complain of a feeling of indigestion and want very hot
water to drink. Milk curdles as it is swallowed, and if a
large quantity is drunk at once, it forms in the stomach
a large hard mass, and the juices of the stomach can
act only on the outside of it; whereas if the milk is
drunk in little sips, it forms a loose mass of small lumps,
and the juices of the stomach can work around and
through them, and thus dissolve the whole in a very
little time. The milk diet may be alternated with
beef-tea, chicken-broth, oyster-broth, coffee, or cocoa.
Oysters contain an amount of albumin, are very nour-
ishing, are easily digested, and are often retained when
all else fails. One oyster, fresh from the shell, may be
given every hour or half hour. It should be remem-
bered that the patient's mouth and lips are very often
parched and dry; therefore they should be moistened
before feeding. The patient should always be awakened
for treatment in the daytime, but the doctor should be
asked if he is to be awakened during the night.
Thirst may be relieved with crushed ice, lemonade,
NURSING IN SPECIAL MEDICAL DISEASES. 2\g
or orangeade. The patient should also be supplied with
plenty of cool filtered or distilled water or with Vichy
water. The object of giving the patient plenty of pure
water to drink is to flush out the kidneys and to aid in
the elimination of the worn-out material generated in the
body by the fever.
The temperature is reduced by means of tepid spong-
ing, the cold pack, and the tub-bath (see pages 83, ?>2>,
89). Besides reducing the temperature, baths soothe and
quiet the patient.
Complications.—Some of the complications of typhoid
fever are pneumonia, hemorrhage, peritonitis, perfora-
tion, and diarrhea.
Two of the most dreaded complications of typhoid
fever are hemorrhage and perforation, and it is the lia-
bility to these two complications that makes it absolutely
necessary for the patient to keep perfectly quiet, not ris-
ing for anything without direct orders from the doctor,
be the case ever so mild, as sitting up causes pressure
upon the ulcerated part, and might result in perforation.
Purgatives must not be given by a nurse on her own
responsibility, as they might irritate the bowels and
cause perforation.
Hemorrhage.—The intestines, though very thin, are
supplied with large and small blood-vessels. In typhoid
fever the intestines are in some parts ulcerated: one of
the ulcers may eat its way into a blood-vessel and cause
hemorrhage, which is indicated by a sudden fall of tem-
perature, a small, rapid pulse, a pale face, an anxious
expression, restlessness, demand for air, faintness, and
blood in the movements.
With children ulceration of the bowels is less likely
220 PRACTICAL POINTS IN NURSING.
than with adults, consequently the dangers of hemor-
rhage and perforation are less. The rash may be absent,
but the brain-symptoms are marked, and generally the
temperature rises suddenly. In very old people the rash
may also be absent.
Treatment of Hemorrhage.—In treating hemorrhage
the foot of the bed should be raised as high as possible.
If the bedstead cannot be raised, then the bed-spring
should be raised and the head of the patient should be
lowered. Ice or ice-cold cloths may be applied to the
abdomen. Morphia (gr. ^) may be given hypodermatic-
ally ; it will both stimulate the heart and secure rest
and quiet. The patient must be kept perfectly quiet on
the back, so that the blood will coagulate in the vessels
and prevent further hemorrhage.
Perforation is due to the breaking of an ulcer of the in-
testine ; the contents of the bowels then escape into the
abdomen, causing inflammation of the peritoneum, and
resulting in peritonitis. The symptoms of perforation are
sudden and sharp pain in the abdomen, which is distend-
ed and tender, vomiting, a fall of the body-temperature,
a small, rapid pulse, and all the symptoms of collapse.
Treatment of Perforation.—The treatment until the
arrival of the physician consists in the application of
hot fomentations to the abdomen and down the limbs,
stimulation, and morphia (gr. jc) to secure rest and quiet
and to relieve the pain.
The nurse must be calm, cheerful, and equal to any
emergency. Whatever happens, she should not let her
patient know, either by word or by look, that there is
anything wrong; she must remember that the patient is
watching her very closely, and is guided by the expres-
sion of her face.
NURSING IN SPECIAL MEDICAL DISEASES. 221
Tympanites, which is distention of the abdomen through
the accumulation of gas in the bowels, is relieved by
turpentine fomentations or by plain poultices and the
rectal tube.
Bed-sores may be prevented by bathing the patient's
back with alcohol or with a solution of salt and whisky
(2 teaspoonsful of salt to a pint of whisky), or by pow-
dering the back with oxid of zinc, fuller's earth, pow-
dered starch, corn-starch, bismuth, or borax. If the skin
breaks, the part should be covered with the white of egg.
When the urine and the feces are passed involuntarily
or when there is much skin moisture, rubbing the back
with olive oil or vaselin will prevent the moisture from
being absorbed. In the absence of alcohol, the parts
should be kept perfectly clean with soap and water; the
sheets should be kept dry and free from wrinkles; pres-
sure should be removed and the position of the patient
should be changed often.
Convalescence.—During convalescence there may be a
temporary rise of temperature, due either to excitement,
change of food, or constipation. The diet should be
light, such as custards, puddings, cream-toast, soft-boiled
eggs, and jellies. A return to solid diet should be made
only with the doctor's permission. Very few visitors
should be allowed. The nurse should be faithful in the
use of disinfectants, and should never go to her meals
without first washing her hands thoroughly with soap
and water and a brush. The germs enter the body by
the mouth ; hence by the thorough washing of her hands
before eating the nurse will guard against the germs of
the disease—typhoid or any germ-disease of which she
has the care—being swallowed with the food.
Walking Typhoid Fever.—" Walking " typhoid fever,
222 PRACTICAL POINTS IN NURSING.
as a rule, is of a mild character; the patient refuses to
give up and go to bed. Still, there is always the danger
of grave symptoms developing and resulting in death.
Scarlet Fever.—Scarlet fever is synonymous with
scarlatina. It is an acute infectious contagious disease
characterized by high temperature, rapid pulse, head-
ache, vomiting, sore throat, and rash. The tongue is
coated, which coating after a few days disappears and
the papillae become prominent and bright red—the
" strawberry tongue," as it is called. The bowels are
constipated, the urine scanty and high-colored. On the
second day of the disease the rash appears. It be-
gins as small red dots on the chest and neck, and
gradually extends until the whole body is a bright scar-
let. About the fifth day the temperature begins to fall,
and gradually decreases, the eruption fades, and desqua-
mation or peeling begins. Very often large scales will
come off the hands, the feet, and the abdomen. This
peeling lasts for two or three weeks.
In the malignant form the rash comes out late, the
temperature is very high, and death often takes place in
from two to three days; while in the simple form the
rash is present, but there is very little throat trouble.
With children scarlet fever is often ushered in with
convulsions.
The treatment''of scarlet fever lies in isolating the pa-
tient in a room as far away from the family apartments
as possible, and in removing all unnecessary articles
from the room. If two adjoining rooms can be used,
the medicines, dishes, disinfectants, etc. should be kept
in the second room; if only one room is available, a
screen may be improvised by covering a clothes-horse
with a shawl, a blanket, or a sheet, and behind this screen
NURSING IN SPECIAL MEDICAL DISEASES. 223
everything may be kept. A small table may be placed
outside the room, and provided with a slate upon which
the nurse writes her requirements, the things needed
being left for her on this table.
The nurse should keep the air of the room perfectly
pure and the temperature at 65° F. When ventilating
the room, she should take care that the air does not
blow from the sick-room into the other rooms of the
house. A sheet wet with some disinfectant should be
hung over the door. Nothing must leave the room
without first being washed in a disinfectant or in boiling
water. The diet is liquid. The patient should be given
to drink plenty of pure cold water, which will flush out
the kidneys and aid in eliminating the worn-out mate-
rial generated in the body.
Baths or cold packs may be ordered to reduce the
fever, followed by oiling of the body with cocoa-butter,
sweet oil, or vaselin. This treatment, besides reducing
the fever, will assist the peeling and prevent the scales
of skin flying about, and thus act as a preventive against
the spread of the disease. The nurse should have every-
thing ready before beginning the bath, and the bed- and
body-linen thoroughly aired before being changed.
The nose, mouth, and throat of the patient should be
kept perfectly clean. Soft rags should be used to wipe
away the fecal discharges, and they should be burned as
soon as used; if this is impracticable, they should be
thrown into a pail of disinfectant. If the throat is
ordered to be sprayed, the nurse should stand a little
to one side when spraying, so that the patient will not
cough in her face.
The ears of the patient should be watched very closely,
and any pain or discharge should be reported to the
224 PRACTICAL POINTS IN NURSING.
physician. Inflammation of the middle ear, a very com-
mon condition after scarlet fever, and deafness, are often
due to carelessness on the part of the nurse. If the pain
is severe, one may, until the arrival of the doctor, try hot
flannels or a bag, made in half-moon shape, filled with
salt and heated. This bag should be applied around
the ear, never over it, because the heat might cause the
walls of the canal to swell, which would bring them
together. Dry heat will give great relief.
Complications.—Uremia, dropsy, and nephritis (inflam-
mation of the kidneys) are complications very apt to
appear. The urine must carefully be watched and meas-
ured. The nephritis and dropsy may be due to cold
taken during a bath or during convalescence, either
through carelessness of the nurse or obstinacy of the
patient. The symptoms of dropsy are puffiness of the
face, the eyelids, and the limbs, paleness, headache, and
smoky-colored urine. With children uremia is very
often ushered in with convulsions. Uremia is caused by
urea (a very poisonous substance of the urine) being re-
tained in the body, owing to the kidneys not properly
doing their work. The symptoms of uremia are head-
ache, suppression of urine, nausea, and the odor of urine
in the breath; unless relieved, these symptoms are fol-
lowed by convulsions, coma, and death. The pulse is
slow and full; the temperature is subnormal.
Uremic convulsions may be relieved by a hot pack or a
hot-air bath, and morphia (gr. ^) hypodermatically ad-
ministered if possible, which will quiet the spasms, en-
courage perspiration, and stimulate the heart. An enema
or a cathartic of oil or of Epsom salt may be given to
clear the bowels. Hot fomentations or poultices may be
applied over the kidneys to relieve the suppression of urine.
NURSING IN SPECIAL MEDICAL DISEASES. 225
Delirium must at once be reported. Should it set in
after the physician has made his visit, cold may be
applied to the patient's head.
Depression must be met with stimulants. The patient
should be well nourished, as the fever is very exhausting.
Convalescence.—The patient will probably require iso-
lation for four weeks, be the case ever so mild. A thor-
ough bath and a complete change of clothing must be
given before he goes into another room. Some doctors
like the patient to be in an adjoining room for two weeks
before mingling with the family. The patient must be
kept away from all draughts. The convalescence is
slow and must be guarded.
Typhus Fever.—Typhus fever is an acute contagious
disease caused by an infecting germ and influenced by
overcrowding, bad food, bad air, and impure drinking-
water.
Symptoms.—Typhus fever begins abruptly with a chill,
followed by high fever, severe pain in the head, the back,
and the limbs, muscular weakness, and great prostration.
The temperature rapidly rises, and about the third or
fourth day it is 104 or 1050 F., with a corresponding
increase of pulse, from 120 to 130 beats, which are at
first full, bounding, and compressible, and later weak
and often dicrotic. .The bowels are constipated, the
urine is scanty and high-colored, the face is dusky, and
the tongue is covered with a whitish fur which in severe
cases becomes black. There is also a peculiar odor
characteristic of the disease.
About the fifth day there appears over the body an
eruption, consisting of rose-colored spots, which after
two or three days become darker. The difference be-
tween the rash of typhoid and that of typhus fever is
15
226 PRACTICAL POINTS IN NURSING.
that the eruption of typhus does not appear in successive
crops, it does not disappear upon pressure, it begins to
fade from the end of the first week to about the middle
of the second week, and is much darker.
In severe cases death may take place in a few days
from coma or from heart-failure, while in mild cases the
improvement begins about the end of the second week,
the temperature falls suddenly, and convalescence is
rapid.
Treatment.—The patient is to be isolated, and disinfec-
tion of the clothing and the excreta must be thoroughly
effected. The exhaustion, which is extreme, is met with
stimulants. Bed-sores and heart-failure are to be guarded
against. All visitors are to be excluded, and the patient
is to be kept bodily and mentally quiet. The nurse must
not hesitate to feed the patient by the rectum if it be-
comes necessary. The high temperature is treated with
cold baths or packs; the headache and delirium are
treated with cold applied to the head and absolute quiet
maintained. The air of the room must be kept fresh and
pure, and the temperature even.
The complications of typhus fever are catarrhal pneu-
monia, inflammation of the kidneys, and swollen paro-
tid glands.
Small-pox.—Small-pox is an acute contagious dis-
ease. The varieties are—discrete, confluent, malignant,
and varioloid or modified small-pox.
Symptoms.—The disease begins with a chill, high fever,
vomiting, intense pain in the back, limbs, and head, sleep-
lessness, and a full and rapid pulse (from ioo to 120 or
more). The temperature reaches its height (104-1050
F.) about the second day, and at the fourth day it begins
to fall. About the third day the eruption begins to
NURSING IN SPECIAL MEDICAL DISEASES. 227
appear on the forehead and face, and consists of small,
round, elevated red spots, which feel like shot. When
the eruption appears the temperature falls and the pa-
tient feels very comfortable. The eruption gradually
spreads over the entire body. On or about the sixth
day these small hard spots become clear vesicles or
blisters, and two or three days afterward they change to
pustules; then the secondary chill sets in, the tempera-
ture rises to 104 or 1060 F., with a corresponding
increase in the pulse. Pus oozes from the pustules,
which in about three days dry up and form crusts hav-
ing an offensive odor. After a week or so these crusts
fall off and leave the " pock-marks." There is delirium,
the face is swollen, the features are disfigured and often
unrecognizable, the bowels are constipated (though there
may be diarrhea), and the urine is scanty. The second-
ary fever in a mild case may gradually subside on the
third or the fourth day, and convalescence set in.
In the confluent form the pimples are very abundant
and they run together; there is a fetid discharge from
the nose and the throat. The symptoms are more severe
than in the discrete form.
The malignant form ends in death in a few days,
before the rash appears. Varioloid, or the modified
form, occurs in a person who has either been vaccinated
or has had a previous attack.
The nursing consists in isolating the patient and using
every precaution against the spread of the disease.
Members of the family must protect themselves by vac-
cination ; the air of the room must be kept pure, and
the temperature even (about 65° F.). The fever may be
treated by cold baths or packs, and pains in the limbs
and back, cither by ice or by heat—whichever is the
228 PRACTICAL POINTS IN NURSING.
more comfortable to the patient. The pitting can to a
certain extent be prevented by darkening the room,
keeping it thoroughly ventilated, covering the patient's
face with a mask soaked in either carbolic-acid or corro-
sive-sublimate solution, or by applying some simple oint-
ment which will relieve the pain and heat. To prevent
scratching, the patient's hands may be tied up in soft
cloths.
When the crusts fall off they must be burned. The
eyes, nose, and mouth must be kept clean, being washed
several times a day. The diet consists of milk, broths,
egg-nog, oysters (which are almost all albumin), oyster-
broth, and beef-juice. Crushed ice, lemonade, or soda-
water may be given to relieve the thirst. Stimulants
may be given if necessary.
After the case is ended everything that can be burned
must be so destroyed, and the room and the furniture be
fumigated and disinfected several times (see p. 234). It
is a dread disease, and the germs, like those of scarlet
fever, are very long lived.
Measles.—Measles begin with all the symptoms of a
severe cold. About the third day the rash appears on
the face and forehead, and then spreads over the body.
It consists of small red spots of different sizes, slightly
elevated. The temperature rises to 1020 F., and in-
creases when the eruption appears. At the end of two
or three days the eruption fades, the temperature sud-
denly falls, and desquamation, or peeling, begins in the
form of a fine branny powder, very unlike the peeling
seen in scarlet fever.
The Nursing.—The patient is to be isolated, as the
disease is contagious; the temperature of the room
should be even (about 700 F.), and the room must be
NURSING IN SPECIAL MEDICAL DISEASES. 229
slightly darkened on account of the condition of the
eyes. Baths should be given to assist the peeling. The
diet is either liquid or of light food, according to the
amount of fever. The bowels must be kept regular.
The eyes, nose, and mouth must be kept perfectly
clean. The patient must be guarded against exposure
to draughts, and must be kept in bed, be the case ever
so mild, until the peeling is over. After the patient has
left the room any tendency to cough must be reported.
Disinfection and fumigation should be practised as for
scarlet fever (see pp. 223, 234).
Complications.—Some of the complications are pneu-
monia, bronchial catarrh, and inflammation of the eyes,
nose, throat, and ears.
Diphtheria.—Diphtheria is an extremely infectious
disease, the germs of which have their seat in the throat.
The poison is carried through the body, and may give
rise to certain forms of paralysis, which is partly due to
the action of the poison on the nervous system, and
partly to its interference with the nutrition of the va-
rious tissues of the body.
The temperature ranges from ioo° to 1050, or 1060 F.
in severe cases, with a correspondingly increased pulse.
The tonsils are red, swollen, and covered with membrane.
This membrane may be of a gray or a yellowish-white
color, and gradually change to a dull gray. When
the membrane extends to the nose and the larynx, this
condition will be manifested by an offensive discharge
from the nose and nose-bleed, and by a gradual loss of
the voice and difficult breathing. Soft cloths should be
used to wipe away the discharges from the nose and the
mouth ; these cloths must be burned or thrown into a
disinfectant as soon as used. The discharges are highly
23O PRACTICAL POINTS IN NURSING.
infectious. All cuts and scratches of the nurse's hands
should be covered, as the smallest amount of discharge
that may get on any raw surface is capable of producing
blood-poisoning.
The Nursing.—The patient must be isolated. The
room is to be properly ventilated, and the temperature
of the room should be 65° F. Moist air may possibly
be ordered, which can readily be secured by keeping pans
or kettles of boiling water in the room, or, if there is a
fire in the room or furnace-heat, by wringing sheets out
of water and hanging them up to dry.
Steam inhalations may be ordered for the throat, or
gargles or sprays. Peroxid of hydrogen is very com-
monly used for the destruction and elimination of the
false membrane, and if the throat is not very sensitive,
this drug may be used undiluted, applied with a swab.
If this cannot be done, the throat may be sprayed with
one part of peroxid of hydrogen to 4 parts of water.
A glass atomizer must be used, because the peroxid of
hydrogen decomposes when in contact with metal.
The antitoxin treatment for diphtheria is the injection
into the body (generally into the broad of the back) of
antitoxin serum, by means of a large hypodermic syr-
inge. The operation is performed by the attending physi-
cian. The wound is sealed with a collodion dressing.
The nourishment and stimulants must faithfully be kept
up. Often the throat is so swollen that the patient cannot
swallow, and resort must be had to nasal or rectal feeding.
Crushed ice or ice-cream will prove very grateful to the
patient, besides helping to reduce the inflammation. The
ice-cream adds to the amount of nourishment taken, as
it is made of milk and eggs. Paralysis of the muscles
of the throat is not uncommon, and the patient must not
NURSING IN SPECIAL MEDICAL DISEASES. 231
return to solid diet without permission from the doctor.
There may also be temporary paralysis of the muscles
of the eyes and of the limbs.
The nurse must watch the urine; it will be high-col-
ored and scanty, and there may be retention, owing to
paralysis of the bladder. The depression is very great,
and heart-failure often occurs through sudden sitting up
or sitting up too soon. The patient must not be allowed
to sit up without direct orders from the doctor.
The nurse must guard herself by good, nourishing
food, fresh air, and the faithful use of disinfectants. The
germs are less likely to infect the lining membrane of
the throat and larynx if these parts are in a healthy
condition; but when the tonsils are inflamed the germs
find the conditions necessary for their development, and
diphtheria is the result. When the case is ended thor-
ough disinfection is necessary.
Tracheotomy is often performed in diphtheria when the
larynx is obstructed through extension of the diphtheritic
membrane and there is danger of suffocation. It is also
performed in membranous croup for the same reason as
that in diphtheria. With the instruments the nurse has
very little to do, but she must have at hand plenty of hot
ivater, basins, tape, scissors, strong white thread, a fan,
stimulants, sponges, a firm, hard table, and a small
pillow, which can be made of a folded sheet. The patient
is placed on the table, and the clothing is slipped well
under the shoulders ; the patient is then rolled in a sheet
or a blanket, which is pinned securely, so that he cannot
struggle or get loose (PI. 3). If the nurse is asked to
hold the head, she should hold it firmly and not too far
back, lest the patient be suffocated before the operation
is begun. When the trachea is opened there will be a
232 PRACTICAL POINTS IN NURSING.
rush of air and mucus; then the silver tube (Fig. 63)
will be inserted and secured by the tape, which is passed
Fig. 63.—Tracheotomy : A, tracheotomy-tube; b, tracheotomy-tube in position.
through the slits on each side of the shield, and carried
round the neck and tied at the side (Fig. 63). The
trachea-tube is made double, so that the inner one may
be taken out and cleansed. The after-care consists of
three things: faithfulness in maintaining the patient's
strength with nourishing food and stimulants, keeping
the tube free from membrane, and the air of the room
moist and warm (temp. 8o° F.), because in tracheotomy
the air does not first go through the nostrils and become
warmed before reaching the lungs, but it goes directly
to the lungs through the tube. This protection is
further effected by folding a light muffler of gauze over
the aperture of the tube. The patient may be fed by
the rectum if necessary.
Everything should be made ready before beginning to
DIPHTHERIA.
Plate 3.
1. Position or patient for tracheotomy; 2. Intubation: inserting the tube (from An American
Text-Book of the Diseases of Children).
diphtheria.
Plate 4.
Croup-tent for steaming and calomel-fumigation (Northrup): i. Croup-tent open. The
fumigation-apparatus, standing on the table, consists of a Bunsen burner, a tripod, and a plate
containing calomel; 2. Calomel-fumigation: croup-tent closed, nurse watching the child while
tumigation is going on.
NURSING IN SPECIAL MEDICAL DISEASES. 233
cleanse the inner tube, which should not be kept out
longer than necessary. If the tube is oiled a little, its
removal will be facilitated and the mucus prevented from
accumulating. The discharge should be noticed—if it be
thin, dry, or moist. A small piece of flannel or of cot-
ton-wool spread with vaselin and placed between the
tube and skin will protect the edges of the wound
against the pressure of the tube and prevent irritation
and chafing.
Should the tube suddenly be coughed out, it should
quickly be replaced; if this is impossible, a small cath-
eter may be inserted or a small rubber tube, which can
be kept in position by means of a safety-pin run through
the end of the tubing, a cord or tape being slipped
through each side of the pin and tied around the neck.
Should either of these measures fail, then the part should
be kept wiped out with absorbent cotton, and the patient
raised in the best breathing position possible until the
arrival of the doctor, and stimulants be given if neces-
sary.
Intubation.—This, as the above operation, is performed
when the larynx is obstructed either from acute or
chronic disease or from a foreign body. The duties of
the nurse in intubation will be, in case the patient is a
child, to hold the child upright in her arms, with its
knees placed firmly between her own, while an assistant
stands behind her chair and holds the head in the proper
position (PI. 3). The patient should be fed well; he
will swallow better with the head to one side. Ice-
cream, crushed ice, and all foods in small amounts may
be given.
If the tube is coughed up or swallowed, the doctor
must be informed. If swallowed, it will probably pass
234 PRACTICAL POINTS IN NURSING.
through the bowels without any trouble. It may not be
necessary to reinsert the tube; however, it is always
well to ask the doctor what to do under such cir-
cumstances.
Fumigation of Sick-room after Contagious Diseases;
Sulphur Fumes.—After recovery or death of a patient
from contagious disease everything in the nature of
books, playthings, etc. that can be burned should be
so destroyed, and the remaining things be washed
thoroughly in carbolic-acid solution (i : 20) or in boil-
ing water, and the room fumigated. The germs, which
are very long lived, may lie hidden in clothes, books,
and other things if these are packed and laid away;
they will also lie in the corners of a room, and will
develop months or even years after the case has ended
and do all the harm of which they are capable. The
fumigation should be very thorough. All the cracks
in the room should be closed either by stuffing them
with cotton or by pasting paper over them. All draw-
ers and closets should be opened, and the pillows and
mattresses should be ripped. A tub or a large pan
should be partly filled with water, and in this be placed
two or three bricks on which to stand a smaller pan. In
this smaller pan is put the roll sulphur, which must be
broken up into very small pieces and be saturated with
alcohol. The water in the large pan will both guard
against fire and furnish moisture in the form of steam.
After everything is secure and there is no possible way
for the sulphur fumes to escape the sulphur is ignited.
If alcohol is not at hand, a few red coals will ignite the
sulphur. The room door is now closed, the key-hole
and all the cracks of the door are stopped up, and the
room is left for twenty-four hours, when it is opened and
NURSING IN SPECIAL MEDICAL DISEASES. 235
aired for twenty-four hours longer; then everything, in-
cluding the walls and floors, must be washed with either
corrosive-sublimate (1 : 1000) or carbolic-acid solution
(1 : 20) and exposed to the action of the sun and air for
a number of days.
If, when preparing the room for fumigation, a hole is
bored through the middle of the top window-sash, and
there is passed through this hole a piece of rope of suf-
ficient length to extend to a window below, the sick-room
window can be opened from the outside at the end of
the fumigation. When closing up the cracks in the sides
of the window care should be taken that they are filled
in securely, so that the sulphur fumes cannot escape
through them, but at the same time that the window
can easily be pulled open.
Moist fumigation is obtained by filling the room with
steam generated from kettles of boiling water, or, if there
is a register or a fire in the room, by hanging up wet
sheets or wet blankets. This procedure is continued
until moisture falls from the walls and the furniture, to
which moisture the germs cling; then, while still moist,
the walls, furniture, and floor are thoroughly washed
with corrosive-sublimate solution (1 : 1000), and after-
ward exposed to the influence of the sun and air.
Another method of disinfection is to close the room
for twelve hours, until the dust has settled, and then to
wash off the furniture with corrosive-sublimate solution
(1 : 1000). Newspapers are then spread upon the floor
and the walls are rubbed with stale bread; the crumbs
fall upon the newspapers, which are afterward taken up
and burned. The disadvantage of this method lies in
the inability to get into the crevices.
When a patient dies of a contagious disease, the body
236 PRACTICAL POINTS IN NURSING.
should be washed with a disinfectant and be wrapped in
a sheet wrung out of the same; the funeral must be
strictly private.
The dress of the nurse must be of wash material, and
she should wear a close-fitting cap. A member of the
family should relieve her at meal-times and when she is
sleeping. She should not eat nor sleep in the sick-room
if this can possibly be avoided. She should go out for
a while each day, no matter how tired she may be, first
making an entire change of clothing, or she should go
into an adjoining room, open the window top and bot-
tom, and walk up and down before the open window.
Phthisis is tuberculosis of the lungs, commonly called
" consumption," and is infectious through the expectora-
tions if the latter are allowed to dry, the germs of the
disease being blown about in the dust. A sputum-cup
(Fig. 64) containing some antiseptic solution should be
used by the patient and be cleaned at least three times a
day. The other excretions must also be disinfected. If
the patient is able to go about, he should be told the
importance of expectorating in pieces of soft cloth, which
can be burned, and not in handkerchiefs, which are to be
washed. Kissing must not be allowed, as the infection
can be transmitted by sores that may be on the lips;
neither should a healthy person sleep in the same room
with a consumptive. It is very important that cuts and
scratches on the hands should be well covered, as there
is danger of the sputum coming in contact with such
injuries and of the germs entering the body through
the broken skin. The nurse will therefore see how
essential it is, when on duty in contagious cases, to take
great care of her hands. The same precaution applies
to the patient, all cuts and scratches being covered so
NURSING IN SPECIAL MEDICAL DISEASES. 237
that the sputa or the excretions cannot come in contact
with the wounds, and in keeping the skin perfectly
clean.
Forms of Phthisis.—There is an acute and a chronic
form of phthisis : the acute form at first is not unlike pneu-
monia ; there is chill, a rise of temperature, profuse per-
spiration, difficulty in breathing; the expectorations at
first are rust-colored, and afterward become purulent-
All these symptoms rapidly increase, and death occurs
in a few weeks or a little longer. In the chronic form
the patient may linger for years.
Patients with phthisis, whose cases are generally hope-
less, esteem the kind attention of the nurse, there being
very little that can be done for them beyond making
them as comfortable and as happy as possible.
Simple Croup.—Simple croup or false croup is a dis-
ease of children, and begins with all the symptoms of a
severe cold—dry cough and suppressed voice, caused
by mucus collecting in the nostrils and larynx, which
becomes dry and hard; consequently the patient is in
great distress and makes spasmodic efforts to breathe.
The patient should be propped up in the best breathing
position, and hot fomentations applied to the throat; an
effort should be made to produce vomiting with luke-
warm water and salt, or by tickling the throat, or by
running the finger down the throat, followed by any
kind of oil, melted vaselin, mutton tallow, etc. A cold
cloth should be wrapped around the neck and the pa-
tient put into a hot bath (temperature from 1000 to 1020
F.), and a simple enema to clean the bowels should be
given. The temperature of the room must be kept
even (700 F.), and the air moist. The attack usually
occurs at night, and a second attack can generally be
238 PRACTICAL POINTS IN NURSING.
prevented by keeping the bowels open and by not allow-
ing the child to sleep uninterruptedly through the night;
it should be given a drink of milk or of water, which
will tend to prevent the mucus collecting.
Membranous Croup.—Membranous croup, or true
croup, is by most authorities considered the same as
diphtheria. The mucous membrane lining the larynx is
inflamed, and a tenacious mucus covers the swollen
membrane, which gradually thickens until the breathing
is obstructed. There is high temperature (102-1040 F.)
and a small, rapid pulse. Until the arrival of the doctor
the nurse can only apply the same remedies as those
used for simple croup. Stimulants should be given if
necessary. If the obstruction is persistent and threatens
to cause suffocation, tracheotomy or intubation will have
to be performed. The patient's strength must be kept
up by proper nourishment and stimulants.
Should the patient appear to be suffocating, the nurse
may, until the arrival of the physician, try to remove the
membrane with a cotton-stick or with her finger; in fact,
at such a time she will be justified in doing anything
that will save the patient's life. Calomel fumigation (PI.
4) often affords relief from the urgent symptoms.
Whooping Cough.—Whooping cough (pertussis) be-
gins with all the symptoms of catarrh of the trachea and
bronchi (the air-passages), high temperature, and rapid
pulse. About the tenth day the cough becomes vio-
lent, the deep, loud, long-drawn, shrill inspirations which
will be heard are probably due to spasmodic contraction
of the glottis. During the attack the child may become
perfectly blue; the veins in the neck become swollen,
and in some cases will be thoroughly exhausted after
coughing, while in others the child will rapidly recover
NURSING IN SPECIAL MEDICAL DISEASES. 239
and continue to play. The patient must be isolated from
other children, and be given light and nourishing food;
the air of the room must be kept pure and the temperature
even. Steam inhalations and counter-irritants to the chest
may be ordered. Anything that seems unusual about the
child must be reported. Should convulsions occur, a
warm bath should be given while waiting for the doctor,
and cold cloths be applied to the head. The disease
may last from four to six weeks, or even longer. The
paroxysms of coughing occur oftener at night than dur-
ing the day, and generally, where there are a number of
children with the disease in the same room, when one
begins to cough the others also begin. Among the
complications are chronic bronchial catarrh, pneumonia,
diarrhea, and phthisis. Whooping cough is very infec-
tious through the discharges from the nose and throat.
2. Functional and Idiopathic Diseases.
Influenza {la grippe) is an acute infectious disease
characterized by fever, pains in the head, back, and limbs,
great prostration, chilliness, sneezing, hoarseness, and
cough.
The treatment is rest in bed and liquid diet. The pains
in the head, chest, and limbs may be relieved with hot
applications. Phenacetin, 5 grains in half an ounce of
whisky every four hours, may be given. It must be
remembered that phenacetin is very depressing on the
action of the heart, and, though some persons can take
doses of from 15 to 20 grains, death has been known
to result from a smaller dose. This fact is mentioned
because the drug is very carelessly used, no thought
being given to its action on the heart; it should not be
taken—in fact, no drug should be taken—without the
240 PRACTICAL POINTS IN NURSING.
sanction or advice of a physician. The patient must
be guarded against draughts, and be stimulated if the
pulse indicates heart-failure. The complications are ca-
tarrhal and croupous pneumonia, inflammation of the
kidneys, and heart-failure. One attack does not mean
immunity from another.
Croupous Pneumonia.—Croupous pneumonia, which
is acute inflammation of the proper substance of the lungs,
is generally confined to one lung; when both lungs are
involved it is called " double pneumonia." The disease
usually begins suddenly with a chill or a chilly feeling
which lasts a long time, high temperature (102 to 1040 F.),
pulse rapid and full (100 to 120 or above), sharp pain in
one side, and the patient can breathe only with difficulty;
consequently the respirations are quickened to thirty-five
or forty per minute, they are shallow, and often irregular.
There is a short dry cough, accompanied later by a rust-
colored tenacious sputa, which must be kept for the
doctor's inspection. The bowels are constipated, and
the urine is scanty and high-colored. Delirium is not
uncommon.
About the seventh or the ninth day there may be a
sudden drop in the temperature, profuse perspiration, and
a general improvement may take place, while in severe
cases a sudden drop of temperature to subnormal, small,
rapid pulse, coldness of extremities, and a blue appear-
ance would indicate collapse, which must be met with
stimulants and heat to the body and a mustard plaster
over the heart. If the patient cannot swallow, the stim-
ulants must be given per rectum.
Until the arrival of a physician the nurse may apply
to the chest flaxseed or mustard poultices or fomenta-
tions. The room must be a sunny room, having an
NURSING IN SPECIAL MEDICAL DISEASES. 241
open fire if possible, and be kept well ventilated, free
from draughts, and the temperature at 700 F.; if the
perspiration is very profuse, the patient should be wiped
dry with warm towels, and fresh clothing which has been
well aired be put on. When the physician arrives he will
give directions, which must faithfully be followed. He
may order ice-bags or compresses, which will often give
great relief, or hot poultices, which must be changed
every two or three hours. Some physicians object to
poultices on account of their weight and because of
the frequent change fatiguing the patient, and prefer
to envelop the chest in a cotton jacket, which can be
removed gradually by cutting off from the bottom about
2 inches each day. The cotton jacket is readily made by
basting two layers of sheet cotton-wool inside an under-
shirt. Oil silk is basted on the outside to prevent evap-
oration of the moisture exhaled from the skin. When
the temperature is very high, cold baths are given,
which, besides reducing the fever, will quiet the respi-
rations and soothe the patient.
The diet must be liquid and nourishing—milk, broths,
beef-juice, koumyss, egg-nog, wine whey, etc. The pa-
tient must be kept in bed, perfectly quiet. The prostra-
tion is often great, in which case there is danger of
heart-failure. The disease reaches its height about the
seventh or the ninth day. As the patient improves the
diet is increased to soft solids—custards, puddings, cream
toast, eggs, scraped-beef sandwiches—gradually prepar-
ing the way for a more solid diet. Pneumonia is a self-
limited disease; hence the nurse must do all in her
power to support life until it has run its course. It is
also infectious through the expectorations; the sputum-
cup (Fig. 64), lined with paper, which can be taken out
16
242 PRACTICAL POINTS IN NURSING.
and burned and the cup boiled about three times a day,
should be used to receive the expectorations.
Fig. 64.—Sputum-cup : a, the cup ; b, the paper lining.
Bronchitis.—Bronchitis, which is an inflammation of
the bronchial tubes, is caused by exposure to cold, es-
pecially when the body has been overheated. It is also
a complication of some of the infectious diseases—mea-
sles, influenza, and typhoid fever. An acute attack begins
with chilliness, a sore and tight feeling in the chest, in-
creased by coughing, which at first is dry, but later is
accompanied by a muco-purulent sputum, which becomes
very profuse as convalescence sets in; the temperature
is 100 to 1010 F., with a corresponding increase of the
pulse. Hot mustard poultices or fomentations must be
applied to the chest, and hot drinks and hot mustard
foot-baths be given. For the relief of the dyspnea, which
is difficulty in breathing, the patient must be raised into
the best breathing position possible and be given inhala-
tions of steam. If the breathing is very difficult, the
patient apparently dying from suffocation, an emetic
NURSING IN SPECIAL MEDICAL DISEASES. 243
should be given to expel the mucus from the tubes, and
heat applied over the heart.
The air of the room must be kept moist and the tem-
perature even (700 F.). The diet should be liquid. The
patient must be guarded from all draughts, the bowels
be kept open, and stimulants be given if the pulse indi-
cates heart-failure.
Asthma also calls for heat over the heart and lungs,
inhalations of steam, hot drinks, hot foot-baths, and
plenty of fresh air.
Pleurisy.—Pleurisy is inflammation of the pleura, the
membrane covering the lungs. The symptoms are severe
pain or " stitch " in the side, short, dry cough, and short-
ness of breath, owing to the pain caused the patient in
breathing. There may be little or no expectoration, and
the cough may be suppressed on account of the pain
the coughing gives the patient. Hot mustard fomenta-
tions should be applied over the seat of the pain. If
there be no mustard at hand, plain fomentations or
a flaxseed poultice may be used; the patient should
be propped up with pillows, thus making the breathing
easier.
If there is effusion of liquid into the pleural cavity,
the amount of urine passed may be very small. The
amount excreted must be measured and reported. An
increase in the amount is a very good sign, as it shows
that the effusion is being absorbed. The effusion into
the cavity causes pressure upon the heart, the lungs,
and other organs, which may be pushed out of place;
paracentesis or tapping is then performed, and the
amount of liquid drawn may vary from a pint to three
quarts.
Empyema.—Sometimes the collection of pus in the
244 PRACTICAL POINTS IN NURSING.
pleural cavity becomes purulent; then we have what is
called " empyema." For this condition the pus is removed,
and the pleural cavity is washed out with disinfectants, a
drainage-tube is inserted, and an antiseptic dressing put
on. In simple cases, when only a small opening is made
with a large hypodermatic needle or a very small trocar,
a piece of adhesive plaster or collodion dressing will be
sufficient to cover the opening. The nurse of course
prepares antiseptically for the operation. It is remark-
able to see the great change for the better that takes
place after the operation, providing there are no com-
plications.
The temperature must carefully be watched; its rise
may indicate a fresh collection of pus in the cavity.
In case of emergency, when the cavity has rapidly filled
up and the patient is in danger of dying during the ab-
sence of the physician, the nurse will be justified in draw-
ing off some of the fluid, but it is generally well to ask
the attending physician, if he lives at a distance and the
nurse is distant from other medical aid, what he would
like her to do in this emergency.
Angina pectoris is neuralgia of the heart: the patient
has severe pain around the heart and there is difficult
breathing. Hot alcoholic stimulants should be given
and heat applied over the heart.
Gastritis, which is inflammation of the mucous mem-
brane of the stomach, is often due to imperfect masti-
cation of food, drinking liquid too hot or too cold, or
drinking any of the corrosive or irritant poisons.
The symptoms are severe pain and a burning sensation
at the pit of the stomach, vomiting, the vomit being
sometimes streaked with blood, intense thirst, small,
rapid pulse, and all the symptoms of collapse.
NURSING IN SPECIAL MEDICAL DISEASES. 245
Treatment of Gastritis.—A physician must be sum-
moned, and in the mean time the nurse can apply hot
fomentations or a mustard plaster over the seat of pain.
If it is known that a poison has been taken within
a short time, she should try to wash out the stomach,
which operation, in the absence of the stomach-pump,
can easily be done by using a fountain syringe or by
giving large quantities of warm water to drink until the
gastric contents become clear. The patient must be fed
by enemata, and the stomach be given absolute rest for a
few days, unless otherwise ordered ; then the nurse should
begin the feeding with a few drops of milk and lime-water,
equal parts; if this is retained, she should gradually in-
crease the dose and the interval between the doses.
Crushed ice, ice-cream, iced champagne, or very cold
Seltzer water, given in very small quantities, will often be
retained. The patient should be fed slowly, and the diet
gradually be worked up to egg-nog, oyster-broth, raw
oysters, arrowroot, custards, etc., though the change of
diet must not be made without the physician's orders.
Peritonitis is inflammation of the peritoneum, the
serous membrane lining the abdomen. Peritonitis
may be due to cold, to blows upon the abdomen, to
inflammation of any of the organs in the abdomen
covered by the peritoneum, or it may follow an opera-
tion upon the abdomen. It may also occur in typhoid
fever after perforation of the bowel, the contents of the
latter escaping into the abdomen and the peritoneum
becoming inflamed. There may be a chill, severe pain
in the abdomen, which is distended and tender, vomit-
ing, constipation, high temperature (from 101 to 1030
F.), small, rapid pulse, and respiration high and shallow,
owing to the pain caused by breathing. The expression
246 PRACTICAL POINTS IN NURSING.
of the face is drawn and anxious. The patient when in
bed lies on the back with the knees drawn up, which
position relaxes the muscles of the abdomen. A roll or
a pillow placed under the knees will remove the strain
that the patient has to make in order to keep up the
knees.
Treatment.—Poultices or fomentations are applied to
the abdomen, and the weight of the bed-clothes re-
lieved by a cradle. The nurse must not give purgatives
on her own responsibility, as there is danger of irri-
tating an already inflamed and tender membrane and
causing perforation. When convalescence begins, the
patient should be fed well with nourishing food, but re-
turn to solids should not be made without the physician's
orders. The nurse will know at the end of a few days
if the patient is to live or to die: if death is imminent,
there will be loss of strength and collapse.
If the peritonitis is the result of perforation of the
bowel, as in typhoid fever, hot fomentations must be
applied, the patient to be kept absolutely quiet, and the
foot of the bed elevated. Gas-accumulation can be re-
lieved by inserting a rectal tube.
Appendicitis is inflammation of the vermiform appen-
dix, the inflammation being sometimes due to the pres-
ence in the appendix of foreign bodies, such as grape-,
lemon-, orange-, or melon-seeds, or concretions of fecal
matter; other causes are intestinal catarrh, a blow on
the abdomen, unusual physical efforts, or cold. Ap-
pendicitis is more common in men than in women for
various reasons. Men work harder and are subject to
more violence than women. The intestines may become
inflamed through constipation or hard drinking, the in-
flammation extending to the appendix. The appendix
NURSING IN SPECIAL MEDICAL DISEASES. 247
is supplied with blood from one artery, a branch of the
mesenteric artery which supplies the cecum. Catarrhal
appendicitis is generally caused by extension of catarrh
of the cecum to the appendix. If an abscess forms, an
operation is necessary or perforation may take place, re-
sulting in septic peritonitis and death within a very few
days. The operation is also considered in the catarrhal
form, as the patient is always liable to recurrent attacks,
each subsequent attack increasing the danger to life, that
may result in perforation and general peritonitis. Per-
foration is a dreaded complication caused by the rupture
of an abscess into the peritoneal cavity. The symptoms
of perforation are sudden pain, a small, wiry pulse, and
subnormal temperature; or there may be a rise of tem-
perature, and the distention of the abdomen may be
increased.
The symptoms of appendicitis are severe pain, swelling,
and tenderness on the right side of the lower part of the
abdomen, rise of temperature, constipation, and, later,
vomiting.
A patient ill with peritonitis lies in bed with both knees
drawn up, and usually in appendicitis the same position
is assumed, or the right knee alone may be drawn up.
The treatment is medical and surgical. For a catar-
rhal attack the treatment is absolute rest on the back,
liquid diet, an ice-bag, or hot turpentine or mustard
fomentations or poultices. The appendix is removed
when there is an abscess and also in case of perfora-
tion (unless the shock is too great).
The writer here desires to impress upon the nurse the
absolute necessity of perfect antisepsis for this opera-
tion, as it can only be successful when she has obtained
thorough surgical cleanliness. The source of infection
248 PRACTICAL POINTS IN NURSING.
at all operations (not only when the abdominal cavity
is to be opened) is often the hands of the surgeon, the
assistant, or the nurse, and the instruments, sponges, and
dressings; any fault or neglect on the part of the nurse,
no matter how small, may cost the patient his life.
The work of the nurse until the arrival of the surgeon,
who must be summoned immediately, lies in securing for
the patient perfect rest and quiet and the application of
hot mustard or turpentine poultices or fomentations.
The bowels must be moved with a soapsuds or an oil
enema, gently and carefully given. When the surgeon
arrives he will decide as to the line of treatment; if an
operation is decided upon, everything must antisep-
tically be prepared as nearly as possible under the
existing circumstances.
A question often asked is whether a nurse is justified
in giving morphia before the arrival of medical aid. In
the writer's opinion a nurse is not justified in giving
morphia when a physician is within easy reach, because
it covers up the symptoms and the physician cannot
judge the case; it may also stupefy the patient so that
he cannot give clear answers to questions ; but if she is
distant from medical aid and the patient has severe pain,
then she may give, hypodermatically if possible, \ gr. of
morphia, which will relieve the pain and vomiting.
After a catarrhal attack, when the appendix has not
been removed, the patient must be very careful with
regard to diet and personal hygiene, and should wear
a flannel abdominal protector, because sudden changes
of temperature are liable to affect the bowels, which are
very sensitive, and cause a recurrent attack.
Dysentery is inflammation of the mucous membrane
of the large intestine. The symptoms are chilliness, some
NURSING IN SPECIAL MEDICAL DISEASES. 249
fever, small and frequent movements from the bowels
mixed with blood and mucus, and tenesmus, or constant
straining and painful efforts to evacuate the bowels. Dys-
entery begins with diarrhea, straining, griping pains in
the abdomen, which is very tender, and the characteristic
movements, which are very offensive and which must be
thoroughly disinfected.
Treatment.—The patient must be put to bed and use
the bed-pan in his defecations; he must not be per-
mitted to get up, as there is danger of ulceration,
perforation of the intestine, and peritonitis. A cathar-
tic of magnesia sulphate, 2 teaspoonsful, or 1 ounce
of castor oil with 15 drops of laudanum, should be
given to clear the bowels of the irritating substance;
the laudanum will relieve the pain and the desire to
stool. Hot turpentine or mustard poultices or fomenta-
tions should be applied to the abdomen.
The diet should be liquid—boiled milk, gruels of
flour, corn-starch, or arrowroot. The bed- and body-
linen must be kept perfectly clean and changed often.
Dysentery is not contagious, but if the movements are
not disinfected, they decompose and the epidemic form
may result.
Cholera morbus, which is inflammation of the mu-
cous membrane of the stomach and intestine, is caused
by irritating food, such as unripe or decayed fruit and
vegetables, and also by sudden changes in temperature.
There are severe cramps in the stomach and abdomen,
violent vomiting and purging, the discharges later resem-
bling rice-water; great prostration.
Treatment.—Hot applications to the abdomen and
body must be resorted to at once, and stimulants ad-
ministered if necessary. Ice will relieve the intense
250 PRACTICAL POINTS IN NURSING.
thirst. A liquid diet must be given—milk, gruels,
broths, and egg-nog.
Acute Diarrhea.—In treating acute diarrhea the pa-
tient must be put to bed and fed on liquid diet—boiled
milk, corn-starch, rice and flour gruels, etc. A laxative of
castor oil 1 ounce and laudanum 15 drops may be given
to remove the irritant and relieve the pain.
Uremia is caused by the retention in the blood of
certain waste material, consisting chiefly of urea, which
should have been eliminated by the kidneys; this reten-
tion of urea gives rise to the disease called "uremia."
Uremia may abruptly begin with convulsions, followed
by coma, or there may be premonitory symptoms, some
of which are headache, nausea, vomiting; scanty urine
deficient in urea; dimness of vision ; the mind dull, deep-
ening into stupor, followed by coma. Sometimes covul-
sions precede the coma, which terminates in death unless
the poison causing the attack is rapidly eliminated. The
pulse is slow and full; temperature subnormal. When
the convulsions occur they may rapidly take place one
after the other, the patient generally being unconscious
between the attacks. The pulse during the convulsions
may be found small and rapid, and the temperature be
raised.
The treatment must be prompt. If the nurse is far
from medical aid, the first thing to be done is to put
something between the patient's teeth to prevent the
tongue being bitten. The patient should then be given
a hot pack or a hot-air bath, which will increase the
activity of the skin and also act as a sedative; morphia
(gr. |) should be given to stimulate the heart, induce
perspiration, and secure rest and quiet.
The bowels must be moved with salts or by an enema.
NURSING IN SPECIAL MEDICAL DISEASES. 2$ I
The second convulsion can be controlled by giving a
little ether if it is at hand; if not, then the hot bath
should be repeated, hot drinks be given, heat applied
over the kidneys and to the feet, cold to the head, and
the morphia repeated every three hours if necessary.
If the pulse is weak, heart stimulants should be admin-
istered. Uremia may occur in scarlet fever, pregnancy,
Bright's disease, and in other diseases.
Cerebro-spinal meningitis is an infectious disease
beginning with a chill, very severe headache, pain in the
muscles of the neck and back, that very soon become
rigid, so that the head is bent backward and the back
is straightened; the arms and legs are flexed; vomit-
ing, delirium, and constipation are present; there may
be intolerance of light and sound and deafness or blind-
ness. After a few days a spotted rash may appear.
The disease attains its height in a very few days, and
the temperature may rise to 105° F. or higher, with
convulsions, stupor, coma, and death, or the symptoms
may gradually disappear and the case end in convales-
cence.
Treatment.—Ice-bags or ice poultices are applied to the
back of the neck and spine, and it is a good plan to apply
heat to the extremities to avoid any depressing effect from
the cold. The diet must be liquid. If the patient can-
not swallow, he must be fed by enemata, and the nurse
should do all in her power to sustain life. Stimulants
must be given if the pulse indicates heart-failure.
Cerebral apoplexy, or cerebral hemorrhage, is caused
by the bursting of a blood-vessel in the brain, which
accident may be due to disease of the cerebral blood-
vessels. The size of the clot varies, it may merely be a
capillary oozing, or it may fill a hemisphere of the brain,
252 PRACTICAL POINTS IN NURSING.
and the amount of paralysis is generally due to the size
of the clot. If the clot is small, the paralysis may be
slight and finally disappear.
The premonitory symptoms are headache, dizziness,
languor, ringing in the ears, and a numb, weak feeling
on the affected side, and there may be gradual paralysis
without unconsciousness.
If an attack comes on suddenly, the patient either falls
back in his chair or to the ground unconscious; the face
is flushed, the breathing stertorous, noisy, and slow, and
the cheeks puff out at each breath; the pulse is slow and
full, and the temperature subnormal, due to shock. The
pupils may be unevenly contracted.
Treatment.—The head and shoulders must be elevated,
the clothing about the neck be loosened, ice applied to
the head (particularly to the affected side), and heat to
the feet and the body. The mucus must be wiped from
the mouth and throat. There should be given a cathar-
tic of croton oil, 2 drops in a little sweet oil or glycerin,
dropped on the back of the tongue, where it will be ab-
sorbed, and the bowels be emptied by enemata. Stimu-
lants must not be given unless ordered by the doctor or
unless the pulse is feeble, as they increase the hemor-
rhage into the brain. To obtain involuntary swallowing
the liquid or powder is placed far back on the tongue
and the nostrils and lips are closed.
The nurse must watch for convulsions, which may be
tonic or clonic. A tonic convulsion is a stiffening of the
muscles of the body without involuntary movements,
while a clonic convulsion consists in involuntary move-
ments of the body. As a convulsion may begin tonic,
it is very important for the nurse to notice in what part
of the body the convulsion begins, and if the pupils of
NURSING IN SPECIAL MEDICAL DISEASES. 253
the eyes change during the day, or if they remain dilated
or contracted, or if they are unevenly contracted.
If recovery takes place, the patient must have nourish-
ing and easily digestible food. He will need the most
careful nursing on account of the paralysis. The nurse
should guard against bed-sores by keeping the patient
and the bed perfectly dry and clean. The patient must
be kept absolutely quiet and free from all mental excite-
ment : another shock generally follows the first, as the
blood-vessels of the brain are in a diseased condition. A
certain amount of paralysis usually remains, according
to the degree of severity of the case. One patient may
recover consciousness, be thoroughly sensible of every-
thing that is being said and done, but be totally unable
to speak, this difficulty lying not with the muscles of
the tongue, but in the brain. Another patient may be
able to utter words, but unable to connect them so as
to make himself intelligible. Because a patient is unable
to speak it does not follow that he is also deaf. Many
times the hearing is very acute, the faintest whisper be-
ing heard; hence the nurse must be very careful as to
what she says when in the patient's room.
Differential Diagnosis.—As apoplexy is often mistaken
for intoxication or for opium-poisoning when the patient
is found in the street, it will be well for the nurse to re-
member that in apoplexy there is unconsciousness, ster-
torous breathing, and paralysis, the movements of the
patient being confined to the sound side of the body;
the pupils of the eyes may be found contracted or dilated
or uneven. This contraction denotes irritation, and the
dilatation denotes compression of the brain. In opium-
poisoning the pupils are very narrowly contracted—the
size of a pin's head; there is unconsciousness, but no
254 PRACTICAL POINTS IN NURSING.
paralysis. In intoxication the pupils may be contracted
or moderately dilated, dilating still more as the patient
comes to his senses. The smell of alcohol on the breath
is of no assistance in determining the condition of the
patient, as spirituous liquor may have been given by the
first person who found the unconscious patient.
Paralysis.—Hemiplegia is paralysis of one side of the
body; paraplegia is paralysis of the lower half of the
body; and monoplegia is paralysis of one limb, such as
an arm or a leg. By paralysis is meant total loss of
power or motion and of sensation; that is, the patient
cannot move the part paralyzed because there is no
power or motion in it, neither may there be any feel-
ing or sensation. When the loss of power is only par-
tial, this condition is called " paresis." It will be appro-
priate to say here that the nerves have their seat in the
brain, and at the base of the brain they cross from side
to side; those at the right side supply the left side of the
body, and those at the left side supply the right side of
the body, so when the right side of the brain is injured
or diseased it is the left side of the body which is para-
lyzed, and vice versa.
The treatment of paralysis consists in good hygienic
surroundings. Extreme cleanliness is necessary to pre-
vent the formation of bed-sores. Massage and electri-
city are employed, which in some cases have effected
partial and even complete recovery.
There is complete helplessness of patients in this class
of cases; they are totally dependent upon the nurse;
they feel their helplessness very keenly, and also appre-
ciate the kindness and cheerfulness with which the nurse
does everything for them.
Epilepsy.—Epilepsy is a disease of the nervous sys-
NURSING IN SPECIAL MEDICAL DISEASES. 255
tem. The attack may occur either with or without
warning. The patient may fall to the ground entirely un-
conscious, with a pale face and the breathing be almost
stopped. After a few seconds this passive condition
passes away and there follow convulsions, which cease
after a few minutes, and the patient falls into a deep,
heavy sleep, awakening without knowing what has hap-
pened. The patient, however, may fall, remain uncon-
scious, and recover in a few minutes. In the milder
form the patient suddenly stands still or may pause in
what she is doing, then recovers her senses and continue
her work. After the severe attack there generally re-
main headache, despondency, and a very tired feeling.
Some patients have the attacks only in the daytime,
while others have them at night. Some patients, again,
can tell when an attack is coming on, and by doing cer-
tain things can ward it off, as, for instance, by rubbing the
part where the sensation is first felt, or if the thumbs or
toes turn in by straightening them out. This sensation
is called the " aura epileptica;" that is, the sensation
which sometimes comes before an epileptic fit and by
which the patient can tell when the fit is coming on.
The treatment of epilepsy lies in first putting something
between the patient's teeth to prevent the tongue being
bitten; then in loosening the clothing about the neck
and chest, and in not restraining the patient unless the
body movements are excessive, in which case the arms
and legs are grasped and the movements followed. One
can thus keep the patient from hurting herself or others.
The nurse must notice the eyes—are they fixed? are
the pupils dilated ?—the color of the face, and on which
side the convulsions began, and whether the unconscious-
ness is complete or partial. Epileptic cases should never
256 PRACTICAL POINTS IN NURSING.
be left alone, but should be watched day and night, as a
fit of temporary insanity may take the place of convul-
sions and the patient may injure herself or others.
The patient must be kept free from all mental and
physical excitement, and take plenty of exercise in the
open air. The diet may chiefly be vegetable. A free
action of the bowels should be secured each day.
Hysteria is very often mistaken for epilepsy, though
one can generally recognize hysteria by noticing that
the patient takes care not to hurt herself; she cannot
bear the eyeball to be touched; there is no grinding
of the teeth nor biting of the tongue, nor the complete
unconsciousness found in epilepsy. There are different
forms of hysteria, from simple fits of laughing, crying,
and screaming, and imagining all sorts of ills and ail-
ments, to hysterical convulsions, paralysis, and insanity.
In dealing with this class of patients, and indeed with all
nervous patients, the nurse needs an ample amount of
patience, tact, and firmness. A strict watch must be
kept over such patients; they are very skilful in deceiv-
ing their attendants ; frequently morphia and other things
received from friends are hidden in the bed and taken
when the nurse is attending to other duties. Various
treatments are prescribed for the simple form, from a
cold bath to an emetic, the patient being under the im-
pression that she is taking morphia; the violent vomiting
and retching that ensue cure both the hysteria and the
morphin habit, but moral suasion must be tried first.
In some cases there is also complete loss of sensation
in certain parts of the body, while in other cases there
is pain in the head, stomach, abdomen, and limbs. This
pain is not imaginary to the patient; to her it is very
real and calls for treatment. Through love for sym-
NURSING IN SPECIAL MEDICAL DISEASES. 257
pathy, however, the patient will pretend to have pain
when she has none, and when her attention is drawn
to other things the pain will vanish.
It is the same with hysterical paralysis: the patient
really believes that she is paralyzed and cannot walk.
Encouragement does a very great deal for this imaginary
condition, and frequently patients will gradually improve
if encouraged to walk, and the paralysis will disappear
in a very short time. All excitement must carefully be
avoided, and hysteria must never be mentioned before
the patient. Globus hystericus is a feeling of choking, a
sensation as of a ball rising in the throat.
Neurasthenia is nervous prostration brought on by
overwork and study and by other causes. Moral treat-
ment is of as much importance here as in hysteria, with
the exception that one cannot sympathize with an hyster-
ical patient, while a patient ill with neurasthenia requires
sympathy, together with the firmness, kindness, and en-
couragement that are used in hysteria.
The treatment of nervous prostration and also of the
severe forms of hysteria is known as the rest cure, which
is complete isolation from family and friends and perfect
rest of mind and body. The patient is allowed to see no one
but the physician and nurse, since the presence of friends
requires conversation and mental effort. Absolute rest in
bed is necessary. The food must be nourishing, easily
digestible, and given at regular intervals. Massage and
electricity are employed to take the place of active exer-
cise. For the treatment to be successful the rules laid
down by the physician must be faithfully carried out.
Dropsy is an unnatural collection of fluid in the tis-
sues or the cavities of the body. Cardiac dropsy usually
begins in the feet and ascends.
17
258 PRACTICAL POINTS IN NURSING.
Diabetes is of two kinds—diabetes mellitus, charac-
terized by the presence of grape-sugar in the urine, and
diabetes insipidus, characterized by the excretion of a
very large quantity of pale urine of a low specific gravity,
and generally free from albumin and sugar. In diabetes
mellitus the urine is increased in quantity. Sometimes
the amount passed in the twenty-four hours is very large,
from 2 to 6 quarts; the specific gravity of the urine
ranges from 1015 to 1050.
Nursing.—The diet should be restricted in this dis-
ease ; everything containing starch or sugar being
omitted, saccharin and glycerin being substituted. It
will be the nurse's duty to keep an accurate account
of the amount and frequency of urine passed, and also
to see that only the diet ordered by the physician is
given.
Rheumatism.—Acute articular rheumatism is cha-
racterized by inflammation of the joints. There is also
high temperature (103 to 1040 F., and sometimes higher)
profuse acid perspiration, pain, tenderness, and swelling
of the affected joints.
Nursing.—The bed should be made up with blankets,
and a flannel bed-gown be worn by the patient, for the
reason that sheets and gowns of muslin become very
wet and cold with the perspiration. The utmost gen-
tleness must be observed when changing the bed- and
body-linen or when changing the position of the patient,
because of the extreme pain.
The room must be kept of even temperature (68° F.),
and the patient be guarded against all draughts, the
affected joints being wrapped in cotton batting. The
diet should consist of milk, soups, egg-nog, etc. and the
thirst relieved with lime- or lemon-juice.
NURSING IN SPECIAL MEDICAL DISEASES. 259
The medicinal treatment is generally salol, salicylic
acid, and salicylate of sodium to relieve the pain and
reduce the temperature. When giving the salicylates
the nurse must watch for the physiological effects, which
are noises in the ears, deafness, nausea, vomiting, perspi-
ration, and delirium. The fever may be controlled by
the cold pack or cold bath, or bathing with tepid water.
Massage and electricity are often employed.
The pain may move from joint to joint, or may affect
only one joint. When only one joint is affected, it is
called " monoarticular" rheumatism, and if more than
one joint, it is called " polyarthritis." As there is great
danger of heart-failure, the patient must not be allowed
to rise from the bed without permission from the doctor.
Severe cases of the disease may develop cerebral symp-
toms : there will be restlessness, delirium, very high tem-
perature, with a small, rapid pulse, pale and rather blue
face, convulsions, and death.
Acute muscular rheumatism is an affection of one or
of a group of muscles. The disease may repeatedly
occur in the same patient; therefore one attack does
not mean immunity from another; there is always a
tendency to the disease. Its treatment is similar to that
of acute articular rheumatism. Cold and dampness must
carefully be avoided, and the patient should wear woollen
garments next the skin.
Diseases of the Skin.—A few words on skin diseases
will close these medical discussions.
Eczema is an inflammatory disease of the skin, and of
it there are many varieties. It is often due to irritation
through using hard soaps and to putting the hands in
certain fluids.
Scabies, or the itch, which is contagious, may be ac-
260 PRACTICAL POINTS IN NURSING.
quired by shaking hands with a person thus affected or
by touching anything that she has used. There is an
intense itching of the hands between the fingers, of the
axilla, and of the inner part of the thighs, that grad-
ually spreads over the body. It is worse when the
patient is warm, and especially when she is in bed.
Ringworm is also contagious; a child thus infected
should be isolated from other children.
Herpes zoster, or shingles, is often due to debility,
to damp clothing, and exposure to cold.
Treatment of Skin Diseases.—The treatments of all
skin diseases differ very much, each case being treated
according to the method of the physician in charge.
The utmost cleanliness with regard to the patient and
nurse is necessary, many skin diseases being infectious.
Ointments are generally ordered for all the above-
described cases, as they exclude the air and are very
soothing. The nurse must be very careful to guard
against infection, and to wash and disinfect her hands
thoroughly after attending the patient, who must also
be kept perfectly clean. Some of the skin diseases are
very difficult to take care of; others, again, are almost
disgusting in their character, and it is very hard for some
nurses to conceal their feelings when dressing the parts;
the patient, too, is often very irritable. All this calls for
a great amount of patience, kindness, and sympathy on
the part of the nurse, who must try to hide her emo-
tions when doing the dressings, for the patients are very
sensitive and narrowly watch her face. We have here a
noble example in the Sisters of Charity, who, as was
said by Dr. Myles Standish, "with kindness in their
manner, gentle care in their hands, and the love of
God in their hearts and souls, could care for and dress
NURSING IN SPECIAL MEDICAL DISEASES. 261
without expression of loathing and disgust the gangrene
then so often seen in the surgical wards, and the most
loathsome disease. All honor to them! They taught
the world, both physician and the layman, the value
of nursing."
Caring for the dead is one of the duties the nurse will
have to perform. The writer need hardly admonish the
nurse to be very sure that the last sacraments are re-
ceived,1 and that the friends be notified before the patient
becomes unconscious. The nurse should remain with
the patient to the end, and not let her die alone.
When the end has come the following instructions
should be followed: Straighten the limbs, close the eyes
by pressing the lids down with the fingers, and then
leave the room to the family for a while. After the
family have left the room the bed-clothes must be re-
moved and a fresh under-sheet put on the bed; take
away all pillows but one. Wash the body with soap and
water and some disinfectant, and guard it against expo-
sure the same as if the body were conscious. The rec-
tum and vagina must be packed with cotton of any kind
to prevent discharges. Sometimes it is necessary to
pack the mouth and nostrils for the same reason. Put
a napkin, drawers, under-vest, night-gown, and stockings
on the body. Comb and dress the hair in the way that
it was usually worn by the patient. Arrange the lips
and prop up the jaw with a roll; do not bandage, as this
will wrinkle the skin, it being desirable to have the face
look as life-like as possible. Clean the nails.
If there are wounds on the body, they must have a
fresh dressing put on; wounds about the head can be
1 The nurse should see that all her patients, Catholic or Protestant,
receive the last sacraments before death.
262 PRACTICAL POINTS IN NURSING.
covered with a small cap made of black silk. Tie the
limbs with a bandage and cover the body with a sheet.
Put the room in perfect order and remove all signs of
the illness. If the case has been contagious, the body
must be washed with disinfectants and be wrapped in a
sheet wrung out of the same; the funeral must be pri-
vate and the room afterward fumigated (see p. 234).
VI. THE NURSING OF SICK CHILDREN.
Care of the New-born.—The sudden contact with
the outer air is generally a shock to a new-born infant.
The temperature of the room should be 760 F. for the
first week, and the temperature of the water for the bath
be 980 F. Everything should be made ready before be-
ginning to bathe the baby. It should be wrapped in a
blanket and one part at a time be bathed without the aid
of soap. The body then is thoroughly oiled to remove
the cheesy substance called " vernix caseosa" which
protects the skin of the child while in the womb.
The nurse will find this cheesy substance very thick
upon the scalp, and if not removed it may cause inflam-
mation ; indeed, it may cause inflammation if allowed to
remain on any part of the body. After the body has been
thoroughly greased, it must be washed with soap and
water, care being taken that the soap does not enter the
eyes. White castile is the best soap; it is the least irri-
tating. The babe should be thoroughly dried and pow-
dered with corn-starch, which is about the best powder
to use for an infant unless the nurse can have talcum
powder. Some physicians do not want the baby to have
a soap-and-water bath after the oiling, but simply to have
THE NURSING OF SICK CHILDREN. 263
the oil wiped off and the baby dressed. The body of
the babe should be examined to see that it is perfectly
normal ; any abnormality must be reported. The flan-
nel used in giving the first bath should be burned.
Dressing the Cord.—The navel cord is dressed by
wrapping it in sterilized gauze or antiseptic cotton, the
binder put on, and the cord placed on the left side of the
body, because if placed on the right side it would press
upon the liver, which at birth is larger than the other
organs, and which reaches down to the navel. The
binder must not be pinned too tight or the gas cannot
pass through the intestines.
Dressing the Infant.—The clothing of the new-born
consists of a shirt, a diaper, socks, and a flannel slip,
which, made after the manner of the muslin slip, fastens
in front and extends from 8 to 10 inches below the feet.
Over this comes the muslin slip, made about 2 inches
longer than the flannel one. These slips afford warmth
and lightness and also looseness, so that the body can
expand, the body not being bound by bands about the
abdomen and chest, as when the old-fashioned skirts
were worn; the first of these skirts was generally pinned
so tightly about the abdomen that the gas could not
escape from the bowels, and the child had colic; the
skirt was also brought up over the child's feet, so that
they could not be moved. The second skirt was pinned
so tightly around the chest that the chest could not ex-
pand. Taking the old method of dressing all together,
the child was so uncomfortable that it cried a good deal,
and every cause was thought of except that of the cloth-
ing being pinned too tight.
These two garments or slips can be put one within
the other and both put on at once. In summer-time the
264 PRACTICAL POINTS IN NURSING.
waist of the flannel slip may be made of muslin, and the
skirt be attached to it. All the garments are fastened
with small pearl buttons, and if instead of flannel there
is provided an elastic knitted-wool binder, which is slip-
ped on over the feet, there will be needed only one
safety-pin, and that for the diaper.
After the dressing the baby is laid in the crib or a
clothes-basket, covered lightly, and the eyes shaded
from the light. A baby should sleep during the first
few days twenty hours out of the twenty-four, and will
do so if it is left alone and not taken up for exhibition
or to be rocked, or carried about, all of which tends to
keep the child in a perpetual state of excitement, thus
making it nervous.
Bathing the Baby.—Until the cord separates, which
should be on the fourth or fifth day, the infant should be
given a sponge-bath every morning, and after the separa-
tion a tub-bath. The temperature of the water must be
98° F., tested with a bath-thermometer. The child must
be lowered gently into the water. The head is supported
with the left hand and the body washed with the right.
After five minutes the child is taken out, laid on a warm
blanket, and thoroughly and gently dried. The skin
must be kept well powdered, especially in the folds, as
it is very sensitive and the air and water act as an irri-
tant. If there is chafing, the chafed parts should be
covered with soft linen.
Defecation and Urination.—The first bowel movements
of a baby are dark, almost black; if cloths are placed in-
side the diaper, they can be burned. This color of the
feces gradually changes to a bright yellow, which is the
normal color; any departure from this condition shows
that something is wrong and it must be reported, and
THE NURSING OF SICK CHILDREN. 265
also if the baby passes urine. Owing to the absence
of coloring matter in the infant's urine, whereby it
will not stain the diaper, and the small amount voided
at the frequent urinations, it is often supposed that
there is some obstruction. Close and frequent exami-
nation will clear, up the condition. The diapers must
be changed as soon as wet, and the parts bathed and
powdered.
Nursing of the Infant.—The baby should be put to
the breast regularly every two hours during the day,
and only when it awakes during the night. It should
suckle about fifteen minutes. A baby's stomach holds
only about I ounce. Feeble babies must be fed oftener
day and night. The mouth must be washed before
and after each feeding with water to which has been
added a little borax.
When the baby cries the nurse should find out the
trouble. Very often the trouble is some little thing,
such as being thirsty, which a little clear cold water will
relieve. The infant must not be put to the breast unless
it is time. Babies get tired of lying in the one position ;
they cannot turn themselves, and they waken and cry;
therefore their position should be changed by taking
hold of the clothing at the shoulders and limbs, and
gently turning them; they will not awaken, and besides
making them more comfortable the change will lengthen
their sleep.
Artificial Feeding.—If the baby must be brought up by
hand (bottle feeding), the physician will direct the cha-
racter of the food to be given and the nurse must faith-
fully carry out his orders. At times the food consists of
equal parts of milk and water until after the first month,
when the water is gradually diminished, until at the fifth
266 PRACTICAL POINTS IN NURSING.
or sixth month, when the milk is given plain. If the
milk seems to disagree with the infant, a teaspoonful
of lime-water added may correct the trouble. The bot-
tles and nipples, and the vessels in which they are
washed, must all be kept perfectly clean. The rubber
nipples must be cleansed inside and out, and should be
boiled for about ten minutes before being used, and be
kept in cold water during the intervals of feeding. The
bottles should be scalded inside and then filled with cold
water to which is added about a teaspoonful of baking-
soda.
Milk Sterilization.—If it is required to sterilize the
milk, sufficient should be sterilized to last twenty-four
hours, and enough be put in each bottle for a single
feeding. The mouths of the bottles should be stoppered
with absorbent cotton, which will absorb the germs of
the air and keep them away from
the milk. The best apparatus for
sterilizing milk is the Arnold ster-
ilizer (Fig. 65). In the absence
of this sterilizer the bottles can
be placed in an ordinary boiler
of cold water either on sticks or
on a folded towel to keep them
from touching the bottom of the
vessel, the water reaching to the
necks of the bottles. The water
should come to a boil, then the
boiler cover be put on, and the
boiler removed from the fire, and
Fig. 65.—Arnold sterilizer.
left to steam for about one hour,
after which time the bottles are taken out and put away
in a cool place. The bottles must not be opened until
THE NURSING OF SICK CHILDREN. 267
needed. A bottle of the milk should be warmed by
allowing it to stand a few minutes in a pan of hot water;
the cotton is then taken out and the rubber nipple put
on. If any of the milk is left in the bottle, it must be
thrown away. Sterilizing the milk renders it free from
germs. Pasteurization is the preferable method.
Infant Food and Rules for Feeding.—Dr. Meigs' food
is the favorite with some physicians. It consists of—
2 tablespoonsful of cream,
1 " of milk,
2 of lime-water,
3 of sugar-water.
Sugar-water is made by adding 8 teaspoonsful of sugar
of milk to 1 pint of water. Lime-water must be added
to the milk after sterilizing, not before, because in boiling
it chemically changes and discolors the milk.
General Rules for Feeding {Rotch).
Age. Intervals of feeding. Number of feedings in 24 hours. Average amount at each feeding. Average amount in 24 hours.
[st week. 2 hours. IO 1 ounce. 10 ounces.
1-6 weeks. 2.y2 hours. 8 1^-2 ounces. 12-16 ounces.
6-12 weeks and possibly to 6th month. 3 hours. 6 3-4 ounces. 18-24 ounces.
At 6 months. 3 hours. 6 6 ounces. 36 ounces.
At 10 months. 3 hours. 5 8 ounces. 40 ounces.
At the time of feeding the baby must be taken on the
nurse's lap, and it must not be allowed to doze over its
268 PRACTICAL POINTS IN NURSING.
meal; the baby, however, must not be hurried; the
bottle should be taken away when the meal is over, and
on no account should the child suck from an empty
bottle. As the baby grows the intervals between the
feedings are lengthened and the amount of food is in-
creased. At seven months the baby may have milk
slightly thickened with good bread or well-boiled oat-
meal once or twice during the day; at ten months a
little meat-broth made with barley or rice, without vege-
tables ; at twelve months it should be weaned. The baby
must have no solid animal food until after the second
year, and even during the second year milk should be its
chief food. It must not be given tea, pastry, stimulants,
fruit, cheese, or soothing syrups, or a?iy medicine without
proper medical advice.
Infant Development.—At the third week the baby may
be taken out doors for its first airing, being carried in the
arms, not in a carriage, and with its head supported. A
baby will hold up its head at from three to five months,
will quickly recognize objects at from six to eight months,
will sit alone at from the seventh to the eighth month,
will walk at from the ninth to the twelfth month, will ut-
ter single words about the first year, and will begin to talk
by the second year. A baby does not shed tears until
the second or the third month of age, and if very sick at
eight months the tears do not flow until convalescence
sets in. The teeth begin to grow between the fourth and
the seventh month. The anterior fontanelle—that is, the
middle opening in the top of the head—rather increases
in size during the ninth and twelfth months, and then de-
creases, and should be closed at eighteen months. The
baby must not be allowed to stand alone before twelve
months; the leg bones are not very strong and they
THE NURSING OF SICK CHILDREN. 269
may bend; when sitting up its head and neck should be
supported. A baby should gradually increase in weight,
after the second day, from 3 to 5 ounces each week. It
loses weight during the first two days.
The temperature at birth is 990 F., pulse from 130 to
140 beats, respirations fiom 40 to 46 per minute. The
temperature is usually normal after the first week.
Care of Premature Infants.—A premature baby is
one born before full term ; it is usually put in an incu-
bator (Fig. 66), which supplies the infant with artificial
Fig. 66.—Modified Auvard incubator or couveuse : a, glass plate of the movable lid
(b); c, ventilating tube containing small rotary fan ; K, ventilating slide ; m, hot-water
cans ; o, slide closing hot-air chamber.
body-heat until it reaches its full time. An incubator
may be improvised out of a large wooden box by having
one side so arranged that it will slide in and out; the top
is also arranged to allow a piece of glass to be inserted and
to slide in and out. Across the middle of this box are
nailed three wooden strips, which will divide the box into
two compartments, the lower one for the heaters, hot-
water bottles or hot bricks, etc., the upper one being
999999999
27O PRACTICAL POINTS IN NURSING.
fitted with flannel or with cotton for the baby. The glass
cover is kept open about half an inch at the foot of the
box, to allow entrance of fresh air to the infant. A ther-
mometer is also placed in the upper compartment, and
an even temperature of 86° F. should be kept. When
the baby is taken out to be changed or bathed the glass
cover is drawn back: when the heaters are to be re-
newed the sliding side is drawn back. If a box cannot
be procured, then the baby should be wrapped in cotton
and be kept in a basket near the fire. The temperature
of the water for the bath must be ioo° F.; the tempera-
ture of the room should be from 80 to 86° F., and the air
be kept fresh and pure.
If brought up by hand, the baby is wrapped in cotton
and flannel so arranged that the napkin can be changed
without disturbing the baby, which must only be taken
out of the incubator to nurse. Should the attending
physician not allow the mother to nurse the infant, it
should be fed every hour during the day with about two
teaspoonsful of the mother's milk, given by means of a
medicine-dropper.
Diseases of Infancy.—Thrush is a disease caused by
decomposition of food in the mouth of the child, and is
characterized by small white spots on the tongue, the
sides of the mouth, and the gums, that may spread to
the throat and stomach. To prevent this disease, the
mouth should be thoroughly washed after each feeding
with water to which has been added a little borax.
Should the disease appear, wash the mouth every two
hours with borax-water (about 15 grains to 1 ounce of
water).
Colic is relieved by the application of hot fomentations
to the abdomen, and internally 1 teaspoonful of anise-seed
THE NURSING OF SICK CHILDREN. 27\
tea every ten minutes until three doses have been taken;
or plain water may be used should the tea not be at
hand. Colic is due to cold or to the accumulation of
gas in the bowels, and it generally yields to heat. The
child lies with the knees drawn up, its cries are sharp,
long, and loud, and they die away as the pain is re-
lieved.
If the food does not digest well, the movements will
be green, and in them there will be curds of milk. This
condition must promptly be reported to the physician.
Lime-water or baking-soda (about half a teaspoonful
added to the milk) will often correct the indigestion ; the
white of an egg well beaten up and added to about 6
teaspoonsful of cold water and a little sugar-water will
also give the stomach a rest for a few days from milk
digestion, besides being nourishing. If the baby is nurs-
ing) glve half a teaspoonful of lime-water to the same
amount of water before putting the child to the breast.
Bowel Obstruction.—Blood in the movements and con-
stipation may be due to obstruction of the bowel. The
child screams with pain; the abdomen is distended and
tender; there is vomiting; the respiration is difficult, and
there may possibly be convulsions. Until the arrival of
the physician hot fomentations may be applied over the
abdomen and a soapsuds enema given. To give the enema,
everything must first be prepared and laid on a chair or a
table near by; the nurse takes the baby on her lap, and
lays it on its left side, with the knees drawn up. The
tube, which for a very small baby should be the smallest
tube that comes with the syringe, should be oiled, the
air expelled, and the tube inserted in the rectum and the
bulb gently squeezed. Pressure is applied over the
rectum to retain the enema for a short time.
272 PRACTICAL POINTS IN NURSING.
Diarrhea.—In diarrhea the bowel-movements will be
found acid, and sour-smelling, and will contain particles
of undigested food ; their color will be green. The baby
has, besides the frequent movements, griping pains in the
abdomen, vomiting, and restlessness. Diarrhea is often
caused by improper feeding and changes in the temper-
ature during the hot summer months. The extreme heat
depresses the system and leaves it susceptible to the
slightest change.
The treatment of diarrhea lies in getting rid of the irri-
tation, by giving either an enema of half a teaspoonful of
castor oil in hot, sweetened milk, or in the same amount
of glycerin or of hot coffee. The baby should be kept
in bed and be given for a few days, instead of milk, the
white of an egg well beaten and added to an equal
amount of cold water and a little sugar. When the
vomiting is persistent the stomach is to be washed out.
A small rubber catheter, with a funnel attached to one
end, is used, and the washing is done in the same man-
ner as that for an adult (see p. 70).
Vomiting may be caused by over-feeding, when the
milk will be returned clear because the stomach cannot
hold the amount ingested. This condition is not serious;
but when the milk is returned curdled and sour, it is due
to indigestion or it may be a symptom of some disease.
Cholera infantum begins with vomiting and diarrhea,
weak, rapid pulse, and symptoms of lowered vitality and
collapse.
Treatment consists of high starch-and-laudanum ene-
mata to check the movements. Heat must be applied to
the body or the child may be put in a hot bath (temp, of
105 ° F.). The food for a while is generally white of egg
with 4 drops of brandy, alternated with 10 drops of Val-
THE NURSING OF SICK CHILDREN. 2~$
cntine's or expressed beef until the appearance of undi-
gested food is removed from the bowel movements. The
air of the room must be kept pure and fresh. When the
child is strong enough to be taken out, it should be kept
outdoors the greater part of the day. Cholera infantum
is caused by impure air and improper food and exposure
to heat.
Rickets, which is also due to improper food and impure
air, is a disease of the bones owing to an insufficient amount
of inorganic matter in the bones, that makes them soft, so
that they easily bend. The child is restless when asleep,
throwing off the bed-clothes ; when awake it is fretful and
irritable, and cannot bear to be touched; the abdomen is
distended ; the head is large ; the anterior fontanelle (the
middle opening in the top of the head) is found open at
the time when it should be closed—that is, at about
eighteen months ; the teeth are late in appearing; there
may be hydrocephalus (dropsy of the brain); and the
long bones of the legs are so bent that the child is
knock-kneed. There are other symptoms, all caused
by the want of proper nutrition, and the child presents a
sickly, puny appearance.
The treatment of rickets lies in nourishing food, perfect
cleanliness, pure, fresh air, and massage, and in not allow-
ing the child to walk, to stand, or to sit until its bones
are strong enough to bear the weight of the body.
Many cases of knock-knee are caused by the child be-
ing allowed to walk or to stand before the bones of
the legs are strong.
Convulsions may be due to indigestion, pin-worms,
etc., or to brain-excitement in rickets, or to irritation of
the nerve-centres in teething. A great number of the
diseases of children are ushered in with convulsions,
18
274 PRACTICAL POINTS IN NURSING.
which take the place of the initial chill in the adult.
They may come on suddenly or gradually.
Treatment.—The first thing for the nurse to do is to
put the child into a hot bath (the temperature about from
ioo to 1040 F.), without waiting to undress it, which can
be done in the water. The head should be kept raised
and cold applied to it. The hot-water bath will dilate
the blood-vessels of the body, thus diverting the blood
from the brain to the body. If the attack is the begin-
ning of any of the eruptive diseases, the heat will also
bring out the rash, besides relieving any pain in the
abdomen or elsewhere. The baby is to be kept in the
bath about five minutes, and is then taken out and
wrapped in a warm blanket; an enema is given to clear
the bowels. A physician should be summoned.
Teething, which usually begins about the seventh
month, may be accompanied by many disturbances, such
, as diarrhea, indigestion, convulsions, all of which should
receive attention.
Worms.—Delicate children are often troubled with
worms, which are of three kinds—thread-worms, round-
worms, and tape-worms. The first two are the most
common. The symptoms are numerous: itching and
rubbing of the nose and external parts, vomiting, rest-
lessness, grating the teeth during sleep, convulsions,
etc.; but we must wait until the worms are seen in the
movements before attributing to them any of these
symptoms. The worms are generally found in the
lower bowel, and are passed in the movements, though
sometimes they are vomited. The bowels should be
thoroughly cleared by giving the child a dose of castor
oil, followed by an enema of salt and water, and these
measures continued daily until the worms have all been
THE NURSING OF SICK CHILDREN.
275
passed, no more being seen in the movements. The
expulsion of a tape-worm belongs to the physician.
Protrusion of the bowel may be remedied by placing
the child on its back and elevating its buttocks. The
parts should be washed with tepid water and the bowel
replaced, then a pad or compress wrung out of ice-water
be applied, and kept in place with a napkin. If this
treatment does not succeed, a physician should be sum-
moned. Protrusion is often caused by constipation and
the straining efforts of the baby. A baby should be
taught regular habits, which, with a little patience, can
be established.
Ophthalmia neonatorum is an inflammation of the
conjunctiva, which is one of the coats of the eye-
ball. It is a very serious variety of ophthalmia, gen-
erally caused by infection during birth from the ma-
ternal discharges. In this case the fault usually lies
entirely with the nurse in not cleansing the eyes
immediately after the head is born, and also in not
washing the baby's hands, because in this way any
mucus on its hands is rubbed into the eyes; it is also
caused by using the same cloth and water for washing
the eyes that have been used for the body. Any red-
ness of the eyes or the eyelids must promptly be re-
ported. If cold compresses are ordered, they must be
changed every two minutes.
Syringing the eyes is best done with a medicine-drop-
per. The dropper is filled with the ordered solution, which
may be of boric acid: in applying the solution it should
flow from the outer to the inner corner of the eye, thence
to a piece of cotton or of compress. The eye must be
kept perfectly clean, and all pieces of cotton or compress
used about it must be burned. Ophthalmia is a germ
276 PRACTICAL POINTS IN NURSING.
disease and is highly contagious. If the nurse has to
touch the eyes with any solution, she should twist a
piece of absorbent cotton around the end of a tooth-
pick or a match-stick, a fresh piece being used for each
eye, these eye-swabs being burned immediately after-
ward. These cases are very fatiguing, but the baby's
sight depends upon the faithfulness with which the phy-
sician's orders are carried out. Many cases of blindness
are due to neglect. The nurse must protect herself by
not touching her face, eyes, or hair unless her hands
have been thoroughly washed and disinfected. Every-
thing employed about the eye or eyes must be burned,
and on no account be used about other parts of the body.
Snuffles, or cold in the head, may be relieved by keep-
ing the baby warm, oiling the outside of the nose, and
keeping the nostrils clear by cleaning them with a small
piece of cotton twisted around a match-stick.
Infant paralysis is recognized by the baby having no
power over its limbs. Sometimes the affection is ushered
in with convulsions and a high fever, and vomiting, then
follows a wasting of one or more muscles. The limb is
at first tender, and the baby may cry when it is touched.
The baby must be kept warm, good nourishing food be
given, and massage and electricity applied.
Tongue-tie.—Sometimes the band beneath the baby's
tongue is too short and the baby cannot nurse. It is
then tongue-tied, and the band will have to be snipped.
This is a simple and almost painless operation, taking only
a very few minutes, and no anesthetic is required, neither
is there any loss of blood. The nurse can see the baby's
tongue by placing a little sugar on the lower lip of the baby;
this will cause it to put out the tongue to get the sugar.
The temperature of babies and that of some of the
THE NURSING OF SICK CHILDREN.
older children must be taken in the rectum, the ther-
mometer being oiled before it is inserted, and carefully
watched lest any sudden movement of the child should
break the thermometer, the mercury and fine glass
entering the rectum. The baby should be placed on
its left side on the nurse's lap.
Pulse and Respiration.—The pulse can only be taken
correctly when the baby is asleep. The pulse is very
easily affected, the least thing sending it up, together
with the temperature, and increasing the respirations.
The pulse at birth is about 140 beats per minute, and
gradually it decreases with increase in age, as follows:
First month the pulse is about . . .
First to second year it is about . . .
Second to fifth " " " ...
Fifth to eighth " " " ...
Respirations at birth are from . . .
First month, about . .
First to third year, about
Third to fifth "
Signification of the Baby's Cry.—Until the child be-
gins to talk its cry is its only language. If the cry is
long and persistent it is usually due to hunger, or the
child has earache, in which case the hand is drawn up
to the ear. If there is pain in the head, the hand is
also drawn up to the head and the cry is sharp and
piercing, the face flushed, and there is restlessness.
With pain in the abdomen the cry is long, sharp, and
loud, and gradually ceases as the pain subsides. The
knees are drawn up to the abdomen. If the pain is in
the chest, the cry is sharp and suppressed, with the
cough which accompanies it; the nostrils dilate and
contract.
. 120
. no
. 100
. 90
40-50
. 40
• 35
25
278 PRACTICAL POINTS IN NURSING.
Diseases of Childhood.—Any of the diseases which
attack grown persons may also attack children.
Typhoid fever is apt to run a milder course in children
than in adults ; the nursing, however, is just the same. A
strict watch must be kept of the temperature for hemor-
rhage, which is indicated by a sudden drop of tempera-
ture and a weak, rapid pulse. The bowel-movements
after the hemorrhage are dark red, but if the feces are
not passed for some time after, they resemble tar. The
child must be kept perfectly quiet (not allowed to move),
so that the blood will coagulate in the blood-vessels and
prevent further hemorrhage. Cold water or crushed ice
may be given in small quantities; only the amount of
water or ice it is intended the child to have should be
put into the tumbler; if there is more and the tumbler is
taken away, the child will cry for it. Baths and packs
are given in the usual manner. Ice can be applied to
the head by crushing the ice and making an ice poul-
tice which can be stitched upon a night-cap. This will
prevent the poultice falling from side to side. In the
absence of rubber there may be used flannel or towels,
which are fastened to the pillow, so that the weight of
the poultice will not be on the child's head.
With children ulceration of the bowels is less likely
than with adults, consequently the dangers of hemor-
rhage and perforation are less. The rash may be absent,
but the brain-symptoms are marked and generally the
temperature rises suddenly.
Meningitis is inflammation of the membranes of the
brain.
Symptoms.—The child is restless, listless, drowsy, and
fretful; loses flesh; grinds the teeth when asleep, and
the pain in the head causes him to wake up with a
THE NURSING OF SICK CHILDREN. 279
scream ; he cannot tolerate the light or the slightest noise;
the pulse is increased and the temperature is raised. These
symptoms deepen ; the drowsiness increases, followed by
delirium. The pupils of the eyes may be dilated or evenly
contracted, or the child may squint; there may be convul-
sions. Finally there is complete coma.
The treatment of meningitis lies in keeping the child
perfectly quiet in a darkened room and in applying cold
constantly to the head. The bowels must be kept open
and the child be fed by the rectum if necessary. The
child must be kept perfectly clean. As the stupor sets
in the urine and the excreta will involuntarily be passed.
Mumps is an inflammation of one or both of the par-
otid glands, situated beneath the ears. There are fever-
ishness, headache, restlessness, chill, and vomiting, and
then the swelling begins. The disease is both conta-
gious and infectious, and for this reason an affected child
must be isolated from other children.
Treatment.—The child must be kept warm and hot
fomentations applied to relieve the pain, or the neck and
face may be covered with absorbent cotton or flannel.
Oil rubbed into the skin will relieve the tight feeling.
After four or five days the swelling begins to subside
and the pain is relieved. Soft food should be given.
Incontinence of urine needs the care of a physician, as
it may be due to some trouble with the bladder, or the
urine may contain too much acid. Children who have
this trouble are very often whipped and scolded by both
parents and nurses : this is a great mistake, and is wrong
to a child, unless the nurse is sure that the incontinence
is due to carelessness.
Chorea, or St. Vitus' dance, is a nervous disease of
childhood, and is characterized by the involuntary
28o PRACTICAL POINTS IN NURSING.
twitching of one or more or of all the muscles of the
body, that ceases when the child is asleep. In mild
cases recovery takes place in from four to six weeks;
but in severe cases, when the whole body is involved, the
child may die, either through inability to take nourishment
or to sleep, or from heart complications. The affected
child must be isolated from other children or they will
imitate its affliction. Good nourishing food must be
given, and the child be kept free from all excitement.
Rheumatism being one of the complications of chorea,
any stiffness of the joints must be reported. The child
must be treated very kindly and gently spoken to; a
sharp word has been known to throw a child into con-
vulsions. Should convulsions set in without any appa-
rent cause, such as fear, worry, or excitement, they may
be the beginning of some complication. In severe cases
of chorea the patients are kept in bed. There is always
the liability to recurrent attacks, and women who have
had an attack in childhood may have a recurrence of
the disease during pregnancy.
Surgical Diseases of Children.—The surgical dis-
eases of children are similar to those of adults, and
demand the same treatment. After any trouble with
the bowels, such as peritonitis or appendicitis, the child
should wear a flannel abdominal binder, because sud-
den changes in the temperature are liable to affect the
bowels; the binder will keep the bowels warm and
guard against recurrent attacks; the bowels must also
be kept open. Pain in the knees or the hips must be
reported; it may denote hip disease.
Hip-joint disease (Coxalgia) is caused by a blow or a
fall, or it may originate from tubercular inflammation of
the structure of the hip-joint or scrofula, the patient in-
THE NURSING OF SICK CHILDREN. 281
heriting either of these diseases. The germ lodges in the
end of the femur or thigh-bone. If the disease is of
tubercular origin, tubercular meningitis may set in. The
child must be confined to bed; he must not sit up.
Every little while he will scream in his sleep on ac-
count of pain caused by a muscular spasm which brings
the inflamed surfaces of the joint together. Any knock-
ing against or jarring of the bed causes great pain.
Children must have plenty of fresh air and sunlight;
they cannot live healthfully without; also good nourish-
ing food, of which milk should be the chief.
Nurse's Management of Children.—A child who has
been used to home-training and to having every whim
satisfied does not take kindly to the nurse, and often
will not allow her to do anything for him. Therefore,
it is generally well for the child to see the nurse in
the room for a little while, the mother acting under her
directions, and after he has become accustomed to the
nurse's presence the way will be much easier. If the
first thing the nurse has to do is to dress a painful
part, she should not go up to the child and begin the
dressing, but she should talk to him about his play-
things ; then, after a while, with a little tact, she can look
at the part, touching it very gently; if this causes no
pain and the child thinks the nurse is not going to hurt
him, he will let her do the dressing, the nurse all the time
keeping up the conversation to attract his attention to
other things. With children the nurse should be firm
and at the same time be gentle ; she should let yes mean
yes, and no mean no. If the nurse has difficulty with a
child at first, he will see that she is firm and that her
orders are to be carried out. On no account must the
child be deceived. A child will often take the most dis-
282 PRACTICAL POINTS IN NURSING.
agreeable medicine from a nurse whom he loves and by
whom he has never been deceived, because she says that
it is easy to take, the patient having a child-like faith in
her, when no power nor persuasion could make him take
it from a nurse who was unkind or who has deceived him.
Children live in the present, the past is soon forgot-
ten. We should encourage their little efforts to be good,
provide them amusement, and sympathize with them in
their little troubles. A little boy (about four years old)
went into his father's study holding up a finger which
had been pinched by the door, and, with a look of pain
on his face, said, " Look, papa, how I have hurt my fin-
ger." His father, who was busy writing and did not
want to be interrupted, said rather impatiently, " I can't
help it, dear." The little fellow's eyes filled with tears,
and as he turned to leave the room he said in a low
tone, " You might have said ' Oh !'" Children live in a
world of their own; their little trials are just as great
to them as are our greater ones to us, for " there is no
misery like the misery of childhood;" a little sympathy
for a pinched finger or a stubbed toe, a bumped head, a
smashed doll or toy, is always a great comfort to them.
In conclusion the writer begs to remind the nurse of
what has been said about sympathy and kindness to her
patients. They are so dependent upon her for comfort
and sympathy that a gentle word or a pleasant smile,
kind attention to their needs, and regard for their feel-
ings, though little things, give great consolation. Sym-
pathy and comfort are especially necessary before an
operation, of which all patients naturally have a dread.
None can realize what the feelings of the patients must
be as they go bravely (outwardly) to the etherizing
room, or what a comfort it must be to them to know
THE NURSING OF SICK CHILDREN. 283
that some one who fully sympathizes is with them. It
is here that they want their own to be with them, and it
is here by kindness and sympathy that the nurse can, in
a measure, take the place of their own. " The small
kindnesses," says M. A. Kelty, " the small courtesies,
the small considerations habitually practised, the sympa-
thy in our every-day work, give a greater charm to the
character than the display of great talents and accom-
plishments ; " and in Felix Holt, George Eliot says : " A
supreme love, a motive that gives a sublime rhythm to
a woman's life, and exalts habit into partnership with the
soul's highest needs, is not to be had where and how
she wills : to know that high initiation, she must often
tread where it is hard to tread and feel the chill air and
watch through darkness. It is not true that love makes
all things easy; it makes us choose what is difficult."
ANATOMY.
Plate 5.
Anatomy of the Thorax and Abdomen : a, the thyroid ; b, the trachea ; c, cx, the first ribs ;
p. u«, the clavicle (cuti : G, arch of the aorta; g1, descending aorta; h, h*, right and left
bronchi; I, esophagus; k, vena azygos; L, thoracic duct; M, M1, seventh ribs; N, diaphragm in
section ; o, cardiac orifice of the stomach ; p, liver in section, showing orifices of hepatic veins; R,
inferior vena cava; s, gall-bladder; T, pyloric end of stomach, joining t1, the duodenum; u, the
spleen ; v, the pancreas ; w, the sigmoid flexure of colon ; x, caput coli (cecum); z, coils of the small
intestine; 2, the innominate artery; 3, right subclavian artery; 4, common carotid artery; 5, left
subclavian artery; 6, left common carotid artery; 7, left axillary artery; 8, superior mesenteric
artery ; 9, left kidney (Maclise).
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 285
PHYSIOLOGY AND DESCRIPTIVE
ANATOMY.
I. Physiology.
Blood-circulation.—The circulation of the blood
through all the parts of the body, taking with it the mate-
rial for nutrition and gathering up the waste material, is
caused by the action of the heart, the arteries, the capil-
Fig. 67.—The heart.
larics, and the veins. The arteries carry the blood from
the heart, and contain pure, rich red blood. The aorta,
the largest artery leading from the heart, branches off
into smaller arteries, which finally become very small,
and which are termed capillaries. These vessels are
286 PRACTICAL POINTS IN NURSING.
very tiny, yet they allow a constant stream of blood to
pass through them; they are very numerous and near
the surface of the body, so that in pricking the finger we
get an oozing of blood which comes from the capillaries.
The capillaries connect with
the veins, which at first are
very small, but they grow
larger and larger until they
merge into two large veins,
the vena cava superior and
the vena cava inferior, which
bring the blood back to the
heart, and which are on the
right side of the heart.
la v
Fig. 68.—Orifices of the heart, seen from
above, both the auricles and the great vessels
being removed (Huxley) : PA, pulmonary ar-
tery and its semilunar valves ; A O, aorta and
its valves ; RA V, tricuspid, and LA V, bicus-
pid valves; MV, segments of mitral valve;
LV, segment of tricuspid valve.
Fig. 69.—Left auricle and ventricle,
opened and part of their walls removed
to show their cavities (Allen Thomson):
1. right pulmonary vein cut short; 1,
cavity of left auricle; 3, 3', thick wall
of left ventricle ; 4, portion of the same
with papillary muscle attached; 5, the
other papillary muscles; 6, 6', the seg-
ments of the mitral valve; 7 in aorta is
placed over the semilunar valves; 8,
pulmonary artery; 10, aorta and its
branches.
The Heart: its Structure and Valves.—The heart is a
pear-shaped organ (Fig. 67), situated in the front of the
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 287
chest, with its apex, or the small end, pointing down and
to the left. This important muscular organ has two dis-
tinct parts, each of which is again divided into two parts
connected with each other. Each of these four parts, or
chambers, holds about 2 ounces; the two upper cham-
bers are called "auricles," the two lower "ventricles"
(Fig. 69). There are openings between the right and
left auricles and ventricles guarded by valves; the one
between the right auricle and ventricle is the tricuspid
valve; that between the left auricle and ventricle is the
mitral valve (Fig. 68). There are two other valves, one
in the right ventricle, where the pulmonary artery be-
gins, the other in the left ventricle, where the aorta be-
gins. These valves are called " semilunar valves " (Fig.
68), and the object of these valves is to prevent the blood
flowing back when the heart dilates.
Mechanism and Course of the Circulation.—To return
to the two great veins. The venous blood, which is
loaded with impurities and is dark colored, reaches the
two great veins, the vena cava superior and the vena
cava inferior, which join together and empty into the
right auricle; this chamber contracts and forces the
blood down through the tricuspid valve into the right
ventricle, which contracts and sends the blood through
the right semilunar valve and pulmonary artery into the
lungs. In the lungs the blood throws off its impurities,
takes up a new supply of oxygen, and becomes pure,
bright-red arterial blood. This change is due to the
respiration. This pure blood returns to the heart by the
pulmonary veins, which empty into the left auricle; this
contracts and forces the blood down through the mitral
valve into the left ventricle, which also contracts, and
sends the blood through the left semilunar valve into the
288 PRACTICAL POINTS IN NURSING.
aorta, which is the largest artery in the body. The first
branch of the aorta is the coronary artery, which sup-
plies the heart itself. The branches of the aorta are
many, and they grow smaller and smaller as the distance
from the heart increases, carrying the pure blood to all
parts of the body; the last of these branches are the
capillaries, which are so small that they are invisible to
the naked eye. The blood, when passing through the
capillaries, loses its bright-red color and becomes dark,
because the different tissues take from the blood what is
necessary for their support, and give in return the waste,
worn-out material; the oxygen disappears from the
blood to a great extent, and the blood on reaching the
veins becomes dark blue, being full of impurities. The
blood then returns to the heart and thence to the lungs,
where its impurities are thrown off with the breath.
The blood takes up a new supply of oxygen in the
lungs, and repeats its journey through the body.
There is one instance where the arteries carry venous
blood, and the veins carry arterial blood ; it occurs in the
pulmonary circulation, generally called the " lesser " cir-
culation. In this circulation the venous blood enters
the right auricle and ventricle, and passes through the
semilunar valves into the pulmonary artery, thence to the
lungs, where, as we have seen, it is purified and made
into bright-red arterial blood, and returns to the heart
by the pulmonary vein.
There is another circulation, called the "portal" cir-
culation, in which four large veins—the inferior and su-
perior mesenteric, splenic, and gastric—form one large
trunk called the " vena portae." This portal vein collects
the blood from the stomach, the pancreas, the spleen,
and the intestines, and carries it to the liver, where it
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 289
mixes with the blood that is supplied to the liver. The
blood then passes from the capillaries of the liver into
small veins, the hepatic veins, which carry it to the vena
cava inferior.
The greater or systematic circulation begins at the left
ventricle, thence through the aorta, and is distributed to
all parts of the body, going through capillaries and veins,
and then returning to the right auricle.
Respiration.—The air we breathe is mainly composed
of two gases, oxygen and nitrogen, there being more
oxygen than nitrogen. The oxygen is absolutely neces-
sary to support life; still, alone it would not support life,
because it is too stimulating; hence there can be danger
from too much as from too little oxygen. The nitrogen
serves to dilute the oxygen. There is also a small quan-
tity of carbonic-acid gas, which is very poisonous, and a
certain amount of watery vapor, which, when exhaled, is
invisible, except in cold weather, when it is seen to issue
from the mouth or the nostrils in the form of a white
cloud.
Mechanism of Respiration.—Each time we breathe the
air passes into the lungs through the nose, mouth,
larynx, and trachea, thence to the bronchial tubes and
air-cells of the lungs. The muscles of the chest ex-
pand, the diaphragm contracts, allowing the lungs plenty
of room to expand, the ribs are lifted, the lungs expand,
the air-cells open, and a fresh supply of oxygen is in-
haled. This action is called " inspiration." The second
movement is called " expiration," in which the diaphragm
relaxes and rises in the form of a dome, the ribs descend,
the chest contracts, the lungs, which are elastic, shrink,
and the impure air is driven out. We breathe in oxy-
gen and give out carbonic-acid gas, which must not be
19
29O PRACTICAL POINTS IN NURSING.
inhaled again, and to which there is a faint odor, but un-
noticeable except when present in large quantity.
Upon entering a poorly-ventilated hall or a room in
which there are many people, one will at once notice
the bad air. It is due to the carbonic-acid gas expired
by each inmate, there being not enough oxygen to purify
the air. Lighted gas-jets also consume the oxygen.
If there is too little oxygen to purify the blood, the
venous blood is distributed to the heart and thence to the
body, and there is a feeling of faintness and suffocation.
Our bodies must be supplied with fresh air, food, and
drink; we cannot live without them. One knows the
need of food by the cravings of the stomach, the need of
water by the dryness of the mouth and throat, the need
of pure air by the feeling of suffocation.
Animals, like human beings, take in oxygen and give
out carbonic acid. Plants take in carbonic-acid gas and
give off oxygen in the day-time; in the night they take
in oxygen and give off carbonic-acid gas. It is for this
reason that plants should be removed from a room at
night.
Besides the lungs, the skin and the kidneys assist in
removing impurities from the body.
The Digestion.—The organs of digestion are the sali-
vary glands, the stomach, the liver, the pancreas, and the
intestines. These so change the food we eat that it can
be taken into the blood and nourish the body.
The alimentary canal (Fig. yd) is about 30 feet long;
it begins with the mouth and ends with the rectum. It
is in this canal that the process of digestion is carried on.
The first part, which extends from the mouth to the
stomach, is called the "esophagus" (gullet), and con-
ducts the food to the stomach. The stomach is the most
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 291
expanded part of the canal; its left end is enlarged,
and because it is on the heart side of the body is called
the " cardiac dilatation." The right end of the stomach
narrows and connects with the
small intestine. The small in-
testine is a continuation of the
canal, is about 20 feet long, and
lies in convolutions in the abdo-
men ; it ends in the large intes-
tine, which is about 5 feet long,
and which runs up the right side
of the body (ascending colon),
crosses over under the liver and
stomach (transverse colon), de-
scending the left side (descending
colon), and ends in the sigmoid
flexure and rectum (Fig. 70).
Mastication and Deglutition.—
The food when taken into the
mouth is cut and ground by the
teeth, reduced to a fine pulp, and
mixed with the saliva, which
changes the starch that the food
contains into sugar by its active
principle, ptyalin. When suffi-
ciently masticated the food is carried backward to the
opening which leads into the pharynx, and is thrust
into the latter, the soft palate being lifted and its pillars
brought together, while the backward movement of the
tongue causes the epiglottis to incline backward and
downward over the glottis, thus forming a lid over
which the food can travel without dropping into the
air-passages. The epiglottis prevents the food from
Vermiform
appendix
Fig. 70.—The alimentary canal.
292 PRACTICAL POINTS IN NURSING.
passing into the trachea, and the soft palate keeps it
from passing into the nasal cavities.
Stomach and Intestinal Digestion.—When the food
passes into the stomach it is rolled about and thor-
oughly mixed with the gastric juice until it is reduced
to the consistency of pea-soup, called " chyme." It then
passes through the pylorus (a narrow opening at the
right end of the stomach), and the duodenum, the first
part of the small intestine adjoining the stomach. A
large quantity of the fluid (chyme) is absorbed through
the walls of the stomach and joins the blood-circulation.
When the food or chyme passes into the duodenum it is
mixed with the pancreatic juice and the bile, and is con-
verted into chyle, a milky fluid formed by the digestion
in the intestines of fatty particles of food. After passing
through the small intestines the food gradually loses its
nourishing properties, and finally enters the large intes-
tine, where it acquires its characteristic fecal odor and
color.
Secretions.—Some of the secretions of the body are:
saliva, perspiration, sebaceous matter, tears, gastric juice,
pancreatic juice, intestinal juice, milk, bile, and mucus.
In the mouth is the saliva < > , which changes
I Ptyalin J ' 5
starch into grape-sugar.
In the stomach is the gastric juice—water, pepsin, hy-
drochloric acid—which digests albuminoids.
In the intestines are the juices of the intestines—bile,
pancreatic juice, water—which digest fats, starch, and
albuminoids.
Parotid Glands.—The parotid glands are situated one
in front of each ear. They are salivary glands.
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 293
Excretions.—The excretions are eliminated from the
body by the skin, the lungs, the kidneys, and the bowels.
Urinary Organs.—The urinary organs are the kid-
neys, the ureters, the bladder, and the urethra (see page
308). The kidneys purify the blood by removing from
it waste and worn-out material. They also regulate
the amount of water to be removed from the body, and
the amount to be retained in the body for resorption.
The Urine.—The urine is one of the excretions of the
body, and contains waste and worn-out material held
in solution, or " salts," as they are called, among which
is urea, uric acid, urates, chlorids, and earthy phosphates.
The normal quantity of urine passed in the twenty-
four hours is from 30 to 50 ounces. The color is a light
amber, the reaction acid, and the specific gravity (by
which is meant the weight of the urine) averages from
1018 to 1024, or may be as high as 1030 without there
being any disease. There is a characteristic aromatic odor.
The amount of urine is varied at different times,
more being passed during the day than
the night. Food and drink increase the
quantity. After profuse perspiration the
amount is decreased; while, on the con-
trary, cold decreases the activity of the
skin, and consequently the flow of urine
is increased. Some diseases are charac-
terized by an increase or a decrease in
the amount passed; as, for instance, one
of the first symptoms of diabetes melli-
tus is the increased amount of urine
passed daily, which amount may be as
high as 80 or 100 ounces, of a specific
gravity ranging from 1020 to 1045, which may indicate
294 PRACTICAL POINTS IN NURSING.
an abnormal amount of sugar in the urine, and the color
may be a clear light yellow, without any sediment.
When there is an excess of sugar or urea, or of any of
the other substances in the urine, it does not follow that
the kidneys are diseased; they may be perfectly healthy,
and the change be due to some nutritive or other dis-
turbance; but when we find albumin in the urine, the
kidneys are generally diseased.
In acute diseases the quantity of urine may be dimin-
ished and its color and specific gravity be high. When
convalescence sets in the amount increases and the spe-
cific gravity may be found below the normal.
The odor of the urine is affected by taking certain
foods and medicines.
The color of the urine varies from a light amber to a
dark red (PI. 6). In nervous diseases the urine is very
often pale, like water. In fever cases it is a high red color,
and is generally thick and loaded with sediment, because,
as the amount of food taken into the body is much less,
the wasting process is more active; hence the amount of
solids in the urine is increased. Medicines influence the
color. Bile may give to it a dark-brown or a greenish
color, as will also carbolic acid; iodoform will give to it
a dark smoky color.
The reaction for the twenty-four-hour amount is acid.
After meals it may be neutral or alkaline. The reaction
is taken with blue litmus-paper, which, if the urine is
acid, will be turned red. If the urine is alkaline, it will
turn red litmus-paper blue, and if it is neutral (neither
acid nor alkaline), it will have no effect upon either red
or blue litmus-paper.
The specific gravity of urine is taken with the urinom-
eter (Fig. 71). When taking the specific gravity the
URINE.
Plate 6.
PALE YELLOW.
LIGHT YELLOW.
m.
YELLOW.
IV.
REDDISH YELLOW.
v.
YELLOWISH RED.
VI.
RED.
VII.
BROWNISH RED.
VIII.
REDDISH BROWN.
IX.
BROWNISH BLACK.
Scale of Urinary Colors, according to Vogel (Wolff).
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 295
urine is poured into the tall glass and in the middle is
dropped the urinometer, the number of degrees being
read from off the scale at the level at which it rests.
Tests of Urine.—To test for albumin a test-tube is
half filled with urine and heat applied until boiling
occurs. If albumin is present, the urine appears cloudy,
and this cloudiness does not disappear on the addi-
tion of a few drops of nitric or acetic acid. Another
ready way, if nitric acid is at hand, is to pour some
of the acid into a small glass, incline the glass, and
pour down the side of it an equal amount of the clear
urine, which will spread over the acid; if albumin is
present, there will be a sharp white ring between the
urine and the nitric acid. Very often we get this white
ring when the mixed urates are present, and it might be
mistaken for albumin; but if urates are present and not
albumin, the white ring, or " zone," as it is called, will
not appear where the urine and nitric acid meet, but
higher up, and later will spread into the urine, and if it
is heated will disappear. When normal urine is poured
on nitric acid a brown ring appears between the urine
and the acid, due to the action of the acid on the color-
ing matters. Hence, when there is an abundance of
coloring matter the albumin precipitates may be simi-
larly colored.
A pretty test for sugar is to add to the urine an equal
amount of sodii hydrate, which will make the urine
alkaline, then add drop by drop a solution of sulphate
of copper; if sugar is present, the mixture turns a dark
navy-blue color. If this mixture is boiled, there will re-
sult a reddish-yellow precipitate ; this is Trommer's test.
Another test is to take urine and liquor potassae equal
parts, and add a little bismuth subnitrate; this solution
296 PRACTICAL POINTS IN NURSING.
when shaken and boiled, if sugar is present, will turn
perfectly black.
2. Descriptive Anatomy.
The anatomy of the body will not minutely be con-
sidered, but merely a brief description of the skin, the
muscles, and the bones, and the situation of the different
organs of the body will be given.
1. Skin.—The skin is the covering (integument) of the
body that protects the parts beneath it, and that regulates
the heat of, and gives off waste material from, the body.
There are two layers of skin—an outer layer, the epider-
mis, and an inner layer, the cutis (derma) or true skin.
The latter is supplied with capillaries and nerves, and
bleeds freely if cut or pricked. The epidermis does not
bleed. Just below the cutis is a layer containing fat and
the larger arteries of the body. On some parts of the
body the skin is thicker than on others, as the palms of
the hands and soles of the feet, while in other parts, the
mouth, nose, rectum, etc., the skin apparently ends,
which is not the case; it is only very much thinner,
having two layers as before, the inner layer (endothe-
lium) containing blood-vessels and nerves; the outer
layer, which is similar to the epidermis, is called the " epi-
thelium." The black color of the skin in the negro and
the tawny color among some of the white races are due
to the presence of pigment in the cells of the cuticle.
Developed from the skin are the hair and the nails.
2. Bones of the Body.—The bones are the frame-
work of the body; they afford protection to the important
organs, and are covered with a fibrous membrane called
the "periosteum." There are in the body about 206
bones of different shapes and lengths. They are divided
ANATOMY.
Plate 7.
Parietal bone.
Temporal bone.
The Human Male Skeleton.
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 297
into three groups—bones of the head, of the trunk, and
of the extremities (PI. 7). The femur or thigh-bone is
the largest, longest, and strongest bone in the body, and
the stapes (one of the little bones of the ear) is the small-
est bone in the body.
The ends of bones, when jointed movably with others,
are covered with cartilage, having within the joint free
surfaces of great smoothness, which surfaces are lubri-
cated by the synovial fluid secreted from the synovial
membrane which lines the joints. The bones are further
held together by fibrous tissue in the form of ligaments.
Bones of the Skull.—The skull is a box of bone con-
taining the brain, which is a soft, pulpy substance and is
the chief organ of the nervous system. The skull is
composed of two plates of bone from which the brain is
separated a little distance.
The thickest part of the skull is at the back, where it
is half an inch thick, and the thinnest part is at the tem-
ples. Just above the eyes on the forehead the two plates
of bone are separated half an inch or more, so that when
a person is kicked by a horse or otherwise injured, the
outer table may be indented to a considerable extent,
and it may even affect the inner plate without injuring
the brain.
Bones of the Trunk: Thorax.—The thorax, or chest,
is bounded by the ribs, the breast-bone, and the back-
bone. The chest contains the heart and the lungs, and
also the large blood-vessels.
There are twenty-four ribs (twelve on each side), of
which the seven upper ones are called " true ribs;" the
five lower are " false ribs." All the ribs are attached to
the spinal column by ligaments and cartilage, which hold
them in position. The seven true ribs are connected
298 PRACTICAL POINTS IN NURSING.
with the sternum (breast-bone) by means of fibrous
bands. The 8th, 9th, and 10th ribs are each attached to
the lower border of the rib above it. The nth and 12th
ribs are called " floating ribs," having only one attach-
ment, that of the spinal column. The sternum is the
breast-bone. The clavicle, or collar-bone, is a long bone
which articulates with the sternum and scapula. The
clavicle connects the upper extremity, which is divided
into shoulder, arm, forearm, and hand, with the body.
The scapula, or shoulder-blade, is a large, flat, triangular
bone held in place by the clavicle and muscles.
The spinal column, or the back-bone, extends from
the base of the skull to the lower extremity of the back,
and is composed of twenty-six bones called " vertebras,"
piled one upon the other, making a strong pillar for the
support of the head and trunk. Between each of these
small bones is a layer of cartilage of an elastic character
which allows the body to bend in many directions.
The seven cervical (or neck) vertebras extend from the
base of the skull to the shoulders, the twelve dorsal
(or back) vertebrae extend from the shoulders to the
lower ribs. Between each articulating pair of vertebrae
is an opening on each side for the passage of nerves
throughout the entire length of the column—the spinal
cord. The five lumbar (loin) vertebrae extend from be-
low the ribs to the pelvis, the bones of the sacrum and
the coccyx forming the extremity of the spine.
The pelvis is formed by the sacrum, the coccyx, and
the two ossa innominata. The female pelvis contains
the ivomb, ovaries, Fallopian tubes, bladder, and rectum
(see p. 308).
Bones of the Extremities.—The humerus is the largest
bone of the arm, and articulates with a shallow joint-
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 299
surface on the shoulder-blade. Under each arm is the
axilla, containing a great bunch of nerves and blood-
vessels and numerous glands. The forearm is com-
posed of two bones—the radius and ulna—the radius
being on the outer or thumb side of the forearm, where
we feel the pulse. The elbow-joint is called a " hinge-
joint," the movements being limited to flexion to an
acute angle and to extension in a straight line. Below
the forearm is the wrist, and next the hand.
The lozver extremity consists of the thighs, the legs,
and the feet.
The femur or the thigh-bone, has a round head, and
fits into a deep cup-shaped socket in the hip-bone.
The patella, or knee-cap, is a small flat bone situ-
ated in front of the knee-joint. The two bones of the
leg below the knee are the tibia and fibula. The tibia
is the stronger of the two, and is on the inner side of the
leg. It is joined to the femur, and the fibula, which is
long and slender, is joined to the tibia, and both articu-
late with the ankle-bone (astragalus).
3. Muscles of the Body.—The muscles are the fleshy
portions of the body, and by their contraction and relax-
ation are organs of motion. They are divided into two
classes—those subject to the will, or voluntary muscles,
and those not subject to the will, or involuntary muscles,
of which the muscles of the heart and of the intestines
are examples. The muscles differ in length and form,
being long, short, broad, round, and flat. The smallest
muscle in the body is the stapedius (one of the muscles
in the ear), which is only jr of an inch in length, and the
longest muscle in the body is the sartorius, which is
over 18 inches in length, reaching from the hip to below
the knee.
300 PRACTICAL POINTS IN NURSING.
Running up from the sternum and clavicle to the
mastoid process is the sterno-cleido-mastoid muscle; be-
neath this is a large artery which supplies blood to the
face and head, and the jugular vein, which, if opened,
may cause instant death.
The diaphragm is a sheet of muscle which separates
the cavity of the chest from the abdomen.
Tendons.—Tendons are white, glistening fibrous cords
which attach certain muscles to bone. The largest
tendon in the body is the tendo Achillis inserted in the
heel-bone.
Fascia.—The fascia is a fibrous membrane covering
the muscles. It is very tough, does not stretch, neither
can pus penetrate it.
4. Heart, Blood-vessels, and Lymphatics. — The
heart is a large muscular organ situated in the front part
of the left side of the chest, pointing toward the left, and
enclosed in a membraneous sac called the "pericardium."
The movements of the heart are involuntary—that is,
are not under the control of the will—and, though the
walls of the heart are constantly expanding to take in a
fresh supply of blood, and contracting to drive out the
blood, the heart has after each contraction a short rest
of about two-fifths of a second, which, as it comes regu-
larly every second, amounts at the end of twenty-four
hours to about nine hours of total rest (see Blood-cir-
culation, p. 285).
Arteries.—The aorta, which is the largest artery in the
body, springs from the heart. When it leaves the left
ventricle it forms an arch, then gives off branches which
divide and subdivide until they become very small ves-
sels, called " capillaries." The carotid arteries supply the
head and the neck. The subclavian arteries are in the
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 3OI
upper part of the chest. The axillary is a continuation
of the subclavian, and passes through the armpit and
down the inner side of the arm as the brachial artery.
This artery divides at the elbow into the ulnar and radial
arteries. The ulnar is on the inner side of the forearm,
and the radial is on the outer or thumb side, and both
supply blood to the hand and fingers. The aorta de-
scends through the thorax into the abdomen, and is
called respectively the " thoracic " and the " abdominal "
aorta.
The internal iliac artery supplies the walls and organs
of the pelvis. The external iliac runs along the brim of
the pelvis down the inner side of the thigh, where it
takes the name of the femoral artery, whose pulsations
can be felt in the groin. The femoral passes into the
back of the thigh and knee, and is called the " popliteal
artery." The leg and foot are supplied by the tibial and
peroneal arteries.
The lymphatics are the vessels which take up the
lymph from all parts of the body, with the exception of
the intestines, and return it into the venous system.
5. Brain, Cord, Nerves, and Organs of the Senses.
—The brain is composed of gray matter at the surface
and white matter in deeper portions. It is divided into
the big brain, or the cerebrum, and the little brain, or the
cerebellum, and is enveloped from within outward by
three membranes, the pia mater, the arachnoid, and the
dura mater. The brain is supplied with about one-fifth
of the amount of blood that the body possesses. The
brain gives off twelve pairs of nerves which supply the
head and face (the organs of special sense), the heart,
the lungs, and the stomach.
Spinal Cord.—The medulla oblongata is the enlarged
302 PRACTICAL POINTS IN NURSING.
upper portion of the spinal cord within the skull. It re-
sembles the cord in being composed of both white and
gray matter. It is the headquarters of the important
nerve lines which go to the heart, lungs, stomach, and
other prominent organs. The spinal cord is composed of
gray and white matter, the gray matter being inside the
cord. It is covered with membranes similar to those of
the brain, the pia mater, the arachnoid, and the dura
mater. It is also divided into two halves, and gives off
thirty-one pairs of nerves, which supply the trunk, the
extremities, and portions of the head and neck (see p.
298). At the beginning of the spinal cord the nerve-
fibres (see p. 254) cross from right to left, so that the
nerves at the right side of the brain supply the left side
of the body and vice versa. Thus, when one side of the
brain is injured it is the opposite side of the body which
is affected. This crossing is called the " decussation " of
the nerve-fibres.
The nervous system consists of the brain, the spinal
cord, and the nerves. Through it all the functions of
the body, both mental and physical, are performed.
Thought, sensation, and motion are all under the con-
trol of the brain, which is the seat of government.
The brain, which is the chief organ of the nervous
system, may be regarded as a central telegraph office;
the gray matter along the spinal cord is the district
offices, and the nerves are the telegraph wires.
The nerves are composed of silvery-white fibres, and
furnish both sensation and motion. The sensory (sensa-
tion) fibres begin in the skin and end in the brain, and
carry messages to the brain. The motor (motion) fibres
begin in the brain and end in the skin, and carry mes-
sages from the brain. When we want to lift up anything
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 303
or to move a hand, an arm, or a foot, the brain sends a
message over the nervous system to the muscle of what-
ever part we want to move. The muscles contract and
the part is moved. These are the nerves of motion, or
the motor nerves. Again, when we are being burnt with
a hot iron or injured in any way, however slight, the
nerves of sensation reflect the message to the brain ; then
we feel the pain, and the brain instantly sends down the
message over the motor fibres to move the part away.
The spinal cord gives off thirty-one pairs of nerves,
each nerve issues from the cord by two separate roots—
motor and sensory (motion and sensation). The cord
has the power of reflecting messages without sending
them to the brain; as, for instance, if a message comes
up a sensory fibre that a foot is being injured, the gray
matter of the cord has the power of sending a message
to the foot, through the motor fibres, to move the foot,
the muscles contract, and the foot is moved.
The vasomotor nerves are the nerves controlling the
blood-vessels.
Reflex action is involuntary action, such as winking or
coughing and sneezing when the throat or nostrils are
trying to get rid of some irritating substance.
Eyes.—The eye, strictly speaking, consists only of the
eyeball or eye-globe; but connected with the eyeball
externally are muscles, nerves, blood-vessels, as well as
other parts specially designed for its protection (see p.
112). The cavities containing the eyeballs are called
"orbits," which are about 1^ inches deep. At the bot-
tom are small holes through which enter the optic
nerves.
Nose.—The nose is composed of bone and cartilage.
Ear.—The ear is divided into three parts—the ex-
304 PRACTICAL POINTS IN NURSING.
ternal ear or auricle, the middle ear, and the internal
ear (Fig. 72).
The auricle {pinna) is composed of cartilage covered
with skin {A), and has a tube about an inch long called
the " auditory canal " {G). The cavity of the middle ear,
or the tympanum, is separated from the external canal by
the drum-membrane {T). This drum-membrane is about
one-eighth of an inch in diameter and -^\-^ of an inch in
Fig 72.—Semidiagrammatic section through the right ear (Czermak): G, external
auditory meatus; T, membrana tympani; P, tympanic cavity; o, fenestra ovalis;
r, fenestra rotunda; B, semicircular canal; S, cochlea ; Vt, scala vestibuli; Pt, scala
tympani.
thickness, and has three layers—one of skin, one of
fibrous tissue, and an inner layer of mucous membrane—
and is also supplied with blood-vessels and nerves. The
ear should not be picked with pins, as there is great dan-
ger of perforating the drum and causing deafness. The
middle ear {P) contains the small bones of the ear, the
incus, stapes, and malleus, which are the smallest bones
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 305
in the human body. The middle ear is connected with
the back part of the throat by the Eustachian tube {E),
the blocking of which causes deafness. The internal ear
or labyrinth consists of the vestibule ( Vt), the cochlea {S),
and three semicircular canals {B), also the ends of the
auditory nerve, the nerve of hearing. Behind the ear is
a prominence, the mastoid process, closely connected
with the ear and the brain. Any disease of the middle
ear may extend to the mastoid, and diseases of both the
middle ear and the mastoid are always liable to affect the
brain.
6. Respiratory, Digestive, and Urinary Organs.—
The trachea (Fig. 73, 3) extends from the larynx to the
lungs, then divides into two branches called " bronchi."
These again divide into smaller tubes called " bronchial
tubes," which finally terminate in extremely fine air-cells.
The lungs (Fig. 73, 4-6, 7, 8) are the organs of res-
piration. They have a light, spongy appearance, and
crepitate or crackle when pressed with the fingers, owing
to the contained air in them. There are two lungs, one
on each side of the chest. The right lung is larger
than the left and has three lobes; the left lung, being
smaller, owing to the room taken up by the heart, has
only two lobes.
The abdomen contains the stomach, liver, spleen, intes-
tines, kidneys, and ureters. It is the largest cavity in the
body, and is separated from the chest above by the dia-
phragm and from the pelvic cavity below by the brim of
the pelvis. It is not, like the chest, protected on all
sides by bone, and consequently its contained organs
are easily injured.
The stomach lies on the left side directly under the
heart (see p. 290).
20
306 PRACTICAL POINTS IN NURSING.
The liver, the largest gland of the body (weighing
from 50 to 60 ounces), is situated on the right side of the
body under cover of the ribs. Attached to the under
side of the liver is a bag called the " gall-bladder," large
enough to hold about 1 ounce of bile, which is a green-
ish-yellow secretion of the liver. Jaundice is caused by
stoppage of the gall-duct, the bile being carried into
the blood and throughout the circulation, and giving
the whole body a yellow appearance.
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 307
The pancreas, or sweetbread, lies across the abdomen
below the liver, nearly touching the spleen on the left.
The secretion or juice of the pancreas is concerned in
the digestion.
The spleen is situated at the heart end of the stomach
beneath the diaphragm. Its function is obscure.
The peritoneum is the serous membrane which lines
the abdomen and covers the various organs.
The intestines are part of the alimentary canal (see p.
290) continuous with the stomach; the small intestine is
about 20 feet long, and lies in convolutions or coils in
the abdomen, ending in the large intestine, (which is
about 5 feet long, and runs up the right side of the body,
crosses over under the liver and stomach and down the
left side, ending with the rectum. The duodenum is
the first part of the small intestine near the stomach.
The ileum is the lower half of the small intestine; the
ilco-cecal valve is the valve between the ileum and the
cecum.
The cecum is the head of the colon, and lies in the
lower part of the right side of the abdomen. Opening
from the cecum is the vermiform appendix (Fig. 70), a
narrow worm-shaped tube from 2 to 5 inches long. Its
opening is guarded by a valve, but sometimes food, seeds,
fruit-stones, or hard fecal matter slips into the appendix,
and inflammation may result (appendicitis).
The colon is the first part of the large intestine, and
passes up the right side as the ascending colon, across
the body as the transverse colon, and down the left side
as the descending colon, where it forms the sigmoid flex-
ure (Fig. 70), which is curved like an S, and which serves
to remove the fecal matter from the body, this action
being done by muscles of its own. The colon ends in
308 PRACTICAL POINTS IN NURSING.
the rectum, which is from 6 to 8 inches long, and which
terminates at the anus.
The omentum is a fold of the peritoneum lying in
front of the bowels like an apron.
The kidneys are situated at the back part of the ab-
dominal cavity, one on each side of the upper lumbar
region of the spine. They are about 4 inches long, 2
inches wide, and 1 inch thick ; the right kidney is a
little lower than the left on account of the large space
taken up by the liver. The kidneys excrete the urine,
which is carried by a tube (from 12 to 16 inches long)
called the " ureter," attached to each kidney, and empty-
ing into the bladder. The urine passes drop by drop
from the ureters into the bladder, which holds about a
pint, and which is emptied by the process of urination.
If the urine is retained in the bladder a long time, it may
decompose, or rupture of this organ may take place
through over-distention.
The bladder is situated in the front portion of the pel-
vis, is oval in shape, and holds about a pint.
The urethra is a small canal that conveys the urine
from the bladder. The opening of the urethra (the
meatus urinarius) opens immediately above the entrance
into the vagina.
7. Internal Female Organs of Generation (PI. 8).—
The womb or " uterus," as it is more commonly called, is
a hollow, pear-shaped organ about 3 inches long and 2
inches broad at the top, or fundus, and about 1 inch thick.
It consists of the fundus, which is the rounded upper
portion, into each side of which enters a Fallopian tube,
of a body, and of a cervix or neck, which projects into
the vagina, and which is about 1 inch long. The os uteri
is the mouth of the womb. The womb is situated be-
FEMALE GENERATIVE ORGANS.
Plate 8.
Veins.
Blood-vessels of the pelvis (Bourgery and Jacob): the anterior part of the pelvis has been
removed, and the bladder and the anterior vaginal wall have been partially cut away. The uterus
is drawn up, and the Fallopian tubes are displaced into the iliac fossa; (from An American Text-
Book of Obstetrics).
PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 309
tween the bladder and the rectum, and any distention of
either of these organs alters its position; for instance, if
the bladder is distended with urine, the womb is tipped
backward, and if the rectum is distended with fecal mat-
ter, it is tipped forward.
The broad ligaments, which are composed of folds of
peritoneum, connect the sides of the womb with the
walls of the pelvis, so that the womb is suspended in the
pelvis.
The Fallopian tubes are from 3 to 5 inches long. They
are attached at one end to the top of the womb, while
the other end has a fringe-like appearance, called the
" fimbriated extremity," part of which is attached to an
ovary.
The ovaries are two small oval bodies about \\ inches
in length. They lie on either side of the womb about 1
inch from its top, and are enclosed between layers of the
broad ligament.
APPENDIX.
I. GENERAL RULES FOR FEEDING THE SICK,
AND HOW TO MAKE CERTAIN ARTICLES OF
FOOD.
i. Serving the Food.
The question of serving food, which is one of educa-
tion and training, is of vast importance in the successful
nursing of private patients. Much depends upon obser-
vation and tact. Little things are more apt to influence
the condition of the patient than large ones, and, no
matter how much medical care the patient has received,
or how successfully a difficult operation has been per-
formed, or how attentive the nurse has been, the advan-
tages may all be lost through some trifling mistake in
the serving of the food. The laboring man is content
to eat bread and meat with his fingers and to drink
tea from his dinner-pail, but it would make a refined
man or woman very unhappy to be compelled to eat
from broken dishes and to be served by a nurse who
spilled the liquids, who held a cup or a tumbler at the
rim in offering drink, instead of holding it at the bottom
or by the handle, who served the food cold, who tasted
the food in the patient's presence, who had unclean
hands, or who wore a soiled apron.
The serving of food requires a great deal of judgment
and good taste, and in no branch of her work can a nurse
311
312
APPENDIX.
be of more service to a sick patient than in her ability to
serve properly the food. The taking of food is the chief
event of the day for a sick patient, and the patient's
mind should be diverted from her illness in the anticipa-
tion of the meal, which should be served daintily and, if
possible, should be composed of something unexpected.
The tastes of the patient, however, should be consulted
as far as possible: while it is unwise to ask the patient
beforehand concerning the bill of fare, as it is often the
unexpected which pleases, still, if she expresses a prefer-
ence for a certain dish, it should be supplied, provided it
is sanctioned by the physician.
Punctuality should be observed in serving the meals,
as frequently the appetite will be lost if the meal is de-
layed beyond the accustomed hour. When a patient is
very ill only the simplest foods are given, and these are
prescribed by the doctor. Fluids can conveniently be
taken by suction through a bent-glass tube or by a
pretty feeding-cup with a spout, the cup being carried to
the bedside on a small tray covered with a spotless nap-
kin. The mouth of the patient must afterward be wiped
dry with a fresh clean napkin (not with the corner of a
face-towel). When convalescence sets in it becomes
necessary to vary the food. The dishes selected should
be savory, sufficiently varied, and suited to the digestive
power of the patient.
In preparing the tray the nurse should be sure first
that it is clean on both sides, then to cover it with a
spotless tray-cloth, and the dishes, which should be the
prettiest and best that the house affords, should be sys-
tematically arranged upon it. The tray must not be
crowded, and discord in color should always be avoided.
A few flowers in a small vase or laid loosely on the tray
FEEDING THE SICK.
3*3
will add to its attractiveness. Too little rather than too
much food should be served, and plenty of time be
allowed for the meal, so that the food will be thoroughly
masticated and mixed with the digestive juices. Hot
food must be served hot, the dishes having previously
been heated and wiped dry on the outside, and cold food
must be served cold, lukewarm food being unpalatable.
Pains must be taken not to spill the liquids.
When a patient is permitted to sit up out of bed for
an hour each day, it is generally best to utilize this hour
for dinner, which, being the principal meal of the day,
will then be thoroughly enjoyed, and will also be better
digested by the patient. If the patient takes the meals
in bed, care must be taken that a comfortable position is
secured and that the legs are not cramped by the food-
tray.
Every nurse of to-day knows something of the sci-
ence of bacteriology, and that foodstuffs, especially the
animal portions, become spoiled through the presence in
them of bacteria. Nurses have also heard lectures on,
and understand the vast importance of, asepsis in sur-
gical nursing: they would not think of doing a surgical
dressing without first making their hands and everything
to be used about the dressing aseptic, as the lack of such
care might cost the patient her life. The nurse should
be equally careful about cleansing the hands before hand-
ling food, because, not knowing what germs are on her
hands, it is possible thus to infect milk or other food
with the bacillus of tuberculosis or of other disease. It
is in the weakened stomach of the baby and of the inva-
lid that bacteria develop and cause harmful results. That
one has good health notwithstanding the careless prepa-
ration of the food he eats, that he eats fruit which has
3H
APPENDIX.
passed through an endless series of dirty hands, that he
cools the liquids he drinks with ice gathered from ponds
impregnated with every form of bacteria, and that a
healthy stomach has the power to destroy many germs,
are no arguments against absolute cleanliness and neat-
ness when serving food to the sick.
A surgical dressing must be done before meal-time, and
all traces of the dressing cleared away. The bed must
be arranged, the patient's hands and face be bathed, and
the room set in order before serving the meal. While
eating the mind of the patient should be diverted by
cheerful conversation, and the tray be removed as soon
as the meal is finished.
In most fevers patients are allowed to have a liberal
supply of water or beverages, such as orangeade, lemon-
ade, etc., which flush out the kidneys and aid in elimina-
ting the worn-out material generated in the body by the
fever. Eight grains of sodium bicarbonate, soda-water,
or Vichy water will render sour lemonade effervescing
and will make a very refreshing beverage. Cold drinks
should be sipped slowly, the thirst being relieved much
better by sipping fluids than by quickly drinking them.
Strong black coffee should be added to milk; it is a
heart- and brain-stimulant, and is very useful in typhoid
fever when the patient seems to be sinking into a stupor.
The diet-kitchen outfit may consist of the following
appliances and accessories:
A spirit- or gas-light chafing-dish ;
A single porcelain-lined saucepan ;
A double porcelain-lined saucepan ;
An 8-ounce measuring-glass;
A minim measuring-glass;
A cooking-thermometer;
FEEDING THE SICK
315
A mince-meat machine; spoons ; a glass funnel;
Borax ; sodii bicarbonate;
Pancreatin powders.
These, together with other essential articles, should be
kept, if possible, in a small room next the patient's bed-
room, where light foods can be prepared.
Diet in Convalescence.—The following sick-room
dietary has been prepared as a guide for feeding conva-
lescents. The diet for convalescence from typhoid fever
may also be selected from it.
First Day.
Breakfast: Mutton broth with bread-crumbs.
Lunch: Milk-punch.
Dinner: Raw oysters; thin bread and butter with
crust removed; sherry wine.
Lunch : Cup of hot beef-tea.
Supper: Milk toast; jelly; cocoa.
Second Day.
Breakfast: Oatmeal with sugar and cream; cup of
cocoa.
Lunch: Soft custard.
Dinner: Small piece of tenderloin steak, to be
chewed, but not swallowed; baked white
potato.
Lunch : Glass of milk.
Supper: Buttered milk-toast (crust removed) ; jelly;
cocoa.
Third Day.
Breakfast: Soft-boiled egg; bread and butter; coffee.
Lunch: Milk-punch.
316
APPENDIX.
Dinner: Chicken soup; tender sweetbreads ; Bavarian
cream; light wine.
Lunch: Egg-nog.
Supper : Raw oysters ; bread and butter; tea.
Fourth Day.
Breakfast: Oatmeal with sugar and cream; a tender
sweetbread; creamed potatoes; Graham
bread and butter; coffee.
Lunch : Glass of milk.
Dinner: Chicken panada; baked potato ; bread; tapi-
oca cream.
Lunch : Cup of hot chicken broth.
Supper: Buttered dry toast (crust removed); wine
jelly; banquet crackers ; tea.
Fifth Day.
Breakfast: An orange; a scrambled egg; oatmeal with
sugar and cream; soft buttered toast;
coffee.
Lunch: Milk-punch.
Dinner: Cream-of-celery soup; a small piece of ten-
derloin steak ; a baked potato; snow pud-
ding ; bread; wine.
Lunch: An egg-nog.
Supper : Calfs-foot jelly; soft-boiled egg; bread and
butter; cocoa.
Sixth Day.
Breakfast: Oatmeal; poached eggs on toast; coffee.
Lunch : Cup of chicken broth.
Dinner: Chicken soup; small slice of tender roast
beef; baked potato; rice pudding; bread.
RECIPES.
317
Lunch : Glass of milk.
Supper : Baked apples ; raw oysters ; bread and but-
ter; orange jelly; tea.
Seventh Day.
Breakfast: An orange; mush and milk; scrambled
eggs; cream toast; coffee.
Lunch : Cup of soft custard.
Dinner: Mutton soup; small piece of tender beef-
steak ; creamed potatoes; sago pudding;
bread; wine.
Lunch : Cup of beef-tea.
Supper: Sponge-cake with cream ; buttered dry toast;
wine jelly; cocoa.
Eighth Day.
Breakfast: Boiled fresh fish; oatmeal; Graham bread;
coffee.
Lunch: Chicken-broth.
Dinner: Potato soup ; breast of roast chicken; mashed
potatoes ; macaroni; blanc-mange.
Lunch : Cup of mulled wine.
Supper: Cream toast; lemon jelly; chocolate.
The dietary for succeeding days may be selected from
that of preceding days. Change of diet may cause a
temporary rise in the temperature and pulse.
2. Recipes for Invalid Foods and Beverages.
Simple Farinaceous Foods.—Arrowroot.—Mix 1
teaspoonful of Bermuda arrowroot with 4 teaspoonsful
of cold milk. Stir it slowly into half a pint of boiling
milk, and let it simmer for five minutes. It must be
3i«
APPENDIX.
stirred all the time, to prevent lumps and to keep it from
burning. Add half a teaspoonful of sugar and a pinch
of salt, and if desired one of cinnamon. In place of the
cinnamon half a teaspoonful of brandy may be used or a
dozen large raisins may be boiled in the milk. If the
raisins are preferred, they should be stoned and the
sugar may be omitted.
Corn-starch or rice-flour gruel is made in the same
way.
Boiled-flour Gruel.—Moisten I pint of flour with 2
ounces of cold water; make it into a ball and tie it up
tightly in a strong cloth. Slightly dampen the cloth,
sprinkle it with flour, and boil it hard for ten hours;
then take off the cloth, and let the ball dry in a slow
oven for ten hours more. Grate 2 teaspoonsful of flour
from the dry ball, mix the grated flour with cold water
to a smooth paste, and stir it into a \ pint of boiling
milk. Simmer about three minutes, and sweeten.
Oatmeal.—Salt to taste 3 parts of boiling water; then
stir in slowly 1 part of oatmeal (H. O.); boil rapidly
from twenty to thirty minutes; serve either hot or cold
with cream or milk and sugar.
Oatmeal Gruel No. 1.—Take 2 tablespoonsful of oat-
meal, 1 saltspoonful of salt, and 1 quart of boiling water.
Boil one hour. Strain and serve with milk or cream
(Mrs. Lincoln).
Oatmeal Gruel No. 2.—Pound \ cup of coarse oat-
meal until it is mealy. Put it in a tumbler, and fill the
tumbler with cold water. Stir well; let it settle; then
pour off the mealy water into a saucepan. Fill again
and pour off the water, and again repeat this, being care-
ful each time not to disturb the sediment in the bottom
of the tumbler. Boil the water twenty minutes. Season
RECIPES.
319
with salt. Thin with a little cream or milk. Strain and
serve hot (Mrs. Lincoln).
Beef-teas and Extracts.—The best pieces for beef-
tea are the round and rump, as they contain the most
and best-flavored juices. Wipe the meat with a wet
cloth and remove all fat and skin. Beef-tea should not
be allowed to boil, but should be kept at the temperature
at which albumin coagulates, which is from 1340 to 1600.
Boiling water coagulates it, and beef-tea made in this
way is without value as food. It is a stimulant. Beef-
extract is the pure juice of the meat. Beef-tea is the
juice diluted with water. The meat should be cut into
small pieces, as, more surfaces being exposed to the
water, the juices will be drawn out more quickly. Beef-
tea should not be strained, as the sediment contains the
nutritious part.
Beef-essence.—Mince finely 1 pound of lean, juicy
beef, from which all the fat has been removed; put into
a wide-mouthed bottle or fruit-jar and cork tightly. Set
the jar in a kettle of cold water over a slow fire, and
let it boil for three hours. Strain and season with salt
and red pepper.
Bottled Beef-extract.—Cut 1 pound of lean beef
into small pieces. Put it into a large-mouthed jar or
bottle. Place the jar, covered, in a kettle of cold water,
and heat slowly until near the boiling-point. Keep it at
this temperature for two hours. Strain and press the
meat to obtain all the juice. Season with salt. The
water in the kettle should come nearly as high as the
meat in the jar. In administering beef-extract, be care-
ful to stir up the sediment.
Beef-juice.—Place a \ pound of lean, juicy beef on a
broiler over a clear hot fire and heat it through. Press
320
APPENDIX.
out the juice with a lemon-squeezer into a hot cup, add
salt, and serve hot with toast or with crackers.
Beef-tea.—Free I pound of lean beef from fat, ten-
don, cartilage, bone, and vessels ; chop up fine, put into
i pint of cold water to digest two hours. Simmer on
range or stove three hours, but do not boil. Make up
for water lost in the evaporation by adding cold water,
so that a pint of beef-tea represents i pound of beef.
Press the beef carefully and strain and flavor to taste.
Beef-tea may rapidly be prepared by placing the jar
containing the meat, finely divided, without any water,
in an oven for twenty minutes, then add boiling water
according to the quantity required.
Beef-tea Peptonized.—To a \ pound of raw beef, free
from fat and finely minced, add io grains of pepsin and
2 drops of hydrochloric acid. Put this mixture in a
large tumbler and cover with cold water. Let it stand
for two hours at a temperature of 900 F., being fre-
quently stirred. Strain and serve in a red glass, ice-
cold. Peptonized food does not keep well, and should
never be used more than twelve hours old.
Beef-tea with Oatmeal.—Mix 1 teaspoonful of well-
cooked oatmeal with 2 tablespoonsful of boiling water,
Add 1 cupful of strong beef-tea and bring to the boil-
ing-point. Salt and pepper to taste and serve with toast
or with crackers. Rice may be used instead of the
oatmeal.
Raw-meat Diet.—Scrape pulp from a good steak,
season to taste, spread on thin slices of bread; sear
bread slightly and serve as a sandwich.
Meat Cure.—Procure a slice of steak from top of the
round—fresh meat without fat; cut the meat into strips,
removing all fat, gristle, etc. with a knife. Put the meat
RECIPES.
321
through a mincer at least twice. The pulp must then
be well beaten up in roomy saucepan with cold water or
skimmed beef-tea to the consistency of cream. The
right proportion is 1 teaspoonful of liquid to 8 tea-
spoonsful of pulp; add black pepper and salt to taste;
stir the mince briskly with a wooden spoon the whole
time it is cooking, over slow fire or on cool part of cov-
ered range, until hot through and through and the red
color disappears. This requires about half an hour.
When done it should be a soft, smooth, stiff puree of the
consistency of a thick paste. Serve hot. Add for first
few meals the softly-poached white of an egg.
Sweetbreads.—Keep the sweetbreads in cold water
until ready to use; then remove the fat, pipes, and mem-
branes. Put them into boiling salted water, add 1 table-
spoonful of lemon-juice, and cook twenty minutes.
Drain and cover with cold water. Let them stand a
few minutes, then drain, and they are ready to be pre-
pared for the tray.
Broths.—Chicken Broth.—Skin and chop up a small
chicken or half a large fowl: put, bones and all, with a
blade of mace, a sprig of parsley, 1 tablespoonful of rice,
and a crust of bread, in a quart of water and boil for an
hour, skimming it from time to time. Strain through a
coarse colander.
Clam Broth.—Wash thoroughly six large clams in
the shell; put them into a kettle with 1 cupful of water;
bring to boil, and keep it boiling one minute: the shells
open, the water takes up the proper quantity of juice, and
the broth is ready to pour off and serve hot. Add a tea-
spoonful of finely pulverized cracker-crumbs, a little but-
ter, and salt to taste.
Mutton Broth.—The lean part of the neck or loin
21
322
APPENDIX.
should be chosen, be cut up into small pieces, and all
superfluous fat be removed: about i pound of mutton
thus prepared should be placed in a saucepan containing
i pint of cold water and placed on the fire; as the scum
rises to the top it should carefully be removed; when
this ceases let the broth boil for about two hours, strain,
and flavor. A teaspoonful of pearl barley, added when
the broth begins to boil, is often acceptable. Warm up
as wanted.
Oysters.—Fricasseed Oysters.—To i cupful of milk
add a \ cupful of oyster liquor. When the liquids boil
add i teaspoonful of flour and \ teaspoonful of butter,
rubbed together; boil until it thickens; then add I
dozen oysters: cook until the oysters are plump and
their edges curl; serve immediately, plain or on toast.
Peptonized Oysters.—Mince 6 large or 12 small
oysters; add to them, in their own liquor, 5 grains of
extract of pancreas with 15 grains of sodium bicarbonate
(or one Fairchild peptonizing tube). This mixture is
then brought to blood-heat (980 F.), and maintained,
with occasional stirring, at that temperature thirty min-
utes, when 1 pint of milk is added and the temperature
kept up from ten to twenty minutes. Finally, the mass
is brought to the boiling-point, strained, and served.
Gelatin may be added, and the mixture served cold as
a jelly. Cooked tomato, onion, celery, or other flavor-
ing suited to individual taste may be added at beginning
of the artificial digestion.
Oyster Stew.—Take 1 pint of oysters, 1 pint of milk,
1 teaspoonful of salt, \- cupful of water, 1 tablespoonful
of butter, 1 saltspoonful of pepper. Scald the milk.
Wash the oysters by adding the water, and remove all
shells. Drain, saving the liquor. Put the liquor into
RECIPES.
323
a stewpan and heat slowly. Skim carefully. When
clear, add the oysters and cook slowly until the edges
curl and they are plump. Add the hot milk, butter,
salt, and pepper, and serve. Do not let the oysters boil,
as that toughens them and renders them indigestible.
Oyster Broth.—Cut into small pieces 1 pint of oys-
ters ; put them into a \ pint of cold water, and let them
simmer gently for ten minutes over a slow fire. Skim,
strain, and add salt and pepper.
Puddings.—Arrowroot Pudding-.—Add the yolks of
2 eggs to the plain arrowroot recipe (see p. 317), with
1 teaspoonful of powdered white sugar, mix well and
bake in a lightly buttered dish for ten or fifteen minutes.
Custard Pudding-.—Break 1 egg into a teacup, and
mix thoroughly with sugar to taste; then add milk to
nearly fill the cup, mix again, and tie over the cup a
small piece of linen; place the cup in a shallow sauce-
pan half full of water and boil for ten minutes.
If it is desired to make a Light Batter Pudding, a
teaspoonful of flour should be mixed in with the milk
before tying up the cup.
Corn-flour Pudding.—Take 1 pint of milk, and mix
with it 2 tablespoonsful of the flour: flavor to taste,
then boil the whole eight minutes ; allow it to cool in a
mould, and serve up with or without jam.
Rice Pudding.—Take 1 teacupful of rice; wash and
pour over it boiling water, and let stand five minutes;
then drain off the water and add a cupful of sugar to the
rice, a little nutmeg, 2 quarts of milk, and one egg. Bake
slowly about two hours, stirring occasionally until the
last half hour, then brown.
Sago Pudding.—Same as above recipe, sago being
substituted for rice.
324
APPENDIX.
Snow Pudding.—Dissolve half a box of gelatin in I
pint of cold water; when soft, add I pint of boiling
water, the grated rind and juice of 2 lemons, and 2\
cupsful of sugar. Let the gelatinized water stand until
cold and begins to stiffen. Then beat in the well-beaten
whites of 5 eggs. Pour into a mould and set on ice.
Serve with Custard Sauce—1 quart of rich milk, the
yolks of 5 eggs, with 2 extra eggs added, and a \ cup-
ful of sugar. Flavor with vanilla.
Soups.—Chicken Soup.—An old fowl will make a
more nutritious soup than a young chicken. Skin, cut
it up, and break the bones with a mallet. Cover well
with cold water, and boil slowly for three or four hours.
Salt to taste. A little rice may be boiled with it if
desired.
Mutton Soup.—Cut up fine 2 pounds of lean mutton,
without fat or skin. Add 1 tablespoonful of barley, 1
quart of cold water, and a teaspoonful of salt. Let it
boil slowly for two hours. If rice is used in place of
barley, it will not need be put in until half an hour before
the soup is done.
Potato Soup.—Mash 6 boiled potatoes, 1 quart of
milk, \ pound of butter. Season with pepper and salt.
While mashing the potatoes add the butter and gradually
pour in the milk. Stir well and strain through a sieve,
and heat once more. Beat up an egg and put it in the
soup-tureen, and pour over it the soup when ready to
serve.
White-celery Soup.—To a \ pint of strong beef-tea
add an equal quantity of boiled milk, slightly and evenly
thickened with flour. Flavor with celery-seeds or pieces
of celery, which are to be strained out before serving.
Salt to taste.
RECIPES.
325
Miscellaneous Dishes.—Macaroni.—Take of the
macaroni ^ of a pound and break into inch-lengths, and
cook twenty minutes in 3 pints of salted boiling water.
Turn it into a colander and pour over it cold water and
drain. Make a sauce of 1 tablespoonful each of butter
and flour and 1^ cupsful of hot milk; salt. Put on a
dish alternately a layer of macaroni, then a layer of the
sauce, covering the top layer with fine bread-crumbs
and with bits of butter dotted over (a little cheese may
be grated over). Bake until brown.
Creamed Potatoes.—Put 1 tablespoonful of butter
into a frying-pan, and when it bubbles add 1 tablespoon-
ful of flour; add 1 cupful of hot milk; salt and pepper
to taste. Then put in 1 pint of cold boiled potatoes,
cut into small dice; cook until thoroughly hot and
serve.
Omelet.—Take 4 eggs, 4 tablespoonsful of milk, \
teaspoonful of salt, 1 saltspoonful of pepper. Beat the
eggs slightly with a spoon until you can take up a
spoonful. Add the salt, pepper, and milk. Mix well.
Put 1 tablespoonful of butter into a hot omelet-pan.
When melted and hot pour in the egg, letting it spread
over the pan. When the egg begins to harden, draw
the cooked part back toward you, letting the uncooked
egg take its place. So continue until the egg is of a
creamy consistency. Place the pan over the hottest
part of the fire for a few seconds to brown the omelet
slightly. Fold over and turn out upon a hot plate (Mrs.
Lincoln).
Poached Eggs.—Have a frying-pan nearly full of hot
water, not boiling but simmering. Add 1 teaspoonful
of salt. Place in the pan as many muffin rings as there
are eggs to be cooked. Break the eggs carefully into
326
APPENDIX.
the rings. Dip the water over them with a spoon until
a film has formed on the top of the yolk and the white
is firm. Remove the rings and take up the eggs with a
skimmer. Serve on buttered toast. Place a bit of but-
ter and a little salt and pepper on each egg.
Scrambled Eggs.—Take 4 eggs, \ teaspoonful of
salt, 1 saltspoonful of pepper, \ cupful of milk, 1 table-
spoonful of butter. Beat the eggs slightly, add the salt,
pepper, and milk. Put the butter into a saucepan; when
melted and hot add the eggs. Stir over hot water until
of a soft, creamy consistency. Serve on buttered toast.
Soft-boiled Eggs.—Drop 2 eggs into enough boiling
water to cover them. Let them stand on the back of
stove where the water will keep hot, but not boil, for
eight minutes. An egg to be properly cooked should
never be boiled in boiling water, as the white hardens
unevenly before the yolk is cooked. The yolk and
white should be of a jelly-like consistency.
Chicken panada is made by rubbing together in a
mortar the meat from the breast and wings of a roast or
a boiled chicken, with an equal quantity of stale bread;
then add gradually the water in which the chicken was
boiled or other broth; boil for few moments and rub
through a fine sieve.
Infant's Pood.—About 1 teaspoonful of gelatin should
be dissolved by boiling in \ pint of water. Toward the
end of the boiling 1 gill of cow's milk and 1 teaspoonful
of arrowroot (made into a paste with cold water) are to
be stirred into the solution, and from 1 to 2 tablespoons-
ful of cream added just at the termination of the cook-
ing. It is then to be moderately sweetened with white
sugar, when it is ready for use. The whole preparation
should occupy about fifteen minutes.
RECIPES. 327
Prepared Milk.—Peptonized Milk—Cold Process.
—Jnto a clean quart bottle put 1 peptonizing powder
(extract of pancreas 5 grains, sodium bicarbonate 15
grains) or the contents of I peptonizing tube (Fairchild);
add 1 teacupful of cold water, shake; add I pint of
fresh cold milk; shake the mixture again, and place
on ice. Use when required without subjecting to heat.
Milk so prepared will have a faintly bitter flavor; it may
be sweetened to taste or used in punch, gruels, etc., like
ordinary milk.
Warm Process.—Mix the peptonizing powder with
water and milk as described above; place bottle in water
so hot that the whole hand can be held in it for a minute
without discomfort; keep the bottle there ten minutes;
then put on ice to check further digestion. Do not heat
long enough to render the milk bitter. Peptonized milk
may be sweetened, flavored with grated nutmeg, or
taken with carbonated mineral water. Put the mineral
water first into the glass, then quickly pour in the pep-
tonized milk, and drink during effervescence.
Sago Milk.—Wash I tablespoonful of pearl sago and
soak it over night in 4 tablespoonsful of cold water. Put
the sago into a double kettle with 1 quart of milk and
boil until the sago is nearly dissolved. Sweeten to taste
and serve either hot or cold.
Koumyss.—Take an ordinary beer-bottle with patent
shiftable stopper; put in it I pint of milk, the sixth part
of a cake of Fleischmann's yeast, or I tablespoonful of
fresh lager-beer (brewer's) yeast, \ tablespoonful of white
sugar reduced to syrup; shake well and allow to stand
in refrigerator two or three days, when it may be used.
It will keep there indefinitely if laid on its side. Much
waste can be saved by preparing the bottles with ordi-
328
APPENDIX.
nary corks wired in position and drawing off the koumyss
with a champagne tap.
Toasted Bread.—Toast (dry).—Cut thin slices of
bread into strips; toast carefully and evenly without
breaking, slightly butter, and serve immediately on a hot
plate.
Cream Toast.—Take I cupful of cream, i saltspoon-
ful of salt, 2 slices of dry toast. Scald the cream. Add
the salt, and pour it over the toast, or make the same as
milk toast, using cream in place of the milk. If pre-
ferred, the slices of toast may be first dipped in hot salted
water.
Egg Toast.—Take I egg, I saltspoonful of salt, I
cupful of milk, 6 slices of bread. Beat the egg slightly,
add the salt and milk. Soak slices of bread in this until
soft. Butter a hot griddle, put on the bread ; when one
side is brown, put a bit of butter on each slice, then turn
and brown the other side. Serve with sugar and cinna-
mon (Mrs. Lincoln).
Milk Toast.—Take I cupful of milk, \ tablespoonful
of corn-starch, \ tablespoonful of butter, 2 slices of dry
toast, i saltspoonful of salt. Scald the milk. Melt the
butter in a saucepan; when hot and bubbling add the
corn-starch. Pour in the hot milk slowly, beating all
the time until smooth. Let it boil up once. Then add
the salt. Toast two slices of bread. Pour the thickened
milk over the slices. Let it stand five minutes. Serve.
Peptonized Milk Toast.—Over 2 slices of toast pour
I gill of peptonized milk (cold process); let stand on
the back part of the range for thirty minutes. Serve
warm or strain and serve fluid portion alone. Plain
light sponge-cake may be similarly digested.
Invalid's Lunch.—A nice way to prepare a very light
RECIPES.
329
lunch for an invalid (to be taken with a cup of tea) is to
toast 3 milk crackers; then pour boiling water over
them, drawing it off immediately; spread jam or mar-
malade over the toasted crackers and pile them up on a
dish. Set the dish of crackers in the oven while making
the tea, and take both to the sick-room. This lunch
will prove appetizing and refreshing if unexpected.
Desserts.—Baked Apples.—Core and pair 2 tart
apples; fill the core-holes with sugar; grate over the
apples a little nutmeg; add a little water to baking-pan
and put in oven and bake until the apples are soft. Serve
with rich milk or cream. Sprinkle with icing sugar if
not sweet enough.
Bavarian Cream.—Whites of 6 eggs beaten very
light; 1 quart whipped cream; 1 ounce of gelatin (soak
one hour in cold water, drain, and dissolve in a little hot
water); flavor with 1 teaspoonful of vanilla. Beat the
eggs and cream together, add the sugar to sweeten,
flavor, then add the gelatin. Beat again until the mix-
ture begins to thicken, and pour into moulds. Serve
very cold with cream.
Blanc-mange of Rice.—Simmer a \ pint of milk with
1 tablespoonful of pounded white sugar until near boil-
ing ; then stir in 2 ounces or 1 large tablespoonful of
ground rice previously mixed with a \ pint of milk until
smooth; boil for ten minutes, stirring all the while, and
pour into a moistened mould and serve cold.
Soft Custard.—Take of corn-starch 2 tablespoonsful
to 1 quart of milk; mix the corn with a small quantity
of the milk and flavor; beat up 2 eggs. Heat the re-
mainder of the milk to near boiling; then add the mixed
corn, the eggs, 4 tablespoonsful of sugar, a little butter,
and salt. Boil the custard two minutes, stirring briskly.
330
APPENDIX.
Calfs-foot Jelly.—Thoroughly clean 2 feet of a calf,
cut into pieces, and stew in 2 quarts of water until re-
duced to 1 quart; when cold take off the fat and sepa-
rate the jelly from the sediment. Then put the jelly
into a saucepan, with white wine and brandy and flavor-
ing to taste, with the shells and whites of 4 eggs well
mixed together; boil for a quarter of an hour, cover it,
and let it stand for a short time, and strain while hot
through a flannel bag into a mould.
Lemon Jelly.—Take half a box of gelatin, 1 cupful
of cold water, 1 pint of boiling water, 1 cupful of sugar,
\ cupful of lemon-juice. Soak the gelatin in the cold
water twenty minutes or until soft. Add boiling water,
sugar, and lemon-juice; strain (Mrs. Lincoln).
Orange Jelly.—Dissolve half a box of gelatin in a \
cupful of cold water. Take the juice of 6 oranges and
of 2 lemons, 1 cupful of sugar, and 1 cupful of boiling
water. Stir all together and strain. Put in a cold place
and serve with " kisses " or a white cake. This jelly
can be attractively served by placing it in the skins of
the oranges cut in half and the edges notched. The
pulp of the oranges must carefully be removed, and the
skins thrown into cold water until required, then dried
inside and filled with the jelly.
Tapioca Cream.—Take 1 pint of milk, 2 tablespoons-
ful of tapioca, 2 tablespoonsful of sugar, 1 saltspoonful
of salt, 2 eggs. Wash the tapioca. Add enough water
to cover it, and let it stand in a warm place until the
tapioca has absorbed the water. Then add the milk and
cook in a double boiler, stirring often until the tapioca is
clear and transparent. Beat the yolks of the eggs. Add
the sugar and salt and the hot milk. Cook until it
thickens. Remove from the fire. Add the whites of
RECIPES. 331
the eggs, beaten stiff. When cold add 1 teaspoonful of
vanilla.
Peptonized-milk Jelly.—First take about half a box
of Nelson's gelatin, and set it aside to soak in 1 teacup-
ful of cold water until needed; take 1 pint of specially
peptonized milk, heated hot; pare 1 lemon and 1 orange,
and throw the rinds into the specially-prepared milk;
squeeze the juice of the lemon and orange into a glass,
strain, and mix with it 2 or 3 tablespoonsful of wine or
of brandy ; add to the milk, stirring well; strain through
gauze, and when cooled to a syrupy consistence, so as to
be almost ready to set, pour into moulds and set in a
cool place. Do not pour the milk into the moulds until
it is nearly cool, otherwise it will separate in setting.
Wine Jelly.—Take half a box of gelatin, % cupful
of cold water, I pint of boiling water, 1 cupful of wine,
1 cupful of sugar, I lemon. Soak the gelatin in the
cold water until soft. Add the boiling water, wine, sugar,
and lemon-juice. Strain. Keep on ice until ready to
serve (Mrs. Lincoln).
Junket.—Sweeten to taste I quart of fresh milk in a
shallow dish, and stir in liquid rennet 1 tablespoonful;
set near the stove, where it will get warm, and as soon
as it begins to thicken set it on ice; serve with preserves
and cream. This is an excellent dish for invalids; it
may be flavored by grating nutmeg on the surface or by
adding a few drops of brandy.
Irish Moss.—Wash thoroughly a handful of Carrageen
moss, pour over it 2 cups of boiling water, and let it
stand where it will keep hot, but not boil, for two hours.
Strain, add the juice of 1 lemon, and sugar to taste.
Irish-moss Blanc-mange.—Take 1 quart of milk, £
cupful of Irish moss, 1 saltspoonful of salt, 1 teaspoon-
332
APPENDIX.
ful of vanilla. Pick over and wash the Irish moss, and
let it soak in cold water fifteen minutes. Drain off the
water. Add the milk and cook in a double boiler until
it thickens when cold. Strain. Add the salt and vanilla
and turn into a mould. When cold serve with sugar
and cream, also with sliced bananas (Mrs. Lincoln).
Snow-eggs.—Take a small teacupful of new milk and
boil it in a small, shallow saucepan with a little sugar;
while it is boiling break i egg, putting the yolk and
white in separate cups; whip up the white to a fine light
froth, and when the milk is quite boiling take a large
spoonful at a time of the white, place it on the top of
the milk for a moment or two, then turn it, and when
sufficiently solid lift it out on a slice; then mix up the
yolk with some sugar, add the boiling milk, mix and
boil again for a few minutes, then pour around the white
and serve.
Whipped Cream.—Mix 2 gills of rich cream, J cup
of pulverized sugar, and 2 tablespoonsful of sherry
wine; put on ice for an hour, as cream whips much
better if chilled; whip with an egg-beater, and as the
froth rises skim off the latter, and lay it on a sieve to
drain, returning the cream which drips away, to be
whipped over again. Place on the ice a short time
before serving.
Wine "Whey.—Put 2 pints of milk into a saucepan
and stir over a clear fire until nearly boiling; then add
I gill (2 wineglasses) of sherry wine, and simmer a
quarter of an hour, skimming off the curd as it rises.
Add 1 tablespoonful more of sherry, and skim again for
a few minutes; strain through coarse muslin. Lemon-
juice (2 tablespoonsful) may be used instead of the
sherry wine.
RECIPES.
333
Beverages.—Chocolate.—Take 2 squares of vanilla
chocolate to each coffee-cupful of milk. Grate the
chocolate and wet it with cold milk and stir into the
milk when it boils. Whip a tablespoonful of cream, and
beat it into the chocolate just as it is taken from the
stove. This makes I cup of rich, delicious chocolate.
Do not let it boil, as it becomes oily and loses its fine
fresh flavor.
Cocoa.—Allow 1 teaspoonful of cocoa for each cup;
add sufficient hot water to form a paste; pour on boiling
milk (or milk and water) and sweeten to taste; five min-
utes' boiling will improve the cocoa (Wilbur).
Coffee.—Stir together 2 tablespoonsful of freshly-
ground coffee, 4 of cold water, and half an egg. Pour
upon them 1 pint of boiling water, and let them boil for
five minutes. Stir down the grounds, and let the coffee
stand where it will keep hot, but not boil, for five minutes
longer. Sugar and cream should be put into the cup
first in serving, and the coffee poured upon them.
Coffee (French).—Some persons prefer filtered to boiled
coffee. Filtered coffee is best made in a French biggin,
consisting of two tin vessels, one fitting into the other,
the upper one being supplied with strainers. The coffee,
very finely ground, is placed in this utensil, and the boil-
ing water allowed slowly to percolate through it. The
pot should be set where it will keep hot, but not boil,
until the water has gone through. Pouring it through
the coffee a second time will make it stronger, but it
loses in flavor. Cafe noir is always made in this way.
Crust Coffee.—Take 1 pint of crusts—those of Indian
bread are the best—brown well in a quick oven, but
do not let them burn; pour over them 3 pints of boiling
water and steep for ten minutes. Serve with cream.
334
APPENDIX.
Nutritious Coffee.—Dissolve a little isinglass or gela-
tin (Knox) in water; put \ an ounce of freshly-ground
coffee into a saucepan with I pint of new milk, which
should be nearly boiling before the coffee is added ; boil
both together for three minutes; clear it by pouring
some of it into a cup and dashing it back again; add the
isinglass, and leave the coffee on the back part of the
range for a few minutes to settle. Beat up I egg in a
breakfast-cup, and upon it pour the coffee; if preferred,
drink without the egg.
Rice Coffee.—Parch and grind like coffee a -^ cupful
of rice. Pour over it I quart of boiling water, and let it
stand where it will keep hot for a quarter of an hour;
then strain, and add boiled milk and sugar. This is nice
for children.
Egg-nog.—Scald some new milk by putting it, con-
tained in a jug, into saucepan of boiling water, but do not
allow the milk to boil. When cold, beat up a fresh egg
with a fork in a tumbler with some sugar; beat to a
froth, add a dessertspoonful of brandy, and fill up tum-
bler with the scalded milk.
Lemonade.—Squeeze the juice from I lemon. Add
2 tablespoonsful of sugar and I cup of water. Strain
and serve.
Lemon Sherbet.—Take 6 lemons, I tablespoonful of
gelatin, I quart of cold water, i pint of sugar. Soak
the gelatin in \ cupful of cold water twenty minutes.
Then add \ cupful of boiling water, the juice of the
lemons, the cold water, and the sugar. Strain and
freeze.
The water used in soaking and dissolving the gelatin
should be part of the quart of water. In freezing, use
one part salt to three parts finely broken ice. Rock salt
RECIPES.
335
is most generally used. If you have no freezer, a very
good sherbet may be made by freezing it in a tin pail
packed in a pailful of salt and ice. Let it stand fifteen
minutes. Remove the cover, scrape the frozen mixture
from the side of the pail, mix thoroughly, cover, and let
it stand fifteen minutes more; then scrape down again.
Repeat this process until the mixture is frozen sufficiently
(Mrs. Lincoln).
Egg Lemonade.—Beat I egg with I tablespoonful of
sugar until very light; stir in 3 tablespoonsful of cold
water and the juice of a small lemon; fill glass with
pounded ice and drink through a straw or a glass tube.
Sterilized Milk.—Put the required amount of milk in
clean bottles (if for infants, each bottle holding enough
for one feeding). Plug the mouths of the bottles lightly
with rubber stoppers; immerse to their shoulders in a
kettle of cold water; boil twenty minutes; or, better,
steam thirty minutes in ordinary steamer; firmly push
the stoppers in the bottles, cool them rapidly, and keep
in refrigerator. Warm each bottle just before using.
Milk and Albumen.—Put into a clean quart bottle 1
pint of milk, the whites of 2 eggs, and a small pinch of
salt. Cork and shake hard for five minutes.
Milk-punch.—Take £ pint of fresh cold milk and add
2 teaspoonsful of sugar, and stir well until dissolved;
then add 1 ounce of either brandy or sherry wine.
Mulled Wine.—Take a £ cup of boiling water into
which put 2 teaspoonsful of broken stick-cinnamon and
6 whole cloves, and let all steep for ten minutes, then
strain. Now take 2 eggs and 2 tablespoonsful of sugar;
beat them together until very light, and stir into the
spiced water. Pour from height into this mixture a cup-
ful of sweet wine boiling hot (the wine should not be
336
APPENDIX.
boiled in a tin vessel). By pouring this preparation from
one pitcher to another several times it will become light
and foamy. Serve hot.
Orangeade.—Substitute orange-juice for that of lemon
in the recipe for Lemonade.
Orange Sherbet.—Take \\ cupsful of orange-juice, i
tablespoonful of gelatin, \ cupful of cold water, \ cup-
ful of boiling water, I cupful of sugar, I pint of cold
water. Soak the gelatin in the cold water. Then add
the boiling water, the orange-juice, the sugar, and the
cold water. Strain and freeze. Any kind of fruit-juice,
sweetened and diluted, may be used in place of the
orange-juice.
Tea.—Scald out the teapot and put in the tea, using i
teaspoonful for each cupful. Pour on boiling water, and
let teapot stand four or five minutes. If allowed to
stand too long, the tannin in the tea is developed, which
not only darkens the tea, but also renders it hurtful.
Flaxseed Tea.—Flaxseed (whole), I ounce; white
sugar, i ounce (heaping tablespoonful); licorice-root, \
ounce (two small sticks); lemon-juice, 4 tablespoonsful.
Pour on these materials 2 pints of boiling water; let it
stand in a hot place four hours; strain off the liquor.
Albumen-water.—Stir the whites of 2 eggs into a \
pint of ice-water, without beating; add enough salt or
sugar to make it palatable.
Apple-water.—Slice into a pitcher \ a dozen juicy
sour apples; add I tablespoonful of sugar, and pour
over them 1 quart of boiling water. Cover closely until
cold, then strain.
Barley-water.—Wash 2 ounces (wineglassful) pearl
barley with cold water. Boil it five minutes in fresh
water; throw both waters away. Pour on 2 quarts
MINERAL WATERS.
337
boiling water; boil down to I quart. Flavor with thinly-
cut lemon-rind ; add sugar to taste. Do not strain unless
at the patient's request.
Gum-arabic Water.—Dissolve I ounce of gum-
arabic in i pint of boiling water, add 2 tablespoonsful
of sugar, a wineglassful of sherry, and the juice of 1
large lemon. Cool, and add ice.
Lime-water.—Pour 2 quarts of hot water over fresh
unslaked lime of the size of a walnut; stir until slaked,
and let stand until clear, then bottle. Lime-water is
often ordered with milk to neutralize acidity of the
stomach.
Rice-water.—Pick over and wash 2 tablespoonsful of
rice; put into a granite saucepan with 1 quart of boiling
water; simmer two hours, when rice should be softened
and partially dissolved; strain, add saltspoonful of salt;
serve warm or cold. May add sherry or port wine, 2
tablespoonsful.
Tamarind-water.—A very refreshing drink may be
made by adding I pint of hot water to 1 tablespoonful
of preserved tamarinds, and setting aside to cool.
Toast-water.—Toast 3 slices stale bread to a dark
brown, but do not burn. Put them into a pitcher; pour
over them I quart of boiling water; cover closely and
let stand on ice until cold; strain. May add wine and
sugar.
MINERAL WATERS.
Alkaline waters contain sodium carbonate and bicar-
bonate in comparatively large amounts. The conditions
in which these waters produce their best effects are—
Chronic gastric catarrh, especially with hyperacidity
and catarrhal inflammation of the mucous membrane of
22
338
APPENDIX.
the biliary passages. Good results have been obtained
in acute catarrhal nephritis; also in lithemia, gout, and
chronic rheumatism.
Carbonic-acid waters owe their potency to the pres-
ence of carbonic-acid gas. Any variety of water may be
found impregnated with this gas, whose presence possi-
bly increases the diuretic effects of the water. Fever-
patients find these waters very agreeable. The addition
of this gas acts as a sedative to the gastro-mucous mem-
brane, and when taken cold and in sips relieves nausea
and tends to check vomiting. Carbonic-acid water
added to milk is admirably received by some patients
with irritable stomach, and occasionally milk will be
accepted in this form when it is absolutely refused in the
pure state. Another very popular use to which these
waters are put is in diluting wines.
Chalybeate waters are those holding in solution one
or more of the iron compounds, most frequently ferrous
bicarbonate and ferrous oxid. Iron waters owe their
virtues to the presence of iron, which usually exists in
the form of the bicarbonate of the protoxid, held in
solution by an excess of carbonic-acid gas. The ordi-
nary indications for the use of iron are met by employ-
ing waters of this class. They are useful in anemia, but
usually have other constituents, whose administration
may or may not be indicated in certain cases.
Purgative waters usually owe their properties to
sodium sulphate and magnesium sulphate. When a
gentle saline laxative is indicated, these waters often give
better results than either Epsom or Glauber's salt, and
are therefore of greater service. In congestion of the
liver, chronic gastric catarrh with atony, jaundice, lithe-
mia, gout, and in the obese, the regular use of water of
MINERAL WATERS.
339
this class properly selected and administered yields excel-
lent results.
Saline waters contain common salt in solution, also
small quantities of the chlorids, of the alkalies, and of
alkaline earths. This saline when taken into the stomach
dissolves albumin and starches; promotes digestion and
absorption of food; supplies the intestines with chyme
rich in albumin and starches; enters the blood, which
carries the salt to all the tissues of the body after sup-
plying its own needs. The usefulness of these waters,
however, is very restricted. Good results may be ex-
pected in certain dyspepsias with defective gastric secre-
tion and sluggishness of the bowels. In certain cases
of dyspepsia these results are best obtained by adminis-
tering the water early in the morning, before breakfast;
when rapid absorption is necessary it should be taken
hot. Preference should be given to those springs charged
with carbonic-acid gas, which greatly increases the pala-
tableness of this class of waters. The therapeutic dose
is from I to 5 fe daily.
Sulphuretted waters are due to the presence in the
water of sulphuretted hydrogen gas, and they usually
contain the sulphates of sodium and potassium. When
taken internally, they augment peristalsis and perspira-
tion. Frequently sulphur springs are used as baths, and
with good results, especially in chronic skin-affections—
•such as eczema—in rheumatism, and in gout. The
waters are useful in constipation, and are asserted to
have produced good results in cases of chronic bronchitis
and phthisis. In all these diseases they are administered
internally and used externally as baths.
340
APPENDIX.
II. WEIGHTS AND MEASURES.
apothecaries' weight.
Metric
Pound—ft. Ounces—S. Drachms—3- Scruples—3. Grains—gr. grammes.
I = 12 = 96 = 288 = 5760 = 372.96
1 = 8 = 24 = 480 = 31.08
I 3 = 60 = 3.885
I = 20 = 1.295
apothecaries' (wine) measure.
Gallon—C. Pints—O. Fluidounces—f5. Fluidrachms—f3. Minims—HI.
1=8= 128 = 1024 = 61,440
I = 16 = 128 = 7680
1 = 8 = 480
1 = 60
:ompar ative V ALUES OF APOTHECARIES A ND METRIC
FLUID measures.
Cubic Cubic Cubic
Minims. centimetres. Minims. centimetres. Minims 1 :entimetres.
I = O.061 II = O.678 40 = 2.36
2 = O.I23 12 = o-739 50 = 3-o8
3 = O.185 13 = O.801 Fluidrachms
4 = O.246 14 = O.862 I = 3.7
5 = O.308 '5 = O.924 2 = 7-39
6 = O.370 16 = I.OO 3 = 11.09
7 = 0.431 17 = I.06 4 = 15.00
8 = 0-493 18 = 1.12 5 = 18.50
9 = 0-544 20 = 1.23 6 = 22.50
10 = 0.616 30 = 1.84 7 = 26.00
Fluid- Cubic Fluid- Cubic Fluid- Cubic
ounces . centimetres. ounces. centimetres. ounces. centimetres.
1 = 30.001 8 = 236.59 20 = 591-50
2 = 59-14 9 = 266.16 22 = 650.62
3 = 89.00 IO = 295-73 24 = 7IO.O0
4 = 118.29 12 = 355-00 28 = 828.26
5 = 148.00 14 = 414.OO 32 = 946-35
6 = 177-42 16 = 473.17 2-2814 = 1000.00
7 = 207.00 18 = 532-32 128 3785.43
1 More accurately, 29.57 C-C-
WEIGHTS AND MEASURES. 341
APPROXIMATE MEASURES.
One minim varies from one to two drops.1
1 fluidrachm = (about) I teaspoonful.
2 fluidrachms = " 1 dessertspoonful.
\ fluidounce = " 1 tablespoonful.
2 fluidounces = " I wineglassful.
4 fluidounces = " 1 teacupful.
HOUSEHOLD MEASURES.
4 teaspoonsful of liquid = 1 tablespoonful.
1 pint of liquid = 1 pound.
2 gills of liquid = 1 cup.
2 rounded tablespoonsful of flour = 1 ounce.
1 tablespoonful of butter = 1 ounce.
2 cups of granulated sugar = 1 pound.
i\ cups of powdered sugar = 1 pound.
ANTISEPTIC SOLUTIONS2 (e. Q. THORNTON, M. D.).
Drug.
Boric Acid......
Calcium Chlorid . . .
Carbolic Acid ....
Corrosive Chlorid of"|
Mercury (corrosive >
sublimate) .... J
Creolin.......
Lysol........
Potassium Perman-I
ganate......j
Solution of Hydrogen \
Dioxid.....J
Thymol.......
Zinc Chlorid.....
Com-
mercial
form.
Powder.
Masses.
Liquid.
Crystals.
Liquid.
Liquid.
Crystals.
Liquid.
Crystals.
Crystals.
Solution.
Two tablespoonsful to a pint.
Two teaspoonsful to a pint.
Six teaspoonsful to a pint.
Seven and a half grains to a pint.
Two and a half teaspoonsful to a pint.
Two and a half teaspoonsful to a pint,
Half a teaspoonful to a pint.
Eight tablespoonsful to a pint.
Five grains to a pint.
Two teaspoonsful to a pint.
Strength.
1 : 33
1 50
1 : 20
1 1000
1 : 50
1 : 5°
1 : 250
1 : 4
1 : 1500
1 : 50
Per
cent.
0.4
25
1 A drop is popularly, although erroneously, supposed to be a minim. True, there
are 60 drops in a fluidrachm of water, but this is the case with only a few liquid med-
icines. The size of a drop depends on the shape of the vessel from which it is being
dropped and on the adhesiveness of the fluid dropped ; consequently, a drop is a very
indefinite quantity. Tinctures, spirits, and other alcoholic fluids drop from 120 to 130
drops to the fluidrachm, whereas thick syrups and a few other liquids drop less than bo
drops to the fluidrachm (Thornton).
' These antiseptic solutions are of ordinary strengths, and are intended only for local
application. They may be prepared with either hot or cold (preferably distilled) water.
'Io decrease the strength of either solution the quantity of water must be increased;
for example, if a 1 : 2000 corrosive-sublimate solution is required, the proportion would
be 7J4 gr. to the quart.
342
APPENDIX.
TABLE SHOWING THE NUMBER OF DROPS IN A FLUIDRACHM OF VARIOUS
LIQUIDS; ALSO THE WEIGHT OF ONE FLUIDRACHM IN GRAINS.
Liquid.
Acetum Opii.....
" Scillae.....
Acid, Acetic.....
Acetic, Dil. . . .
Carbolic ....
Hydrochloric . .
Hydrocyanic . .
Lactic.....
Nitric.....
Nitro-hydrochlor.
Phosphor. Dil. .
Sulphuric ....
Sulph. Aromat. .
Sulph. Dil. . . .
Sulphurosum . .
jEther Fortior.....
Alcohol........
Aqua.........
" Destillata ....
Bals. Peruvian ....
Bromin........
Chloroform, Pur. . . .
Copaiba.......
Creasote.......
Extractum Belladon. Fl.
Buchu Fl. .
" Digitalis Fl.
Ergotae Fl. .
" Ipecac. Fl. .
" Rhei Fl. . .
" Senegae Fl. .
" Valerianae Fl.
" Zingib. Fl.
Glycerin......
Hydrargyrum ....
Liquor Acidi Arsenosi
" Ferri Chloridi
Drops Weight
in f 5j of f 5j in
(mix). grains.
90 61
68 57
108 58
68 55
m 59
70 65
60 54
m 66
102 77
76 66
59 57
128 101
146 53
60 58J^
59 55
176 39
146 44
60 55
60 53^
101 60
250 165
250 80
no 51
122 56}4
156 57
150 47^
134 62
133 60
120 60
158 61
137 62
150 49
142 48
67 68
150 760
57 55
71 72
Liquid.
Liquor Iodi Compos .
" Potassae . .
" Zinci Chlorid
Oleoresin Aspidii .
'* Capsici .
" Cubebae.
Oleum Anisi . . .
" Bergamii
" Cari ....
" Juniperi . .
" Limonis . .
" Ricini . . .
" Rosae . . .
'* Terebinth. .
" Tiglii . . .
Spiritus jEtheris Comp
" ^Etheris Nitrosi
" Camphorae
Syrupus Acaciae . .
" Ferri Iod.
" Scillae . .
" Comp. .
" Senegae
" Simplex .
Tinctura Aconiti .
" Belladonna?
" BenzoiniComp
'* Cantharidis
" Digitalis .
" Ferri Chlor.
Iodi. . . .
" Opii . . .
" Opii Camph
" Opii Deodoi
Vinum Colchici Rad
" Colchici Sem
" Opii. . . .
Drops
in f5j
(Mllx).
63
62
89
130
120
123
119
130
132
148
129
77
132
136
104
148
146
Hi
44
65
75
102
106
65
146
'37
130
130
no
107
in
100
Weight
of f 3j in
grains.
59
58
88
52
51
52
54
46
5°
49
4? -
5i%
47
45^
5°
45
47
47
73
77
74
70
70
72
46
53
48
5"
53
53
47
53
52
54
53
54
55
LIST OF HYPODERMATIC TABLETS.
Aconitin (crystals)
Apomorphin muriate
Atropin sulphate . .
Atropin sulphate . .
Cocain hydrochlorate
Conin hydrobromate ,
Colchicin......
Corrosive sub. and urea
Digitalin (soluble) .
Gelsemin muriate . .
Hyoscin hydrobromate
Hyoscyamin . . .
Morphin sulphate .
gr. Tfo'
• gr. r\y.
■gr-is ■
■ gr- tJb-
■ gr. J.
• gr. ».
■ gr. ;&•
■ gr- 5"g
• gr. TB5-
■ gr. bV
■ gr- Tit!-
■ gr. ife •
■ gr. i
Morphin sulphate
Morphin and atropin, No
Morphin Sulph
Atropin Sulph.
Morphin and atropin, No
Morphin Sulph.
Atropin Sulph. .
Picrotoxin......
Pilocarpin hydrochlor
Pilocarpin nitrate . .
Physostigmin sulph. .
Sodium arsenate . . .
Strychnin sulphate . .
Strychnin sulphate
gr. 4.
gr.*-
gr. ,40
• gr- i-
• gr. Tib'
• gr- ife.
• gr- *.
. gr- J-
■ gr- iij-
• gr. tV
• gr. i»-
■ gr. jh.
Tablets for hypodermatic use are prepared by prominent manufacturers, each tablet
containing one dose. They may readily be dissolved in a teaspoon at the bedside, and
are very convenient for the pocket, if put up in a case with a good hypodermic syringe.
TABLE FOR CALCULATING THE DATE OF CONFINEMENT.
Jan. i 2 3 4 5 6 7 8 9 io u 12 »3 H 15 16 17 iS 19 20 21 22 23 24 25 26 27 28 29 30 31
Oct. 8 9 IO n 12 »3 14 i5 16 17 18 T9 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 Nov.
Feb. i 2 3 4 5 6 7 8 9 IO n 12 »3 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nov. 8 9 IO n 12 »3 14 15 ib »7 18 19 20 21 22 23 16 24 25 26 27 28 29 30 1 2 3 4 5 Dec.
Mar. i 2 3 4 5 6 7 8 9 IO u 12 '3 14 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Dec. 6 7 8 9 IO n 12 13 14 15 lb 17 18 »9 20 21 22 23 24 25 2b 27 28 29 30 31 I 2 3 4 5 Jan.
April. 1 2 3 4 5 6 7 8 9 10 II 12 M M 15 16 17 18 '9 20 21 22 23 24 2.S 26 27 28 29 30
Jan. b 7 8 9 10 ri 12 13 14 15 ib 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 Feb.
May. 1 2 3 4 5 6 7 8 9 IO 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Feb. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 Mar.
June.
Mar.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3
28 29 30
4 5 6
April.
July.
April.
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3
28 29 30
4 5 6
31
7 | May.
Aug. May. 1 8 9 3 IO 4 11 5 12 6 13 7 8 15 9 IO II 16 17 18 12 13 19 20 14 15 16 17 18 19 20 21 22 23 24 25 21 22 23 24 25 26 27 28 29 30 31 1 26 2 27 28 29 30 31 3 4 5^7 June.
Sept. June. 1 8 2 9 3 10 4 11 5 12 6 13 7 14 8 15 9 IO II 16 17 18 12 13 19 20 14 15 16 17 18 19 20 21 22 23 24 25 21 22 23 24 25 26 27 28 29 30 1 2 26 3 27 28 29 30 4567 July.
Oct. July. 1 8 2 9 3 10 4 11 5 12 6 x3 7 14 8 15 9 10 11 16 17 18 12 13 19 20 14 15 16 17 18 19 20 21 22 23 24 25 21 22 23 24 25 26 27 28 29 30 31 1 26 2 27 28 29 30 31 3 4 5^7 Aug.
Nov. Aug. ; 2 9 3 10 4 II 5 12 6 13 7 14 8 15 9 IO II 16 17 18 12 13 19 20 14 15 16 17 18 19 20 21 22 23 24 25 21 22 23 24 25 26 27 28 29 30 31 1 26 2 27 28 29 30 3 4 5 6 Sept.
Dec.
Sept.
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3
28 29 30
4 5 6
3i
Oct.
Supposing the upper figure in each pair of horizontal lines to represent the first day of the last menstrual period, the
figure beneath it, with the month designated in the margin, will show the probable date of confinement.
4^
344
APPENDIX.
IV. ABBRI
aa., ana, equal parts of each.
A. c, ante cibum, before meals.
Add., adde, add to it.
Ad. lib., ad libitum, as you please.
Alt. dieb., alterna diebus, every other
day.
Alt. hor., alterna horis, every other
hour.
Alt. noc, alterna nocte, every other
night.
Ante cib., ante cibum, before meals.
Applic, applicatur, apply.
Aq., aqua, water.
Aq. font., aquafontana, springwater.
Aq. bull., aqua bulliens, boiling
water.
Aq. dest., aqua destillata, distilled
water.
Aq. marin., aqua mai-ina, sea-water.
Aq. pluvial., aqua pluvialis, rain-
water.
Aq. pur., aqua pur a, pure water.
Bis hor, or bis horis, every two
hours.
Bis ind., bis in dies, twice a day.
Bull., bulliat, let it boil.
C. or Cong., congius, a gallon.
c. c, cubic centimetre.
Cap., capiat, let him take.
Cent., centigrade.
Cochleat., cochleatim, by spoonfuls.
Cochl., cochleare, spoonful.
Coch. mag., cochlear magnus, a
tablespoon.
Coch. med., cochlear medium, a
dessertspoon.
Coch. parv., cochlear parvum, a
teaspoon.
Comp., compositus, compound.
Conf., confectio, a confection.
Cort., cortex, bark.
Cuj., cujus, of which.
Decoct, hord., decoctum hordei, bar-
ley-water.
Decub., decubitus (a bed), lying
down.
Destil., destilla, distil.
Det., detur, let it be given.
Dil., dilutus, dilute.
Dim., dimidius, one-half.
Div., divide.
Div. in p. seq., dividalur in partes
cequales, divide into equal parts.
Drachm., drachma, a drachm.
Duo., duo, two.
Emp., emplastrum, a plaster.
Enem., enema.
Extr., extractum, extract.
F., Fahrenheit.
F. mist., fiat mistura, make a mixture.
Far., faradic.
Fe.,/errum, iron.
Filt., filtra, filter.
F. pil., fiat pilula, make a pill.
Fot.,folus, a fomentation.
Freq., frequenter, frequently.
Fl., or f.,fiuidus, fluid.
Ft., fiat, let there be made.
Fsj, fluidrachma, fluidrachm.
F£, fluiduncia, fluidounce.
Garg., gargarisma, a gargle.
Gm., gramme.
Gossyp., gossypium, cotton-wool.
Gr., granum, a grain, or grana,
grains.
Gtt., gutta, a drop, or gultce, drops.
Guttat., guttatim, by drops.
Hg., hydrargyrum, mercury.
ABBREVIATIONS.
345
Hirud., hirudines, leeches.
Hor. decub., hora decubitus, at bed-
time.
Ind., in dies, daily.
Inf., infusum, an infusion.
Inject., injectio, an injection.
Lat. dol., lateri dolenti, to the
affected side.
L., litre.
Lb., libra, a pound.
Lib. or lbs., libra', pounds.
Lim., limones, lemons.
Liq., liquor.
Lot., /olio, a lotion.
M., misce, mix.
rrL, minimum.
Mac, macera, macerate.
Man., manipulus, a handful.
Mass. pil., massa pilularum, pill-
mass.
Mel., mellita, honey.
Mist., mistura, a mixture.
No., numei-o, in number.
Noct., node, at night.
O., octarius, a pint.
01., oleum, oil.
01. oliv., oleum oliva>, olive oil.
0. m., omni mane, every morning.
Ov., ovum, an egg.
Oz., uncia, ounce.
P. or Pug.,pugillus, a pinch
P. c, post cibum, after meals.
Pil., pilula, a pill.
Pond., pondere, by weight.
Pt., pint.
P. R. N., pro re natd, as occasion
arises.
Pulv., pulvis, a powder.
Q. d., quarter in die, four times a
day.
Q. P., quantum placet, as much as
you please.
Q. S., quantum sufficit, as much as
is sufficient.
Qt., quart.
Quotid., quotidie, every day.
Q. V., quantum vis, as much as you
wish.
R., recipe, take.
Rad., radix, root.
Rect., reclificatus, rectified.
S. or Sig., signa, write.
Ser., scrupulum, scruple.
Sem., semen, seed.
Sol., solution.
Spr., spirilus, spirit.
Sp. gr., specific gravity.
St., stet, let it stand.
SS. or s., semissis, a half.
Sum., sumendus, to be taken.
S. V. G., spirilus vini gallici,
brandy.
S. V. R., spiritus vini rectificatus,
alcohol.
S. F., spiritus frumenli, whiskey.
Syr., syrupus, syrup.
T., temperature.
T., ter, three times.
T. i. d., ter in dies, three times a day.
Tr., tinctura, tincture.
Troch., trochisci, lozenges.
Ung., unguentum, ointment.
W., weight.
3, drachma, a drachm.
%, uncia, an ounce.
^, scrupulum, a scruple.
2 dis., every two hours.
3 tis., every three hours.
4 tis., every four hours.
6 tis., every six hours.
V. DOSE-LIST.
The doses given in this list are for adults ; for children, Dr. Young's rule will be found most convenient. Add 12 to the
age, and divide the result by the age to get the denominator of the fraction, the numerator of which is 1. Thus, for a
child four years old, 4+12= i6-=-4 = |, the dose being one-fourth of that for an adult. Oi powerful narcotics scarcely
more than one-half this proportion should be used. Of mild cathartics, two or even three times the proportion may be
employed. For hypodermatic injection the dose should be one-half of that used by the mouth; by rectum the dose should
be increased to five-fourths of that administered by the mouth.
4^
ON
Latin official name. Dos i.
English name. Synonym or popular r—~
name. Gr. *3 % ™v Drops.
Acetanilid. Acetanilidum. Antifebrin. 2-8
Acid :
acetic, diluted. Acidum aceticum dilutum. \- I
arsenous. arsenosum. White arsenic. TiT""^
benzoic. benzoicum. . . . 10-40
boric. boricum. Boracic acid. 2-15
carbolic. carbolicum. < Phenol, Phenic acid, 1 Phenylic alcohol. / H
citric. citricum. Lemon-juice. 5-15
gallic. gallicum. 2-40
hydrochloric. hydrochloricum. Muriatic acid. 2-IO
dilute. dilutum. Diluted muriatic acid. 5-30
hydrocyanic dilute. hydrocyanicum dilutum. Prussic acid. 1-5
lactic. lacticum. 10-60
nitric. nitricum. Aqua fortis. 2-5
dilute. dilutum. 10-32
nitrohydrochloric. nitrohydrochloricum. Nitromuriatic acid. 1-3
phosphoric, dilute. phosphoricum dilutum. 16-60
salicylic. salicylicum. 5-15
sulphuric. sulphuricum. Oil of vitriol.
aromatic. aromaticum. Elixir of vitriol.
dilute. dilutum. . .
sulphurous. sulphurosum.
tannic. tannicum. 2-10
tartaric. tartaricum. 5-20
Aconite: (Aconitum napellus.*) < Monk's-hood, Wolf's-bane. }
extract of. Extractum aconiti. i-i
fluid extract of. Extractum aconiti fluidum.
tincture of. tinctura aconiti.
Alcohol, absolute (99 : 1). Alcohol absolutum. . i-'i
Aloe: [Aloe socotrina or Perryi.) _. 2-10
extract of. Extractum aloes. . H
tincture of. Tinctura aloes. ,
and myrrh, tincture of. Tinctura aloes et myrrha?. .
Ammonia:
spirit of aromatic. < Spirilus ammonise aromat-icus. } •••
water of. Aqua ammonise. Hartshorne. .
Ammonium :
benzoate. Ammonii benzoas. 10-30
bromide. bromidum. 10-60
carbonate. carbonas. I-IO
chloride. chloridum. 5-15
iodide. iodidum. 2-5
valerianate. valerianas. 10-15
Amyl nitrate. Amyl nitris.
(by inhalation). .... • .
1-2
5-20
I0-20 IO-60
*"2 i-5
*"2 i-2
I- -10
10-20
1-2
'-5
* Italicized names in parentheses indicate, respectively, the botanical name of the drug.
English name. Latin official name. Synonym or popular name.
Anise: (Pimpinella anisum.)
oil of. Oleum anisi. .
spirit of. Spiritus anisi.
Antimonial powder. Pulvis antimonialis. James' powder.
Antimony oxide. Antimonii oxidum.
sulphide. sulphidum.
sulphurated. sulphuratum. Kermes mineral.
wine of. Vinum antimonii. . . .
Antimony and potassium
tartrate (as an expectorant) Antimonii et potassii tartras. Tartrated antimony.
(as an emetic). Tartar emetic.
Antipyrin. Antipyrinum. Phenozone.
Antitoxin (for diphtheria). .... f
Apomorphin hydrochlorate. Apomorphinse hydrochloras. ... !
Arnica : (Arnica montana.)
-flowers, fluid extract of. Tinctura arnicae florum.
•root, extract of. Extractum arnicse radicis.
fluid extract of. fluidum.
tincture. Tinctura arnicse radicis.
Aromatic powder. Pulvis aromaticus.
Arsenate of sodium, sol. of. Liquor sodii arsenatis.
Arsenic, white. Acidum arsenosum.
Dose.
Gr. ^ fs "I
• ' 1-2 2-5
3-10
1-3 10-31 i-5 ••{ Emetic 2-1 > I Sed. and Expec. IO-30
1 1 27 10 5-20 Emetic 1 _l T7 Z kxpec. }" li-2*
¥0"_25 J
3-5 IO-30 5-IO
IO-31 IO-30 i-5
1 _ 1
Iff 2TT
Arsenic, Donovan's solu-
tion of.
Fowler's solution of.
Asafetida.
emulsion of.
tincture of.
Atropin sulphate.
Balsam of gurjun.
of tolu.
Belladonna:
-leaves, fluid extract of.
tincture of.
-root, extract of.
fluid extract of.
Benzanilid.
Benzoin, tincture of.
compound.
Bismuth:
citrate.
salicylate.
subcarbonate.
subnitrate.
Blue mass (see Mercury).
Brandy.
Brimstone (see Sulphur).
Bromid of ammonium.
calcium.
f Liquor arseni et hydrar-1 f
\ I gyri iodidi. J \
potassii arsenitis.
(Ferula fcetida.)
Emulsum asafcetida.
Tinctura asafcetida.
Atrophia? sulphas.
Oleum dipterocarpi.
Balsamum tolutanum. I
[Atropa belladonna.)
Extractum belladonna? fo-
liorum alcoholicum.
Tinctura belladonna? fo-
liorum.
Extractum belladonna?
radicis.
fluidum.
Benzanilidum.
Tinctura benzoini.
composita.
Bismuthi citras.
salicylas.
subcarbonas.
subnitras.
Spiritus vini gallici.
Amrnonii bromidum.
Calcii bromidum.
Solution of arsenic
and mercuric acid.
Solution of potass.
arsenite.
Wood-oil.
I . .
I
}••
3-10
Benzoyl-anilid.
Friar's balsam.
Latin official name. Synonym or popular name.
English name. Gr.
Bromid of gold. lithium. potassium. sodium. Bromoform. Brucin. Bryonia: tincture of. Buchu, fluid extract of. Cacoa butter. Caffein. citrate of. Calcium (lime): bromid. carbonate precipitated. chlorid. hypophosphite. lactophosphate, syrup. < phosphate. sulphate. Calomel. -s Calumba : fluid extract of. tincture of. Auri bromidum. Lithii bromidum. Potassii bromidum. Sodii bromidum. Bromoformum. Brucina. (Bryonia alba.) Tinctura bryoniae. Extractum buchu fluidum. Oleum theobromatis. Caffeina. citrata. Calcii bromidum. carbonas precipitas. chloridum. hypophosphis. Syiupus calcii lactophos-phatis. Calcii phosphas. sulphas exsiccatus. Hydrargyri chloridum-"» mite. J (Jateorhiza palmata.) Extractum calumba? fluidum Tinctura calumbse. 1_1 • • • S S . • . IO-47 . . . 5-60 . . . 5-6o 1 _ 1 • • • SV 271 (Used as a base for suppositories.) Thein. \-i ... i-5 • • • 5-3i . . . 10-30 . . • 2-15 . . . 10-30 }..... ... i5-3o Plaster of Paris. (Used for j j Mild mercurous ") 1 \ chlorid. / 2*"10 i
*3
Dose.
f3
2-
ireparing bandages.)
*-2
"l
i-5
Drops.
16-60
o
Camphor :
monobromated.
spirit of.
water of.
Camphoric acid.
Canabis :
Americana.
fluid extract of.
Indica.
fluid extract of.
tincture of.
Cantharides :
tincture of.
Capsicum.
fluid extract of.
oleoresin of.
tincture of.
Caraway, oil of.
Cardamom:
compound tincture of.
tincture of.
Canon oil.
Cascara sagrada:
extract of.
fluid extract of.
C'ascarilla.
(Ciiinamomum camphora.)
Camphora monobromata.
Spiritus camphora?.
Aqua camphora?.
Acidum camphoricum.
(Apocynum cannabinum.)
Extractum apocyni fluidum.
(Cannabis saliva.)
Extractum cannabis indica?
fluidum.
Tinctura cannabis indica?.
Cantharis.
Tinctura cantharidis.
(Capsicum fastigiatum.) i
Extractum capsici fluidum.
Oleoresina capsici.
Tinctura capsici.
Oleum cari.
(Elettaria repens.)
Tinctura cardamom com-
posita.
Tinctura cardamomi.
(Used as a dressing for burns.)
(Rhamnus Purshiana.) <
pur-
rhamni
Extractum
shiana?.
fluidum.
(Croton eluteria.)
Canadian hemp.
Indian hemp.
} •••
Spanish flies.
Cayenne pepper,
African pepper.
Chittern bark,
Sacred bark.
OJ
Synonym or popular Dose.
English name. Latin official name. '
Gr. £ f3 "I Drops.
Castor oil. Oleum ricini. ..II- -I
Catechu. (Acacia catechu.) io 31
tincture compound. Tinctura catechu composita. . 2-2
Cerium oxalate. Cerii oxalas. I-IO
Chalk mixture. Mistura cretae. 1-4
powder, compound. Pulvis creta? compositus. 5-62
prepared. Creta piseparata. 10-31
Chamomile, oil of. (Anlhemis nobilis.) .... 5-i5 ^
Charcoal, animal, purified. -J Cherry-laurel water. Carbo animalis purificatus ligni. Aqua laurocerasi. \ (Used as a deodorant and disinfectant. Internally for dyspeps j as tabloids.) ia, given *t3
f-i
Chloral hydrate. Chloral. 5-31
Chloralmid. Chloral um formamidatum. 5-60 £
Chlorid of lime. Calx chlorinata. 3-5 ri
Chlorine-water. Aqua chlori. 2-2
Chloroform:
spirit of. Spiritus chloroformi. 5-32
Cimicifuga: (Cimicifuga racemosa.) Black snakeroot.
fluid extract of. Extract, cimicifuga? fluidum. 16-30
tincture of. Tinctura cimicifuga?. 1-2
Cinchona-bark : (Cinchona officinalis.) f Quinin, "I f ( Peruvian-bark. J \ Decoc. IO-60 }'
fluid extract of. Extractum cinchonsefluidum , , 16-30
extract of. Extractum cinchona?. 5-IO [
tincture of. Tinctura cinchona?. . . 1-2
Cinchonin sulphate. Cinchoninse sulphas. 5-15
Cinnamon :
oil of.
spirit of.
tincture of.
Cloves, oil of.
Coca, fluid extract of.
Cocain hydrochlorate.
Cocculus:
fluid extract.
tincture of.
Cocoa (cacao) butter.
Codein or codeia.
Colchiceine.
Cod-liver oil.
Colchicum:
-root.
extract of.
-seed.
fluid extract of.
wine of.
Cologne-water.
Conium :
fluid extract of.
Copper sulphate (emetic).
Corrosive sublimate.
Creolin.
Creosote.
water.
[ Cinnamomum.)
Oleum cinnamomi.
Spiritus cinnamomi.
Tinctura cinnamomi.
Oleum caryophylli.
Extractum coca? fluidum.
Cocaina? hydrochloras.
f Anamirta paniculata.)
Extractum cocculi fluidum.
Tinctura cocculi.
Oleum theobromatis.
Codeina.
Colchiceina.
Oleum morrhuae.
(Colchicum autumnale.)
Colchici radix.
Extractum colchici radicis.
Colchici semen.
Extractum colchici seminis
fluidum.
Vinum colchici seminis.
Spiritus odoratus.
( Conium maculatum.)
Extractum conii fluidum.
Cupri sulphas.
Hydrargyri chloridum
corrosivum.
Creolinum.
Creosotum.
Aqua creosoti.
Picrotoxin.
T77 27
(Used as a base for suppositories.)
1-7
Meadow saffron.
2
1 _ 1
ff? 52
2-8
(A fragrant deodorizing scent.)
Hemlock.
Bluestone,
Blue vitriol.
Bichlorid of mercury.
(Antiseptic and deodorant, J to 2 per cent, solution.)
... .... 1-4
3-5
72~~T5
H
i-
English name.
Croton oil.
Cubeb:
fluid extract of.
oil of.
oleoresin of.
powdered.
tincture of.
Digitalin.
Digitalis:
extract of.
fluid extract of.
infusion of.
tincture of.
Donovan's solution.
Dover's powder.
Distilled water.
Elaterin.
Elaterium.
Ergot, extract of.
fluid extract of.
wine of.
Eserin.
Ether, acetic
spirit of.
Latin official name.
Oleum tiglii.
(Piper cubeba.)
Extractum cubebae fluidum.
Oleum cubeba?.
Oleoresina cubebae.
Pulvis cubeba?.
Tinctura cubebae.
Digitalinum.
(Digitalis purpurea.)
Extractum digitalis.
Extractum digitalis fluidum.
Infusum digitalis.
Tinctura digitalis.
Liquor arseni et hydrargyri
iodidi.
Pulvis ipecacuanha? et opii
Aqua destillata.
Elaterinum.
Elaterium.
Extractum ergotae.
fluidum.
Vinum ergotae.
^ther aceticus.
Spiritus aether.
Synonym or popular
name.
Foxglove.
(A solvent.)
Ergot of rye
Hoffmann's anodyne.
Dose.
Gr.
20-2 dr.
5-10
fS
ft
"1
2-4
1-4
1-3
5-1
1-4
1-3
IP, diluted
in 5 drops
of oil.
IO-60
5-16
5-20
Drops.
5-30
1-2
IO-20
4^
t*l
Ether, nitrous spirit of.
Ethyl bromid.
Eucalyptol.
Eucalyptus:
fluid extract.
oil of.
Exalgin.
Extracts (solid) :
aloes.
arnica-root.
belladonna-leaves (alco-
holic).
belladonna-root.
cimicifuga.
cinchona.
colchicum-root.
digitalis.
ergot.
gentian.
hematoxylon.
hyoscyamus.
iris.
jalap.
nux vomica.
of cascara sagrada.
opium.
physostigma.
quassia.
rhubarb.
stramonium-seed.
Spiritus aetheris nitrosi.
!/Ethyl bromidum.
Eucalyptol.
(Eucalyptus globulus).
Extractum eucalypti fluidum
Oleum eucalypti.
Extractum aloes.
arnica? radicis.
belladonna? foliorum alco-
holicum.
belladonna radicis.
cimicifuga?.
cinchona?.
colchici radicis.
digitalis.
ergotae.
gentiana?.
haematoxyli.
hyoscyami.
iridis.
jalapa?.
nucis vomica?.
rhamni purshiana?.
opii.
physostigmatis.
quassia?.
rhei.
stramonii seminis.
Sweet spirits of nitre.| . ,
(Used as a general anesthetic.)
English name. Latin official name.
Extracts (fluid) :
aconite. Extractum aconiti fluidum.
arnica. arnica? radicis «
belladonna-root. belladonna? radicis "
buchu. buchu fluidum.
calumba. calumba? "
cocculus. cocculi tt
indian hemp. cannabis indica? n
Canadian hemp. apocyni d
capsicum. capsicum tt
cinchona. cinchona? (<
coca. cocae tt
colchicum-seed. colchici seminis «
conium. conii tt
cubeb. cubebae "
digitalis. digitalis «
ergot. ergotae ((
eucalyptus. eucalypti <(
gelsemium. gelsemii tt
gentian. gentianae tt
geranium. geranii "
ginger. zingiberis tt
hamamelis. hamamelidis it
hematoxylon. haematoxyli "
hydrastis. hydrastis "
ipecac (emetic). ipecacuanha? "
Synonym or popular
name.
Dose.
Gr.
%
ft
H
2-1
2-1
2-i
1-4
i-l
"I
2-2
5-10
1-2
l6-6o
i-3
2-20
5-32
1-2
16-3O
-20
2-5
2-6
10-60
1-2
IO-60
2-IO
IO-30
16-32
Drops.
ipecac (expectorant).
iris.
lobelia (emetic).
(expectorant).
lupulin.
nux vomica.
pilocarpus.
podophyllum.
Pulsatilla.
quassia.
rhamnus purshiana.
rhubarb.
sarsaparilla, compound.
savine.
scoparius.
senega.
senna.
squill.
stillingia.
valerian.
veratrum viride.
viburnum.
wild cherry.
Flaxseed.
Gaultheria, oil of.
Gelsemium:
fluid extract of.
tincture of.
Gentian:
extract of.
fluid.
iridis
lobeliae
lupulini
nucis vomicae
pilocarpi
podophylli
Pulsatilla?
quassia?
rhamni purshiana?'
rhei
sarsaparilla? compositum.
sabinae fluidum.
scoparii
senega?
sennae
scillae
stillingiae
Valeriana?
veratri viridis
viburni prunifolii
pruni virginiana
(Linum usitatissimum.)
Oleum gaultheria?.
(Gelsemium sempervirens.)
Extractum gelsemii fluidum
Tinctura gelsemii.
(Gentiana luteal)
Extractum gentiana?.
fluidum.
Oil of
Yellow
wintergreen.
jasmine.
H
H
H
1-2
2-1
1-2
5-1 o
-Id
i-5
10-16
'-5
2-20
i-5
5-10
16-30
10-30
5-16
5-20
10-20
»-5
10-60
1-3
10-32
2-10
10-20
H
u>
English name.
Gentian (continued):
infusion, compound.
tincture of, compound.
Geranium, fluid extract.
Gin.
Ginger:
fluid extract of.
oleoresin of.
tincture of.
Glycerin.
Glycyrrhiza.
Guaiac :
resin of.
tincture of.
ammoniated.
Gum arabic.
Guaiacol.
Green soap (see Soap).
Hematoxylon:
extract of.
fluid.
Hamamelis:
Latin official name.
Infusum gentiana? compos-
itum.
Tinctura gentiana? com-
posita.
Extractum geranii fluidum.
Spiritus juniperi compositus
(Zingiber officinale.)
Extract, zingiberis fluidum.
Oleoresina zingiberis.
Tinctura zingiberis.
Glycerinum.
Glycyrrhiza.
(Guaiacum officinale.) <
Guaiaci resina.
Tinctura guaiaci.
ammoniata.
(Acacia Senegal.)
Guaiacolum.
(Hematoxylon campechia
num.)
Extractum haematoxyli.
fluidum.
Hamamelis virginiana.)
Synonym or popular
name.
Crane's-bill.
Licorice-root.
Lignum vita?.
Guaiacum-wood.
V Logwood.
Witch-hazel.
Gr.
S
}*-
30
5-3°
Dose.
ft
1-4
2-1
2-1
1-4
«l
10-30
2-1
-20
1-2
Drops.
5-10
00
it
fluid extract. Extract, hamamelidis fluid.
Hellebore : ( Ve rat rum viride.)
extract, fluid. ( Extractum veratri viridis \ fluidum. } •••
tincture of. Tinctura veratri viridis.
Honey. Mel.
clarified. despumatum. . • .
Hops: (Humulus lupulus.)
fluid. Extractum lupulini fluidum.
tincture of. Tinctura humuli.
Hydrargyrum (see Mercury).
Hydrastis : (Hydrastis canadensis.) Golden seal.
extract, fluid. Extract, hydrastis fluidum. . . .
tincture of. Tinctura hydrastis. • • .
Hyoscyamus: (Hyoscyamus niger.) Henbane.
extract of. Extractum hyoscyami.
Hypnal. Hypnal. < Monochloral-antipyrin.
Hypnone. Hypnone. Acetophonene.
Hypophosphites, ;yrup of. Syrupus hypophosphitum.
with iron, syrup of. " " cum ferro.
Ichthyol. Ichthyol.
Ignatia: (Strychnos ignatii.) St. Ignatius' bean
tincture of. Tincture ignatia?.
Iodin, solution, cc impound Liquor iodi compositus. Lugol's solution.
tincture of. Tinctura iodi.
Iodoform. Iodoformum.
Iodol. Iodol. Tetraiodopyrrol.
Ipecacuanha: (Cephaelis ipecacuanha?) Ipecac.
fluid extract of. { Extractum ipecacuanha? fluidum. } •■■
. . 1 1
. . J-3 2-1 2-2
2-3
}5-2o
I-IO 1-4 1-4
i-5 5-20
'-3
i-8
10-16
'-5
2-10
5-16
3-5
Emetic
16-32
VO
English name. Latin official name.
Ipecacuanha (continued):
syrup of. Syrupus ipecacuanhae.
wine of. Iris: extract of. Vinum ipecacuanha?. (Iris versicolor.) Extractum iridis.
fluid fluidum.
Irish moss. (Chondrus crispus.)
Iron :
bitter wine of. Vinum ferri amarum.
chlorid of. Ferri chloridum. \ Tinctura ferri chloridi.
tincture of.
citrate. Ferri citras.
dialyzed. hydrated peroxid of hypophosphite, syrup of. 1 Ferrum dialysatum. Ferri peroxidum hydratum. Syrupus hypophosphitum cum ferro.
iodid of syrup. ferri iodidi.
phosphate, soluble. Ferri phosphas solubilis.
sulphate of. sulphas. <
wine of the citrate. Vinum ferri citratis.
Iron and ammonium citrate. Ferri et ammonii citras.
and quinia citrate. Ferri et quinina? citras.
and strychnin citrate. Ferri et strychninae citras.
Synonym or popular name.
Gr.
Blue flag. 2-4
Carragheen moss. 1-2 OZ
Identical with Liquor Ferri Perchloridi. }i-3
2-5
Ferric hydrate. } ••• 5-20
Copperas. Green vitriol. 2-5 } 2-3
• • • 3-5 2-5 i-3
Dose.
8s
fg ft "I Drops.
■•{ Emetic 2-4 •■{ 1-2 1-4 1-2 } Ex pec. IO-30 5-IO IO-30 IO-32 5-32
Jaborandi:
fluid extract of.
infusion of.
Jalap:
compound powder of.
extract of.
Kino:
tincture of.
Lactucarium.
syrup of.
Lard, benzoinated.
Lavender, oil of.
Lead and laudanum.
acetate of.
Lime, solution of.
syrup of.
Licorice powder, com-) f
pound. J \
compound mixture of. <
Lithium:
benzoate.
bromid.
carbonate.
citrate.
salicylate.
Lobelia:
fluid extract of (emetic). "I
(expectorant). J
tincture of.
(Pilocarpus jaborandi.)
[Extract, pilocarpi fluidum.
Infusum pilocarpi.
(Ipomaea ja/apa.)
Pulvis jalapa? compositus.
Extractum jalapa?.
(Pterocarpus marsupium.)
Tinctura kino.
(Lactuca virosa.)
Syrupus lactucarii.
jAdeps benzoinatus.
Oleum lavandulae.
Plumbi acetas.
Calx.
Syrupus calcis.
Pulvis glycyrrhiza? com-
positus.
Mistura glycyrrhiza? com-
posita.
Lithii benzoas.
bromidum.
carbonas.
citras.
salicylas.
(Lobelia infiata.)
Extractum lobeliae fluidum.
Tinctura lobeliae.
Lettuce opium.
(Ointment base.)
Sugar of lead.
v Brown mixture
Indian tobacco.
• 2-1 2-3
15-40 5-IO
5-IO
• • 15-30 • • i-3 i-3
(Used externally.) 1-5 (Pill)
2-1
31-123 . 1-4
5-30 IO-47 2-IO
5-20
I0-3I
• • ■'{ Emeti< 1-2
i-5
16-60
i-5
Expec.
5-32
0\
Dose. Q\
... Latin official name. Synonym or popular to
English name. • *
name. Gr. 3 ft "I Drops.
Lemon-peel. Limonis cortex. 1-5
oil of. Oleum limonis cortex. # 9 *-5
Lysol. (Antiseptic, 1-3 per cent, sol.)
Magnesia. Magnesia. -1 Calcined magnesia. Husband's magnesia. | 31-62
Magnesium carbonate. Magnesii carbonas. IO-I5
citrate of. citris effervescens. 3J-93
sulphate. sulphas. Epsom salt. 2-8
Male fern, oleoresin of. Oleoresina aspidii. 2-1 Eu.
Malt, extract of. 1-2 £ S
Manganese sulphate. Mangani sulphas. 2-5
Menthol. Menthol. Peppermint camphor. 2-1 £
Mercury: Hydrargyrum. Quicksilver.
corrosive chlorid of. -J Hydrargyri chloridum "1 f corrosivum. J \ Corrosive sublimate, Bichlorid of mercury. } *VtV
cyanid. cyanidum. TT)~20
mass of. Massa hydrargyri. 1 Blue mass, Blue pill. | 2-20
mild chlorid of. Hydrargyri chloridum mite. Calomel. 21
APPENDIX.
posed of cells. Cellular tissue is the
network connecting the majority of
the minute parts of the body.
Centigrade. French method of
marking temperature ; the freezing
point is o°, the boiling point ioo°.
(See Temperature.)
Centigramme. The one-hundredth
of a gramme, nearly equal to 0.16 part
of a grain avoirdupois.
Centimetre. Cubic centimetre, writ-
ten cc, and used in foreign prescrip-
tions, equals 16 minims.
Cephalalgia. Pain in the head ;
" cephalo" is used to compound
many terms; thus, cephalometer, an
instrument for measuring the head.
Cephalhematoma. A bloody tu-
mor on the head of an infant.
Cephalotribe. An instrument con-
sisting of two blades and a screw,
used to crush the fetal head.
Cerate. A greasy substance con-
sisting of wax mixed with oils, fatty
substances, or resins, and of such
consistence that at ordinary tempera-
tures it can readily be spread upon
linen or muslin, and yet is so firm
that it will not melt or run when ap-
plied to the skin.
Cerebellum. The little brain at
the back of the head, between the
cerebrum and the medulla oblongata.
Cerebral. Relating to the brain.
Cerebrum. The big brain, occu-
pying the cranium.
Cerumen. Waxy secretion of the
ear.
Cervix. The neck.
Cervix Uteri. The neck of the
uterus.
Cesarean Section. An abdominal
incision for extracting the fetus from
the uterus. It was first performed
successfully' on a woman in 1498.
Chafing. Excoriations, abrasions,
and inflammation produced by fric-
tion of parts, or between the folds of
the skin, etc.
Chalybeate. Containing iron.
Chamomile. Antispasmodic med-
icine.
Charcoal. Prescribed as a medi-
cine in dyspepsia, and generally given
as tabloids. A charcoal poultice is
made of equal parts of flaxseed meal
and powdered charcoal.
Charpie. Unravelled, shredded,
linen, used for dressing wounds.
Chart. A ruled sheet of paper on
which the nurse records the tempera-
ture, pulse, motions, etc., of a pa-
tient.
Chartse. Papers on which medici-
nal substances are spread. Thus,
Charlce sinapis, a leaf of mustard-
paper.
Chattering. The noise made by
the teeth striking together repeatedly
and rapidly, as under the influence
of cold or of fright.
Cheese-cloth. A coarse cotton
fabric of an open texture ; ordinarily
used in cheese-making for wrapping
the cheese.
Chest. (See Thorax.)
Cheyne-Stokes Breathing. Ir-
regular respiration consisting of ten
or fifteen short breaths and then a
long pause. A bad symptom.
Chicken-pox. Varicella. Rash
appears on the chest about the third
day ; the disease runs its course in a
fortnight. Give light food and keep
from cold ; prevent the patient from
scratching the pimples, or scars will
be made. Infectious.
Chilblain. A blain or sore pro-
duced by cold; an erythematous
condition of the hands or feet, ac-
companied with inflammation, pain,
and sometimes ulceration.
Childbirth. The act of bringing
forth a child.
Chill. A sensation of cold accom-
panied by shivering, usually appear-
ing shortly after exposure to cold or
wet. It is usually the first symptom
of grave acute disorders, as pneu-
monia ; and is a prominent symptom
of various forms of malarial fever.
(See Rigor.)
Chiropodist. One skilled in cut-
ting and extracting corns.
Chirurgical. Surgical.
Chloral. White opaque hypnotic.
Antidote for overdose, fresh air, am-
monia, artificial respiration.
Chlorine. Antiseptic. Used as a
lotion for sores ; also as a gargle, in-
halation, etc.
Chloroform. A colorless liquid
used to produce anesthesia by in-
halation. Chloroform must always
GLOSS.
be kept in the dark. The private
nurse has sometimes to administer
chloroform ; a simple inhaler is made
of a small wire mask over which a
piece of flannel is stretched, or a few
drops of chloroform can be sprinkled
on a towel and held close to the pa-
tient's face. Chloroform is only safe
when mixed with air; so at intervals
the towel must be removed and the
patient allowed a breath of air. Un-
consciousness is reached when all the
muscles are relaxed, and the patient's
hand drops when raised. The eye-
ball should never be touched, as it
may cause inflammation. Many
cases have been known through this
practice of the etherizer. Antidote
for an overdose, fresh air and arti-
ficial respiration. If the nurse is ad-
ministering the chloroform, she must
be very careful to watch the respira-
tion of the patient. Before the anes-
thetic is administered, false teeth and
tight clothing must be removed. No
solid meal must be given for six hours
before the operation, but a little beef-
tea may be given two hours before.
After the operation the nurse must
be prepared for the vomiting which
is usual.
Chlorosis. A peculiar form of
anemia common in females about the
period of puberty. It causes weak-
ness, rapid heart-action on exertion,
and faintness, for all of which a nurse
must be prepared. It is generally
met by iron tonics, sea-air, and
strengthening diet.
Cholagogues. Agents which de-
crease the bile in the blood.
Cholera. An epidemic disease.
Symptoms: Cramp, vomiting, and
rice-water evacuations. "English"
cholera is the mild form; "Asiatic"
is the severe form. Much depends
upon the nursing; the patient must
be kept warm and recumbent, medi-
cines for the alleviation of pain must
be given promptly. The great dan-
ger is from collapse. The patient
should, if possible, be placed in a
separate room. Only the persons in
attendance should enter the room.
If the apartment should not allow of
sufficient isolation, the patient should
be removed to a hospital. Those who
'ARY. 381
are in continued attendance upon
choleraic patients, or who live with
them, should obey the following
rules: Neither food nor drink should
be taken in a room occupied by a
patient. The mouth should be care-
fully rinsed before each meal, and the
hands and forearms washed with a
solution of borax. The face, head,
and hands, and, if possible, the whole
body, should be washed daily with
water containing 160 grains of borax.
The disease runs its course swiftly,
and has been fatal in India in a few
hours.
Cholera Infantum. Summer diar-
rhea of infants; it requires immediate
attention, or prostration soon comes
on. Diet is of the utmost importance,
also freedom from chills.
Cholera Morbus. An acute ca-
tarrhal inflammation of the mucous
membrane of the stomach and intes-
tines, with enteric pain, purging,
vomiting, spasmodic contractions of
the muscles, etc. It is a summer
disease.
Chorea. St. Vitus' dance: invol-
untary twitchings of the muscles;
most common in children, who gen-
erally grow out of it. These cases
must not be left alone, and every
effort must be made to prevent chil-
dren from hurting themselves. Diet
nourishing. Baths and gymnastic
exercises may be ordered.
Chorion. The vascular and outer
envelope of the fetus.
Chronic. A term applied to a dis-
ease that is protracted.
Chyle. The milk-like fluid into
which food is transformed before it
is aborbed into the blood.
Chyluria. Milk-like urine.
Chyme. The pulpy mass of food
which passes from the stomach into
the intestines.
Cicatrix. The scar of a healed
wound or ulcer.
Cilia. Eye-lashes.
Cinchona. Peruvian bark, which
yields quinin. A tonic, and a valu-
able medicine in malarial fevers for
reducing the ranges of temperature.
Cinnamon. Sometimes given as
an astringent.
Circulation. The movements of
382
APPENDIX.
the blood from the heart, through
the arteries, veins, and capillaries
back to the heart (see p. 287).
Circumcision. The removal of a
circular piece of the prepuce ; gen-
erally performed on young children.
The child has to be kept very quiet
for some days, and very clean.
Cirrhosis. Contracted granular
state of an organ, usually applied to
the liver or the lung. A cirrhous
liver is generally produced by drink.
Cirsoid. Resembling a varix.
Citrate. Compound of citric acid
and a base.
Citric Acid. Acid prepared from
lemon-juice. Makes an astringent
yet soothing lotion.
Clavicle. The collar-bone, going
from each shoulder to the breast-
bone across the front of the chest.
Fractured clavicle is set by a firm
pad, 4 or 5 inches square, placed in
the axilla, the forearm is bandaged
over the chest, and the point of the
elbow kept well back. No anesthetic
needed as a rule.
Clavus. A corn; a thickening of
the skin, common on the toes.
Cleft Palate. A congenital split
in the roof of the mouth, so that the
nose and mouth form one cavity.
The child must be sat upright when
fed, and a long teat employed, and
the milk poured slowly to the back
of the throat. It cannot suck, as it
cannot create a vacuum, and the
milk is liable to return down the
nose. Operation usually takes place
about two or three years of age.
Climacteric. The cessation of
menstruation in females; often a
critical period, when the health
needs great attention.
Clinic. Bedside.
Clinical Thermometer. A slender
glass instrument used to discover the
temperature of the body. (See Tem-
perature.)
Clitoris. A small organ of erec-
tile tissue, found in the female in
front of the pubes. The seat of sex-
ual excitement.
Clonic. Spasmodic contractions,
short and frequent.
Clot of Blood. A thickened mass
of blood. See Embolism.
Cloves. The dried flower-buds of
the clove tree. Cloves are largely
used as a spice, and in medicine for
their stimulant and aromatic proper-
ties.
Club-foot. Talipes. A congenital
turning of the foot in a wrong direc-
tion. Generally necessitates the
wearing by the child of a light splint,
which may effect a cure. Massage
is useful in the case of infants.
Clyster. An enema, or injection
per anus.
Coagulation. Thickening of a
fluid into curds.
Cocain. A powerful local anes-
thetic, much used by oculists and
dentists. It enlarges the pupil of the
eye. Useful to stay the craving for
opium or drink. The hypodermatic
injection of cocain produces severe
symptoms in some people, and anti-
dotes (amyl nitrite and morphin)
should always be at hand.
Cocainism. Chronic poisoning
from indulgence in the drug.
Coccyx. The tail-like termination
of the spine.
Cochlea. The cavity of the inter-
nal ear.
Codein. A preparation of opium,
used to soothe the nerves and in-
duce sleep. It allays cough, and is
useful in diabetes, etc.
Cod-llver Oil. A medicine used
as a restorative and nutritive, particu-
larly in consumption cases. It ought
to cause the patient to increase in
weight. It should be given after
food, plain, if the patient will take it;
if not, floated in milk, coffee, or or-
ange-juice.
Colchicum. A drug used in gout;
it reduces the blood-pressure, and
lessons muscular irritability. Poison.
Colic. Severe pain in the belly;
generally allayed by hot fomenta-
tions.
Colitis. Inflammation of the colon.
Poultices, opium injections, or mor-
phia suppositories. In membranous
colitis or enteritis casts are passed
from the bowel.
Collapse. Severe sudden prostra-
tion. Symptoms : pallor, faintness of
pulse, unconsciousness. Treatment :
lay patient perfectly flat, keep warm,
GLOSSARY.
383
give sal volatile or alcohol in small
doses, watch the pulse. Hypoder-
matic injection of brandy may be
necessary in severe cases, or even
artificial respiration, if the breathing
actually stops.
Collar Bone. (See Clavicle.)
Collodion. Gun-cotton dissolved
in alcohol and used in surgery to form
a false skin. When painted over a
commencing bed-sore, for instance, it
hardens as it dries, and forms a
slight protection to the tender skin.
The stopper must never be kept out
of the collodion bottle for more than
a moment.
Colocynth. A drug used as a
rapid and drastic purge.
Colon. The part of the large in-
testine between the rectum and the
cecum.
Colostrum. A watery fluid flow-
ing from the breasts the first two or
three days after confinement, before
the true milk comes.
Colotomy. Incision of the colon ;
a serious operation which may be
performed in the lumbar or inguinal
regions, in cases of fistula, obstruc-
tion, cancer, or ulceration of the
rectum.
Coma. Insensibility, stupor, sleep.
Comatose. In a state of coma.
Comedones. Sebaceous secretions
of the hair-follicles, commonly called
" black-heads," and most frequent on
the face.
Complication. The occurrence
during the course of a disease of
some other affection, or of some
modifying symptom, or group of
symptoms not ordinarily observed.
Compress. A tightly folded pad
of linen used to secure local pressure.
Conception. The impregnation
of the ovum.
Concretions. Bony deposits; cal-
culi.
Concussion of the Brain. Sud-
den interruption of the functions of
the brain, and consequent uncon-
sciousness, through a blow or fall.
Rest and quiet are necessary, and
the application of cold to the head
and warmth to the extremities. In
mild cases consciousness returns in
from a few minutes to a few hours.
Inflammation of the brain mav fol-
low if proper quiet is not obtained.
Condyle. A round projection at
the ends of some bones.
Condy's Fluid. A valuable anti-
septic, prepared from permanganate
of potash. Often used by the monthly
nurse when syringing is ordered for
her patient.
Confectiones. Soft pastes contain-
ing drugs.
Confinement. The condition of
women during childbirth.
Confluent. A term applied to
eruptions in which the pustules run
together.
Congenital. Existing at birth.
Congenital diseases or deformities are
those present at birth.
Congestion. Torpid stagnation
of blood in a part of the body, as in
the lungs or brain. Congestion of the
lungs is brought on by chill, and the
nursing treatment is warmth, rest,
flaxseed-meal poultice to the affected
part, and light diet. The tempera-
ture must be taken twice in the twenty-
four hours, as inflammation often
follows as the result of the conges-
tion. Congestion of the brain is a
term sometimes applied to brain
fever, apoplectic strokes, or any form
of delirium; quiet, darkness, and
careful attention to the doctor's
orders are necessary.
Conium. Hemlock, a poisonous
drug which quiets muscular action,
also the central nervous system.
Used specially in cases of mania, or
ovarian pain. Antidotes : Stomach-
pump, stimulants, tannin.
Conjunctiva. The mucous mem-
brane of the eye.
Conjunctivitis. Inflammation of
the membrane of the eye, ophthal-
mia (which see).
Constipation. A confined state
of the bowels ; the nurse must always
report to the doctor when no action
of the bowels takes place in twenty-
four hours. The remedies are usu-
ally either an enema or a laxative
medicine.
Consumption. A wasting away,
caused bv disease of the lungs. (See
Phthisis.)
Contagious. Spreading by touch;
384
APPENDIX.
a contagious disease can only be
caught by those who come into di-
rect contact with the patient; it is
not communicable through the at-
mosphere.
Continued Fever. A simple febrile
attack, which runs its course unin-
terrupted by any attempt at treat-
ment. The patient must be kept
recumbent, cool, and fed on light
diet. Note temperature.
Contraction. The act of drawing
together or shrinking.
Contra-indication. An indica-
tion against a remedy or method of
treatment.
Contusion. A bruise.
Convalescence. The period of
returning strength after an illness.
The nurse needs to amuse her pa-
tient, prevent rash deeds, or fatigue
arising from too many visitors ; sup-
ply light nutritive food at frequent
intervals; avoid all talk about the
past illness, and watch for a relapse.
Convolutions. The folds and
twists of the brain or the intestines.
Convulsions. Violent spasms of
alternate muscular contraction and
relaxation, common in infants, and
usually the result of too strong diet
or of costiveness. Clonic convulsion
is applied to spasmodic movements
of short duration and alternate
periods of relaxation, as in epilepsy.
Tonic convulsion signifies a constant
rigidity. Uremic is due to the altered
state of the blood in diseases of the
kidney. Convulsions occur in epi-
lepsy, tetanus, hydrophobia, and
chorea. (See Eclampsia.)
Copaiba. A diuretic; the oleo-
resin is also given in capsules for
ascarides, etc.
Cord. The connection between
mother and child at birth; after
washing the infant, the remnant of
the cord should be dressed with pow-
dered starch, and a square of anti-
septic gauze.
Core. The central slough or sub-
stance of a boil or carbuncle, formed
of dead tissue.
Coriaceous. Of rough texture,
coarse.
Corium. The internal layer of the
skin.
Cornea. The clear, glass-like front
of the eyeball.
Corn Starch. A flour made from
the starchy parts of Indian corn,
used for puddings, etc.
Coronal Suture. The joint of
the parietal and frontal bones of the
skull.
Corpora Lutea. Yellow bodies in
the ovarium.
Corpuscle. A minute protoplasmic
body—for instance, the red and white
corpuscles of the blood.
Corrective. A drug which modi-
fies the action of another drug.
Corrosive. Eating into, consum-
ing.
Corrosive Sublimate. Bichlorid
of mercury. Antiseptic; poisonous.
The solution i in iooo is very useful
in infectious fevers; it is seldom used
for instruments, as it corrodes steel.
Antidotes: flour, milk, white of egg.
Coryza. Cold in the head, nasal
catarrh,
Costal. Relating to the ribs.
Costive. Constipation.
Cotton. The white fibre obtained
from the cotton-plant (Gossypium).
Absorbent cotton is the fibre prepared
by removal of oily matters for use in
surgical operations, etc. (See Collo-
dion. Antiseptic cotton.)
Cotton-WOOl. (See Cotton.)
Cough. Violent, sonorous expira-
tion after closure of the glottis.
Hacking cough is a short, broken, dry
cough.
Counter-extension. Extension by
means of holding back the upper
part of a limb while the lower is
pulled down.
Counter-irritants. The drugs used
to produce counter-irritation (q. s.),
called rubefacients, epipastics, vesi-
cants or blistering agents, and pustu-
lants.
Counter-irritation. Causing irri-
tation of one part of the body to re-
lieve another; also called " deriva-
tion " and "revulsion."
Coxalgla. Pain in the hip-joint.
(See Hip-joint.)
Coxitis. Inflammation of the hip-
joint.
Cradle. A series of small wooden
arches used to keep the bedclothes
GLOSSARY. 385
from pressing on the injured part of
the body.
Cramp. Sudden and violent con-
traction of the muscles, causing great
pain. Friction may give relief.
Craniotomy. The operation of
perforating the head of the fetus dur-
ing parturition, crushing it, and re-
moving the fragments.
Cranium. The skull.
Cravat. A bandage of triangular
shape, used as a temporary dressing
for a wound or a fracture. (See
Bandage.)
Creolin. A drug nearly related to
carbolic acid; antiseptic and disin-
fectant.
Creosote. An oily antiseptic
liquid got from wood-tar. Used as
an inhalation in phthisis, and as a
remedy for toothache; also as a
styptic, an antispasmodic, and an al-
terative. Gives the urine a blackish
color.
Crepitation. The grating sound
of two ends of a fractured bone rub-
bing together. Also a grating sound
heard on auscultation in cases of
pneumonia.
Cretinism. Imperfect mental fac-
ulties, often accompanied by goitre.
Most common in Switzerland.
Crisis. The deciding point of a
disease, from which the patient either
begins to recover or sinks rapidly ;
often marked by a long sleep, pro-
fuse perspiration or other phenome-
non.
Crotchet. A hooked instrument
used to extract remnants of the fetus
after embryotomy.
Croton Oil. Used as a liniment
and as a swift purge; causes red
eruption on the skin. Poison.
Croup. Acute inflammation of the
larynx and trachea, most common in
young children. A nurse should
know the breathlessness, restlessness,
and crowing sound which are pre-
monitory symptoms of croup; for a
child may suffocate if attention is not
immediate.
Crural. Relating to the thigh.
Cumulative. Increasing; adding
to. Cumulative action, the produc-
tion of a noteworthy and sudden re-
sult, after the administration of a
considerable number of compara-
tively ineffective doses. The possible
cumulative effect of certain drugs is
one of the sources of danger that at-
tend their administration.
Cupping. Blistering or bleeding
by means of bell-shaped glasses. Put
a few drops of spirit of wine in the
glass and swirl it round till the inside
is moist to the brim. A plug of cot-
ton-wool on a stick should then be
dipped in the spirit, lighted, and
passed quickly round the glass; this
will produce a large momentary
flame, and the glass must be imme-
diately pressed on the desired place—
usually the nape of the neck. The
flame will have created a vacuum in
the glass, which will cause an imme-
diate rising of the skin. So far it is
dry cupping; if it is wet cupping that
is ordered, the glasses are removed,
numerous small incisions are made
in the risen skin, and the glass is re-
placed (after having been exhausted
again), and a steady flow of blood
will soon fill the glass. The wound
can be dressed with some simple
ointment on a piece of lint.
Cupri Sulphas. Sulphate of cop-
per. An astringent and emetic.
Poison.
Curette. A spoon-shaped instru-
ment used in operations.
Cutaneous. Pertaining to the skin.
Cuticle. The external, or scarf
skin.
Cutis. The derma or true skin.
Cyanosis. Blue disease, a con-
gestion of the venous system so that
the blue blood of the veins discolors
the skin.
Cyst. A tumor containing fluid,
or semi-fluid, in a membranous sac.
Cystalgia. Pain in the bladder.
Cystitis. Inflammation orcatarrh
of the bladder; often chronic. The
nurse will have to measure and test
urine, and probably give douches. If
obstinate, perineal incision in the
male, or colpocystotomy in the fe-
male, may have to be performed.
Cystocele. Protrusion of the
bladder.
Cystoscope. An instrument for
examining the bladder; sometimes
lighted by electricity.
25
386 appe
Cystotome. A surgical instrument
used in operations on the lens of the
eye and on the bladder.
Cystotomy. Incision of the blad-
der ; for the removal of stones, or for
drainage. The nurse must watch in
case peritonitis supervenes.
D.
Dead. The laying out of the dead
is the nurse's duty ; the eyes must be
closed by gentle pressure of the
fingers, the jaw must be tied up by
a bandage passing under the chin
and tied on the top of the head. The
body must be washed all over one
hour after death, orifices packed with
cotton-wool, and clean garments put
on (see p. 261).
Debilitants. Remedies which re-
duce excitement.
Debility. Weakness, loss of
power.
Decidua. A spongy membrane
produced in the womb by concep-
tion, and thrown off after parturition.
Decoction. The extract obtained
from any substance by boiling.
Decomposition. Putrefaction.
Decussation. An X-like crossing,
especially of nerves or of nerve-like
filaments.
Defecation. The act of evacuating
the bowels.
Deformity. Abnormal shape or
structure of a body or any of its
parts.
Degeneration. Abnormal changes
in the tissues. Amyloid degeneration
is that of the tissues of blood-vessels,
spleen, liver, etc., which became wax-
like. Fatty degeneration is when the
muscular fibres degenerate into fat,
and thus become incapable of work.
A term used especially of the muscles
of the heart.
Deglutition. Act of swallowing.
Dejections. The fecal or other
excrementitious matters discharged
by the body.
Delirium. Extravagant talking,
raving, generally due to high fever.
The nurse must watch the patient
carefully, as he is as irresponsible for
his deeds as for his words, and may
escape from bed, or even commit sui-
cide. Too often a patient has com-
mitted suicide " in the absence of the
nurse." The nurse should never be
absent, at least without leaving some
one in charge.
Delirium Tremens. Afania-a-
potu. The trembling delirium due to
excessive use of alcoholic liquors.
The patient must be humored and
soothed in every way, and watched
incessantly. Collapse must be ap-
prehended.
Delivery. Parturition; childbirth.
Post-mortem delivery is the birth of a
fetus after the death of the mother,
from an accumulation of gases in the
uterus.
Deltoid. The muscle which forms
the prominence of the shoulder.
Demarcation. A line of separa-
tion, as between healthy and gan-
grenous tissue.
Dementia. Feebleness of the
mental faculties, inconsequent ideas.
Demulcents. Agents which pro-
tect sensitive surfaces from irrita-
tion.
Dentaphone. A little hollow in-
strument placed on the teeth to assist
hearing.
Dentine. The tissue which forms
the body of a tooth.
Dentition. Teething; infants have
20 teeth : 8 incisors in front, 4 canine
between, and 8 molars at the back.
The incisors are cut first, in the
seventh month as a rule; at two
years a41 the teeth should be present.
During teething the gums become
swollen ; the child must be kept from
catching cold ; diarrhea, convulsions,
and rashes must be watched for; the
temperature should be taken every
evening. (See also Teeth.)
Deodorant. A substance that will
remove or correct offensive odors, as
chlorin, chlorid of lime, quicklime,
etc.
Deodorizer. Destroyer of smells;
the chief deodorants are chlorid of
lime, sulphurous acid, nitrous acid,
and iodoform. They are all more
or less disinfectants.
Depilatory. An agent for remov-
ing superfluous hairs from the body.
Depletion. Act of emptying;
bleeding; purging.
GLOSSARY. 387
Depressant. A medicine which
reduces the beatings of the heart.
Depression. A low or depressed
physical or mental condition. In
surgery, displacement inward of the
skull, often giving rise to pressure
on the brain.
Dermatitis. Inflammation of the
skin.
Desquamation. Peeling off of the
skin. After scarlet fever the period
of desquamation is the most infec-
tious, and care must be taken that the
cist skin isnot allowed to blow about.
Desudation. Excessive sweating.
Detergents. Fluids used for
cleansing wounds and ulcers.
Determination. Excessive flow
of blood to a part.
Detritus. The waste of tissue,
worn away by disorganization.
Development. Growth; progres-
sive variation toward mature or per-
fected condition.
Diabetes. A disease marked by
an cxcrssivc flow of saccharine urine.
The treatment almost entirely consists
of attention to diet: sweets, pudding,
pastry, potatoes, and bread have to
be avoided; meat, fish, eggs, butter,
cheese, and green vegetables are
allowed. The nurse will have to
measure and test urine ; the quantity
may be as much as 4 or 5 quarts in 24
hours; the specific gravity may be
as high as 1040; the urine in diabetes
turns Fehling's solution yellowish-
brown. Diabetes insipidus, character-
ized by a greatly increased flow of
urine of a low specific gravity, asso-
ciated with a marked degree of thirst.
The urine is pale, almost colorless,
and with a specific gravity but slightly
above that of water. Many of the
cases progressively emaciate and
finally die of exhaustion. Diabetes
mellitus (see Glycosuria).
Diagnosis. The decision as to the
exact nature of an illness, arrived at
by studying the symptoms.
Diaphoresis. Perspiration.
Diaphoretics. Agents which in-
crease perspiration.
Diaphragm. The muscle separat-
ing the chest from the abdomen.
Diaphysis. The middle part of
long bones.
Diarrhea. Frequent loose evacua-
tions of the bowels. Very weakening.
Diarrhea should immediately be re-
ported to the doctor, and the evac-
uations kept for inspection. It is
especially dangerous in children,
being liable to become chronic.
Whenever diarrhea is present it is
necessary to give great attention to
the diet; see that it is light, easily
digestible, and suitable to the age and
illness of the patient. Milk and lime-
water, and barley-water are alone
allowed in serious cases.
Diastole. The dilatation of the
heart and arteries; opposite to sys-
tole.
Diathesis. Constitutional disposi-
tion to certain diseases.
Dicrotic. An apparent double
beat of the pulse.
Diet. System of food. As a rule,
full diet consists of an ample allow-
ance of meat, bread, vegetables, pud-
dings, etc.; middle diet, of mutton,
fish, bread, milk puddings, and eggs
in moderate quantities; fever, or
"light" diet, of beef-tea, chicken-
broth, and milk; no solids.
Digestion. The process of con-
verting the food eaten into chyme
and chyle, so that it can be absorbed
into the blood.
Digestive. Relating to or favor-
ing digestion. The digestive or gas-
tric juices are the normal secretions
of the glands of the stomach.
Digital. Pertaining to the fingers.
Digitalis. A drug extracted from
the foxglove, and used to stimulate
the action of the heart. It causes
decrease of pulse-rate, and increase
of urine. Poison. Marked intermit-
tence of pulse to be immediately re-
ported.
Dilatation. Increase in size, en-
largement.
Diluents. Medicines supposed to
increase the fluidity of the blood.
Diphtheria. Infectious inflamma-
tion of the throat, with formation of
false membrane, which tends to close
up the throat and cause suffocation.
The earlier symptoms of diphtheria
are like those of a heavy cold; the
temperature does not run very high.
Grayish-white patches appear on the
388 APPENDIX.
tonsils and on the interior of the
throat; this is the false membrane.
The patient should be isolated, and
thorough disinfection of everything
used about the patient carried out.
The nurse must be careful never to
inhale the patient's breath. In severe
cases, where suffocation is imminent,
tracheotomy or intubation may be
performed. Death may be due to
blood-poisoning, sudden heart-fail-
ure (permit no exertion on the part
of the patient), or secondary pneu-
monia, as well as to suffocation.
Diplopia. Seeing double.
Dipsomania. An irresistible mania
for drink, occurring at regular inter-
vals. The nurse-attendant in these
cases has a hard time ; the general
health of the patient must be attended
to, he must never be allowed to get
hungry or thirsty. Strong coffee
and salt-beef tea should be given
frequently.
Director. A grooved surgical in-
strument used to guide another in-
strument.
Disarticulation. Amputation at
a joint.
Discharge. Flowing out; emis-
sion of matter evacuated.
Disinfectants. Agents which de-
stroy disease germs: such as heat,
carbolic acid, sulphur, chlorine,
etc.
Disinfection. (See Fumigation.)
Dislocation. Displacement of a
bone out of its socket. An anesthetic is
not usually necessary for the operation
of reducing a dislocation; all that
will be needed will be two or three
bandages, two or three long towels,
and some powdered starch. After-
ward the patient must be kept quiet.
Compound dislocation, rupture of the
coverings of a joint and communi-
cating with the air. Simple dislocation,
without laceration of surrounding
parts.
Disorder. A slight form of dis-
ease. Functional disorder is an un-
explainable disorder in the working
of an organ.
Dispensing. The mixing and pre-
paring of drugs sometimes falls to
the lot of a nurse; it needs special
training.
Dissection. The cutting up of
dead bodies for the purpose of study.
Dissolution. A term for death.
Distal Aspect. Aspect away from
the centre of the body.
Distention. The state of being
stretched or dilated; inflation.
Distortion. A deformity or mal-
formation, acquired or congenital.
Also, a writhing or twisting motion,
as of the face.
Diuresis. Increased flow of urine.
Diuretics. Medicines which cause
an increased flow of the urine.
Dizziness. (See Vertigo.)
Donovan's Solution. Contains
mercury and arsenic. Give after
meals.
Dorsal. Relating to the back.
Dorsum. The back.
Dose. The quantity of a medicine
which when taken will produce thera-
peutic effect.
Douche. A shower of water. Hot
douche 112° F., cold douche 500 F.
Dover's Powder. A favorite sed-
ative medicine of which the chief in-
gredients are ipecacuanha and opium.
It increases perspiration.
Drachm. Weight of 60 grains, or
in fluid measure 60 minims (about
one teaspoonful).
Drainage - tubes. India-rubber
tubes of different sizes for inserting
in suppurating wounds and sores.
Wrhen not in use, they should be kept
in 1: 40 carbolic solution in glass jars.
When used they are snipped up and
down each side, and a safety-pin or
some long threads of silk are put at
the mouth, to keep the tube from
slipping out of sight into the wound.
Drastic. Strong, severe.
Dressing. The cleansing and ap-
plying of healing remedies to a
wound. A nurse must always have
ready the applications for a dressing
before the appearance of the surgeon
or student who is going to perform it.
Surgical dressings are those applied
in operations (see p. 176).
Dropsy. An unnatural effusion of
watery fluid into the tissues or cavi-
ties of the body. Dropsy has been
said to be a symptom, not a disease,
and it frequently sets in toward the
end in cases of cancer, heart disease,
GLOSSARY.
389
etc. Dropsical patients need the
greatest care in moving them. The
operation most likely to be performed
is aspiration.
Drown. To deprive of life by im-
mersion in a fluid.
Drug. Any chemical substance
(simple or compound) used in the
treatment of disease.
Dry Heat. Heat without moisture.
Duct. A canal or tube ; usually a
passage through which the secretion
of a gland empties. The biliary ducts
are the hepatic, cystic, and com-
munis choledochus ducts of the liver
and gall-bladder. Lactiferous ducts
are the canals of the mammary glands.
Duodenum. The first part of the
small intestine, beginning at the
stomach.
Dura Mater. A strong membrane
lining the interior of the cranium and
spinal column.
Dysentery. Inflammation of the
intestine, accompanied by bloody
evacuations. Absolute rest, attention
to diet, and regular administering of
remedies. Chills must be avoided.
Enemas are frequently ordered. The
motions must be counted and kept
for inspection, The patient is liable
to suffer from weakness and depres-
sion.
Dysmenorrhea. Painful or diffi-
cult menstruation. It may be de-
pendent on anemia, and disappear
with the cure of the latter; or it
may be due to causes which require
surgical interference. If only occa-
sional, hot fomentations to the abdo-
men, hot drinks, and a hot bottle to
the feet and back may give relief.
Dyspepsia. Indigestion: careful
attention to diet. Note the condition
of the tongue and the evacuations.
Be prepared for irritability and mel-
ancholy on the part of the patient.
Dysphagia. Difficulty in swallow-
ing.
Dysphasia. Difficulty in speak-
ing-
Dysphrasia. Loss of power to
speak the words wanted.
Dyspnea. Difficult breathing.
Dystocia. A difticult labor.
Dysuria. Difticult discharge of
the urine.
E.
Eau. Water ; eau-de-vie is ardent
spirit.
Ecchondroma. A tumor on the
cartilage.
Ecchymosis. A bruise ; an effu-
sion of blood under the skin.
Eclampsia. Serious puerperal
convulsions, with rapid motions of
eyes, mouth, and fingers.
Ecraseur. An instrument for re-
moving piles, malignant grow ths, etc.
Eczema. An eruption on the skin ;
not contagious, but very unpleasant,
and causing great irritation. The
local remedies are often left to the
nurse to apply; washing is to be
avoided as a rule, and no soap used.
To remove crusts, soak with oil, or
apply poultices; some dusting-pow-
der will probably be ordered. For the
face, ointment, as a rule, is applied
on a mask of lint. Children's hands
must be gloved or tied to their sides,
to prevent scratching. A chill will
increase the disease in children.
Edema. Swelling of a dropsical
nature ; when the finger is pressed on
the part affected the flesh pits and
does rfOt regain its color and form for
some seconds. In case-taking any
edema should be noted.
Effervescent. A fizzing medicine.
Effleurage. A massage movement,
light and gentle, between stroking
and friction, done with the finger
tips.
Effusion. A flow of fluid into
tissues.
Elaterium. A drastic purge some-
times given in dropsy. May cause
nausea.
Elbow-joint. The articulation of
the arm and forearm.
Electricity. A natural force gen-
erated by chemical action, friction, or
magnetism.
Electrode. The point where an
electric current enters or leaves the
body.
Electuary. A concoction of pow-
ders and syrup, making a sweet medi-
cinal draught.
Elephantiasis. A skin disease,
causing terrible enlargement of the
limb or limbs affected. It is chronic ;
39o
APPENDIX.
the skin thickens until it somewhat
resembles an elephant's hide.
Elevator. A muscle which raises
a limb.
Elixir. A term sometimes applied
to certain tinctures having a sweet
taste.
Emaciation. General thinness of
the body.
Embolism. Coagulation of blood
into an embolus, or clot, and conse-
quent obstruction. There is always
the danger of the clot passing to the
heart in these cases, and causing sud-
den death.
Embrocation. A lotion for rub-
bing on to the body.
Embryo. Term for the fetus be-
fore it has quickened.
Emergency. A sudden, pressing,
and unforeseen occasion for action.
An accident or condition unlooked
for, and calling for prompt decision.
Emesis. Vomiting,
Emetic. Any means used to pro-
duce vomiting, Tickling the throat
with a feather; large draughts of
tepid water, salt water, or mustard
and water, will produce the desired
effect.
Emmenagogue. A medicine which
promotes the flow of the menses.
Emollients. Softening and sooth-
ing applications or liniments.
Emphysema. Swelling produced
by air, as dropsy is caused by liquid.
Empiricism. Treatment founded
on experience only, not on learn-
ing.
Emplastrum. A plaster.
Emprosthotonos. Spasms caus-
ing the body to bend forward.
Empyema. A collection of pus in
one or both of the cavities of the
pleura.
Emulsion. A mixture of oil, such
as cod-liver oil, with water, by aid of
gum, etc.
Enamel. The hard outer coating
of the tooth.
Encephalocele. Protrusion of the
brain through the skull.
Encephalon. The brain.
Encysted. Tumors contained in
a sac or cyst.
Endarteritis. Inflammation of
the lining membrane of the arteries.
Endemic. A disease prevalent in
a particular locality.
Endocarditis. Inflammation of
the lining membrane of the heart.
Often occurs after rheumatism or
renal disease; seldom directly fatal.
Endocardium. The lining mem-
brane of the heart.
Endometrium. The lining mem-
brane of the uterus.
Endothelium. The lining mem-
brane of cavities.
Enema. A rectal injection for
medicinal or nutritive purposes. The
instrument used is commonly a
syringe, a bulb from which go two
tubes; one tube has an ivory mouth-
piece, which is inserted into the anus,
the other is put into the fluid to be
injected. In administering an enema,
cause the patient to lie on the left
side with knees drawn up, have the
basin containing the enemata on a
chair by the bed, oil the mouthpiece
of the syringe, and, standing behind
the patient, insert it gently: pre-
viously the air should have been
squeezed out of the syringe and the
fluid drawn into it. The injecting
should be done slowly and gently.
Plural, enemata (see pp. 59-63).
Enterectomy. Excision of part
of the intestine; a serious opera-
tion.
Enteric Fever. (See Typhoid
Fever.)
Enteritis. Inflammation of the
small intestine. A disease accom-
panied by much pain, and needing
careful nursing. No solid food is
permitted, and absolute rest in the
recumbent position is necessary.
Enterocele. Hernia, consisting of
a protrusion of the intestine.
Enterotomy. Opening the peri-
toneal cavity and raising and opening
the distended bowel. Like all forms
of intestinal surgery, it is serious, and
needs careful nursing.
Entozoa. Parasites living within
the body.
Enuresis. Involuntary discharge
of urine. Give no liquid near bed-
time.
Epidemic. A disease attacking a
number of people in the same place
at one time. Epidemics are usually
GLOSSARY. 391
accounted for by the disease being
either infectious or contagious.
Epidermis. The outermost layer
of the skin.
Epigastrium. The region over
the stomach.
Epiglottis. The thin flaps of car-
tilage which guard the entrance to
the glottis or windpipe.
Epilepsy. A disease of the brain
marked by the occurrence of con-
vulsive fits. Perseverance in treat-
ment is the chief hope of cure, hence
it behooves nurses or attendants to
be very patient and careful. A
slight fit is called petit mat, a severe
fit grand or haul mat. The fits are
often brought on by excitement or
any slight ill-health, lack of attention
to the bowels, for instance. The
nurse must note if the fit commences
with a cry, where the convulsions
begin, and how they spread, if the
thumb is flexed, and how long the fits
last. There is nothing to be done
for the patient but to put him flat on
the floor, unloose tight clothing, put
a cork or pencil between the teeth to
prevent the tongue being bitten, and
otherwise prevent him from injuring
himself.
Epiphysis. A process of bone at-
tached by cartilage to the ends of
bones, and from which growth takes
place.
Epiploon. The omentum, a mem-
branous expansion which floats upon
the intestines.
Episiotomy. Incision of labia in
difficult parturition.
Epispastics. Agents applied to
the skin to produce discharge, such
as blisters or vesicatories.
Epistaxis. Bleeding from the
nose, apt to become serious in debili-
tated or anemic persons. Applica-
tions of ice-bags to the back of the
neck and to the forehead, or plug the
nose with lint dipped in vinegar or
lemon-juice.
Epithelial Casts. Filaments of
renal epithelium found in the urine
in certain diseases, when examined
under the microscope. They are
chiefly polygonal, are finely granular,
and have large nuclei. If in consid-
erable quantity, they signify nephritis
or some other disease of the kid-
neys.
Epithelium. The outermost
bloodless layer of the mucous mem-
brane ; corresponding with the epi-
dermis of the skin.
Ergot. A drug derived from a
fungus which grows on rye ; it is used
especially in labor cases to contract
the uterus and arrest hemorrhage. It
prolongs the length and force of pains
in a paturient uterus.
Ergotin. A form of ergot specially
used hypodermatically to arrest
bleeding.
Erosion. Ulceration of parts.
Eructation. Flatulency, with ex-
tension.
Eruption. A breaking out on the
skin.
Erysipelas. Contagious inflam-
mation of the skin, tending to spread,
accompanied by fever and pain in
the part affected. It is necessary for
a surgical nurse to keep watch for
erysipelas, though, in these days of
antiseptic surgery, it seldom ap-
pears. The symptoms are redness
round the edges of the wound, vom-
iting, rigors, and a rise of tempera-
ture—all this must immediately be
reported to the surgeon. The pa-
tient and nurse are isolated and great
care must be taken to disinfect all ar-
ticles used. The period of incubation
for erysipelas is from three to seven
days; on the second or third day
after rigor, a diffuse red rash with
swelling appears. Constitutional ery-
sipelas of the head and face is not
uncommon. Erysipelas contagion
produces puerperal fever in parturient
women.
Erythema. Non-contagious cir-
cumscribed inflammation of the skin.
If acute, often followed by rheumatic
fever.
Eschar. A dry healing scab on a
wound; generally the result of the
use of caustic. Also the mortified
part in dry gangrene.
Esophagus. The canal which runs
from the throat into the stomach.
Essences. Strong solutions of one
part volatile oil in four of rectified
spirits. Usually given in a few drops
on sugar.
392
APPENDIX.
Ether. A volatile liquid much
used as an anesthetic. It must never
be used near an uncovered light, as
it is very inflammable. Spirits of
nitrous ether are diuretic and carmin-
ative.
Etherization. Anesthesia or un-
consciousness produced by the in-
halation of the vapor of ether.
Ethmoid. A bone of the nose,
through which the olfactory nerve
passes.
Etiology. The science of the
causation of disease.
Eucalyptus. An antiseptic much
used in catarrhal affections ; it is used
as an inhalation in phthisis. It is a
colorless, oily liquid, with a pungent,
resinous smell.
Eustachian Tube. The canal from
the throat to the ear.
Eustachian Valve. A fold in the
membrane of the right auricle of the
heart.
Evacuation. Discharge of excre-
ment from the body. (See Move-
ments.)
Eventration. Protrusion of the
intestines.
Eversion. Folding outward.
Exacerbation. A return of fever;
a paroxysm of disease.
Exanthemata. Diseases accom-
panied by eruptions or rashes.
Excision. Act of cutting away.
Excoriation. Abrasion of the skin.
Excrescence. An unnatural pro-
truding growth.
Excreta. The urine and feces.
Excretion. The throwing off of
waste matter.
Exfoliation. Scaling off of a dead
bone or tissue in thin flakes.
Exhaustion. Great loss of vital
and nervous power from fatigue or
protracted disease.
Exostosis. A bony tumor grow-
ing from bone.
Expectant. Treatment which re-
moves obstacles and then watches the
course of events without using medi-
cinal remedies.
Expectoration. Secretions from
chest coughed up. The nurse must
note the quantity and character of
the expectoration. In pneumonia it
is viscid, tenacious, sticks to the sides I
of the sputum-cup, and is of rusty ap-
pearance, or may even be of a prune-
color ; in bronchitis the expectora-
tion is frothy, abundant, and often
streaked with black, and of a green-
ish-yellow color, from the presence
of pus ; in consumption the expectora-
tion varies from a small quantity of
frothy fluid to abundant greenish-
yellow offensive phlegm or sputum,
often streaked with blood.
Expression. The recognizable
manifestation through the facial line-
aments or the voice of any subjective
feeling.
Expulsion. The act of driving out.
Extension. A certain pull or
weight applied to a fractured or dis-
located limb to keep it straight.
Extensor. A muscle which ex-
tends a part.
Extirpate. To completely re-
move.
Extracts. Medicinal preparations
made by extracting the ingredients
of vegetable substances, An extract
is a solid preparation ; a fluid extract
i is a liquid preparation.
Extra-uterine Gestation. Preg-
! nancy outside the uterus ; in the ab-
dominal cavity, for instance.
Extravasation. Escape of fluid
from its proper channel into sur-
rounding tissue.
Extremities. The limbs; the ter-
minal end of an organ.
Exudation. Oozing ; slow escape
of liquid.
Eyeball. The globe of the eye.
Eyes. The organs of vision or
sight.
Eye-teeth. The canine teeth (see
Teeth).
F.
Facial. Relating to the face.
Fahrenheit. The scale of most
thermometers used in America; the
freezing point is 320, the normal heat
of the human body 98.40, the boiling
point 2120 (see Thermometer).
Faint. A short swoon. Lay the
patient flat, and let him have plenty
of fresh air. Consciousness will soon
return. Patients are very liable to
faint the first time they are allowed up
GLOSSARY. 393
after a long illness, unless the nurse
is careful strictly to limit the exertion
allowed.
Faintness. (See Syncope.)
Fallopian Tubes. Two trumpet-
like canals, about 3 inches long,
passing from the womb to the ovaries.
Faradism. Electricity generated
by induction.
Farinaceous. Containing flour or
grain. Farinaceous diet consists of
puddings, gruel, bread, etc.; no meat.
Fascia. The membrane which en-
closes the muscles.
Fauces. The throat, the back of
the mouth.
Favus. A contagious cutaneous
disease, most common on the scalp.
It is marked by a honeycombed
scab. The nurse must be careful
about disinfection.
Febrifuge. An agent for allaying
fever.
Febrile. Relating to fever.
Fecal. Relating to the feces.
Feces. The refuse material ex-
pelled from the bowels by the anus.
Fecundation. Impregnation.
Feeble. Lacking strength ; weak.
Feeding. Artificial feeding is the
introduction of food into the body
by artificial means, such as the stom-
ach-pump, or in the form of an
enema. Also, the nourishing of a
child by food other than the mother's
milk.
Felon. Whitlow.
Femoral Artery. The artery of
the upper leg, from the thigh to the
knee.
Femur. The thigh-bone.
Fenestrum. An aperture or fora-
men, as in certain bones.
Ferrum. Iron. The most import-
ant of tonics ; to be given after food,
because if given on an empty stomach
it decomposes the digestive fluid.
Fester. Inflammation, with col-
lection of pus.
Fetal Movements. The muscular
movements of the fetus /'// utero.
Fetid. Offensive smelling.
Fetor. Strong unpleasant smell.
Fetus. An unborn child, espe
daily from the fourth month.
Fever. Disease marked by heat
of the body, quick pulse, lassitude,
and often delirium. The nursing
treatment of every fever is rest, free-
dom from chills, and light nourishing
diet.
Fibre. Thread-like structure. Mo-
tor fibres are centrifugal nerve-fibres
exciting contraction of the muscles.
Sensory nerve-fibres, centripetal fibres
conveying sensory impulses to the
brain.
Fibrin. Albumin of the blood,
which solidifies when exposed to the
air and causes coagulation.
Fibula. The small bone on the
outer side of the lower leg.
Fimbriae. The fringe-like pro-
cesses of the outer extremity of the
oviduct.
First Intention. A surgical term
for healing of a wound by bringing
the edges directly together, so that
they unite without the necessity of
new granulations to fill in spaces.
Fissure. A term applied to va-
rious grooves of the body.
Fistula. Any unnatural passage
by which an internal organ or pus-
sac communicates with another or
with the external air.
Fit. A sudden convulsive attack.
The nurse must prevent the patient
from injuring himself, and loosen
any tight clothing. She must note
where the spasms commence, how
they spread, and how long the fit
lasts.
Flabby. Deficient in firmness.
Flatulence. Wind or gas in the
intestines; sometimes causing severe
pain, but as a rule, merely discom-
fort.
Flexion. Being bent; the oppo-
site to extension.
Flexor. A muscle which causes
flexion.
Floccillatlon. Carphology. Pick-
ing the bed-clothes: a grave symp-
tom in acute diseases.
Flooding. Excessive bleeding
from the uterus during parturition.
(See Post-partum.)
Flow. (See Menstruation.)
Fluor Albus. White discharge
from the vagina or uterus.
Flush. A temporary redness, as
the hectic flush.
Flux. A flow of liquid.
394 APPENDIX.
Follicle. A minute bag contain-
ing some secretion. (See Graafian.)
Fomentation. Flannel wrung
out in some hot fluid and applied
for the alleviation of pain. The
flannel should be put in a basin and
boiling water poured over it, then
lift it quickly into the centre of a
towel; catch the towel with one end
in each hand, twist opposite ways till
the flannel is well wrung out, apply
as hot as can be borne, and cover
with a dry flannel bandage. For a
turpentine fomentation, sprinkle 20 to
30 drops of turpentine on the flannel
immediately before application; for
an opium fomentation, sprinkle 15 to
20 drops of laudanum on in the same
way. Fomentations need frequent
changing, every hour or oftener.
Fontanelle. A soft space in the
skull bone of an infant before the
skull has hardened.
Foramen. A hole; an opening
into the body. For instance, the
foramen ovale, which separates the
left and right auricles in the fetus.
Forceps. Surgical pincers used
for lifting and moving instead of
using the fingers. Dressing forceps
are shaped like scissors, with blunt,
flat points; dissecting forceps are
shaped like sugar-tongs. Every nurse
should carry forceps, and use them ;
they need to be kept clean, and to
be disinfected always before and
after use. Obstetric forceps are of
different sizes and shapes, and are
used for grasping the head of the
fetus in difficult labor; there are also
many other kinds of forceps.
Forearm. That part of the arm
between the wrist and the elbow.
Forehead. That part of the face
between the orbits of the eyes, the
hair above, and the temples.
Formula. A prescription.
Fossa. Little depressions of the
body, such as fossa lacrymalis, the
hollow of the frontal bone, which
holds the lachrymal gland.
Fourchette. The commissure join-
ing the labia majora of the puden-
dum posteriorly.
Fracture. A broken bone : symp-
toms—crepitus, limb shortened and
helpless, pain. Keep the limb at
rest in a natural position between
sand-bags. For setting a fracture,
an anesthetic is usually given. Per-
fect rest is the only cure, and the
nurse must see that it is carried out.
Colles fracture, a fracture of the
wrist; comminuted fracture, when the
bone is splintered ; complicated frac-
ture, some injury is added to the
fracture : thus fractured rihs may be
complicated by injury to the lungs;
compound fracture, a fracture with an
open wound from the skin to the
broken bone ; green-stick, one side
of the bone being broken, the other
bent; impacted, the end of one frag-
ment being firmly driven into the
tissue of the other; simple, one in
which the seat of fracture does not
communicate with the air.
Friction. Medical rubbing or
shampooing. Should always be done
from the extremities toward the heart.
Frontal. Relating to the fore-
head.
Frost-bite. Injury to the skin or
a part of the body from extreme
cold.
Fuller's Earth. Chiefly consists
of silica, alumina, and oxid of iron.
Very absorbent.
Fumigation. The private nurse has
often to fumigate, or expose to disin-
fecting vapors, a room in which an in-
fectious case has been nursed. When
the room is vacated a fire should be
lighted in the fireplace, and all papers,
old linen, old clothes, and other objects
of small value, burnt there, if they
have been contaminated. The chim-
ney, windows, and other openings
should then be shut, and in the mid-
dle of the room containing the furni-
ture and bedding a pan with some
live coals should be placed. On the
coals should be put a layer of sand,
and on that a quantity of sulphur
(broken into pieces), proportionate to
the size of the room, 1 lb. to 1000
cubic ft. The door should then be
shut. After being hermetically closed
and exposed to the sulphur fumes for
twenty-four hours, the room should
be fully aired by opening the win-
dows, and must not be again occu-
pied for at least a week after being
disinfected (see p. 234).
GLOSSARY.
395
Function. The special work of an
organ.
Fundament. The anus.
Fundus. The base of an organ,
usually applied to the uterus.
Fungus. A microscopic, parasitic,
vegetable growth.
Funis. The umbilical cord.
Fur. An unnatural coating of the
tongue, common in fevers.
Furunculus. A little boil con-
taining a central core.
G.
Galactia. Disorder of the milk-
secretion.
Galactorrhea. Excess of milk.
Gall. A bitter secretion found in
the gall-bladder.
Gall-bladder. The membranous
sac which holds the bile.
Gall-ducts. Ducts conveying the
bile.
GaU-stone. Calculus in the gall-
bladder. If the stone passes into the
duct and thence to the duodenum,
there is great pain. Local applica-
tion of heat and injections of morphia
are usual. Diet important.
Gallic Acid. An astringent; used
to control bleeding and lessen the.
night-sweats of phthisis.
Galvanism. Electricity generated
by means of a battery of cells with
carbon and zinc plates in acid solu-
tion. Practically the application of
continuous currents as distinct from
alternate currents.
Ganglion. An enlargement of a
nerve forming a semi-independent
nerve-centre. Also swelling of the
sheath of a tendon.
Gangrene. Death of a part. It
begins with discoloration of one of
the extremities, generally the toes,
and gradually becomes mortification.
The hardening of the arteries and
consequent defective circulation of a
part in old people sometimes brings
on a form of dry gangrene called
" senile gangrene." Moist gangrene
is a form with abundant serous exu-
dation and rapid decomposition. The
nurse's dutv is strict cleanliness ; the
only cure is amputation. Fresh air
and nourishing food are necessary.
Raise the limb. Keep the part warm
by the aid of hot-water bottles.
Gargle. A liquid medicine for
washing out the throat.
Garrot. An improvised tourni-
quet, consisting of a handkerchief, a
stone, and a stick.
Gastralgia. Unpleasant burning
feeling or acute pain in the stomach
due to indigestion.
Gastric. Relating to the stom-
ach.
Gastric Fever. Fever accompa-
nied by catarrh of the stomach, and
bearing a close relationship to enteric
fever, and needing the same care in
nursing and in diet.
Gastric Juice. The digestive fluid
of the stomach.
Gastritis. Inflammation of the
stomach.
Gastrohysterotomy. Opening into
the uterus through the abdomen.
Porro-Cesarean operation.
Gastrostomy. Making an artificial
mouth into the stomach.
Gauze. Fine tarlatan used as a
surgical dressing, and generally im-
pregnated with some antiseptic. Car-
bolic gauze, unbleached tarlatan im-
pregnated with carbolic acid, resin,
and paraffin; usually prepared in
lengths of 6 yds. by I yd. and used
in antiseptic dressings. Should be
kept in a tightly-closed tin box.
GavageT Forced feeding.
Gelsemium. A nerve-soothing
drug prescribed in tetanus, mania,
and nervous affections. Contracts
the pupil. Watch for frontal head-
ache or double vision. Poison.
Generation. Production of human
beings.
Genitalia. The outer generative
organs, or privates.
Gentian. A useful drug, very
bitter, acts as a stomachic tonic.
Genu Valgum. Knock-knee.
Germ. A microbe or bacterium.
Gestation. The period of carry-
ing the young in the womb.
Giddiness. A sensation of un-
steadiness of the body, usually ac-
companied with more or less nausea.
(See Vertigo.)
Ginger. Carminative and stimu-
lant.
396
APPENDIX.
Gingivitis. Inflammation of the
gums.
Glanders. A febrile disease with
inflammation of the nasal cavities,
communicable to man from the horse,
ass, and mule. Often fatal.
Glands. Small bodies occurring
in different parts of the body and
having the power of secretion. Con-
catenate glands of the neck, Cowper s
glands of the prostate, Brunner's
glands of the duodenum, etc. Cow-
per s glands are two small glands like
peas above the bulb of the urethra ;
Lachrymal glands are those which
secrete the tears; Salivary glands
are three glands at the back of the
lower jaw.
Glans. Bulbous extremity of the
penis and clitoris.
Glauber's Salt. Sulphate of soda,
a purge.
Glenoid. A cavity ; a term applied
to the socket of the shoulder-joint
and similar parts.
Globule. A very little pill.
Globulin. An albuminous con-
stituent of the blood-corpuscles.
Globus Hystericus. Hysterical
choking feeling, as of a ball in the
throat.
Glonoin. Nitroglycerin; used as
a drug to accelerate the heart's
action in angina pectoris, shock, etc.
Glossitis. Inflammation of the
tongue.
Glottis. The opening into the
windpipe.
Glycerin. A sweet, colorless
liquid, obtained from oils and fats.
Used as an emollient ointment.
Also in enemata as an aperient; one
teaspoonful is injected from a special
piston-syringe.
Glycosuria. Grape-sugar or glu-
cose in the urine, a symptom in dia-
betes. Sometimes a transitory state
only.
Gnathic. Relating to the jaw or
cheek.
Goiter. Enlargement of the thy-
roid gland of the throat, common in
Switzerland, where it is often associ-
ated with cretinism.
Gonorrhea. Inflammation of the
genitals and flow of pus. Contagious:
the nurse must be very careful to
burn all soiled dressings, and always to
use forceps. If the patient is a fe-
male, frequent baths and hot douches
of warm water may be ordered. In-
flammation of the external genitals
must be watched for.
Gorget. A blunt grooved instru-
ment used in operations in stone.
Gouge. A grooved instrument of
steel or bone used to scoop out dead
bone.
Gout. A disease marked by at-
tacks of acute pain and swelling of
the joints, usually of the big toe or
the thumb. Chalky concretions form
about the joints in time. The nurse
has to attend to the local applications
(often tincture of opium, iodid of
potassium, or carbonate of lithia, ap-
plied on charpie and covered with
oil-silk); she has also to see to the
diet, for dyspepsia generally accom-
panies gout. Hot baths followed
by passive manipulation may be
ordered. The urine must be meas-
ured and tested, the presence of
lithates being specially watched for.
Graafian Follicles. Small vesicles
found near the surface of the ovary.
Grafting. Snipping minute por-
tions of the skin from a healthy part
and planting them on some sore or
wound where there is no skin, that
they may grow there and help the
wound to heal over.
Gramme. Unit of metric weight,
15.5 grains.
Granulation. The process by
which tiny granules of flesh form on
the face of a wound during its heal-
ing. This is healing by second inten-
tion (q. v.).
Granule. Small particle or grain.
Grape-sugar. Glucose.
Gravel. A popular term for stone
of the bladder and other calculi.
Gravid. Term applied to the
womb during gestation.
Gray Matter. The gray substance
of the brain.
Groin. Back of the thigh.
Gruel. Hot drink for invalids.
Guaiacum. A drug used as an
alterative.
Gurgling. Sound of bubbling
heard in a lung cavity by means of
the stethoscope.
GLOSSARY.
397
Gutta. A drop or minim.
Gynecologist. A physician who
is a specialist in the treatment of dis-
eases peculiar to women.
Gynecology. The study of the
diseases special to women.
Habit. That condition or quality
one naturally possesses or acquires.
Hair. The hirsute appendage of
tin- skin. Each hair consists of a
bulb and a shaft.
Hair-follicle. Little pit in the
skin in which the root of the hair is
fixed.
Hallucinations. Imaginary ap-
pearances, the fault of disease of the
brain.
Hamamelis. Witch-hazel, pre-
scribed for piles, diarrhea, and bleed-
ing from various parts.
Harelip. A congenital slit in the
upper lip, sometimes double, and
then consisting of two slits. The
child is generally operated on very
young, and the slit strapped up by
specially cut strapping. It is most
necessary to prevent the child crying,
and to feed it with great care, or the
slit may open again. Hare-lip is fre-
quently associated with cleft palate
(which see).
Hartshorn. Ammonia; ordinary
smelling-salts is a carbonate of am-
monia, and in that form is generally
called "hartshorn." Poison.
Haversian Canals. The minute
canals which permeate bone.
Hay Fever. Attacks of parox-
ysmal sneezing supposed to be caused
by the pollen of plants irritating the
nose ; it occurs late in the summer.
Inhalations of ipdids and antiseptics
is the usual local treatment. A
respirator may be worn with advan-
tage. Sea-bathing and tonics maybe
ordered.
Headache. Pain in the head,
especial in the frontal region. Sick
and bilious headaches are due to dis-
orders of the digestive system ; head-
aches at the vertex, to cerebral
troubles; and occipital headache to
anemia.
Healing. (See Union.)
Heart. The muscular organ which
pumps the blood through the system.
The heart is situated behind the
breast-bone in front of the chest with
the apex, or small end, pointing
rather to the left under the left
breast. If the ear be placed over a
healthy heart, a sound like that of
gentle breathing is heard occurring
with the rise of the heart; this is im-
mediately followed by a short sharp
sound as the heart falls back ; a short
pause follows, then the first long
sound again. A nurse should know
the natural sounds, so as to recognize
any deviation from them. In heart
disease the patient generally turns
blue, there is an anxious expression
of the face, and the least exertion
causes panting. All heart cases need
the most incessant care and unbroken
quiet, as the slightest movement or
excitement may be fatal.
Heartburn. Uneasiness and burn-
ing in the stomach and cardiac region
in indigestion; a gnawing sensa-
tion.
Heart-failure. Failure of the heart
to act.
Heat. Body-heat indicates a tem-
perature of above 98.6° F.
Hectic. The sudden feverish
flushes of consumption and other
protracted wasting diseases. The
fever is not always present, usually
coming on at night, when the patient
is bathed in perspiration and is very
weak. By careful changing of linen,
gentle sponging, and arrangement of
bed, much can be done by the nurse
to ease the distress of the patient.
Heel-bone. The largest bone of
the foot, the calcaneum.
Hellebore. A poisonous drug,
used as a depressant. Antidote for
overdose, stimulants.
Hematemesis. Vomiting blood
from the stomach. Dark-colored and
often in clots. Recumbent position,
ice to suck, notice the color of stools.
Hematin. The coloring matter of
the red blood-corpuscles.
Hematocele. A tumor containing
extravasated blood.
Hematoma. A blood-tumor.
Hematosalpinx. Distention of
the Fallopian tube with blood.
INDIX.
398 APPE
Hematoxylon. Logwood ; a dis-
infectant, chiefly used for sores.
Hematuria. Blood in the urine ;
may be a sign of malignant disease
of the kidney. Urine looks smoky or
claret-colored. Rest; ice-bags to the
back. Astringents will probably be
given internally.
Hemicrania. Headache on one
side of the head only.
Hemiplegia. Paralysis of one side
of the body. Watch for constipa-
tion.
Hemispheres. The two sides of
the brain.
Hemoglobin. Principal constitu-
ent of red blood-corpuscles.
Hemoptysis. Coughing up blood
from the lungs. Frothy, and of a
bright red color. Rest, no talking,
ice to suck. All food must be cold,
no stimulants. Watch the tempera-
ture and pulse.
Hemorrhage. A flow of blood.
Hemorrhoids. Piles, small tumors
about the anus. Usually the result
of constipation or pregnancy. Regu-
larity of the bowels must be secured.
Bleeding piles may necessitate injec-
tions of iced water or mild astrin-
gents.
Hemostatic. An agent to arrest
a flow of blood.
Hepatic. Relating to the liver.
Hepatica. Medicines acting on
the liver.
Hepatitis. Inflammation of the
liver.
Hereditary. Transmitted from
one's parents.
Hermaphrodite. One whose gen-
erative organs are neither entirely
male nor female.
Hernia. Commonly called •' rup-
ture;" protrusion of any of the inter-
nal organs through the surrounding
tissues, most common in the case of
the bowels. Inguinal hernia is
through both abdominal rings; direct
through the external ring, and
oblique through the internal ring.
Strangulated, so tightly constricted
that gangrene results if operation
does not relieve. Scrotal is descend-
ing into the scrotum, and umbilical is
hernia at the navel. Taxis is the
usual means of returning the pro-
truded part if possible, and a truss is
then worn to prevent the rupture oc-
curring again. A rupture not amen-
able to taxis is termed irreducible.
Herniotomy. Dividing the con-
stricting band of a strangulated
hernia and returning the protruding
part. The patient, after the opera-
tion, must be kept recumbent; no
food must be given save the light diet
ordered.
Heroic. Severe treatment of the
kill-or-cure type.
Herpes. Acute inflammation of
the skin, with eruption. Herpes zoster
shows in rings of vesicles around the
body, and is usually called " shin-
gles"; circinatus, chiefly about the
head, is called "ring-worm." Local
treatment consists of protection from
irritation, a dusting-powder, or a
mild astringent lotion.
Hiccough. A short, noisy, invol-
untary inspiration, caused by a spas-
modic contraction of the diaphragm
followed by a sudden closure of the
glottis. A grave symptom when occur-
ring in a serious case of illness.
Hip-joint Disease. Inflammation
of the hip-joint, most common in
children, and extremely painful. The
child is usually put in splints, and
extension applied to prevent the
painful jerking of the inflamed joint.
The nurse's duty is to avoid any jar-
ring or movement of the patient,
to keep the bed fresh and sweet, and
the general health good, and to be
very careful in lifting the patient, and
to move slowly and gently. Abscesses
often accompany hip-joint disease.
Hirsute. Hairy.
Histology. Science of the minute
tissues of the body.
Homeopathy. Medicine worked
on the system of like cures like.
Started by Hahnemann. Homeo-
pathic medicines are mostly given in
infinitesimal doses.
Hot-water Bag. A rubber bag in
which hot water of any degree can
be introduced for topical application.
Hot-water bottle is substantially the
same as the above, the difference
being merely in shape.
Humerus. The bone of the upper
arm.
GLOSSARY.
399
Humor. Any fluid of the body
other than the blood.
Hydragogue. A medicrhe which
helps the discharge of water from the
system.
Hydrargyria. A sort of eczema
caused by taking mercury.
Hydrarthrosis. Accumulation of
fluid in a joint, most common in the
knee; white swelling.
Hydrastis. A drug procured from
the plant of Golden Seal, and used as
a stomachic tonic, and as a local ap-
plication for sores and ulcers.
Hydremia. Excess of water in
the blood.
Hydrocele. Watery tumor in the
scrotum. In infants, acupuncture
may be performed; in adults, the
treatment is usually injection, with
a stimulating fluid, or excision.
Hydrocephalus. Water on the
brain; a disease, most common in
children, that causes the head to
swell to an enormous size. The vic-
tim is usually idiotic.
Hydrocyanic Acid. A local seda-
tive, allays irritation. Also anti-
spasmodic. Poison. (See Prussic
Acid.
Hydroma. Watery swelling of a
limb; a watery tumor.
Hydrometra. Accumulation of
water in the womb.
Hydropathic. Relating to cure
by means of water; by baths; and
by the absence of alcohol as a
drink.
Hydrophobia. Madness of an
acute form, contracted by the bite
of a rabid dog. Tranquillity is of
the greatest importance, and the
nurse may do much to secure this
and allay the terrible fears of the
patient. Keep the room dark and
quiet. The saliva of a hydrophobic
patient is supposed to be capable of
conveying infection, so a nurse must
be careful on this point.
Hydrotherapeutics. The water-
cure from a scientific standpoint.
Hydrothorax. Fluid in the cavity
of the chest.
Hygiene. The science of the pre-
servation of health by means of at-
tention to sanitary surroundings and
habits.
Hymen. A fold of membrane at
the entrance to the vagina.
Hyoid. The name of a bone shaped
like a V, at the root of the tongue.
Hyoscyamus. Henbane, a poi-
sonous antispasmodic and narcotic.
Enlarges the pupil of the eye. Anti-
dotes, emetic of sulphate of zinc, am-
monia, and stimulants.
Hyperemia. Excess of blood in
a part.
Hyperesthesia. Excess of feeling
in a part.
Hyperidrosis. Excess of per-
spiration.
Hyperinosis. Excess of fibrin in
the blood.
Hyperplasia. Excessive growth
of tissue.
Hyperpyrexia. Excess of fever,
shown by a very high temperature.
Cold baths (temperature 650) or cold
packs with ice-water are often used
to reduce the temperature; quinin,
salicylic acid, and other drugs are
sometimes given to reduce the tem-
perature. (See Pack.)
Hypertrophy. Excessive growth
of a part; it is called false when
caused by a deposit within the part
and not by the general growth.
Counter-irritants and stimulants, such
as iodin, are sometimes applied lo-
cally.
Hypnone. A colorless, pungent
fluid, used rarely as a soporific.
Hypnotic. Agent for causing sleep.
Hypnotism. State of unconscious-
ness caused by straining the eyes to
look at some bright object; a form
of mesmerism.
Hypochondriasis. Slight melan-
cholia. The chief symptom is mental
distress about the health, and delu-
sions that the patient is the victim of
many diseases. The attention should
be distracted as much as possible.
Hypodermatic. Under the skin ;
a term applied to injections given
under the skin by means of a hypo-
dermic syringe. The injection is
usually given in the fleshy part of
the chest, thigh, abdomen, or arm.
This syringe is marked in minims
or drops, and fitted with a fine
hollow needle. In giving an injec-
tion pinch up a piece of the skin with
400 APPENDIX.
the left hand; hold the syringe be-
tween the thumb and middle finger
of the right hand, with the first finger
on the piston. Run the needle into
and under the piece of pinched-up
skin ; slowly and steadily press down
the piston ; withdraw the needle
gently and press a finger on the
puncture for a moment to prevent
the return of the fluid. The syringe
must be kept perfectly clean ; a bristle
kept in the needle will keep it from
getting clogged with dust, etc. All
drugs used as hypodermatics are
highly concentrated, and many of
them, such as morphia, atropia, etc.,
are poisonous. One-fourth of a grain
of morphia is the hypodermatic most
commonly ordered.
Hypogastric. Term applied to
the region of the abdomen just be-
low the umbilicus.
Hypoglossal. The controlling
nerve of the tongue, situated under
it toward the back.
Hysteralgia. Pain in the womb.
Hysterectomy. Complete or par-
tial removal of the womb, either
through the abdomen or the vagina.
Hysteria. A nervous disease
marked by convulsive seizures, and
very often by dislike to food, painful
impressions, and untruthfulness. The
nursing of these cases is very trying,
and can only be successfully carried
on if the patient is removed from her
usual surroundings, and her family
kept at a distance. Infinite patience,
and persistent cheerfulness mingled
with a certain amount of sympathy,
may work wonders. A good nurse
will soon persuade a patient who has
fasted for months to take food natu-
rally again. Terrible weakness and
even paralysis are brought on by
hysteria.
Hysterics. A term vulgarly ap-
plied to screaming and crying fits in
women, who cannot or will not con-
trol their emotions.
Hysterocele. Hernia of the womb.
Hysteroscope. Mirror for reflect-
ing light in examining a wound.
Hysterotomy. Cesarean section,
opening into the womb. The in-
strument used is called a " hystero-
tome."
I.
Ice-bag. A bag of waterproof
material filled with ice for applica-
tion to any part of the body.
Ichor. The thin colorless discharge
from ulcers and other sores.
Icterus. Jaundice : a yellow dis-
coloration of the skin, caused by
absorption of bile into the blood.
Idiocy. Mental weakness, which
dates from birth ; feeble-mindedness.
Few know how much can be done
with idiot children by patience. The
kindergarten method of teaching
them is admirable. Physical train-
ing forms an important part of the
treatment. A nurse who can secure
the touching devotion of an idiot
child will be able to cure him of all
dirty habits, and even train his mental
faculties to a varying degree. An
idiot child should be placed in a
home.
Idiopathic. A morbid condition
arising primarily, and not following
on any disease or accident.
Idiosyncrasy. An individual pe-
culiarity in regard to the action of
certain drugs, their action and effect
being entirely different to what is
expected.
Ileo-cecal Valve. Valve at the
junction of the large and small in-
testine.
Ileum. The lower portion of the
small intestine.
Iliac Arteries. There are five
iliac arteries: i. Circumflex, arising
from the external iliac; 2. common,
the continuation of the abdominal
aorta, dividing into (3) the external,
and (4) the internal iliac. The bifur-
cation is about at the last lumbar
vertebra. The external iliac becomes
the femoral after passing under Pou-
part's ligament. The branches of
the internal iliac supply nearly all the
pelvic organs.
Iliac Region. The region con-
taining the cecum, vermiform appen-
dix, and some coils of the small
intestine.
Hium. The shaft of the haunch-
bone.
Illusion. A deceptive appear-
ance.
GLOSSARY.
401
Dnmunity. Exemption from dis-
ease by vaccination or by some analo-
gous procedure, or by previous ill-
ness.
Impaction. State of being wedged
in.
Impetigo. A skin rash of an
acute kind, chiefly seen in weakly
women and children. Nutritive diet,
and locally zinc ointment, will proba-
bly be ordered.
Implicated. Applied to fevers
when two attack a patient at the same
time.
Impregnation. Act of rendering
pregnant.
Improvise. To do or to perform
anything on the spur of the moment
for a special occasion; to contrive.
Impulse of the Heart. Sensation
of a stroke felt on placing the hand
on the heart, occurring as the ventri-
cles contract.
Inanition. Exhaustion from want
of food.
Incarcerated. Applied to a hernia
which cannot be reduced.
Incision. Act of cutting into with
a sharp instrument.
Incisors. The eight front teeth.
Incompressible. A full pulse, the
beat of which cannot be arrested by
pressure.
Incontinence. Inability to retain
the evacuations of the bladder or of
the bowels. Incontinence of urine is
often a disease of childhood. Much
depends on the patience and firmness
of the nurse in training in good
habits. (See Enuresis.)
Incubation. The period between
the time when a disease is contracted
and the time when the illness be-
gins.
Incubator. A sort of glass-cov-
ered box warmed by hot-water cans,
in which premature infants, born at
the sixth or seventh month, are kept.
The child is swathed in cotton, and
never taken out of the box except to
change the diaper. Great care is
necessary to keep the box at the
ordered temperature.
Incus. A small anvil-shaped bone
of the inner ear.
Indigestion. Failure of the di-
gestive powers; generally accom-
26
| panied by morbid appetite and mental
irritation.
Indolent. A term applied to a
painless sore which is slow to heal;
Induration. The process of hard-
ening.
Inertia. Sluggishness; applied to
the womb when it will not contract.
Infant. A new-born child ; a male
should weigh at birth 7% lbs., a
female 7 lbs.; it should increase 6 to
7 ounces in weight weekly.
Infection. The communication of
a disease through the atmosphere. It
is particularly the nurse's duty in in-
fectious cases to prevent the spread
of the disease to others by thorough
disinfection.
Inferior Vena Cava. The chief
vein of the lower part of the trunk of
the body.
Infiltration. An effusion of fluid
into the connective tissue.
Inflammation. A diseased state
marked by heat, redness, swelling,
and fever; it passes on to congestion
of the parts, and possibly to suppura-
tion or mortification. Thus inflam-
mation of the lungs may become
congestion ; the congested parts may
dry up and die, and cavities are
formed, and phthisis may set in. The
Greek term for inflammation is
" itis "; hence we get glossitis, inflam-
mation of the tongue; peritonitis,
inflammation of the peritoneum ; and
so on.
Inflation. Blown out or expanded
by air or gas.
Influenza. Epidemic catarrhal
fever.
Infundibulum. A term applied to
several funnel-shaped organs of the
body.
Infusum. An infusion : prepared
by pouring boiling water on a drug,
letting it stand and then straining.
Ingesta. Food taken into the
body through the mouth.
Inguinal. The region at the lowest
part of the abdomen on either side
of the symphysis pubis.
Inhalation. Act of breathing in
vapor or fumes into the mouth, a
form of treatment frequently ordered
in disorders of the throat or chest.
The ordinary inhaler consists of a
402 APPENDIX.
vessel fitted with a mouth-piece com-
ing out of the lid ; the hot water and
the medicament ordered are put in
the vessel and the patient takes the
mouth-piece in his mouth and in-
spires the vapor which rises through
it. A teapot makes a very good in-
haler, the patient keeping the spout
in his mouth.
Inhibition. The arrest of some
activity by the restraining influence
of a nerve-centre.
Injection. A watery or other so-
lution thrown into the vessels beneath
the skin, or into any cavity of the
body.
Innominate. Name of the large
artery of the body proceeding from
the aorta.
Innominatum. The pelvic bone.
Inoculation. The injecting of
diseased fluid from the body of one
creature into the body of another, as
calf lymph is used to vaccinate chil-
dren.
Insanity. Madness ; disease of
the brain causing loss of reason. The
four principal types of the affection
are melancholia, mania, delusional
insanity, and dementia. (See Puer-
peral mania.) The nurse must never
argue with an insane patient; she
must watch and be patient; no
matter what violence she suffers,
she must never strike the patient
back again. In restraining a mad
person, catch hold of the gar-
ments, not the limbs. The nurse
who knows no fear, never loses her
self-control, and is ever watchful,
stands in no danger from even the
most violent patient.
Insertion. The attachment of a
muscle to the part it moves.
Insomnia. Sleeplessness; often a
troublesome complication during
convalescence.
Inspiration. Drawing in the
breath.
Instillation. Pouring in drop by
drop.
Instrument. Any mechanical de-
vice or tool used in operation or
treatment. Surgical instruments
should be immersed in 1:40 carbolic
solution ten minutes before the ope-
ration; directly after the operation
all hollow instruments should be
taken to pieces, cleansed with a
nail-brush, put together, and laid
away in their cases.
Insufflation. Blowing air into a
cavity of the body.
Insulation. State of a body sur-
rounded by non-conductors of elec-
tricity.
Integument. The skin.
Intestines. The alimentary canal
from the stomach to the anus (see p.
290). Intestinal obstruction arises
from various causes, such as hard-
ened feces.
Intolerance. Constitutional in-
capacity to endure or benefit by a
remedial agent.
Intoxication. The effect of the
excessive use or an overdose of alco-
holic liquor; in a wider sense, any
poisoning.
Intravenous. Denoting within or
into the veins. An intravenous injec-
tion is the introduction into the vein
of a saline solution or other liquid.
Intubation. Passing a tube down
the throat and leaving it there; an
operation sometimes performed on
children with diphtheria instead of
tracheotomy. It needs careful nurs-
ing, for the tube may be coughed up
or may be swallowed.
Intussusception. The reception
of one part of the intestine into an-
other ; common in children and caus-
ing obstruction of the bowels, and
calling for prompt treatment.
Inunction. Rubbing in of medi-
cines with a view to effect absorption.
Generally resorted to when the
stomach will not tolerate the medi-
cine.
Invagination. Another term for
intussusception.
Inversio Uteri. Inversion of the
womb, so that it is turned inside out,
and generally falls into the vagina.
Divoluntary. A term applied to
certain motions and functions of the
various'organs of the body that are
not controlled by, or are not depend-
ent on, the will.
Involution. The shrinking of the
womb after labor. The womb, from
weighing a pound and a half at labor,
shrinks in eight weeks to the weight
GLOSSARY.
403
of an ounce and a half. Any chill
may arrest this involution and cause
great mischief.
Iodin. A poisonous element ob-
tained from the ashes of seaweed.
Very useful as an antiseptic. The
solution is painted on the skin to
cause absorption. The tincture is
given internally for scrofula, etc. Re-
port at once any catarrhal symptoms.
Iodoform. A form of iodin con-
sisting of yellow crystals or a prim-
rose-colored powder. It possesses a
strong and lasting odor. It is largely
used to dust on wounds, its action
being antiseptic and stimulating.
Iodoform gauze, wool, and lint are
employed. The symptoms of poi-
soning from iodoform are vomiting,
hallucinations, red skin rash, and
dusky urine.
Iodol. Ointment containing iodin,
and having the same properties as
iodoform, without the strong smell.
Ipecacuanha. A prompt emetic,
secured from the root of a Brazilian
plant. Greatly used for children in
cases of croup and whooping-cough.
In small doses it is a stomachic and
expectorant; when used as an emetic,
some 60 drops are given.
Iris. The colored circle surround-
ing the pupil of the eye.
Iron. When ordered as a medi-
cine, should be given after food and
through a tube. Dialyzed iron does
not injure teeth. Iron causes black
stools.
Irreducible. That which is inca-
pable of being returned to its proper
place by manipulation.
Irrigation. Constant application
of a lotion to a part.
Irritant. A drug which causes
excitation and stimulates action.
Irritation. An inflamed state;
also, the stimulus necessary to the
performance of the functions of an
organ.
Ischium. The hip-bone ; the back
part of the os innominatum.
Isolation. Set apart; an isolation
room or ward is one kept for con-
tagious or infectious diseases, and the
nurse has to follow strict rules to
prevent the spread of the disease.
A sheet hung over the door of such
a room, and kept saturated with car-
bolic or some other disinfectant, to
prevent the disease germs that are in
the air getting out at the door and
into other parts of the building.
Itch. A skin eruption. (See
Scabies.)
J.
Jaborandi. A drug containing
pilocarpin and jaborin. It increases
perspiration and stimulates the heart.
Jalap. A drug which purges rap-
idly, acting in from two to four hours.
Jaundice. Disease of the liver
causing yellowness of the skin ; usu-
ally brought on by over-indulgence
or by chill. Infants often become
jaundiced, and should then be kept
indoors, and an extra fold of flannel
put round the body. In the diet of
a patient, avoid fat and sugar as
much as possible, and give no wine.
Jejunum. The upper portion of
the small intestine.
Joint. Point of union of two
bones. (See Articulation.)
Jugular. Relating to the neck.
K.
Keloid. A connective - tissue
growth of the skin.
Kidneys. Two organs in the re-
gion of the hollow of the back which
secrete the urine. In all diseases of
the kidneys, the nurse has to measure
and test the urine.
Kilogramme. One thousand
grammes, equal to 2.2 pounds
avoirdupois.
Kino. An astringent.
Knock-knee. The inward curving
of the knee.
Koumyss. Fermented mare's milk;
nutritive and easily digested. Given
in cases of wasting. (See p. 327.)
Kyphosis. Hump-back deformity
(curvature) of the spine.
L.
Labial. Relating to the lips.
Labia Majora. Two large folds
at the mouth of the pudendum ; called
also the " labia pudendi majus."
Labia Minora. Two smaller folds
404 APPENDIX.
within the majora; called also the
" nymphse."
Labor. The progress of the birth
of a child. There are three stages.
(i) The dilatation of the mouth of
the womb. (2) The passage of the
fetus through the canal and its birth.
(3) From the birth of the child to the
coming away of the placenta. Prema-
ture labor is the birth of a child after
the seventh month, but before full
time.
Labor-pains. The pains of, or
the contraction of, the uterus during
labor. False labor-pains are irregu-
lar and short, resembling colic, and
occur with a certain regularity.
Labyrinth. The internal ear, con-
sisting of a series of cavities.
Lacerated. A lacerated wound is
one with torn or irregular edges ; not
clean-cut.
Lachrymal. Relating to the tears
and the glands which secrete them.
The lachrymal or nasal duct conveys
the tears from the lachrymal sac into
the inferior meatus of the nose.
Lachrymation. Excess of tears.
Lactagogue. Drug for inducing
milk-secretion.
Lactation. The process or period
of sucking.
Lacteals. The lymphatic vessels,
which convey the chyle from the in-
testinal canal.
Lactiferous Ducts. The canals
of the mammary gland.
Lactose or Lactin. Sugar of milk.
La Grippe. (See Influenza.)
Lancet. Surgical knife, with point
and two edges, sharp.
Lancinating. An adjective ap-
plied to sharp cutting pains.
Lanugo. The downy growth or
first hair of the fetus.
Laparotomy. Cutting into the
abdomen ; a serious operation in the
removal of a tumor, etc.
Laryngeal. Relating to the
larynx.
Laryngismus Stridulus. Spas-
modic croup accompanied by a crow-
ing noise ; most common in infants.
(See Croup.)
Laryngitis. Inflammation of the
larynx, causing loss of voice. Com-
mon in clergymen and public speak-
ers. May be chronic or acute ; the
latter is serious.
Laryngoscope. A reflector used
for examining the throat.
Larynx. The upper part of the
windpipe, from which the voice-
sounds proceed.
Lassitude. A state of exhaustion
or weakness arising from causes other
than fatigue.
Latent. Not visible, lying hid for
a time.
Lateral. Relating to the side.
Laudanum. Tincture of opium,
poison. Given in a few drops it re-
lieves pain and procures sleep; it
also arrests diarrhea. Sprinkled on
a poultice or fomentation it allays
pain. For an overdose the antidotes
are emetic, external stimulation, walk-
ing patient about, artificial respiration.
Laughing-gas. Nitrous-oxid gas,
given particularly by dentists to se-
cure short anesthesia.
Laxative. A mild purgative.
Lead. The acetate is given in small
doses as an astringent. The lotion
evaporates rapidly and is cooling.
The iodid makes a soothing oint-
ment.
Lead-poisoning. Difficult cases
to nurse, owing to the frequent severe
colic. Baths and opium fomentations
are part of the treatment the nurse
may have to look after. The diet is
light but nutritive, with plenty of
lemonade. Note blue line on gums.
Lead-poisoning is common among
painters and other lead-workers.
Leech. An aquatic worm used for
the local abstraction of blood.
Leeches should be kept in a cool
place, in a glass jar filled with rain- or
river-water. The top of the jar must
carefully be covered with muslin.
The water should be changed weekly.
The part to which a leech is to be
applied should be washed and moist-
ened with cool water; put the leech
in a small wine-glass or test-tube, and
reverse it on the part. If it will not
bite, moisten the skin with sugar and
water, or scratch the skin gently till
the blood comes. When the leech
has sucked its fill it drops off; it
should then be disposed of by put-
ting it in a very strong solution of
GLOSSARY.
405
salt and water or dry salt, cover the
vessel tightly and let the leech remain
until dead.
Leiter Apparatus. Coils or tubes
of flexible metal designed for appli-
cation about any part of the body.
Cold water is passed through the
tubes, thereby reducing the tempera-
ture of the parts encased.
Leprosy. A constitutional malig-
nant disease, cutaneous in its earlier
stages, but afterward involving both
tissue and bone.
Lesion. Any injury or morbid
change in the function or texture of
an organ.
Lethargy. Unnaturally deep
sleep ; not quite so decided as coma.
Leucemia. Increase of white cor-
puscles of the blood.
Leucocytes. White corpuscles of
the blood.
Leucomaines. Certain alkaloids
developed in living tissue.
Leucorrhea. A whitish discharge
from the vagina, commonly called
the "whites"; a sign of weakness.
Must be reported to the doctor.
Levator. A muscle which lifts up
a part.
Lichen. A term for a group of
skin diseases in which the striking
feature is inflammatory papules.
Licorice Powder. A preparation
containing senna; a purge.
Lieberkiihn's Glands. Tubular
glands of the small intestine.
Ligament. A tough band of
fibrous tissue connecting together the
bones at the joints.
Ligatures. Threads of silk, wire,
catgut, etc., used to tie arteries or sew
up parts. The nurse has to see that
all ligatures are sterilized and count
the number used. Catgut, the most
common ligature, may be kept in a
solution of carbolic (1 : 10) and cut
into lengths of 11 inches when re-
quired for use.
Lime, Chlorid of. A deodorant
powder.
Lime-water. Used to dilute milk
for infants, and generally to counter-
act acidity. Mixed with equal parts
of olive oil, it makes carron oil, a
dressing for scalds and burns.
Lingual. Relating to the tongue.
Liniment. A liquid for external
application.
Lint. Loosely woven cotton ma-
terial, having one side smooth and
the other side rough. As a rule,
the smooth side is applied next the
skin. The name " lint" is also
given to scraped or unravelled linen,
though the proper term for this is
" charpie."
Liquor Amnii. The watery fluid
in which the fetus floats.
Liquores. Solutions of active
substances in water.
Liquor Sanguinis. Liquid portion
of the blood.
Listerism. Antiseptic surgery.
Lithemia. An excess of lithic
acid in the blood, producing gouty
dyspepsia.
Lithia. An alkali, given in gout,etc.
Lithoscope. Instrument for ex-
examing the bladder.
Lithotomy. Operation of cutting
into a bladder to remove a stone.
Lithotrity. Operation of crushing
a stone in the bladder. Nursing
treatment similar to that in lithotomy,
but the urine must be measured and
strained, and all fragments of stone
kept for the surgeon's inspection.
Lithuria. Passing gravel with the
urine.
Litmus Paper. Used in testing :
acid turns the blue paper red ; alkali
turns the red paper blue.
Litre. About 1 quart; or 33.81
fluidounces.
Liver. The organ which secretes
the bile ; it is situated in the abdomi-
nal cavity on the right side. A yellow
tinge of the skin marks derangement
of the liver; the nurse must be care-
ful that her patient gets no chill.
Lobe. Rounded division of an
organ.
Lobelia. A drug used as an anti-
spasmodic, and also in enemata. May
cause poisoning.
Lochia. The discharge following
confinement; it is for two days al-
most pure blood, then turns reddish-
gray, and becomes clear by the ninth
day, and then ceases.
Lock-jaw. (See Tetanus.)
Locomotor Ataxy. Impaired gait
in walking.
406
APPENDIX.
Lordosis. Anterior curvature of
the spine.
Lotion. A solution for external
use. Evaporating lotions are used
to procure local coldness. Lead
lotion or eau-de-Cologne and water
are the commonest.
Lubrication. Making smooth,
oily, or slippery.
Lumbago. A rheumatic affection
of the loins ; painful but not serious.
Cold must be avoided. Rubbing in
of such linimpnts as turpentine and
chloroform, or aconite, may fall to the
nurse's share ; or galvanic currents or
hot baths.
Lumbar. The region of the loins,
right and left of the umbilicus.
Lunar Caustic. Nitrate of silver,
used to cauterize pounds, or arrest
the growth of proud flesh.
Lungs. The two organs of respira-
tion, situated in the right and left
side of the cavity of the chest. For
nursing treatment of congestion of
the lungs see Pneumonia.
Lupuli. Hops; the tincture is a
sedative and stimulant.
Lupus. A tuberculous disease of
the skin, most common on the face
in young people of a consumptive or
scrofulous tendency. Nourishing
diet.
Luxation. (See Dislocation.)
Lying-in. Pertaining to the state
of childbirth; parturition.
Lymph. A colorless alkaline fluid
found in the lymphatic vessels.
Lymphadenitis. Inflammation of
the lymphatic glands. Tonics and
nourishing diet.
Lymphatics. Small vessels per-
vading the body, and containing
lymph.
Lysis. Gradual decline of a fever.
M.
Macrocephalous. Very large-
headed.
Macrocytes. Abnormally large
corpuscles present in the blood in
anemia.
Magnesia. A laxative and ant-
acid. The sulphate (Epsom salt) is a
powerful purge.
Malaria. Effluvia from marshy
ground; the cause of intermittent
and remittent fevers.
Malignant. An adjective applied
to very virulent and dangerous forms
of disease which run a more rapid
course than the milder forms.
Malignant Pustule. Anthrax
contracted from cattle, causing gan-
grenous carbuncle.
Malingering. Shamming sick-
ness.
Malleolus. The projections of the
ankle-bone.
Malleus. A little bone of the
middle ear.
Malpighian Bodies. Small capil-
lary masses in the structure of the
kidney.
Malpresentation. Unusual pre-
sentation of the fetus at birth; for
instance, feet first.
Mammae. The breasts, or milk-
supplying glands.
Mammary. Relating to the
breasts.
Mammitis. Inflammation of the
breasts, generally occurs during lac-
tation, and points to improved diet.
Mandibulum. The lower jaw.
Manganese. A drug used in skin
diseases, in diseases of the kidney,
and also to induce menstruation ; it
is tonic in its action.
Mania-a-potu. Drink madness;
delirium tremens (q. v.).
Manikin. A small representation
of the human body used for teaching
purposes.
Manipulation. Rubbing and
working with the hands to procure
some healing result.
Marasmus. A wasting of the
flesh; generally due to tubercular
disease of the mesenteric gland.
Massage. Scientific rubbing and
manipulation of the body ; strength-
ens the tissues and restores tone gen-
erally, acting as mild and thorough
exercise for the patient. All move-
ments are from the extremities toward
the heart, and consist of kneading,
rolling, beating, and rubbing move-
ments. Ejfleurage, tapotement, and
petrissage (which see) are the terms
used for the chief movements, though
each school of massage has its own
terms and methods.
GLOSSARY.
407
Masseter. A strong facial muscle
which moves the lower jaw.
Masseur. A male practitioner of
massage.
Masseuse. A female practitioner
of massage.
Mastitis. Inflammation of the
breast.
Mastoid. Having the shape of the
breast. Mastoid process, the pro-
truding part of the temporal bone
felt behind the ear.
Materia Medica. The branch of
medical science which deals with the
character and use of drugs.
Maxilla. The jaw-bone. Inferior
maxillary is the bone of the lower
jaw.
Measles. An eruptive fever com-
mon in children. First stage of
coryzais infectious; the rash appears
on the third day, commencing on
neck and face, and lasting three days.
Keep the patient in bed and feed with
light diet. Watch for bronchitis or
inflammation of the eyes or ears. A
cough is usual in measles. The
period of infection is supposed to last
a month. German measles is a milder
disease, the rash appearing on the
fourth day, the period of incubation
being ten days. Convalescence is
usually rapid and uninterrupted.
Meatus. An opening into a pas-
sage. Meatus urinarius, the orifice
of the urethra.
Meconium. A black, sticky sub-
stance voided from the bowels of an
infant during the first day or two of
its life.
Median. In the middle ; an imag-
inary longitudinal line dividing the
body down the centre ; mesial.
Medulla Oblongata. The en-
larged portion of the spinal cord
where it enters the base of the brain
at the back of the head.
Medullary. Relating to the mar-
row.
Melancholia. Morbid depression,
a form of insanity. Watch for con-
stipation.
Melena. A discharge of black
blood from the bowels.
Membrane. A thin expanding
tissue lining the cavities of the body.
False membrane is a growth caused
t by inflammation, as in diphtheria.
Mucous membrane, the continuation
of the skin which lines those internal
cavities and organs exposed to or
communicating with the air.
Meninges. The membranes of the
brain.
Meningitis. Inflammation of the
membranes of the brain, a serious
disease, often ending fatally. Pains
in the head are the first symptom, the
temperature rises, and delirium sets
in. Ice-bags to the head, iodoform
applications, and menthol may be
ordered. The nurse must take the
temperature every four hours, and
watch for signs of collapse. Keep
the room darkened and absolutely
quiet; feed assiduously. There will
probably be delirium.
Meningocele. Protrusion of the
brain through the skull.
Menopause. Change of life ; the
cessation of the menses, occurring
about the forty-fifth year, and gen-
erally a somewhat critical period.
Menorrhagia. Excessive flow of
the menses; may be due to many
causes. Rest, flat on the back, and
hot vaginal douches are almost cer-
tain to be left to the nurse to see
carried out.
Menorrhea. The menstrual flow.
Menses. The menstrual flow.
Menstruation. Monthly discharge
from the vagina, common in healthy
females between the ages of thirteen
and forty-five.
Menthol. A local anodyne, often
applied as a plaster.
Mercurialism. Heart affection
and trembling, caused by long use
of mercury.
Mercury. An alterative and pur-
gative given hypodermatically and
internally in cases of syphilis and in
skin diseases. It is a poison in large
doses, and the antidotes are white of
egg and milk and water. (See Mer-
curialism.)
Mesentery. A large portion of
the peritoneum to which the small
intestines are attached.
Mesmerism. The control of one
will over another ; the influence be-
ing supposed to be obtained by
making passes with the hands.
408
APPENDIX.
Metabolic. Capable of being
changed.
Metacarpus. The five bones of
the hand joining the fingers to the
wrist.
Metastasis. Shifting of a disease
from one organ to another.
Metatarsus. The five bones of
the foot between the ankle and the
toes.
Metritis. Inflammation of the
womb.
Metrorrhagia. Bleeding from the
uterus, other than at the period.
Miasm. A noxious emanation
generating in marshy localities ; ma-
laria.
Microbes. Germs capable of
rapid increase; disease-germs or
bacteria.
Micrococci. Practically the same
as microbes.
Micturition. The act of passing
urine.
Midriff. The diaphram or muscle
which divides the chest from the ab-
domen.
Midwife. A woman trained to
attend confinements, and fulfil all
duties so long as the labor is a nat-
ural one.
Midwifery. Obstetrics ; the knowl-
edge necessary to performing the
duties of a midwife.
Migraine. Headache usually
known as "sick headache" coming
on periodically.
Miliaria. Prickly heat; an affec-
tion due to sweat-secretion and want
of action of the skin. Sometimes
occurs after operations or fevers, and
causes rise of temperature.
Minim. The sixtieth part of a
fluidrachm ; practically one drop.
Miscarriage. Premature birth of
an infant, before seventh month.
Mitral Valve. The valve of the
heart between the left auricle and the
left ventricle.
Modus Operandi. The method of
operating.
Molluscum. Skin disease, either
contagiosum, common in childhood,
orfibrosum, involving the tissue.
Monoplegia. Paralysis of one limb
only.
Monster. A creature born of
woman, but so malformed as to have
but slight resemblance to a human
being.
Mons Veneris. The eminence just
over the os pubis in women.
Morbid. Unnatural, diseased.
Moribund. In a dying state.
Morning Sickness. The nausea
of pregnant women, occurring chiefly
in the early months of gestation.
Morphin. A vegetable alkaloid
used as a sedative or anodyne. In-
jected under the skin, it causes the
pain to decrease, and sleep is in-
duced. An overdose causes death,
chiefly by paralysis of the muscles of
respiration. Stimulation, artificial
respiration, and an emetic are the
antidotes.
Morphinism. Chronic poisoning
from indulgence in morphin.
Mortification. The death of a
part, gangrene. Always serious: the
nurse must pay great attention to
cleanliness, and use disinfectants.
Movements. The evacuations of
the bowels, which it is the duty of
the nurse to note on her nursing chart
in every case, and call the attention
of the doctor if they exceed 2 in the
24 hours (except in children), or if
the patient goes more than 24 hours
without passing any. The nurse
should also note if they are streaked
with blood, contain mucus, or undi-
gested food, or worms. The color
should be noticed ; it is like pea-soup
in typhoid, light in jaundice, green in
mercurialism.
Mucoid. Resembling mucus.
Muco-purulent. Containing mu-
cus mingled with pus.
Mucus. A viscid fluid of the body
secreted by the mucous membranes.
Mucus in the urine shows as a heavy
white sediment, clinging to the bottle
when it is shaken.
Multipara. A woman who has
had more than one child.
Mumps. Parotiditis. A highly-
infectious swelling of the salivary
glands. Keep the patient isolated in
a warm room ; take the temperature
night and morning; give light nutri-
tive diet.
Murmur. A sound of the heart or
the lungs heard upon auscultation.
GLOSSARY.
409
Muscle. Strong tissue of the body
capable of great contraction, and the
means by which the limbs are
moved. Sterno-cleido-mastoid muscle,
a large muscle on each side of the
neck; it depresses and rotates the
head. Involuntary muscle, one not
under control of the will.
Mutter. To utter with imperfect
articulation, or in a low murmuring
tone.
Mycoid. Resembling a fungus.
Mydriatics. Drugs used to dilate
the pupil of the eye.
Myocarditis. Inflammation of the
muscular tissue of the heart. Often
follows acute rheumatism: chances
of recovery small.
Myopia. Short-sightedness.
Myotics. Drugs which cause the
pupil to contract.
Myrrh. A stimulating and tonic
concoction of vegetable origin.
N.
Naboth's Glands. Small glandular
bodies situated at the neck of the
uterus.
Naphthalan. An antiseptic and
expectorant. Given for indiges-
tion.
Narcosis. A state of unconscious-
ness produced by the use of nar-
cotics.
Narcotic. A medicine which in-
duces sleep.
Nares. The nostrils.
Nasal. Relating to the nose.
Nates. The buttocks.
Nausea. A feeling of sickness, but
without actual vomiting.
Navel. The umbilicus, the point
of connection of the cord.
Necrosis. Death of a part; usually
applied to bone. Where there is
dead bone there is always a sore, and
pieces of dead bone at times work
out through the sore : they should
always be kept for the doctor to
see.
Negative Pole. That connected
with the least oxidizable plate of a
galvanic battery.
Nematoidea. Thread-worms.
Neonatorum. Of the new-born.
Neoplasm. A new growth.
Neoplasty. Any operation which
restores lost tissue.
Nephritis. Inflammation of the
kidney. Measure and test urine, and
watch for renal casts, pus, etc. Put
patient between blankets.
Nephrotomy. Cutting into the
kidney.
Nerve. A bundle of fibres con-
veying sensation and volition to and
from the organs. Motor nerves are
those nerves which, passing from a
nerve-centre, convey an order of
motion; the opposite of sensory
nerves which, passing to a nerve-
centre, convey a sensation to the
brain. Optic nerve, the nerve of
sight arising in the occipital lobe and
distributed to the retina of the eye.
Sympathetic nerve is a nerve beside
the spine. Vaso-motor nerves are of
two kinds, those which cause con-
traction, and those which cause dila-
tion, of vessels.
Nervous. Connected with the
nerves; applied to low fevers and
similar affections.
Nettle-rash. (See Urticarial)
Neuralgia. Pains of a nerve or
nerves; if of the sciatic nerve it is
sciatica; or tic-douloureux or hemi-
crania if of the nerves of the face. Very
often neuralgia of one part is a symp-
tom of disease elsewhere, and, there-
fore, neuralgia should always be
watched and reported.
Neurasthenia. Nervous exhaus-
tion. No cases are more trying to a
nurse than those where the nerves are
disordered. The patient is weak and
fanciful, and needs to be treated with
sympathy, yet with firmness; the
nurse must be cheerful but quiet, pa-
tient and forbearing, yet strict in
carrying out the doctor's orders.
Neuritis. Inflammation of a nerve.
Neuroses. A class of diseases
connected with the nervous system,
but arising from no structural cause
which can be detected.
Neutral. Neither acid nor al-
kaline.
Nevus. A birth-mark, a congenital
blemish of the skin, often curable if
the attention of the physician is
called to it in time.
New-born. A designation applied
4io
APPENDIX.
to the child for a short period after
its birth.
Nicotinism. Illness caused by
over-indulgence in tobacco.
Nictitation. Involuntary winking
of the eyelids.
Nightingale. A bed-cloak made
out of two yards of flannel (see
P- 35)-
Nipple. The small eminence in
the centre of each breast.
Nipple-shields. Coverings of
glass or india-rubber put on the
nipples to protect them when they are
sore.
Nitrate of Silver. Lunar caustic;
used in the form of a pencil to arrest
bleeding from a leech-bite or other
small wound by its styptic action.
Also to check the growth of proud
flesh. As an astringent lotion, half a
grain to the ounce, it is used to bathe
the eyes in cases of ophthalmia. Salt
and water is the antidote in case of
poisoning.
Nitric Acid. A corrosive fluid
used in testing for albumin, etc.
Minute doses, prescribed for indi-
gestion, should be given after food,
through a tube. If allowed to fall on
the finger, it burns the skin. The
antidotes for poisoning are alkalies,
white of egg, and milk.
Nitrite of Amyl. Useful as an
inhalation in angina pectoris, and in
some cases of poisoning.
Nitrogen. A colorless gas enter-
ing largely into the composition of
the air we breathe.
Nitroglycerin. An oily liquid,
highly explosive, used as a heart-
stimulant, and for neuralgia, etc.
Sometimes causes headache. Must
never be taken near a light. Poison.
Nitrous Oxid. Laughing gas ; an
anesthetic used for short operations,
especially by dentists.
Nodule. A little knob.
Noli-me-tangere. A name given
to bad ulcers, especially if on the
face, and of syphilitic or consumptive
origin. In dressing them, the nurse
must certainly be careful to " touch
them not," and to use disinfectants.
Non compos mentis. Not of sound
mind.
Normal. The ordinary and proper
state. Thus the temperature of the
body in health is 98.40, and this is
said to be normal. The normal respi-
ration in an adult should be about 16
a minute; the pulse about 70 a
minute.
Nostalgia. Home sickness, or
longing for home, so strongly devel-
oped as to cause serious bodily ill-
ness.
Nostril. One of the external ori-
fices of the nose.
Nostrum. A quack medicine, or
one of which the ingredients are kept
secret.
Nullipara. A woman who has
never had children.
Nutrient Enemata. A substance
that nourishes by rectal injection.
Nux Vomica. A form of strychnin
much used as a nerve tonic and in
cases of gastric affection, and also in
paralysis. In large doses it is poison-
ous, and the antidotes are an emetic,
tannin, chloroform or ether inhala-
tion.
Nymphse. Two folds of mucous
membrane on either side of the
vagina ; the lesser or inner lips which
protect the orifice of the vagina.
0.
Oakum. The fibre obtained by
picking old tarred rope into pieces.
Used to some extent in surgical
dressings.
Oatmeal. The meal made from
oats.
Obesity. Excessive fatness.
Obstetrician. One who practises
obstetrics.
Obstetrics. That part of medicine
and nursing which is connected with
midwifery, and with the operations
and illness due to the bearing of
children.
Obstruction. Stoppage or block-
ing up of a canal or opening of the
body.
Occipital. Relating to the back
of the head.
Occiput. The back of the head.
Occlusion. Closure.
Ocular. Relating to the eye.
Oculist. An eye specialist.
Odontalgia. Toothache.
GLOSSARY.
4II
Odontoid. Tooth-like.
Official. Term applied to medi-
cines which are in the " Pharmaco-
peia."
Ohm. Unit of resistance in gal-
vanism.
Oidium Lactis. A micro-organism
found in milk, and supposed to cause
thrush in children.
Oiled Silk. Silk impregnated with
boiled oil, semi-transparent, and
waterproof; used in the antiseptic
dressing of wounds. Prepared in
rolls of about 5 yds. long, and in
widths of 2s, 29, and 32 inches.
Ointment. A soft application
having healing virtues, usually con-
sisting of lard impregnated with some
drug. Ointment should be spread on
lint with a palette-knife, and applied
next the sore.
Oleaginous. Oily.
Olecranon. The bone composing
the point of the elbow.
Olfactory. Relating to the sense
of smell.
Olive Oil. A teaspoonful is some-
times given to children as an aperient.
It is used to oil instruments, such as
the nozzle of an enema syringe.
Omentum. A fold of fat in front
of the intestines.
Onychia. Inflammation of the
matrix of a nail.
Oophorectomy. Removal of the
ovaries.
Oophoritis. Inflammation of the
ovaries.
Opacity. Want of transparency,
cloudiness.
Operation. An act, especially a
surgical act upon the body. Ope-
rating-table, the table on which a
patient lies during a surgical opera-
tion.
Ophthalmia. Inflammation of the
eye. Once contracted, the cure is
chiefly in the hands of the nurse;
for constant care is alone successful.
Rags used about the eyes must be
promptly burnt, and the nurse must
wash her hands in disinfecting fluid,
for ophthalmia is contagious. Gran-
ular ophthalmia is a chronic form
with granulation of the lids.
Ophthalmia Neonatorum. Oph-
thalmia of the new-born.
Ophthalmoscope. A small instru-
ment fitted with a magnifying glass,
and used to examine the eye.
Opiate. A drug which causes
sleep.
Opisthotonos. A spasm which
arches the back ; seen in severe cases
of tetanus.
Opium. A preparation of poppy-
juice, much used to induce sleep and
to allay pain. It contracts the pupil.
Children are specially susceptible to
the influence of opium. In large
doses it is a poison, the antidotes
being external, stimulation, cold
water to the face, an emetic.
Optic. Relating to the sight.
Orbit. The bony cavity which
holds the eye.
Organ. A part constructed to ex-
ercise a special function. Organs of
genera/ion, those that are functional
in reproduction ; the genitalia. Pel-
vic organs, those situated in the pel-
vis. Urinary organs, those concerned
in the secretion and excretion of the
urine—the kidneys, bladder, ureters,
and urethra.
Organic. Relating to the organs;
thus, organic disease of the heart
means that the structure itself is af-
fected ; whereas, if the evil is inor-
ganic it may be the result of mischief
elsewhere, causing functional de-
rangement of the heart.
Orthopedic. Relating to the cure
of deformities in children.
Orthopnea. Breathlessness, the
patient needing always to maintain
an upright position.
OS. A bone; also the mouth, as
of the uterus.
Os Calcis. The bone of the heel.
Os Externum. Entrance to the
uterus.
Os Lnternum. The inner orifice
of the uterus.
Os Uteri. The mouth of the
womb.
Osseous. Like bone.
Ossification. Hardening into
bone.
Ostalgia. Pain in a bone.
Osteitis. Inflammation of a bone.
Osteomalacia. Softening of the
bones. Test urine. A lengthy and
fatal illness.
412
APPENDIX.
Osteomyelitis. Inflammation of
the soft tissue of bone. Apt to oc-
cur after amputations and to end
fatally.
Osteotome. A surgical saw for
sawing bones.
Osteotomy. An operation on a
bone ; generally breaking and reset-
ting it, as is done in the case of bow-
legs. An anesthetic is used ; the pa-
tient has to be kept quiet, and is put
in splints.
Osteotrite. An instrument used
for scraping bone.
Otalgia. Ear-ache.
Otitis. Inflammation of the mid-
dle ear, marked by rolling of the head
and severe pain. Hot poultices, or
even leeches, may be ordered.
Otorrhea. A purulent discharge
from the ear. In all diseases of the
middle ear there is fear of penetra-
tion to brain and fatal termination.
Ounce. In fluid measure about
two tablespoonsful.
Ovarian Tumor. The conversion
of the ovary into a tumor, which
may grow to a tremendous size, and
may contain hair, teeth, or sebacous
matter.
Ovariotomy. Excision of an
ovary ; a serious operation, the nurs-
ing treatment of which is very im-
portant.
Ovaritis. Inflammation of an
ovary, very painful, and likely to de-
press the patient.
Ovaries. Two small, oval bodies
situated on either side of the uterus,
the female organ in which ova are
formed.
Over-distention. The state of
being excessively stretched, or di-
lated.
Oviduct. The Fallopian tube be-
tween the ovary and the womb, con-
veying the ova.
Ovisac. Small vesicles found near
the surface of the ovary.
Ovum. The egg : the embryo from
which the fetus grows. Plural, ova.
Oxalic Acid. A poisonous acid
obtained from wood sorrel; antidotes,
chalk and magnesia.
Oxygen. A colorless, odorless
gas. Inhalations in heart and chest
cases. Applied to ulcers and sores.
P.
Pack. Wrappings of wet fabric ap-
plied to a patient. A cold pack consists
in wrapping the patient in a sheet
wrung out of cold water, then envel-
oping him in a dry blanket and mack-
intosh, and leaving him for thirty min-
utes, or the prescribed time. An ice
pack consists in wringing out towels
in ice water and applying them to the
patient, perpetually changing them as
they get warm. This last is to lower
the temperature, and the temperature
should be taken every few minutes
while it is in progress. Hot pack is
sometimes used in dropsy cases, and
is applied in the same manner as
the cold pack. Of course the pa-
tient's body-clothing is removed be-
fore a pack is given ; and care must
be taken to avoid chill, particularly
after the pack, when the patient must
be carefully dried. Packing the va-
gina consists in inserting in the
vagina pads of antiseptic cotton held
together by a cotton string.
Pads. Little pledgets of cotton
enclosed in antiseptic gauze, and used
instead of sponges.
Paget's Disease. A bright raw
patch on the nipple that after some
time develops into a cancer.
Pain. Bodily or mental suffering.
Griping pain, a. spasmodic pain in the
bowels. (See also Bearing-down
pains, and Labor-pains.)
Palate. The roof of the mouth.
Palliative. A medicine which re-
lieves but does not cure.
Palpation. Examination by the
hand.
Palpitation. Rapid throbbing of
the heart. Should always be reported
to the doctor. Keep the patient at
rest during the attack.
Palsy. The popular name for
paralysis (which see).
Panacea. A m edicine which cures
all diseases.
Pancreas. A long, flat gland be-
hind the stomach ; it supplies a juice
which aids digestion to the duodenum.
Pancreatin. The active principle
of pancreatic juice.
Papilla. A small eminence; gen-
erally applied to the nipple.
GLOSSARY.
413
Papula. A small, solid pimple.
Paquelin's Cautery. Agalvano-
cautery on the syringe and ball sys-
tem, in which the heat is obtained by
benzoline vapor driven over plat-
inum.
Paracentesis. Tapping for dropsy;
performed on the abdomen, chest,
etc., to discharge the fluid secreted.
(See Aspiration.)
Faraldehyd. A swift soporific,
having a pungent taste. As it is of an
oily, unpleasant nature, it is usually
given in stimulant (brandy) in the
proportion of 1 to 3. It taints the
breath. Poison. Antidotes, friction,
strong coffee.
Paralysis. Loss of sensation and
of the power of movement. The
one great point for the nurse in
these cases is to prevent bed-sores.
Measures must be taken to keep the
patient dry and clean. Paralysis
usually arises from brain disease,
from injury to the spine, or nerve
disease; it may be partial or com-
plete. Infantile paralysis occurs in
weakly children under four years : the
legs being usually affected. It arises
from injury to the marrow of the
spine, due to heat, cold, or over-
walking. The limbs get thin, and
must be kept wrapped in thick wool,
and be rubbed night and morning for
a quarter of an hour, passing the hand
up the limb. Douching with hot water
or electricity may be ordered. Prevent
bed-sores, and give nourishing food.
Paralytic Stroke. A sudden com-
plete attack of hemiplegia.
Paraphimosis. Retraction of the
prepuce behind the glans penis.
Paraplegia. Paralysis of the lower
half of the body,including the bladder
and rectum, so that the nursing direc-
tions given under Paralysis must be
carefully heeded.
Parasite. Any living thing which
draws its nourishment from another
living thing.
Paregoric. Camphorated tincture
of opium used to relieve pain.
Parenchyma. The spongy part of
an organ.
Paresis. A slight form of paraly-
sis.
Parietal. The two bones which
form the vault and sides of the cra-
nium.
Parietes. The sides of any cavity
of the body.
Paronychia. Whitlow; inflamma-
tion and abscess at the end of a
finger near the nail.
Parotid. Near the air; applied to
a conglomerate gland under the ear.
Parotitis. Mumps (which see).
Paroxysm. Periodical increase of
disease.
Parturient. Child-bearing.
Parturition. The act of bringing
forth young.
Patella. The knee-cap.
Pathogenesis. The origin and
progress of disease.
Pathological. Relating to pathol-
ogy ; morbid.
Pathology. The study of dis-
eases.
Patulous. Open, wide.
Peccant. Not healthy.
Pectoral. Relating to the breast.
Pedicle. The foot-stalk which
forms the neck of a tumor.
Pediculus. The louse, a parasite
infesting the hair and skin. An oint-
ment will be ordered. The head may
have to be shaved. If the lice are on
the body, see that all clothing is dis-
infected. Great cleanliness neces-
sary.
Pellicle. A thin skin or mem-
brane.
Pelvic. Relating to the pelvis.
Pelvimeter. An instrument for
measuring the size of the pelvis.
Pelvis. The bony basin composed
of the hips and the lower bones of
the spine, and holding the bowels,
bladder, and organs of generation.
Pemphigus. A skin disease which
is marked by eruptions of large blis-
ters.
Pendulous. Hanging down.
Peppermint. Carminative and
stimulant. A household remedy for
flatulence and stomach-ache.
Pepsin. The ferment of gastric
juice, which chiefly causes digestion
of the food in the stomach.
Peptonized Foods. Food which
has been partially digested by arti-
ficial means.
Percussion. Striking upon the
414
APPENDIX.
chest, the sound heard being helpful
in diagnosis. Place one finger of the
left hand flat on the part to be exam-
ined, and strike sharply with the ends
of the three fingers of the right hand,
holding them at the same length.
There is a certain degree of resonance
in the sound emitted, but this is dulled
when there is fluid in the lung, or the
lung is solid. Only a practised ear
can detect and learn from the degrees
of resonance, but the fact of dulness
can be detected by a nurse, and may
be useful to her. Immediate percus-
sion is that by putting the finger
against the patient and striking it,
without the intervention of the plex-
imeter.
Perforation. A hole in an organ
caused by disease.
Perforator. An obstetrical in-
strument for opening the cranium of
the fetus.
Pericarditis. Inflammation of the
outer coat of the heart; apt to follow
in cases of acute rheumatism or
typhoid. Perfect rest, light diet, in-
creasing watchfulness to anticipate
all the patient's wants. The remedies
ordered must be kept ready at hand.
The patient will probably breathe
better if propped up by plenty of
pillows. On no account should the
patient be permitted to make a sud-
den movement.
Pericardium. The outer mem-
brane or sac which holds the
heart.
Perineorrhaphy. Operation for
repairing a perineum ruptured during
labor.
Perineum. The space between
the anus and the vagina.
Periosteum. The membrane cov-
ering a bone.
Peripheral. Relating to the cir-
cumference or outer surface.
Peristaltic. The worm-like con-
tractions and movements of the in-
testines in forcing onward their con-
tents.
Peritoneum. The membrane or
sac which holds the intestines and
viscera generally.
Peritonitis. Inflammation of the
peritoneum. The symptoms are shal-
low breathing, vomiting, pinched fea-
tures, abdominal pain with knees
drawn up, and rapid pulse. May
follow any abdominal operation,
therefore these symptoms must be
watched for, and at once reported.
Treatment differs with the doctor in
charge. A cradle must be placed
over abdomen. Collapse must be
feared. In peritonitis with perfora-
tion of the bowel, the operation of
laparotomy may be performed. The
convalescence is slow, and care is
needed for a long time. Death may
occur from exhaustion.
Peroneal. Pertaining to the fibula.
A branch of the posterior tibial
artery.
Peroxid. Oxid containing a large
preponderance of oxygen,
Peroxid of Hydrogen. A power-
ful antiseptic and germicide ; used as
a disinfectant in diphtheria, etc., and
as an antispasmodic.
Pertussis. Whooping-cough; a
contagious spasmodic cough, com-
mon in childhood. The first ten days
the patient should be kept indoors;
the disease runs its course in from
two to three months. Watch for chest
complications.
Pessament. A massage move-
ment up the spine ; pick up the flesh,
and roll it between the thumb and
fingers.
Pessary. An instrument worn in
the vagina to prevent or remedy pro-
lapse of the uterus ; generally in the
shape of a ring or a ball, and made
of gutta-percha or vulcanite.
Petechia?. Small red spots on the
skin.
Petrissage. A massage move-
ment, consisting in picking up and
rolling the muscles between the
thumb and fingers—it is slow and
continuous.
Petroleum. A mineral oil; anti-
septic and expectorant. Used to ex-
pel worms.
Petrous. Stony ; a term given to
a hard part of the temporal bone.
Peyer's Patches. Small glands
situated on the surface of the intes-
tines.
Phagedena. Ulcers or wounds,
which spread rapidly and slough.
Phagocytes. Free parasites of the
GLOSSARY.
415
body ; supposed to counteract the
action of disease microbes.
Phalanges. The small bones of the
fingers and toes.
Pharmacopeia. An authorized
handbook of directions for com-
pounding medicines.
Pharmacy. The science of pre-
paring and mixing medicines or
drugs.
Pharyngitis. Inflammation of the
pharynx.
Pharynx. The membranous sac
at the back of the mouth and leading
to the stomach.
Phenacetin. An antipyretic in the
form of a tasteless, reddish powder.
Phlebitis. Inflammation of the'
veins, caused by the coagulation of
the blood in the vein.
Phlebotomy. Bleeding a patient
by opening a vein in the arm.
Phlegm. Thick expectoration
coughed up in chest diseases.
Phlegmasia Alba Dolens. Com-
monly called " milk-leg," a form of
phlebitis occurring sometimes after
labor. The leg becomes swollen,
white, and tense, and is very painful.
Slightly raise the limb on a pillow,
and arrange it so as to give as much
ease as possible. The danger is of the
clot moving and going to the heart
and causing sudden death. The
swelling usually begins to go down
after the ninth day. Gentle friction
after the eighth week may be used.
Phlegmatic. Sluggish.
Phonetic. Relating to the voice.
Phosphate. A compound of phos-
phoric acid and a base. Phosphates
in urine appear as a dense, white de-
posit ; a few drops of nitric acid dis-
solves them at once.
Phosphorus. A non-metallic ele-
ment, used as a tonic and stimulant.
It must not be allowed to come in
contact with water. Give after food.
Phosphuria. Excess of phosphates
in the urine.
Photophobia. Dread of light, a
symptom of inflammation of the eyes.
Phthisis. Consumption ; tuber-
cular disease of the lungs. The pa-
tient must be weighed, the diet nour-
ishing, chills avoided, temperature
taken, and the sputa noted as to color
and amount. The night-sweats are
often a distressing symptom, leaving
the patient weak and wretched, and
necessitating much patience and care
in providing warm, dry changes. In
cases of pyrexia, the temperature
must be taken during the attack.
The patient should wear wool only ;
see that the bed-clothes are light.
Before washing or dressing the pa-
tient, and immediately after, give
some stimulating food. If hemor-
rhage comes on, give ice to suck.
Note if the urine is scanty.
Physiology. The science which
treats of living bodies, and the laws
which govern them.
Physostigmin. Another name for
eserin, and an antiseptic much used
in eye cases.
Pia Mater. The fine membrane
surrounding the brain and spinal
cord.
Piles. Enlarged veins about the
rectum ; hemorrhoids. Bleeding piles
cause discharge of blood ; blind piles
do not.
Pilocarpin. A drug which causes
increased salivation and perspiration.
Pipette. A small graduated tube
for taking up liquids.
Pityriasis. A scaly skin disease.
The serious variety rubra is most
common in men of middle age. Diet
nourishing, no stimulants. Rosea,
which is most common in children,
is not so obstinate to cure.
Placebo. Medicine given to please
the patient, often only tincture of
orange or bread pills.
Placenta. The after-birth ; a cir-
cular, flesh-like substance surround-
ing the fetus, and expelled from the
womb after the birth of the child.
Placenta Praevia. Presentation
of the placenta before the fetus. In
these cases hemorrhage must be
feared.
Plantar. Relating to the sole of
the foot.
Plasma. The liquid in which the
corpuscles of the blood float.
Plaster of Paris. Used for pre-
paring bandages for slight fractures.
Rub the dry powder into a crinoline
muslin bandage and pass it through
a basin of water as it is used. For
416
APPENDIX.
the ordinary bandage, mix the plaster
of Paris with cold water into a cream
(an assistant must stir the cream con-
stantly or it will harden), place the
bandage in plain water, and re-roll
in the plaster of Paris.
Plasters. Used for keeping
wounds together, binding sores, and
applying medicaments to different
parts of the body. The spreading of
plasters is sometimes left to the nurse.
Take a piece of glazed muslin and
stretch it on a board with drawing-
pins, spread the plaster hot with the
edge of a warm knife. To apply a
surgical plaster cut it into convenient
strips, and hold the wrong side against
a tin filled with hot water; this is a
cleaner method than dipping the
plaster into hot water. In removing
plasters, commence at the corners
and work toward the centre: never
pull away from the wound, or you
may tear it open. The marks left
by plasters can be removed with
chloroform.
Pledget. A small compress of
lightly-rolled lint,
Plethora. Fulness; an excess of
blood.
Pleura. The membranous bag
which holds the lung and lines the
cavities of the thorax.
Pleurisy. Inflammation of the
pleura. This, like all chest cases,
needs careful nursing; it is often
found in conjuction with pneumonia
or phthisis. Temperature every 4
hours; poultices will probably be
ordered ; temperature of room 650 ;
fever diet. The sputa must be
watched. In cases of effusion, aspi-
ration may be performed. Great care
is necessary in convalescence, and
woolen vests must be worn.
Pleuro-pneumonia. Pleurisy com-
bined with pneumonia. The term is
usually applied to a certain cattle
disease.
Pleximeter. An ivory disc or
other hard substance placed on the
body to receive the stroke in mediate
percussion (q. v.).
Plexus. A network of vessels or
nerves.
Pneumogastric. Relating to the
lungs and the stomach, and applied
to certain nerves, etc., connecting
these two parts.
Pneumonia. Inflammation of the
lungs. Single pneumonia means one
lung only is affected ; double pneu-
monia, that both lungs are diseased.
Nearly every physician has a differ-
ent method of treating pneumonia,
but the most common nursing treat-
ment is to keep the patient in bed, in
a room with temperature of 650;
jacket poultices every four hours;
temperature every four hours ; keep
a steam kettle going; liquid stimu-
lating food frequently. Some physi-
cians, instead of stimulating diet, ap-
ply hot jacket poultices. Others,
again, instead of poultices, apply ice-
bags or Leiter tubes. The sputa
must be kept for the inspection of the
doctor. The crisis usually comes
about the end of the first week, if
delayed beyond the ninth day the
case is critical; the convalescence
takes three weeks. Relapse is al-
ways to be feared, and flannel vests
must be worn.
Pneumothorax. Air in the pleural
cavity. Causes shock, which is
usually met with stimulants and opi-
ates. Light food frequently. Aspira-
tion may have 'to be performed.
Pock-marks. The pits left by the
small-pox pustules.
Podophyllum. A drug used as a
purge and as an alterative.
Poison. A substance capable of
producing noxious and even fatal
effects when absorbed by the system.
For a classification of poisons and
their antidotes see p. 208.
Polarization. The tendency to a
reverse current in the battery cell.
Politzer Bag. An india-rubber bag
with long tube and nozzle. Used in
ear cases, etc.
Polyclinic. A large general hos-
pital.
Polyemia. Excess of blood.
Polyuria. Excessive flow of urine
of low specific gravity, and con-
sequent thirst of patient. Meas-
ure urine. Nourishing food. Avoid
chills and make the patient wear
flannels.
Popliteal. Behind the knee; a
term given to a certain artery. The
GLOSSARY.
417
continuation of the femoral artery,
etc.
Pore. A small opening.
Positive Pole. The pole of a gal-
vanic battery, by which electricity
flows out from the generator.
Position. Posture or attitude of
the body in obstetric, gynecologic,
or surgical examination and opera-
tion. The dorsal position is lying on
the back; the knee-chest position is
the patient on the knees ; Sims' posi-
tion is the patient lying on left side.
(See pp. 137-143-)
Posthumous. After death ; a post-
humous child is one born after the
father's death.
Post-mortem. The opening and
examining of a dead body.
POSt-partum. After labor. Post-
partum hemorrhage is bleeding after
the child is born.
Posture. Should be noted by the
nurse ; the knees are drawn up in ab-
dominal pain; the body lies flat in
fevers; shoulders raised in chest and
heart complaint; arms overhead in
heart complaint; lying on affected
side in pneumonia, on stomach in
colic. Slipping off the pillows is a
sign of exhaustion.
Potassium. A useful alkali; the
bicarbonate is given in indigestion
and rheumatic gout: the bromid in
nervous diseases, epilepsy, etc.; the
iodid in aneurysm, scrofula, etc., and
to check milk-secretion ; and the per-
manganate is a favorite disinfect-
ant.
Pott's Disease. (See Spinal
Curvature.)
Pott's Fracture. Fracture of the
fibula close above the ankle, some-
times also with dislocation of the
ankle. Usually set in plaster splint.
Twelve weeks' rest necessary.
Poultices. One of the most im-
portant items of nursing treatment
(see p. 95).
Poupart's Ligament. A muscle
of the abdomen, stretching between
the ilium and the pubis.
Precordial. The region in front
of the heart. Precordial pain, spas-
modic pain about the heart, not or-
ganic.
Predisposition. A state of body
rendering it specially liable to certain
diseases.
Pregnancy. The state of being
with child. Usual period 280 days.
Morning vomiting a marked symp-
tom. Test urine monthly. Abdomi-
nal pregnancy, fetation in the abdo-
men (see also Extra-uterine). For
signs of pregnancy see p. 115.
Premature. Occurring before the
proper time.
Presentation. Position of the
fetus at birth.
Preventive. A medicine or agent
which prevents the taking of disease ;
prophylactic.
Primary. The early stage, or
symptom, of disease.
Primipara. A woman who has
borne a child but once.
Probang. A slender rod, some-
times with sponge attached, used to
remove foreign bodies from the esoph-
agus.
Probe. A slender rod, usually of
silver, used for exploring wounds.
Proctitis. Inflammation of the
rectum.
Prognathous. Forward promi-
nence of the jaws.
Prognosis. The art of foretelling
the course of a disease.
Prolapsus Ani. The falling of the
membrane of the rectum through the
anus. Not uncommon in children
who are constipated, and therefore
given to straining. Regulate the
bowels, and when they are acting
press the buttocks together.
Prolapsus Uteri. The falling
down of the uterus into the pelvic
cavity.
Promontory. A projection of the
internal ear.
Pronation. Downward turning of
the palm of the hand.
Prophylactic. A preventive of
disease.
Prostate. Heart-shaped gland at
the neck of the male bladder. When
enlarged, causes retention of urine.
Prostration. Extreme exhaustion
of nervous or muscular force; col-
lapse.
1 Protective. Thin green oil-silk
put between the first and second lay-
[ ers of gauze in an aseptic dressing.
27
418 APPENDIX.
Protein. Protoplasm ; an artificial I
compound almost similar to white of
egg-
Proud Flesh. Too vigorous gran-
ulation, growing up above the proper
surface of the wound. May have to
be touched with caustic.
Prurigo. A skin disease marked
by very irritable and lasting erup-
tions. Tar, sulphur, and naphthol
may be applied locally, or by means
of vapor baths.
Pruritus. Local skin irritation,
generally of the genitals. Medicated
baths and soothing ointments may be
ordered.
Prussic Acid. Violent poison
found in bitter almonds, laurel-
leaves, etc. Antidotes: alkalies,
chlorine, cold water dashed on face
and neck. (See Hydrocyanic Acid!)
Psoas. Two muscles of the loin ;
a psoas abscess is a chronic abscess of
the loins. These abscesses are most
wearisome cases to nurse, and need
the greatest care to avoid sepsis. If
the dressing is left to the nurse, she
must be most particular in every de-
tail. Nourishing diet, cod-liver oil.
The abscess is usually lanced, a drain-
age-tube inserted, and an antiseptic
dressing applied.
Psoriasis. A scaly skin disease
of a chronic character. Medicated
baths, ointments, and arsenic subcu-
taneously, may be part of the treat-
ment to be carried out by the nurse.
Psychical. Relating to the mind.
Ptomaines. Minute alkaloid bod-
ies found in putrefying matter, and of
a poisonous nature.
Ptyalism. Excessive flow of sa-
liva. Sometimes a symptom of mer-
curialism.
Puberty. The period of develop-
ment of the generative faculties or
when reproduction first becomes pos-
sible.
Pubes. The hair-covered region
about the genitals.
Puerperal. Related to child-bear-
ing.
Puerperal Fever. Septicemia;
fever following labor, and due to
contagion. Note the temperature
and pulse every four hours. Be
extremely careful to use antiseptics
freely. The fever is usually acute,
reaching a crisis in a few days ; then
if the temperature, pulse, and respi-
ration decrease, recovery is possible.
Death usually results from exhaus-
tion.
Puerperal Mania. Usually begins
from 4th to 14th day after childbirth,
with pain in head, restlessness and in-
somnia. Never leave patient alone ;
keep the child and the family away.
Puerperium. The period from
childbirth to the time when the uterus
or womb has regained its normal size;
about six weeks.
Pulmonary. Relating to the lungs.
Pulsatilla. A drug used particu-
larly in cases of arrested menstruation.
Pulsation. Beating of the heart,
or of the blood in the arteries.
Pulse. To feel pulsation, put the
three middle fingers on the radial
artery at the wrist, beneath the thumb.
The pulse in health beats about 120
to the minute in infants, 80 in chil-
dren, 60 to 70 in maturity, and 50 in
old age. An intermittent or irregular
pulse is a sign of exhaustion ; a jull
pulse is a sign of the early stage of
fever; a thread-like pulse is a sign of
want of blood, and is common after
hemorrhage; a hard pulse is one
which is not easily stopped by press-
ing on it; a soft pulse is easily com-
pressible (see p. 39).
Pupil. The iris or centre of the
eye.
Purgative. A medicine for caus-
ing evacuation of the bowels. Should
be given on an empty stomach.
Purpura. A serious skin disease
marked by purple patches, caused by
the escape of blood from the vessels
into the skin. Complete rest in hor-
izontal position, and nourishing diet.
Purulent. Pus-like.
Pus. Matter given off from an
open sore. Laudable or healthy pus
is cream colored, not offensive, and
not very thick. Unhealthy pus is
brownish, offensive, and clotted. If
stringy, it is a sign of scrofula. Pus
in the urine shows as a white sedi-
ment, thick and ropy ; it gelatinizes
when liquor potassae is added.
Pustule. A pimple containing pus.
Putrefaction. The rotting away
GLOSSARY.
419
of animal matter. Decomposition
advanced to an offensive stage.
Pyelitis. Inflammation of the
pelvis of the kidney.
Pyemia. Blood-poisoning caused
by pus in the blood, and marked by
the presence of abscesses. It usually
occurs about the second week after
an injury or operation. Be very care-
ful not to convey the contagion else-
where. Diet nourishing. Take pre-
caution against bed-sores. Use anti-
septics freely. Note the temperature
and pulse both morning and evening.
Pylorus. The lower opening of
the stomach into the intestines.
Pyrexia. A state of fever, ill-de-
fined.
Pyuria. Pus in the urine.
Q.
Quarantine. A period of separa-
tion of infected persons from others,
necessary to prevent the spread of
disease.
Quartan. A fever rising and fall-
ing in periods of four days. If quinin
is given, note if it arrests the parox-
ysms.
Quickening. The first movements
of the fetus in the womb, usually felt
by the mother at the end of the fourth
month.
Quicklime. Unslaked lime.
Quinin. A tonic procured from
the bark of a tree. It has remark-
able antiperiodic properties, and is
particularly useful in intermittent
fevers. It should be given before
food.
Quinsy. Inflammation and en-
largement of the tonsils. (See Ton-
sillitis.)
Quotidian. A fever having a pe-
riod of twenty-four hours. If quinin
is given, note if it arrests the parox-
ysms.
R.
Rabies. Madness in animals.
Racemose. Glands having numer-
ous branched tubes.
Rachitis. Rickets; a constitu-
tional disease of childhood, marked
by curving of the spine or long bones,
and enlargement of the joints. Light,
air, good food, and soap and water are
the best cures for rickets, but if the dis-
ease is far advanced, splints may have
to be applied, and raw-meat juice and
cod-liver oil be given. Rickety chil-
dren are specially liable to colds, and
must be warmly yet lightly clad.
Radial. Relating to the radius.
Radial artery is the smaller of the
two terminal branches of the bra-
chial. Begins at the bend of the
elbow and extends along the radial
side of the forearm, passes around
the outer side of the carpus, and for-
ward to the palm.
Radical. That which goes to the
root; thus radical treatment aims at
an absolute cure, not a palliation.
Radius. The smaller bone of the
forearm, from the elbow to the wrist.
Rale. Slight rattling sound heard
in the air-passages upon ausculta-
tion.
Rash. (See Eruption!)
Reaction. The effect produced in
response to treatment.
Reagent. One substance used as
a test for another.
Reaumur. A temperature scale
of 80 equal degrees, from freezing (o°)
to boiling point.
Recrudescence. Return of bad
symptoms.
Rectitis. Inflammation of the rec-
tum.
Rectocele. Prolapsus of the rec-
tum through the vagina.
Rectum. The lower end of the
large intestine from the colon to the
anus.
Rectus. Straight; applied to cer-
tain muscles.
Recurrent. Returning again.
Reducible. A term given to such
hernias, dislocations, etc., as can be
replaced.
Reflex Action. Involuntary action
caused by irritation of the nerve-
centre.
Regimen. A rule of diet.
Regurgitation. A backward flow
of blood through defective valves; an
eructation.
Relapse. A return of disease after
convalescence has once begun.
Relapsing Fever. A contagious
fever due to starvation. Light nour-
420
APPENDIX.
ishing diet given very frequently,
fresh air, warmth, and cleanliness.
Remittent. Returning at regular
intervals; applied to agues and fevers.
Renal. Relating to the kidney.
Rennet. A nutritious whey.
Repair. (See Healing!)
Resistance. In electricity the
non-conducting force of certain
bodies to the current.
Resorcin. Antiseptic and anti-
pyretic used chiefly in dermatology.
May cause poisoning.
Resorption. The absorption of a
fluid or substance previously depos-
ited.
Respiration. Breathing. In count-
ing a patient's respiration, hide the
fact of what you are doing; for in-
stance, when taking the pulse, note
the respirations. They should be
in infants 50 to the minute, in chil-
dren 36, in adults 16 to 18. Note
whether the breathing is shallow or
from low down, whether it is regular
or intermittent. Note in which po-
sition the breathing is easiest, and if
accompanied by any noise such as
the crowing of croup, or the snoring
due to enlarged tonsils.
Respirator. An instrument worn
over the mouth to prevent direct con-
tact with cold air.
Rest-cure. The mode of treat-
ment of patients suffering from hys-
teria and neurasthenia, namely: (1)
rest, (2) isolation, (3) systematic feed-
ing, (4) massage and electricity.
Restless. Deprived of repose or
sleep ; unable to sleep.
Resuscitation. Reviving those
who are apparently dead. The Mar-
shall Hall method of restoring the
apparently drowned is rolling the
body over from the back to the side,
and pressing the chest on the raised
side.
Retching. Ineffectual efforts to
vomit.
Retention. To hold back. In-
ability to void urine.
Retina. The inner membrane of
the eye, upon which objects are re-
flected ; it is formed by an expansion
of the optic nerve.
Retractor. An instrument used
to keep the edges of a wound apart,
or to keep back muscles during an
amputation.
Retroversion. A morbid, back-
ward inclination, as of the womb.
Rheophores. The current-bearers
of a battery : they are placed directly
on the organ or muscle to be galvan-
ized.
Rheum. Rhubarb: a favorite purge.
Rheumatism. A diseased condi-
tion of the blood ; if acute, it is com-
monly called rheumatic fever; but it
may be chronic or muscular. There
is always great pain, and the nurse
must so arrange the bed-clothes that
no weight rests on the affected limbs.
Put the patient between blankets.
The temperature should be taken
every four hours. Fever diet. Keep
the temperature of the room not
higher than 6o°. The two chief causes
of death in cases of acute rheumatism
are heart complications and hyper-
pyrexia. The patient must never be
allowed to move suddenly, even dur-
ing convalescence. Cold baths or
cold packs will probably be ordered
for hyperpyrexia. Test the urine for
acid reaction (see p. 295).
Rhinitis. Inflammation of the
nose.
Rhinoscope. Nasal speculum.
Rhubarb. A favorite household
medicine given as a purgative.
Ribs. Long lateral bones enclos-
ing the chest, seven pairs of true ribs
which join the breast bone, and five
pairs of false ribs. Floating ribs are
the two lower pairs of ribs.
Rickets. (See Rachitis.)
Rigor. A sudden attack of shiv-
ering, usually the herald of a dis-
ease. A nurse should note how
long the rigor lasts, what the temper-
ature of the patient was during the
attack, and the hour of its occur-
rence. Rigors should be immediately
reported to the sister in charge.
Rigor Mortis. The stiffening of
the body after death. Articulo mortis
is the moment of death.
Ringworm. A circular skin erup-
tion ; contagious and very difficult to
cure if occurring on the scalp. The
hair should be shaved and a cap of
oil-silk worn. The ointment ordered
must be rubbed in daily after wash-
GLOSSARY. 421
ing the places with soap and water,
and the nurse must see that the pa-
tient's general health is maintained.
A separate brush and comb and
towel must be kept for the patient.
Risus Sardonicus. A convulsive
grin, symptomatic of lock-jaw.
Rochelle Salt. An aperient con-
taining potash and soda.
Roseola. A rose-colored rash
due to slight fever, and of no great
importance,
Rubefacients. Mild irritants which
cause redness of the skin.
Rubella. German measles. Keep
the patient in bed three days, and in
the house a week.
Rubeola. Measles (which see).
Rupture. Hernia (which see).
Rupture of a blood-vessel means the
bursting of the same.
S.
Sac. A small bag, such as a her-
nial sac.
Saccharin. A substitute for sugar,
used in diabetic cases ; it is usually
in the form of tabloids, two of which
(lA gr. in each) will sweeten a cup of
tea.
Sacculated. Bagged, or pursed
out.
Sacrum. The lowest division of
the back-bone, forming part of the
pelvis.
St. Anthony's Fire. Erysipelas.
St. Vitus' Dance. Chorea.
Salicylic Acid. An antiseptic and
antipyretic. A favorite drug for allay-
ing the joint-pains of acute rheuma-
tism. Causes depression and singing
in the ears. Steel instruments must
not be put in this acid.
Salicylic Wool. An antiseptic
wool impregnated with the white
crystals of the acid and a small
quantity of glycerin. This wool must
not be shaken, or the crystals fall out
and cause sneezing.
Saline. Containing salts. A com-
pound of an acid and an alkali.
Saliva. The watery fluid poured
into the mouth by the salivary glands.
Salivation. An excessive secre-
tion of saliva.
Salol. A white powder composed
of salicylic and carbolic acids. Given
internally in acute rheumatism, and
also used locally as an antiseptic.
Note any decrease of urine.
Saltpeter. Nitrate of potassium :
diuretic and sedative.
Salt-solution. Sodium chlorid
(common salt) dissolved in distilled
water. In medicine it is employed to
restore to the system the fluids lost
by severe hemorrhage, etc.
Salve. An ointment.
Sanguineous. Relating to the
blood.
Santonin. A worm expeller.
Usually given in cream. After a few
doses the sight becomes disordered.
Sapremia. Poisoning of puerperal
women by retention of some decom-
posing matter. The cause being re-
moved, there is rapid recovery.
Sarsaparilla. A mild laxative ob-
tained from the root of a Central
American vine. Given in strumous
and skin cases.
Sartorius. The long muscle of
the thigh.
Scab. An incrustation formed
over a wound.
Scabies. The itch ; a contagious
skin disease due to a parasitic insect.
A sulphur bath will probably be
ordered (four ounces of sulphid of
potassium to thirty gallons of water,
in a porcelain bath), in which the pa-
tient should be allowed to remain
for twenty minutes. Disinfect (or
burn) all the clothing. Vaselin will
relieve the soreness caused by
scratching.
Scalds. Cover up the scalded
part with the dressing ordered (lint
soaked in carron oil probably), and
expose the part to the air as little as
possible. Guard against shock and
exhaustion.
Scalpel. A straight knife; chiefly
used in dissecting.
Scapula. The shoulder-blade.
Scarification. Small incisions for
blood-letting; used instead of cup-
ping.
Scarificator. A small box-like
instrument fitted with many little
blades, and used to perform scarifica-
tion.
Scarlet Fever. Scarlatina; an
422
APPENDIX.
infectious fever accompanied by
redness of the skin, and most com-
mon in children. Period of incuba-
tion, four to eight days; rash on sec-
ond day. The rash shows chiefly on
the chest and back, and lasts about a
week. Then the fever subsides.
Desquamation lasts about five weeks,
and this is the infectious period.
Keep the room cool and well venti-
lated, and a sheet soaked in carbolic
solution hung over the door. Isola-
tion is absolutely necessary, as is also
disinfection and fumigation. (See
Fumigation!)
Schizomycetes. A general term
for all classes of bacteria.
Schneiderian Membrane. The
lining membrane of the top of the
nose.
Sciatica. Neuralgia of the sciatic
nerve—the large nerve of the hip.
A very painful disease. Such local
treatment as the injection of morphia,
atropia, or thein, or the application
of blisters, or cupping, may be left to
the nurse. Keep the patient warm.
Scleroderma. A chronic disease
of the skin causing hardness. Turk-
ish baths and rubbing in of lanolin
or other ointment.
Scleroma. A hardening of the
tissues. Scleroma neonatorutn, infan-
tile disease. Rare, very fatal.
Scoliosis. Lateral curvature of
the spine.
Scorbutus. Scurvy; a skin dis-
ease marked by dejection and anemia,
and caused by want of vegetable
food. Plenty of green vegetables
and lemons needed in the diet. Do
not let the patient sit up or make any
sudden movement, or syncope may
be the result.
Scrofula. Constitutional debility,
with a tendency to tuberculosis.
Characterized by swelling and sup-
puration of the glands of the neck.
Fresh air, nourishing diet, cod-liver
oil, and attention to the general
health are necessary. The glands
may have to be removed.
Scruple. A weight equal to 20
grs. troy.
Scurvy. Scorbutus (which see).
Sebaceous. Fatty; secreting oily
matter.
Seborrhea. Excessive secretions
of the sebaceous glands.
Secondary Disease. A disease
consequent on another disease gone
before.
Second Intention. The healing
of a wound by means of granulation,
or the growing of new skin.
Secretion. Substance separated
from the blood by a natural function
of the body.
Section. (See Cesarean.)
Sedative. A soothing medicine,
Seidlitz Powder. A popular aperi-
ent in the form of two powders,
which, when mixed, effervesce.
Semicircular Canals. Three ca-
nals of the internal ear.
Senility. Decline of power after
passing the climacteric.
Senna. A disagreeable rapid aperi-
ent, usually given as a black draught.
The syrup of senna is best disguised
if given in coffee.
Sepsis. The condition of putre-
faction.
Septic. Anything that causes pu-
trefaction.
Septicemia. Septic matter in the
blood; blood-poisoning. Use disin-
fectants freely.
Septum. The division between
two cavities; such as septum ven-
triculorum, which separates the right
ventricle from the left.
Sequelae. Morbid conditions re-
maining after, and consequent on,
some former illness.
Serum. The fluid of the blood in
which the corpuscles float.
Shingles. (See Herpes!)
Shiver. A tremor or shaking of
the body ; often concomitant with or
symptomatic of fevers, especially
those of an infectious nature.
Shock. Sudden prostration due
to painful impressions; a frequent
cause of death after operations and
accidents, especially after burns. It
is best met by stimulants and
warmth.
Show. A popular name for the
sanguineous mucous discharge from
the vagina before labor.
Sigmoid Flexure. The flexure of
the descending colon, shaped like the
letter S ; serves to remove the fecal
GLOSSARY.
423
matter from the body by muscles of
its own and ends in the rectum.
Silkworm Gut. The thread drawn
from a silkworm killed when ready to
spin the cocoon.
Sinapism. A mustard plaster.
Sinciput. The upper fore part of
the head.
Sinew. A tendon uniting a muscle
to a bone.
Sinus. A passage leading from an
abscess, or some diseased part, to an
external opening.
Sitz-bath. A hip-bath. (See p. 82.)
Sling. A bandage suspended from
the neck for the support of a wounded
arm or hand.
Slough. Dead matter thrown off
by gangrene or ulcers.
Small-pox. (See Variola.)
Sneezing. Convulsive action of
the respiratory muscles from irrita-
tion of the mucous membrane lining
the nasal cavity.
Snoring. (See Stertor.)
Snuffles. The peculiar hard
breathing noise by infants affected
with chronic cold in the head.
Sodium. The basis of common
salt. The bicarbonate is a favorite
remedy for acidity of the stomach.
The chlorid is an emetic. The sul-
phate a cathartic. The nitrate, given
in epilepsy, etc., may cause serious
symptoms. Sodamint is a prepara-
tion given for indigestion.
Solubility. Capable of being
dissolved.
Solution. The product of a solid
dissolved by a liquid. In therapeu-
tics, the termination of a disease.
Solution of continuity, the separation
of united parts, or division of tissues,
as from a wound.
Somnambulism. Walking in the
sleep.
Sopor. An unnatural profound
sleep.
Soporific. An agent which in-
duces sleep.
Sordes. The secretions collected
about the teeth and on the lips in
fever.
Souffle. Sound heard on auscul-
tation.
Sound. A probe-like instrument
used for exploring.
Spasm. Sudden involuntary
movement.
Spatula. A flat, flexible, blunt
knife, used for spreading ointments
and poultices. Also, in a smaller form,
used to press down the tongue when
the throat has to be examined. Every
nurse should carry a spatula.
Specific. Applied to a medicine,
it means infallible; applied to a dis-
ease, it means of special character.
Specific Gravity. The weight
or density of a substan9e compared
with some standard substance—usu-
ally water in the case of liquids.
Speculum. A polished instru-
ment for examining the interior cavi-
ties of the body.
Sphincter. A circular muscle
which contracts the orifice of any
organ.
Sphygmograph. An instrument
affixed to the wrist, which moves
with the beat of the pulse and regis-
ters the rate and character of the
beats.
Spica. A spiral bandage done
with a roller in a series of figure
eights. Most used for the shoulder,
groin, thumb, and great-toe.
Spina Bifida. A congenital mal-
formation of the spine, forming a
kind of tumor. Found in infants,
and often terminating fatally. Usual
treatment is tapping and subsequent
dressing of absorbent wool, rather
tightly strapped on. Watch for con-
vulsions, signs of brain mischief, or
paralysis.
Spinal Cord. The marrow of the
spine.
Spinal Curvature. Constitutional
curving of the spine. When accom-
panied by caries of the spine it is
called Pott's disease. A Sayre's
jacket of plaster of Paris, applied
during suspension, will probably be
used. Long cases, needing good
food and prevention of sores and the
recumbent position.
Spine. The back-bone or verte-
bral column.
Spirometer. An instrument for
measuring the capacity of the lungs.
Spissated. Thickened.
Spleen. An oval body to the left
of the stomach. Forms and purifies
424
APPENDIX.
the blood. Hemorrhage is peculiarly
liable to occur after any operation on
the spleen. Such operations are
always serious, and need careful
nursing.
Splints. Stiff pieces of board or
material used to secure rest to some
injured part. The most common are
wooden splints, but iron, tin, felt,
gutta-percha, etc., are used. An an-
gular splint has one part at right
angles to the other, and is used for
the arm, the elbow occupying the
angle. An interrupted splint has the
part just over the wound removed to
facilitate the dressing. The nurse's
duty is to keep splints clean and pad
them for use. The pads should be
linen stuffed with antiseptic wool,
made slightly larger than the splint;
the padding must be even. The pad
can either be sown on by cross
threads on the wrong side of the
splint, or fastened on by three bands
of strapping going right round the
splint. When necessary, the pads
near a discharging wound should be
covered with oil-silk.
Sponge. A porous substance,
varying in texture, derived from an
aquatic organism of low order, and
formerly much used in operations.
Artificial sponges of absorbent wool
enclosed in antiseptic gauze are now
used extensively instead of the nat-
ural sponge.
Sporadic. A disease which is not
epidemic, but occurs in one or two
isolated cases in a district.
Sprain. Severe strain of a joint
without dislocation. Cold-water
bandages is the favorite mode of
treatment, but severe sprains some-
times need splints, ice-bags, and all
the time and trouble given a fracture.
Sputum. Expectorated matter
from the mouth.
Squill. Drug used as an expector-
ant and diuretic. Overdose poisons.
Staff. A lithotomy instrument
used to guide the knife.
Stapedius. A muscle of the in-
ternal ear.
Stapes. A stirrup-like bone of the
internal ear.
Stasis. Defective circulation of
the blood.
Stenosis. Contraction of an or-
gan.
Stercoraceous. Resembling the
feces.
Sterile. Barren; inability to have
children.
Sterilization. Rendered free from
germs ; generally by boiling.
Sternum. The breast-bone.
Stertor. The rasping, rattling
sound produced when the larynx and
the air-passages are obstructed with
mucus.
Stertorous. The snoring sound
of breathing heard in apoplexy,
etc.
Stethoscope. A tube used for
listening to the sounds of the chest
and heart; one end is placed against
the patient's chest, and the ear of
the listener at the other end. The
binaural stethoscope has two flexible
ends to apply to the ears of the list-
ener.
Sthenic. Strong, active.
Stigmata. Marks on the skin.
Stillborn. Born after the seventh
month, but without having made a
complete breath.
Stillingia. Drug used as a ca-
thartic ; also in cases of syphilis.
Stimulant. That which causes
temporary increase of the vital en-
ergy.
Stomach-pump. An instrument
used for emptying the stomach by the
mouth : also to feed refractory pa-
tients.
Stomatitis. Inflammation of the
mouth, and ulceration; most com-
mon in infants. Attend to the diet,
give a mild purgative; wash the
mouth out frequently with a little
borax.
Stools. Discharge from the anus.
(See Motions!)
Strabismus. Squinting; divergent
when the eye turns out; convergent
when it turns in.
Stramonium. A drug used as a
sedative. Overdose poisons.
Strangulated. A hernia which
cannot be reduced by taxis, but needs
operation.
Strangulation. Choking; con-
striction.
Strangury. Painful passing of
GLOSSARY.
425
urine in drops. Hot sponge to part,
hot baths, etc., may be ordered.
Strawberry Tongue. Applied to
a characteristic clear-red appearance
of the tongue in scarlet fever after a
thick white fur has disappeared.
Stricture. Contraction. Usually
applied to the urethra, and conse-
quent inability to pass urine.
Stridulous. A creaking sound in
breathing.
Stroma. The tissue which forms
the foundation of an organ.
Strophanthus. A poison, used in
small doses as a heart-stimulant.
Struma. Scrofula ; or a scrofulous
swelling.
Strychnin. A poison, used as a
nerve and spinal stimulant. Anti-
dotes : an emetic, strong tea, ether
inhalation.
Stump. The part ot a limb re-
maining after an amputation.
Stupe. A fomentation (see p. 94).
Stupor. State of unconsciousness.
Styptic. Agent to arrest bleed-
ing; astringent.
Subclavian. Under the shoulder-
blade.
Subcutaneous. Under the skin.
Subinvolution. A condition of
imperfect restoration of the uterus to
its original size after delivery in child-
birth.
Subluxation. Sprain and partial
dislocation.
Subnormal. Below the normal.
Subsultus. Involuntary twitch-
ing.
Sudor. Perspiration.
Sudorific. An agent causing per-
spiration.
Suffocation. Stoppage of respi-
ration. Asphyxia.
Suffusion. Fluid poured out of
its natural organ into the surround-
ing parts.
Sugar. To test for sugar in urine
boil together a drachm of urine and
a drachm of picric acid, add half
drachm of liquor potassrt, reboil; if
sugar be present the color will be in-
tense deep red, nearly black.
Suggilation. Livid spots on the
body.
Sulphonal. Crystalline tasteless
substance, used as an hypnotic. Give I
2 hours before bed-time. Note any
headache next day.
Sulphur. Used as a laxative. The
ointment is used for skin diseases,
particularly scabies.
Sulphuric Acid. Vitriol. A poi-
son ; the antidotes are lime-water,
potash-water, oil and milk.
Sumbul. Antispasmodic and stim-
ulant. Given chiefly for neuralgia
and hysteria.
Sunstroke. Brain mischief caused
by heat. Symptoms : Headache, sick-
ness, confusion of ideas, refusal of
food. Put patient in darkened room,
and keep quiet. Ice to head.
Superfetation. Supposed concep-
tion by a woman already pregnant.
Supination. Turning the palm of
the hand upward.
Suppository. A solid medicine
introduced into the rectum or vagina.
Suppression. Failure of the kid-
neys to secrete urine.
Suppuration. Gathering of pus
under the skin.
Sutures. Silk, silver-thread, or
catgut used to sew a wound or tie an
artery (see p. 171). Also the union of
flat bones by their margins.
Swelling. Morbid enlargement of
a part.
Symphysis. Growing together of
bones. Symphysis pubis, the line of
union of the two pubic bones.
Symptom. A sign by which dis-
eases are recognized.
Syncope. Suspension of the heart's
action and consequent state of swoon.
Stimulation, warmth, and artificial
respiration may have to be tried. Put
the patient flat on his back and open
the windows.
Synovial Fluid. The liquid se-
creted in the ligaments that lubricates
the joints.
Synovitis. Inflammation of the
synovial membrane of a joint.
Syphilis. Venereal disease, spe-
cific and contagious. There are three
stages, the one marked by primary
symptoms, the second a period of
outbreak, and the third certain well-
marked sequela?. In dressing all
sores in these cases the nurse must
be most careful to use forceps, and to
burn soiled dressings. Infantile syph-
426
APPENDIX.
ilis is inherited; the infant looks old,
head large.
Syringe. An instrument for in-
jecting fluids.
Systole. The contraction of the
heart in its beat.
Tabes. Wasting; dorsalis, a dis-
order of the spinal marrow, marked
by loss of power over the voluntary
muscles; mesenteric, consumption of
the bowels.
Tactile. Relating to the touch.
Talcum. Silicate of magnesia ; a
white, unctuous powder.
Talipes. Club-foot. Talipes val-
gus, the foot turned outward ; varus,
the foot turned inward ; equinus, the
heel lifted from the ground; calca-
neus, heel projecting downward.
Tampons. Plugs of antiseptic
wool enclosed in gauze, and used for
introducing into the vagina, etc. A
string is usually attached to the plug
to aid in its withdrawal.
Tansy. A favorite household
remedy derived from a common
plant. Promotes menses, and is a
diuretic. Poisonous.
Tape-worm. Tenia (q. v.).
Tapotement. A massage move-
ment; the hand is lightly clinched
and held hammer-like, used to beat
the muscles with swift, short strokes.
All beating movements are sometimes
included under this term.
Tapping. (See Aspiration!)
Tar. A thick, black, resinous
substance obtained from the wood
of the pine or fir tree.
Tarsus. The seven small bones
across the instep.
Tartar. Incrustation on the teeth
if they are not kept clean.
Tartar Emetic. Potassio-tartrate
of antimony ; an emetic ; or in small
doses a sedative.
Taxis. Hand-manipulation for
restoring a part to its natural posi-
tion, such as reducing a hernia.
Tears. The fluid secreted by the
lachrymal gland.
Teeth. The principal organs of
mastication. There are four kinds
of teeth—incisors, canine, bicuspids,
and molars. The first set of teeth in
childhood are called " milk-teeth,"
which are only temporary teeth.
They number 20, 10 in each jaw.
namely, 4 incisors, 2 canine, and 4
molars. The two middle teeth of
the lower jaw should appear about
the seventh month. In the adult the
permanent teeth consist of 32 teeth,
16 in each jaw, viz.: 4 incisors (front
teeth); 2 canines; 4 bicuspids, and 6
molars. (See Dentition.)
Temperature. Degree of heat.
The average temperature of the body
in health is 98.2° F., but it rises
slightly at night and falls in the
early morning. A temperature of
99^ ° degrees indicates the presence
of fever; a temperature of 1040 is
serious. In collapse, the temperature
falls below the normal point, and may
be 960. A subfebrile temperature
is slightly feverish ; subnormal tem-
perature is below the normal; an
algid body-temperature is seen in
pernicious intermittent fevers in
which there is great coldness of the
surface of the body. The tempera-
ture of a sick-room should be 68°
as a rule, rather lower for surgical
cases, rather higher for chest cases.
Temples. The part of the fore-
head between the outer corner of
each eye and the hair.
Temporal. Two bones at the
side of the skull containing the
organs of hearing.
Tenaculum. Small surgical hook
to secure arteries, etc., and used by
anatomists in dissection.
Tendon. A sinew, a cord of fibrous
white muscle.
Tenesmus. Constant futile strain-
ing to evacuate the bowels.
Tenia. The tape-worm. When a
cathartic has been given with the ob-
ject of expelling this worm, it is the
duty of the nurse to sift the evacuation
through fine muslin, and see that the
head of the worm comes away. If
merely the long flat joints of the worm
are expelled, the worm will grow
again.
Tenotomy. Cutting a tendon
under the skin by means of a small
knife especially devised for the pur-
pose. As a rule no anesthetic is used.
GLOSSARY.
427
Tension. Stretching.
Tensor. A muscle which stretches.
Tent. A prepared roll of lint or
cvlinder for keeping open a passage.
Terebene. A preparation of oil
of turpentine. From 5 to 10 drops
on a lump of sugar acts as an ex-
pectorant. A teaspoonful to a pint
of water for an inhalation.
Terminals. The extremities of a
conductor of a battery.
Tertian. An intermittent fever
with attacks every third day.
Testicles. The two glands of the
scrotum, which secrete the semen.
Testing. Finding the constituents
of the urine by means of chemicals.
The common tests include acid or
alkali reaction, deposits of urates,
phosphates or oxalate of lime ; pus,
blood, chlorids, bile-pigment, albu-
min and sugar.
Tetanus. Lock-jaw. Severe
spasms occur at intervals, during
which try to prevent the patient
biting the tongue, or in any way in-
juring himself. Perfect quiet and
darkness, as the least irritation re-
news the spasms. Death may occur
about the third or fifth day. Food
and medicine can seldom be taken
by the mouth in cases of tetanus.
Therapeutics. That branch of
medicine which treats of the appli-
cation of remedies and all forms of
cure.
Thermometer. An instrument
used to measure the degree of heat.
There are several thermometric scales,
the one in popular use in America
being that of Fahrenheit. The ac-
companying diagram presents to the
eye the difference between the mark-
ings of the centigrade and the Fah-
renheit scales. Clinical thermometer
is a slender glass instrument used to
discover the temperature of the body.
(See Temperature.) (See Fig. 7, p.
«'»
Thoracentesis. Puncture of the
thorax, as the tapping for pleurisy.
Thoracic. Pertaining to the chest
or thorax.
Thorax. The chest; the cavity
which holds the heart and lungs.
Thread-worm. Small parasitic
worm in the rectum; common only
in children. Injections of salt water
or quassia may be ordered. Oxyuris
vermicularis.
Thrombosis. The consequent
evils attending the presence of a
thrombus, or coagulation of the blood,
which, forming into a clot, obstructs
some blood-vessel.
Thrush. (See Aphtha.)
Thymol. An antiseptic, used as a
solution or spray, also as an ointment.
Thymus. A gland at the root of
the neck.
Thyroid. The name of the largest
cartilage of the larynx, and oi a.gland
in the front of the neck.
Boiling-point \
of water, j
Centigrade. Fahrenheit.
phoid.)
typhus. (See Typhus!)
Fevers, coated tongue in, 46, 47
Fibrin, blood, 90
Fibula, the, 299
Finger-nails of patient, condition of,
50
Fire, accidents from, 203
sick-room, management of, 36
Fistula, 192
Fits, epileptic. (See Epilepsy.)
Flatulence, treatment of, 206
Flaxseed enema, 63
poultice in removing a slough,
97
preparation of, 95, 96
Fomentation, the, action of, 91
Fomentations, 94, 95
—hot-water, 94
—laudanum, 95
—mustard, 95
—turpentine, 95
Fontanel, anterior, closing of the
268
Food, administration of, before sur-
gical operation, 150
artificial, for the new-born, 265
Meigs', 267
infant, 326
record of, taken by patient, 46
serving the, proper method of, 56,
3"
Food-changes in the stomach, 292
Foods, invalid, recipes for, 317-332
—beef-teas and extracts, 319
—broths, 321
—desserts, 329
—farinaceous, 317
—miscellaneous, 325
—oysters, 322
—prepared milk, 327
—puddings, 323
—soups, 324
—toasts, 328
Foot-bath, 55
hot, 84
action of, 82
Forearm, the, 299
Foreign bodies, obstruction due to,
204
Fracture, moving of the patient in, 31
signs of a, 173
Fractures, 172-175
management of, 53, 173
nurse's preparations for the surgeon
in, 174
removal of patient's clothing in,
53, I73, 174
splints in, application of, 186
varieties of, 172
Friar's balsam, 349
Frost-bite, cause and treatment of,
207
complications of, possible, 207
Fumigation after contagious diseases,
234-236
moist, 235
preparation of sick-room for, 236
sulphur-fume, 234
apparatus for burning the sul-
phur, 234
Functional disturbances. (See Dis-
turbances!)
Furuncle. (See Boil.)
44^ INDEX.
Gall-bladder, 306
Gangrene, 191
dry or " senile," 191
symptoms of, 191
from improper bandaging, 179
moist, symptoms, 191
Gargles, no
Gas, rectum, passage of, after opera-
tion, 50, 164
Gas-accumulation, rectal, relief of,
246
Gastric juice, 292
digestive action of, 292
Gastritis, symptoms, 244
treatment, 245
Germs, disease, conditions necessary
for development of, 213
media of leaving the body, 213
of phthisis, dissemination of, 236
Gland, lachrymal, 112
parotid, function of, 292
Glauber's salt, 366
" Globus hystericus," 257
Glossary, 369
Glottis, edema of, from scalds, 198
Glycerin enema, or substitutes, 61, 62
Golden seal, 359
Gruels, 318
Gums of the patient, condition of, 46
Hair, patient's, dressing of, 53
Hand, palm of the, bleeding from,
checking, 196
Hartshorn, 347
Head-accidents, 203
Head-douche, 87
Healing by first intention, 188
by second intention, 188
under a blood-clot, 189
Heart, the, 300
its structure and valves, 286
neuralgia of the. (See Angina!)
Heart-failure, unconsciousness from,
treatment, 201
Heat as a disinfectant, 171
dry, application of, 101
moist, 94
of inflammation, cause of, 91
Heat-exhaustion, treatment, 200
Heel-pad, 35
Ilematemesis, 196
Hemiplegia, 254
Hemoptysis, 196
Hemorrhage, body-temperature in,
160
cerebral, 251
checking, by flexion, 194
by tourniquet, 195
fainting in, 195
of venous, 195
with ice, 195
following surgical operation, 161
from the lungs, treatment of, 196
from the nose, treatment, 197
from the palm, checking, 196
from the stomach, treatment, 196
of amputation-stump, checking, 194
of pregnancy, treatment, 120
of typhoid fever, 219
treatment, 220
post-partum, 133
treatment, 133, 134
puerperal, 133
stimulants in, 162
symptoms of, 194
thirst in, 196
treatment, 194
Hemorrhages:
—primary, 193
—recurrent, 193
—secondary, 193
Henbane, 359
Herpes zoster, 260
Hiccough, cause and relief, 52
of the patient, character of, 51
High enema, administration of, 61
" Hinge-joint," 299
Hip-joint disease, 280
Hoffmann's anodyne, 354
Hot bath, action of, 83
Hot-air bath, 84
Humerus, the, 298
Hunger, relief of, by rectal feeding,
83
Hydrocyanic acid, antidotes, 209
Hygiene of children, 281
of the sick-room, 29, 36, 290
—air, 37
—temperature, 36
—ventilation, 37
personal, of patient, following ap-
pendicitis, 248
Hyperpyrexia, body-temperature in,
42
INDEX.
443
Hypnotics, action of, 72
Hypodermatic tablets, list of, 342
Hysterectomy, after-care in, 165
Hysteria, 256
diagnosis of, from epilepsy, 256
forms of, 256
treatment of, 256
Ice, action of, in inflammatory pro-
cess, 91
in checking hemorrhage, 195
in treatment of sunstroke, 200
serving of, to the sick, method of,
57
lee-bags, 103
Idiosyncrasy defined, 71
Ileo-cecal valve, 307
Ileum, the, 307
" Immunity" defined, 214
Incontinence of urine, 50, 279
in pregnancy, cause of, 119
Incubation of typhoid fever, period
of, 215
period of, defined, 213
Incubator, improvised, 269
Indian-meal enema, 63
Indigestion, infant, treatment, 271
Infancy, diseases of, 270-277
Infant, bathing the, 264
cry of the, signification of, 277
crying of the, causes of, 265
defecation of the, 264
development of the, 268
dressing the, 263
feeding of the, artificial, 265
care of the utensils, 266
periods of, 268
rules for, 267
food. (See Food!)
new-born, care of, 262
nursing of the, 265
paralysis, 276
pulse of, at birth, 41, 269, 277
how to take, 277
urination of the, 264
weaning, time for, 268
Infants, body-temperature of, 42
premature, care of, 269
pulse-rate of, 41, 269, 277
respiration of, 45, 277
syringing the eyes of, method
275
Infection, diphtheritic, conditions fa-
voring, 231
Inflammation, 90
from frost-bite, treatment, 207
symptoms of, 91
treatment of, 91
Influenza (grippe), 239
complications of, 240
symptoms, 239
treatment, 239
Inhalations of medicines, 80
—dry, 80
—moist, 80
Injection, intravenous, defined, 78
of medicines, hypodermatic, 76
(See Enemata, and Douches.)
Insanity following hysterectomy,
165
puerperal, 135
Insect bites and stings, 205
in the ear, removal of, 204
Insomnia, treatment, 206
Inspiration, 289
Intestines, the, 291, 307
lengths of, 307.
Intoxication, diagnosis of, from apo-
plexy, 253
Intubation in diphtheria, 233
duties of the nurse, 233
in scalds of the glottis, 198
Inunction, mercurial, 78
Inunctions of medicines, 78
Involution, 125, 131
method of promoting, 128
Iodin, antidotes, 210
tincture of (counter-irritant), 106
Ipecac, 359
Itch, 259
Ivy-poisoning, treatment, 210
Jacket-poultice, preparation of, 97
James' powder, 348
Jaundice, cause of, 306
Jaw dislocation, treatment, 176
fracture, treatment, 175
Jellies, recipes for, 329-332
Kidney, inflammation of. (See
Nephritis.)
Kidneys, the, 308
if, Kitchen, the, as an operating-room,
'I i45, I5I>I52
444
INDEX.
Knee-cap, 299
Koumyss, 327
Labor,122-129
duration of, 126
normal, birth in, 122, 123
conduct of, 126-129
first sign of, 123
stages of, 123-126
preparations for, nurse's, 120
—accessory, 121
—aseptic cleanliness of nurse,
122
—of the bed, 121
—of the patient, 120
—special articles needed, 122
Labor-pains, 123, 124
false or true, differential diagnosis,
120, 123, 124
Labyrinth (ear), 305
Lactation, 131
La grippe. (See Influenza.)
Laudanum, 363
Lavage, 70
in gastritis, 245
Laxatives, administering, 75
Leeches, application of, 92, 93
Leeching, 92
Leg fracture, treatment in, 175
Leiter coil, 101-103
Leucorrhea, cause of, 52
Licorice-root, 358
Ligation, 171
Lightning-stroke, 201
Limbs, swelling of, in pregnancy,
cause of, 119
Lime-water, recipe for, 337
Liniments, no
Liver, the, 306
Lochia, 130
Lockjaw. (See Tetanus.)
Logwood, 358
Lotions, no
Lugol's solution, 359
Lunch, invalid's, 328
Lung, gangrene of, expectoration in,
47
Lungs, the, 305
function of the, 287
hemorrhage from the, 196
tuberculosis of. (See Phthisis!)
Luxations. (See Dislocations.)
Lying-in, period of, 129
Lymphatics, 300, 301
Lysis, 44
Mad-dog, bites by, treatment, 212
Magnesia, calcined, 362
Husband's, 362
Massage, 108-110
breast, 131
in infant paralysis, 276
in neurasthenia, 257
in paralysis, 254
in rheumatism, 259
skill required in applying, 109, no
therapeutic effect of, 109
Mastication, 291
Mastoid process, 305
Measles, 228
complications of, 229
nursing-treatment, 228
symptoms, 228
Meat cure, 320
raw, diet, 320
Meatus urinarius, 308
Medicine-glasses, care of, 73
Medicines, absorption of, rapidity, 70
action of, 71
—cerebral, 72
—hypnotic, 72
—sedative, 72
—stimulant, 72
—tonic, 72
time required for, 71
administration of, 70-80
by inhalation, 80
by inunction, 78
by the mouth, 74
hypodermatic, 76
per rectum, 76
precautions in handling, 72
Medicine-spoons, care of, 73
Medulla oblongata, 301
Melancholia, puerperal, 135
Meningitis, cerebral, symptoms, 278
treatment, 279
cerebro-spinal, symptoms, 251
treatment, 251
Menstruation, 52
painful, treatment, 205
retarded, relief of, 82
Mercury, inunction of, method of,
78,79
INDEX.
445
Milk, mother's, first appearance of,
I3»
not to be given before an abdomi-
nal operation, 149, 150
sterilization, 266
sterilized, 335
use of, in typhoid fever, 218
Milk-leg, 135
Milk-secretion, scanty, 132
Mineral waters, 337-339
Molasses enema, 62
Monoplegia, 254
Morphia, antidotes, 211
is the nurse justified in giving,
248
Morphin, 362
Mouth, patient's, cleansing of, 53
state of the, 46
Movements (bowel) after labor, 130
character of, 50
color of, 50
indications from, 50
composition of, 50
disinfection of, in contagious dis-
eases, 215
in typhoid fever, 216
disposition of, from contagious
cases, 215
in infant, bowel obstruction, 271
colic, 271
diarrhea, 272
in typhoid fever, 216, 278
of the new-born, 264
Moving the patient, 57
Mumps, symptoms, 279
treatment, 279
Muriatic acid, 346
Muscles of the body :
—involuntary, 299
—longest, 299
—smallest, 299
—sterno-cleido-mastoid, 300
—the diaphragm, 300
—voluntary, 299
Mushrooms, poisonous, antidotes, 212
Mustard plaster, 106
Napkins during the puerperium, 130
Narcotics, action of, 72
Nausea and vomiting, 46
following etherization, 154, 155
of pregnancy, 119
Nephritis complicating scarlet fever,
224
Nerve-fibres, motor, 302
sensory, 302
Nerves, the, 302
action qf, impulsive, 302, 303
reflex, 303
of the brain, 301
of the spinal cord, 302, 303
vasomotor, 303
Nervous system, the, 302
Neuralgia, heart. (See Angina.)
Neurasthenia, 257
treatment, 257
New-born, bathing the, 262
care of the, 262-269
dressing the cord, 263.
(See Infant!)
Nightingale wrap, 36
Nipple, cracked, 132
Nitrate of amyl, antidotes, 212
Nitric acid, antidote, 210
Nitromuriatic acid, 346
Nose, the, 303
obstruction in the, removal of, 205
spraying the, 111
Nose-bleed, 197
Nurse, the, 17-28
aseptic cleanliness of, in surgical
operations, 122, 247
in obstetric cases, 122
compensation of, 19
conduct of the, in emergencies, 212
dress and personal habits, 25
in contagious diseases, 236
in operating-room, 156
duties of the, 20
—in circumstances of envi-
ronment, 21
—in conversing with patients,
21, 22
—in dissensions, 22
—in operating-room, 156
—in preparations for the
night, 21
—in preservation of confi-
dences, 21, 22
—to her superiors in hospital
practice, 23
—to the doctor, 22
—to the family, 20
—to the patient, 20
446
INDEX.
Nurse, duties of, in emergency cases,
151, 212
night duty of, responsibility of, 19
personal bearing, 18
care, 18
in contagious diseases, 236
qualifications of, 19
responsibilities of, 17
sympathy and kindness of the,
toward the patient, 282
Nurse's equipment, 25
for an obstetric case, 122
hands, sterilization of, importance
of, 136, 221.
management of children, 281
meals, 21, 22
records. (See Record.)
Nursing, hospital, etiquette in, 23
versus private, 23
in accidents and emergencies,
172-193
in common emergency cases, 193—
212
in general surgical cases, 144-172
in gynecologic cases, 137-144
in obstetric cases, 115-137
in special medical diseases, 213-
262
of sick children, 262-283
private, etiquette in, 24.
(See Patient!)
Nursing of infant by the mother, 265
Nutritive enema, administration of,
64
formulae for, 64
frequency and amount of, 64
retention of, 64
stimulating, formula, 63
Nux vomica, antidotes, 211
Observations in medical cases, 39-
52
—body-temperature, 41-44
—the pulse, 39-41
—the respiration, 44
—the symptoms, 45
of symptoms :
—chills, 49
—cough and expectoration, 47
—delirium, 48
—hiccough, 51
—pain, 47
Observations of symptoms :—sleep,
48
—the bladder, 50
—the bowels, 50
—the breath, 48
—the facial expression, 47
—the menstruation, 52
—the mouth, 46
—the skin, etc., 49
—the taking of food, 46
—the tongue, 46
Oil of chenopodium, 368
of vitriol, 347
Oils, administering, 75
Ointment, mercurial, inunction of,
78-80
Olive-oil enema, 61
Omentum, the, 308
Operating-room, nurse's duties in
the, 156
preparation of, for surgical case,
144
selection of, 145
the kitchen as an, 141, 152
Operating-table, improvised, for sur-
gical cases, 145, 146
Operation:
gynecologic, after-care of patient,
I43.
examination for, preparation of
patient, 137
positions for, 137
preparation for, 140
surgical, after-care of patient, 159
arranging the patient for, 158
cleansing the part for, 149
diet before, 149
disinfection and materials, 167
dressing the patient for, 150
emergency, duties of the nurse
in, 151, 152
food before, giving, 150
preparation for the, articles re-
quired, 146, 147
of patient, 152
sequelae of operation, 159
—collapse, 161
—hemorrhage, 161
—shock, 159
Operations, abdominal, after-treat-
ment, 163, 164
catheterization after, 164
Operations, surgical, 144-172
antiseptic cleanliness of nurse
in, 122, 247
emergency, duties of the nurse
in, 151
Ophthalmia neonatorum, 275
(ipisthotonos, 190
Opium, antidotes, 211
-poisoning, diagnosis of, from
apoplexy, 253
Orbits, eye, 303
Organs, circulatory, 285, 300
digestive, 290, 305
of generation, female, 308
respiratory, 305
sensory, 301
urinary, 293, 308
function of, 293
Os uteri, the, 308
Ovaries, the, 309
Oxalic acid, antidotes, 209
Oxygen, deficient, effect of, 290
Oysters, recipes, 322
Pack, cold, 88
hot, 89
partial, 90
" Packed feces," 50
Pads, obstetric, antiseptic, 121
Pain from burns, 198
inflammatory, cause of, 91
reporting the, of the patient, 47
Pancreas, the, 307
Pancreatic juice, 292
digestive action of, 292
Paracentesis in pleurisy, 243
Paralysis, 254
changing the patient's clothing in
case of, method, 53
hysterical, 257
of infancy, 276
treatment of, 254
Paraplegia, 254
Paregoric, 363
Paresis, 254
Paris green, antidotes, 210
Patella, the, 299
Patient, the, 39-114
administration of medicines, 70-80
—by the mouth, 74
—by the rectum, 76
—hypodermatic, 76
ex. 447
Patient, the, administration of med-
icines :—by inhalation, 80
—inunction, 78
after-care of, in gynecologic opera-
tions, 143
in surgical operation, 159
after-treatment of, in amputations,
163
in abdominal operations, 163
in surgical operation, 163
arranging the, for surgical opera-
tion, 158
bathing the, 55
bodily care of, 52-59
body-temperature of the, 41
bowels of the, condition of, 50
breath of, character of, 48
breathing of the, character of, 49
changing the bed-clothing of, 30,
3i
the body-clothing of, 52
chills of the, reporting of, 49
convalescent, wrap for, 36
cough of, reporting the, 47
delirium of the, character of, 48
dressing the, for surgical opera-
tion, 150
expectoration of the, 47
expression of, facial, 47
external applications to, general
and local, 81-115
feeding of the, 56
rectal, 64
food taken by, record of, 46
functional disturbances of, relief
of, 59-7o
—catheterization, 68
—douches, 65
—enemata, 59
—rectal feeding, 64
—washing out the bladder, 69
—washing out the stomach, 70
gynecologic, after-care of, 143
—the diet, 143
—vaginal dressings, 144
—vaginal tampons, 143
positions of, for examination,
!37
preparation of, for examination,
137
for operation, 140
helpless, carrying the, 59
448
INDEX.
Patient, helpless, lifting of the, 57,
s8
hiccough of the, character of, 51
menstruation of the, 52
mouth of the, state of, 46
moving of the, 57
with fractured limb, 31
nausea and vomiting of, 46
observation of symptoms in, 45
obstetric, preparation of, 120
pain of the, reporting the, 47
position of, symptoms in, 46
in giving vaginal douche, 66
in peritonitis, 246
preparation of, for surgical opera-
tion, 149, 152
the morning of the operation,
150
pulse of the, 39
respirations of the, 44
serving the food to the, 311
—beverages, 314
—necessity for cleanliness,
3J3
—preparing the tray, 312
—preparation of the patient,
—taking the meal, 313
—varying the bill of fare,
312, 3n
serving liquids to the, 312
skin, etc. of the, condition of, 49
sympathy and kindness of the
nurse toward the, 282
toilet of the, 53
unconscious, administering med-
icine to, 73
rectal feeding of, 57
urine of the, condition of, 50
vital powers of, lowest ebb, 36
Patients, bed-, appliances for the re-
lief of, 33, 34
delirious, caution observed with,
48
Pelvis, the, 298
female, contents of, 298
Pepper, cayenne, 357
Peppermint camphor, 362
Peptonized beef-tea, 320
milk, 327
toast, 328
oysters, 322
Perforation, bowel, in typhoid fever,
278
complicating typhoid fever, 220
Pericardium, 300
Periosteum, 296
Peritoneum, the, 307
inflammation of. (See Peritonitis.)
Peritonitis, 245
causes of, 245
position of patient in, 46, 247
septic, 165-167
symptoms of, 245
treatment, 246
Pertussis. (See Whooping-cough.)
Peruvian bark, 352
Phenacetin, danger in use of, 239
Phenic acid, 346
Phenol, 346
Phenozone, 348
Phlegmasia dolens, 135
Phosphoric acid, antidote, 210
Phosphorus, antidotes, 210
Phthisis, 236
acute, symptoms, 237
chronic, 237
danger of contagion by contact
with patient, 236
forms of, 237
nursing of patients with, 237
Physiology, 285-296
of blood-circulation, 285
of digestion, 290
of respiration, 289
of urinary function, 293
Pia mater, 302
Picrotoxin, 353
Pillows, bed, changing the, 31
Pills, administering, 75
Pinna, the, 304
Placenta, fetal and maternal, 117
Plants in the sick-room, removal of,
290
Plasma, blood, 90
Plaster, cantharidal, 106
mustard, 106
removing a, method of, 178
Plaster of Paris, 350
Pleura, inflammation of. (See
Pleurisy.)
Pleurisy, 243
position of patient in, 46
symptoms of, 243
INDEX.
449
Pleurisy, treatment, 243
Pneumonia, croupous, 240
symptoms, favorable and unfa-
vorable, 240
treatment, 240
" double," defined, 240
Poison defined, 208
Poisoning, accidental, 208-212
what to do in case of, 208
by tainted meats or fish, antidotes,
212
carbolic-acid, from absorption,
symptoms, 169
from ivy, treatment, 210
induction of vomiting in, 209
iodoform, from absorption, symp-
toms, 170
mercurial, by inunction, symptoms
of, 79, 169
septic, from catheterization, 68
Poisons, classification and action of,
208
irritant, 209
action of, 208
narcotic, 211
action of, 208
Polyarthritis, 259
Position, change of, by patient, favor-
able sign, 46
for gynecologic examination, 137
—dorsal, 137
—knee-chest, 139
—Sims, 138
—upright, 140
for surgical operation, 14S
Trendelenburg, 148, 149
Potash, antidotes, 210
Potassium carbonate, antidotes, 210
Poultice, the, action of, 91
boric-acid, 100
carbolic-acid, 100
corrosive-sublimate, 100
creolin, 100
green soap, in surgical operations,
150
renewal of, on sleeping patient, 97
Poultices, 95-101
—antiseptic, 100
—bread, 98
—bran-jacket, 98
—charcoal, 98
—flaxseed, 95
Poultices :—green-soap, 100
—hop, 100
—ice, 100
—jacket, 97
—mustard, 98
—slippery-elm, 100
—spice, 99
—starch, 99
—yeast, 99
method of applying, proper, 96
renewal of, frequency, 96
Powder, applying, to the throat,
method of, m
Powders, administering 74
Pregnancy:
—abdominal enlargement,
rate of, 116
—conception, 116
—date of confinement, 116
—disorders of, 119
—duration of, 116
—fetal movements, 118
—fetus, the, 117
—nurse's preparations for the
confinement, 120
—signs and symptoms of, 115
—termination of, 120
disorders of, 119
extra-uterine, 136
Presentations in labor, 122, 123
Prostration, nervous, 257
Protrusion, bowel, of infancy, 275
" Proud flesh," 189
Prussic acid, 346
antidotes, 209
Puddings, recipes for, 323
Puerperium, management of the, 129
—breast-bandage, 132
—care of the breasts, 131
—catheterization, 129
—lactation, 131
—the after-pains, 131
—the diet, 130
—the lochia, 130
—the napkins, 130
—the temperature and pulse,
130
pathology of the, 133-136
—eclampsia, 135
—hemorrhages, 133
—insanity, 135
—phlegmasia dolens, 135
29
45o
INDEX.
Puerperium, pathology of the:—septi-
cemia, 134
—thrombosis, 136
Pulse, the, 39-41
"dicrotic wave" of, 40
during the puerperium, 130
frequency of, 40
in children, 41
in croupous pneumonia, 240
in hemorrhage following surgical
operation, 161
in septicemia, 166
in shock, 160
in small-pox, 226
in typhoid fever, 216
in typhus fever, 225
in uremia, 250
of infancy, 277
taking of the, 40
varieties of, 40
—compressible, 40
—dicrotic, 40
—frequent, 40
—full, 40
—high-tension, 40
—incompressible, 40
—intermittent, 40
—irregular, 40
—low-tension, 40
—rapid, 40
—regular, 40
—running, 40
Pulse-rate, 39-41
at puberty, 41
conditions influencing the, 39
influence of body-temperature on,
42,43
in septicemia, 166
normal, 41
of infant at birth, 41, 269, 277
rate of decrease, 277
of infants and children, 41
of the aged, 41
Purgative enemata, administration of,
61, 62
formulae for, 62
Purgatives, administering, 75
Pyemia, symptoms, 190
treatment, 190
Quicksilver, 362
Quinia, antidotes, 212
Radius, the, 299
Rash. (See Eruption!)
Recipes:
beef-teas and extracts:
—beef-essence, 319
—beef-extract, bottled, 319
—beef-juice, 319
—beef-tea, 319, 320
—beef-tea, peptonized, 320
—beef-tea with oatmeal, 320
beverages:
—chocolate, 333
—cocoa, 333
—coffee, 333
—coffee, crust, 333
—coffee, nutritious, 334
—coffee, rice, 334
—egg-nog, 334
—lemonade, 334
—lemonade, egg, 335
—milk and albumen, 335
—milk, sterilized, 335
—milk-punch, 335
—orangeade, 336
—sherbert, lemon, 334
' —sherbert, orange, 336
—tea, 336
—tea, flaxseed, 336
—water, albumen-, 336
—water, apple-, 336
—water, barley-, 336
—water, gum-arabic, 337
—water, rice-, 337
—water, tamarind-, 337
—water, toast-, 337
—wine, mulled, 335
broths:
—chicken, 321
—clam, 321
—mutton, 321
—oyster, 323
desserts:
—apples, baked, 329
—cream, Bavarian, 329
—cream, tapioca, 330
—cream, whipped, 332
—Irish moss, 331
—Irish moss, blanc-mange,
331
—jelly, calfs foot, 330
—jelly, lemon, 330
—jelly, orange, 330
Index.
45i
Recipes, desserts:—jelly, peptonized-
milk, 331
—jelly, wine, 331
—junket, 331
—rice blancmange, 329
—snow-eggs, 332
—soft custard, 329
—whey, wine, 332
farinaceous foods:
—arrowroot, 317
—corn-starch, 318
—gruel, boiled-flour, 318
—gruel, oatmeal, 318
—gruel, rice-flour, 318
—oatmeal, 318
milk:
—koumyss, 327
—peptonized, 327
—sago, 327
miscellaneous:
—chicken panada, 326
—eggs, poached, 325
—eggs, scrambled, 326
—eggs, soft-boiled, 326
—infant's food, 326
—macaroni, 325
—omelet, 325
—potatoes, creamed, 325
oysters:
—broth, 323
—fricasseed, 322
—peptonized, 322
—stewed, 322
puddings:
—arrowroot, 323
—corn-flour, 323
—custard, 323
—rice, 323
—sago, 323
—snow, 324
soups:
—chicken, 324
—mutton, 324
—potato, 324
—white-celery, 324
sweetbreads, 321
toasts:
—cream toast, 328
—dry toast, 328
—egg toast, 328
—milk toast, 328
—milk toast, peptonized, 328
Record, nurse's, of food taken by
patient, 46
of pulse, temperature, and res-
piration, importance of, 45
of symptoms, 45-52
Records, nurse's, keeping the, 25-28
Rectal douche, 67
Rectum, the, 308
gas, passage of, 50
medicines administered by the, 76
temperature in, taking the, 44
Reflex action, 303
Relapse in typhoid fever, 216
Reports, nurse's, essentials of the,
39
method of making, 26, 27
Respiration, 45, 46, 289
artificial, in the apparently
drowned, 201, 202
in shock, 161
of the new-born, 127
Cheyne-Stokes, 45
conditions influencing the, 45
mechanism of, 289
normal, 44
of infancy, 45, 277
of the new-born, first, 125
taking the, 44
Rest for inflammation, 105
in after-treatment of surgical
operation, 163
Rest-cure, 257
Retention of urine of the new born,
264
treatment of, 203
Rheumatism, 258
articular, acute, 258
complications of, 259
" monoarticular," 259
muscular, acute, 259
nursing in, 258
treatment, medicinal, 259
Ribs, the, 297
attachment and number, 297, 298
Rickets, symptoms of, 273
treatment of, 273
Ringworm, 260
Rochelle salt, 364
enema of, 62
Roller-bandages, 178-183
Room disinfection by corrosive-sub-
limate solution, 235
452
INDEX.
Room temperature for rheumatic
patients, 258
regulation of, 37
Room-ventilation, 37
in scarlet-fever cases, 223
Rubefacients, 104
Shock, from burns, 198
from surgical operation, 159
respiration, artificial, in, 161
symptoms, 160
treatment, 160
Shoulder-blade, 298
" Show," the, 124
Shower-bath, 86
Sick, feeding the, general rules for,
3"-3x7
serving the food in, 311
Sick-room, the, 29-38
air of the, 37
cooling the, 37
bearing of the nurse in, 18-23
bed, preparation of, 29
care of the, 36
dress of the nurse in the, 25
etiquette of the, 24
fumigation of the, after contagious
diseases, 234-236
keeping the records, methods of,
25-27
plants in the, removal of, 290
preparation of, 29 *
removal of excreta from, 38
selection of, 29
temperature of, 36
regulation of, 37
ventilation of, 37, 38, 223
protection of patient during, 38
Sigmoid flexure, 307
Sign of labor, first, 123
Signs of pregnancy, positive, 116
probable, 115
"vital," the three, 39
Sinus, 192
Sitz-bath, action of, 82
Skin, anatomy of the, 296
color of, cause of, 296
diseases of the:
—eczema, 259
—herpes zoster, 260
—ringworm, 260
—scabies, 259
treatment of, 260
of the patient, color of, 49
condition of, 49
redness of, inflammatory, cause of,
91
Skin-grafting, 200
Skull, bones of the, 297
Sacrum, 298
St. Vitus' dance. (See Chorea!)
Saliva, digestive action of, 292
Salt enema, 63
-solution, 162
Sand-bags, how made, 174
Sartorius, 299
Scabies, 259
Scalds. (See Burns and Scalds!)
Scapula, the, 298
Scarlatina. (See Scarlet fever.)
Scarlet fever, 222-225
complications of:
—dropsy, 224
—nephritis, 224
—uremia, 224
convalescence of, 225
delirium of, 225
depression in, 225
disinfection in, 223
malignant, 222
room-ventilation in, 223
symptoms of, 222
treatment of, 222
uremic convulsions of, treatment,
224
Scarlet-fever tongue, 47
Screen, bed-, improvised, 34
Sea-bathing, 82
Secretions, body, 292
Sedatives, action of, 72
Sepsis after childbirth, symptoms, 131
death from, responsibility for, 166
Septicemia, 165
puerperal, 134
symptoms, 166
treatment, 166, 167
Serpent-bites, treatment, 212
Sheet-bath (drip-sheet), 87
Sheets, bed-, changing of, without
removing the patient, 30, 31
Shingles, 260
Shock, body-temperature in, 160
conditions influencing, 160
enemata in, 160
INDEX.
453
Sleep, taking of, by the nurse, 21
Sleeplessness, treatment of, 206
Small-pox, 226-228
confluent, 227
malignant, 227
nursing-treatment, 227, 228
pitting of, prevention, 228
symptoms, 226
Smoke, escaping through, how to
prevent suffocation in, 203
Snuffles of infancy, 276
Soda, antidotes, 210
Sodium carbonate, antidotes, 210
Solutions, antiseptic, 341
Soups, recipes for, 324
Spanish flies, 351
Spanish-fly blister, 106-108
Spinal column, 298
cord, 301
Spleen, the, 307
Splint, coaptation, 186
improvised, in fracture, 173
plaster-of-Paris, 186
how to remove, 187
Splints, 186, 187
Sponge-bath, 55
Sponges, gauze, 147
sterilizing the, 172
surgical, attention required of the
nurse in handling, 157,
158
Sprains, treatment, 176
Sprays, 110
Sputum, disposition of, in infectious
diseases, 48
Sputum-cup, 48, 236, 241
Stages of normal labor, 123-125
—first stage, 123
—second stage, 1.24
—third stage, 125
Stapedius, 299
Stapes, 297
Starch-and-laudanum enema, 62
Steam-bath, acid, action of, 86
Sterilization by boiling water, 152
for surgical operations, 147
milk, 266
of foods. (See Recipes.)
of gauze sponges, 172
of nurse's hands, importance of,
150. 221.
of suture-materials, 171
Sterilization of utensils, etc. used for
surgical operations, 157,
171,172
personal, of nurse, for surgical
operation, 156, 157
surgical, 147, 151, 152
Sterilized milk, 335
Sternum, 298
Stimulants, action of, 72
alcoholic, in treatment of hemor-
rhage, 194
per rectum, effect of, 64
Stimulating enemata, 63
Stomach, the, 290, 305
bleeding from the, 196
food-changes in the, 292
inflammation of. (See Gastritis!)
washing out the, 70
" Strawberry-tongue," 47, 222
Stretcher, improvised bed-room, 59
Strychnia, antidotes, 211
as a heart-stimulant, 161
Stupes. (See Fomentations.)
Subinvolution of womb, 126
Suffocation from drowning, treat-
ment, 201
Sugar in the urine, Trommers' test
for, 295
Sugar-water, 267
Sulphuric acid, antidotes, 210
Sunburn, treatment, 206
Sunstroke, 200
body-temperature in, 42, 200
symptoms, 200
treatment, 200
Suppositories, introduction of, 76
Suppuration, 189
Suture, button, 171
continuous, 171
interrupted, 171
Sutures, materials of, 171
sterilizing of, 171
Suturing, 171
Swallowing, involuntary, how to in-
duce, 252
Sweeping and dusting the sick-room,
36
Sweetbreads, cooking of, 321
Sweet oil, 363
spirits of nitre, 355
Swelling, inflammatory, cause of, 91
Symptoms, observation of, 45_52
454
INDEX.
Synovial fluid, 297
Syringe, fountain, uses of, 25
hard-rubber, to prevent leakage of,
60
hypodermic, care of the, 78
method of using the, 77
Syringing the eyes of infants, method
of, 275
Table, gynecologic, 141
Table salt, 366
Tablets, hypodermatic, list of, 342
Tampon, kite-tail, 144
Tampons, vaginal, 143
Tartar emetic, 348
Tartaric acid, antidotes, 209
Tears, age when infant first sheds, 268
Tear-secretion, 112
Teeth, age when growth of the, be-
gins, 268
development of the, 268
Teething of infancy, 274
Temperature, body-, 41-44
after childbirth, rise of, 131
conditions influencing increase
of, 41
during the puerperium, 131
in bronchitis, 242
in cerebro-spinal meningitis, 251
in croupous pneumonia, 240
in diphtheria, 229
in hemorrhage, 160, 161
in measles, 228
in peritonitis, 245
in rheumatism, 258
in scarlet fever, 222
in septicemia, 166
in shock, 160
in small-pox, 226, 227
in sunstroke, 200
in tetanus, 42
in typhoid fever, 215
in typhus fever, 225
of infant at birth, 269
of infants, how to take the, 276
subnormal, causes of, 42
taking of the, 43
sick-room, 36
regulation of, 37
Tendo Achillis, 300
Tendons, 300
Tents (surgical), 177
Tepid bath, action of, 82
Tetanus, 190
body-temperature in, 42
symptoms, 190
treatment, 190
Thermometer, bath-, 81
clinical, the, 43
Thigh-bone. (See Femur.)
Thirst in hemorrhage, 196
relief of, by bathing, 82
after operation, 163
in typhoid fever, relief of, 218
Thorax, 297
Throat, gargling and spraying the,
no, m
precautions in, in
obstruction in the, removal of,
205
sore, hot-water gargling in, m
Thrombosis, 136
Thrush, treatment, 270
Tibia, the, 299
Toasts, recipes for, 328
Toilet of the patient, 53-56
—bath, the, 55
—bed-pan, the, 56
—care of the body, 54
—cleansing the mouth, 53
—dressing the hair, 53
Tongue, appearance of, in scarlet
fever, 222
coated, in fevers, 46, 47
infant's, how to see the, 276
" strawberry," 47, 222
Tongue-tie, 276
Tongue-trembling, 47
Tonics, action of, 72
Toothache, treatment of, 206
Tourniquet, 195
Trachea, the, 305
Tracheotomy, after-care in, 232
in diphtheria, 231
duties of the nurse, 231
in scalds of the glottis, 198
Tracheotomy-tube, care of the, 232,
233
Transfusion, 162
Trendelenburg position, 148, 149
Tub-bath, 55, 83
Tubes, bronchial, 305
Fallopian, 309
Turpentine enema, 62
INDEX.
455
Tympanites in typhoid cases, relief
of, 221
Tympanum, the, 304
Typhoid fever, 215
bed-sores in, prevention of, 221
body-temperature of, 215
excreta of, disinfection of, 216
coating of, tongue in, 46, 47
complications of, 219
—hemorrhage, 219, 220
—perforation, 220
convalescence, management of,
221
diet in, 217, 218
nursing in, 216
of children, 278
treatment, 278
period of incubation, 215
relapse in, 216
symptoms, 215
synonyms of, 215
tepid baths in, 219
the eruptions in, 216
thirst in, relief of, 218
treatment of, 217-222
tympanites of, relief of, 221
walking, 221
Typhus fever, 225
complications of, 226
symptoms, 225
treatment, 226
Ulcer, 192
Ulna, the, 299
Union of broken bones, process of,
173
Uremia, 250
complicating scarlet fever, 224
symptoms, 250
treatment, 250
Ureters, the, 308
Urethra, the, 308
Urinalysis, 295
Urination of infant, 264
Urine, the, 293
abnormalities of the, 51
albumin in the, 294
test for, 295
amount of, conditions affecting the,
293, 294
in diabetes mellitus, 293
color of, 293, 294
Urine, color of, conditions affecting,
294
composition of, 293
excretion of, in pleurisy, 243
incontinence of, 50, 119
in children, 279
in diabetes, 258
odor of, 293, 294
of the patient, condition of, 50
of the pregnant, attention to, 119
passage of, 50, 51
points to be noted, 51
quantity of, normal, 293
reaction of, 293
method of determining, 294
retention of, by the new-born, re-
lief of, 265
danger of, 308
in typhoid fever, 217
treatment of, 203
specific gravity, 293
method of ascertaining, 294
sugar or urea in, 294
test for, 295
suppression of, from cantharidism,
107
testing the, 295
Urinometer, 204
Uterus, the, 308
Vaginal douche, administration of,66
apparatus for, 65
purpose and effect of, 66, 67
Valve, mitral, 287
tricuspid, 2S7
Valves, heart, 287
semilunar, 287
Vapor-baths, action of, 81,83
Varioloid, 227
Vein, jugular, 300
Veins, the, 286
hepatic, 289
pulmonary, 287
" Vena porta?," 288
Ventilation, sick-room, 37, 223
Ventilator, window, 38
Ventricles, heart, 287
Vermiform appendix, 307
Vermin, head, extermination of, 53
Vernix caseosa, 262
Vertebra', 298
cervical, 298
456 INDEX.
Vertebrae, dorsal, 298
lumbar, 298
Vesication, 105
Vestibule (ear), 305
"Vital signs," the three, 39
Vomiting, induction of, in poisoning,
209
in ether anesthesia, 154
in septicemia, 166
treatment of, 167
of infancy, 272
of patient, symptoms of, 46
repetition of dose after, 76
treatment of, 206
Wafers, medicine, 74
Warm bath, action of, 81, 82
Water-bed, 33
Water-dressing (surgical), 176, 177
Waters, mineral, alkaline, 337
carbonic acid, 338
chalybeate, 338
purgative, 338
saline, 339
sulphuretted, 339
Weaning infant, time for, 268
Weights and measures, 340
Wharton's jelly, 118
Whispering in the sick-room, 24
Whooping-cough, 238
complications of, 239
symptoms, 238
treatment, 239
Witch-hazel, 358
Womb, the, 308
involution and subinvolution of,
125, 126
Wood-oil, 349
Worms of infancy, 274
Wound, contused, 188
defined, 188
gunshot, 188
incised, 188
lacerated, 188
nurse's preparation of a, for the
surgeon, 177
poisoned, 188
punctured, 188
Wounds, 188-191
aseptic and septic, 188
dangerous sequelae of, 189-191
healing of, 188
suppuration of, 189
varieties of, 188
PUBLISHED BY
W. B. SAUNDERS, 925 Walnut Street, Philadelphia, Pa.
♦American Text-Book of Applied Thera-
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" If this text-book is a fair reflex of the present position of American surgery, we must
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4
W. B. SAUNDERS'
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J William White, Philadelphia.
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6
W. B. SAUNDERS'
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AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL
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CATALOGUE OF MEDICAL WORKS. 7
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the artist and engraver, and appeal at once to the eye as well as to the mind of
the student and practitioner.
AN AMERICAN TEXT-BOOK OF APPLIED THERAPEUTICS.
By American Teachers. Edited by J. C. Wilson, M. D., Professor of
the Practice of Medicine and of Clinical Medicine in the Jefferson Medical
College, Philadelphia. (Nearly Ready.)
AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. By American
Teachers. Edited by William H. Howell, Ph. D., M. D., Professor
of Physiology, Johns Hopkins University. (In preparation for early pub-
lication.)
AN AMERICAN TEXT-BOOK OF NURSING. By American
Teachers. (In preparation.)
8 W. B. SAUNDERS'
For Sale by Subscription.
A NEW PRONOUNCING DICTIONARY OF MEDICINE, with
Phonetic Pronunciation, Accentuation, Etymology, etc. By John
M. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila-
delphia ; Vice-President of the American Psediatric Society; Ex-President
of the Association of Life Insurance Medical Directors; Editor " Cyclo-
paedia of the Diseases of Children," etc.; and Henry Hamilton, author
of " A New Translation of Virgil's ^Eneid into English Rhyme;" co-
author of "Saunders' Medical Lexicon," etc.; with the Collaboration of
J. Chalmers DaCosta, M. D., and Frederick A. Packard, M. D.
With an Appendix containing important Tables of Bacilli, Micrococci,
Leucomaiines, Ptomaines, Drugs and Materials used in Antiseptic Sur-
gery, Poisons and their Antidotes, Weights and Measures, Thermometric
Scales, New Official and Unofficial Drugs, etc. One very attractive volume
of over 800 pages. Second Revised Edition. Prices: Cloth, $5.00 net;
Sheep, $6.00 net; Half-Russia, $6.50 net, with Denison's Patent Ready-
Reference Index; without patent index, Cloth, £4.00 net; Sheep, $5.00 net.
PROFESSIONAL OPINIONS.
" I am much pleased with Keating's Dictionary, and shall take pleasure in recommending
it to my classes."
Henry M. Lyman, M. D.,
Professor of Principles and Practice of Medicine, Rush Medical College, Chicago, III.
" I am convinced that it will be a very valuable adjunct to my study-table, convenient in
size and sufficiently full for ordinary use."
„ , , _, C. A. Lindsley, M. D.,
Professor of Theory and Practice of Medicine, Medical Dept. Yale University:
Secretary Connecticut State Board of Health, New Haven, Conn,
"I will point out to my classes the many good features of this book as compared with
others, which will, 1 am sure, make it very popular with students."
John Cronyn, M. D., LL D
Professor of Principles and Practice of Medicine and Clinical Medicine ■
President of the Faculty, Medical Dept. Niagara University, Buffalo, N. Y.
AUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro-
fessor of Surgery in the Jefferson Medical College of Philadelphia, with
Reminiscences of His Times and Contemporaries. Edited by his sons
Samuel W. Gross, M. D., LL.D., late Professor of Principles of Surgery
and of Clinical Surgery in the Jefferson Medical College, and A. Haller
Gross, A. M., of the Philadelphia Bar. Preceded by a Memoir of Dr
Gross, by the late Austin Flint, M. D., LL.D. In two handsome volumes,
each containing over 400 pages, demy 8vo, extra cloth, gilt tops, with fine
Frontispiece engraved on steel. Price, $5.00 net.
This autobiography which was continued by the late eminent surgeon until
within three months of his death, contains a full and accurate history of his
early struggles, trials, and subsequent successes, told in a singularly interesting
and charming manner and embraces short and graphic pen-portraits of many
of the most distinguished men—surgeons, physicians, divines, lawyers, states-
men, scientists etc.-with whom he was brought in contact in America and in
Europe; the whole forming a retrospect of more than three-quarters of a century
CATALOGUE OF MEDICAL WORKS.
9
For Sale by Subscription.
SURGICAL PATHOLOGY AND THERAPEUTICS. By J. Col-
lins Warren, M. D., LL.D., Professor of Surgery, Harvard Medical
School, etc. One handsome octavo volume of 832 pages, with 136 illus-
trations, 33 of which are chromo-lithographs, and all of which were drawn
from original specimens. Prices : Cloth, #6.00 net; Half-Morocco, $7.00 net.
Covering as it does the entire field of Surgical Pathology and Surgical Thera-
peutics by an acknowledged authority, the publisher is confident that the work
will rank as a standard authority on the subject of which it treats. Particular
attention has been paid to Bacteriology and Surgical Bacteria from the stand-
point of recent investigations. The chromo-lithographic plates in their fidelity to
nature and in scientific accuracy are incomparable.
PATHOLOGY AND SURGICAL TREATMENT OF TUMORS.
By N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and
of Clinical Surgery, Rush Medical College; Professor of Surgery, Chicago
Polyclinic; Attending Surgeon to Presbyterian Hospital; Surgeon-in-Chief,
St. Joseph's Hospital, Chicago. One volume of 710 pages, with 515
engravings, including full-page colored plates. Prices: Cloth, $6.00 net;
Half-Morocco, $7.00 net.
This work epitomizes the results of many years of personal observation and
successful experience of its author, whose professional eminence guarantees the
authoritative character of the subject-matter. The illustrations are profuse and
unusually fine, including more than 100 original photographic reproductions of
the microscopic appearances of a great variety of morbid conditions.
MEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of
Medicine at the University of Heidelberg. Translated, with additions,
from the Second Enlarged German Edition, with the author's permission,
by Francis H. Stuart, A. M., M. D. Third and Revised Edition. In
one handsome royal-octavo volume of 700 pages, 178 fine wood-cuts in
text, many of which are in colors. Prices : Cloth, $4.00 net; Sheep, #5.00
net; Half Russia, $5.50 net.
In this work, as in no other hitherto published, are given full and accurate
explanations of the phenomena observed at the bedside. It is distinctly a clin-
ical work by a master teacher, characterized by thoroughness, fulness, and accu-
racy. It is a mine of information upon the points that are so often passed over
without explanation. Especial attention has been given to the germ-theory as
a factor in the origin of disease. .
This valuable work is now published in German, English, Russian, and
Italian. The issue of a third American edition within two years indicates the
favor with which it has been received by the profession.
IO W. B. SAUNDERS'
For Sale by Subscription.
DISEASES OF THE EYE. A Handbook of Ophthalmic Practice.
By G. E. de Schweinitz, M. D., Professor of Diseases of the Eye, Phila-
delphia Polyclinic; Professor of Clinical Ophthalmology, Jefferson Medical
College, Philadelphia, etc. A handsome royal-octavo volume of nearly 700
pages, with 256 fine illustrations, many of which are original, and 2 chromo-
lithographic plates. Prices: Cloth, #4.00 net; Sheep, #5.00 net; Half-
Russia, $5.50 net.
SECOND EDITION, REVISED AND ENLARGED.
The object of this work is to present to the student and practitioner who is
beginning work in the fields of ophthalmology a plain description of the optical
defects and diseases of the eye. To this end special attention has been paid
to the clinical side of the question; and the method of examination, the symp-
tomatology leading to a diagnosis, and the treatment of the various ocular defects
have been brought into special prominence. The general plan of the book is
eminently practical. Attention is called to the large number of illustrations
(nearly one-third of which are new), which will materially facilitate the thorough
understanding of the subject.
"At once comprehensive and thoroughly up to date."—Hospital Gazette (London).
PROFESSIONAL OPINIONS.
"Contains in concise and reliable form the accepted views of Ophthalmic Science."
William Thomson, M.D.,
Professor of Ophthalmology, Jefferson Medical College, Philadelphia, Pa.
" A very reliable guide to the study of eye diseases, presenting the latest facts and newest
ideas-" Swan M. Burnett, M. D.,
Professor of Ophthalmology and Otology, Medical Department Univ. of Georgetown,
Washington, D. C.
THE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI-
LITIC AFFECTIONS. (American Edition.) Translation from
the French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy-
sician to, and Physician to the department for Diseases of the Skin at, the
Middlesex Hospital, London. Photo-lithochromes from the famous models
of dermatological and syphilitic cases in the Museum of the Saint-Louis
Hospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts,
at $3.00 per Part. Parts 1 to 3 now ready.
"The plates are beautifully executed."—Jonathan Hutchinson, M. D. (London
Hospital).
"The plates in this Atlas are remarkably accurate and artistic reproductions oi typical
examples of skin disease. The work will be of great value to the practitioner and student."
—William Anderson, M. D. (St. Thomas Hospital).
CATALOGUE OF MEDICAL WORKS.
II
ESSENTIALS OF ANATOMY AND MANUAL OF PRACTI-
CAL DISSECTION, containing " Hints on Dissection." By Charles
B. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the
University of Michigan, Ann Arbor; Corresponding Member of the Royal
Academy of Medicine, Rome, Italy; late Surgeon Jefferson Medical Col-
lege, etc. Fourth and revised edition. Post 8vo, over 500 pages, with
handsome full-page lithographic plates in colors, and over 200 illustrations.
Price : Extra Cloth or Oilcloth for the dissection-room, $2.00 net.
Neither pains nor expense has been spared to make this work the most ex-
haustive yet concise Student's Manual of Anatomy and Dissection ever pub-
lished, either in America or in Europe.
The colored plates are designed to aid the student in dissecting the muscles,
arteries, veins, and nerves. The wood-cuts have all been specially drawn and
engraved, and an Appendix added containing 60 illustrations representing the
structure of the entire human skeleton, the whole being based on the eleventh
edition of Gray's Anatomy.
"The plates are of more than ordinary excellence, and are of especial value to students in
their work in the dissecting-room."—fournal of American Medical Association.
" Should be in the hands of every medical student."— Cleveland Medical Gazette.
" A concise and judicious work."—Buffalo Medical and Surgical Jour nal.
A MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens,
A. M., M. D., Instructor of Physical Diagnosis in the University of Penn-
sylvania, and Demonstrator of Pathology in the Woman's Medical College
of Philadelphia. Specially intended for students preparing for graduation
and hospital examinations, and includes the following sections: General
Diseases, Diseases of the Digestive Organs, Diseases of the Respiratory
System, Diseases of the Circulatory System, Diseases of the Nervous Sys-
tem, Diseases of the Blood, Diseases of the Kidneys, and Diseases of the
Skin. Each section is prefaced by a chapter on General Symptomatology.
Third edition. Post 8vo, 502 pages. Numerous illustrations and selected
formulae. Price, $2.50.
Contributions to the science of medicine have poured in so rapidly during the
last quarter of a century that it is well-nigh impossible for the student, with the
limited time at his disposal, to master elaborate treatises or to cull from them
that knowledge which is absolutely essential. From an extended experience in
teaching, the author has been enabled, by classification, to group allied symp-
toms, and by the judicious elimination of theories and redundant explanations
to bring within a comparatively small compass a complete outline of the prac-
tice of medicine.
12 W. B. SAUNDERS
MANUAL OF MATERIA MEDICA AND THERAPEUTICS.
By A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the
University of Pennsylvania, and Demonstrator of Pathology in the Woman's
Medical College of Philadelphia. 435 pages. Price, Cloth, $2.25.
This wholly new volume, which is based on the 1890 edition of the Pharma-
copoeia, comprehends the following sections: Physiological Action of Drugs;
Drugs; Remedial Measures other than Drugs; Applied Therapeutics ; Incom-
patibility in Prescriptions; Table of Doses; Index of Drugs; and Index of
Diseases; the treatment being elucidated by more than two hundred formulae.
" The author is to be congratulated upon having presented the medical student with as
accurate a manual of therapeutics as it is possible to prepare."—Therapeutic Gazette.
" Far superior to most of its class ; in fact, it is very good. Moreover, the book is reliable
and accurate."—New York Medical Journal.
" The author has faithfully presented modern therapeutics in a comprehensive work, . . .
and it will be found a reliable guide."— University Medical Magazine.
NOTES ON THE NEWER REMEDIES: their Therapeutic Ap
plications and Modes of Administration. By David Cerna, M. D.,
Ph. D., Demonstrator of and Lecturer on Experimental Therapeutics in
the University of Pennsylvania. Second edition, revised and enlarged.
Post-octavo, 253 pages. Price, #1.25.
SECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED.
The work takes up in alphabetical order all the newer remedies, giving their
physical properties, solubility, therapeutic applications, administration, and
chemical formula.
It thus forms a very valuable addition to the various works on therapeutics
now in existence.
Chemists are so multiplying compounds, that, if each compound is to be thor-
oughly studied, investigations must be carried far enough to determine the prac-
tical importance of the new agents.
" Especially valuable because of its completeness, its accuracy, its systematic consider-
ation of the properties and therapy of many remedies of which doctors generally know but
little, expressed in a brief yet terse manner."—Chicago Clinical Review.
TEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size
8x13^ inches. Price, per pad of 25 charts, 50 cents.
A conveniently arranged chart for recording Temperature, with columns for
daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc On the
back of each chart is given in full the method of Brand in the treatment of
lyphoid .Fever.
CATALOGUE OF MEDICAL WORKS. 13
SAUNDERS' POCKET MEDICAL LEXICON; or, Dictionary of
Terms and Words used in Medicine and Surgery. By John M.
Keating, M. D., editor of "Cyclopaedia of Diseases of Children," etc.;
author of the " New Pronouncing Dictionaiy of Medicine; and Henry
Hamilton, author of " A New Translation of Virgil's ^Eneid into Eng-
lish Verse;" co-author of a " New Pronouncing Dictionary of Medicine."
A new and revised edition. 32mo, 282 pages. Prices: Cloth, 75 cents;
Leather Tucks, $1.00.
This new and comprehensive work of reference is the outcome of a demand
for a more modern handbook of its class than those at present on the market,
which, dating as they do from 1855 to J884, are of but trifling use to the student
by their not containing the hundreds of new words now used in current litera-
ture, especially those relating to Electricity and Bacteriology.
" Remarkably accurate in terminology, accentuation, and definition."—Journal of Amer-
ican Medical Association.
"Brief, yet complete .... it contains the very latest nomenclature in even the newest
departments of medicine."—New York Medical Record.
SAUNDERS' POCKET MEDICAL FORMULARY. By William
M. Powell, M. D., Attending Physician to the Mercer House for Invalid
Women at Atlantic City. Containing 1750 Formulae, selected from several
hundred of the best-known authorities. Forming a handsome and con-
venient pocket companion of nearly 300 printed pages, with blank leaves
for Additions; with an Appendix containing Posological Table, Formulae
and Doses for Hypodermatic Medication, Poisons and their Antidotes,
Diameters of the Pemale Pelvis and Fcetal Head, Obstetrical Table, Diet
List for Various Diseases, Materials and Drugs used in Antiseptic Surgery,
Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables
of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Third
edition, revised and greatly enlarged. Handsomely bound in morocco,
with side index, wallet, and flap. Price, $1.75 net.
A concise, clear, and correct record of the many hundreds of famous formulae
which are found scattered through the works of the most eminent physicians
and surgeons of the world. The work is helpful to the student and practitioner
alike, as through it they become acquainted with numerous formulae which are
not found in text-books, but have been collected from among the rising genera-
tion of the profession, college professors, and hospital physicians and surgeons.
"This little book, that can be conveniently carried in the pocket, contains anjmmense
amount of material. It is very useful, and as the name of the author of each pre.scnpt.on is
given is unusually reliable."—New York Medical Record.
» Designed to be of immense help to the general practitioner in the exercise of his daily
calling."—Boston Medical and Surgical Journal.
14
W. B. SAUNDERS"
DISEASES OF WOMEN. By Henry J. Garrigues, A.M., M.D.,
Professor of Obstetrics in the New York Post-Graduate Medical School
and Hospital; Gynecologist to St. Mark's Hospital and to the German
Dispensary, etc., New York City. In one very handsome octavo volume
of about 700 pages, illustrated by numerous wood-cuts and colored plates.
Prices : Cloth, $4.00 net; Sheep, $5.00 net.
A practical work on gynecology for the use of students and practitioners,
written in a terse and concise manner. The importance of a thorough know-
ledge of the anatomy of the female pelvic organs has been fully recognized by
the author, and considerable space has been devoted to the subject. The chap-
ters on Operations and on Treatment are thoroughly modern, and are based
upon the large hospital and private practice of the author. The text is eluci-
dated by a large number of illustrations and colored plates, many of them being
original, and forming a complete atlas for studying embryology and the anatomy
of five female genitalia, besides exemplifying, whenever needed, morbid condi-
tions, instruments, apparatus, and operations.
EXCERPT OF CONTENTS.
Development of the Female Genitals.—Anatomy of the Female Pelvic Organs.—Phys-
iology.—Puberty.—Menstruation and Ovulation.—Copulation.—Fecundation.—The Climac-
teric—Etiology in General.—Examinations in General.—Treatment in General—Abnormal
Menstruation and Metrorrhagia.—Leucorrhea.—Diseases of the Vulva.—Diseases of the
Perineum.—Diseases of the Vagina.—Diseases of the Uterus.—Diseases of the Fallopian
Tubes.—Diseases of the Ovaries.—Diseases of the Pelvis.—Sterility.
The reception accorded to this work has been most flattering. In the short
period which has elapsed since its issue it has been adopted and recommended
as a text-book by more than 60 of the Medical Schools and Universities of the
United States and Canada.
" One of the best text-books for students and practitioners which has been published in
the English language; it is condensed, clear, and comprehensive. The profound learning
and great clinical experience of the distinguished author find expression in this book in a
most attractive and instructive form. Young practitioners, to whom experienced consultants
may not be available, will find in this book invaluable counsel and help."
Thad. A. Reamy, M. D., LL.D.,
Professor of Clinical Gynecology, Medical College of Ohio; Gynecologist to the Good
Samaritan and Cincinnati Hospitals.
A SYLLABUS OF GYNECOLOGY, arranged in conformity with
"An American Text-Book of Gynecology." By J. W. Long, M. D.,
Professor of Diseases of Women and Children, Medical College of Vir-
ginia, etc. Price, Cloth (interleaved), $1.00 net.
Based upon the teaching and methods laid down in the larger work, this will
not only be useful as a supplementary volume, but to those who do not already
possess the text-book it will also have an independent value as an aid to the
practitioner in gynecological work, and to the student as a guide in the lecture-
room, as the subject is presented in a manner at once systematic, clear, succinct,
and practical.
CATALOGUE OF MEDICAL WORKS. 15
OUTLINES OF OBSTETRICS : A Syllabus of Lectures Deliv-
ered at Long Island College Hospital. By Charles Jewett, A. M.,
M. D., Professor of Obstetrics and Pediatrics in the College, and Obstetri-
cian to the Hospital. Edited by Harold F. Jewett, M. D. Post 8vo,
264 pages. Price, $2.00.
This book treats only of the general facts and principles of obstetrics : these
are stated in concise terms and in a systematic and natural order of sequence,
theoretical discussion being as far as possible avoided; the subject is thus
presented in a form most easily grasped and remembered by the student.
Special attention has been devoted to practical questions of diagnosis and
treatment, and in general particular prominence is given to facts which the stu-
dent most needs to know. The condensed form of statement and the orderly
arrangement of topics adapt it to the wants of the busy practitioner as a means
of refreshing his knowledge of the subject and as a handy manual for daily
reference.
" Rarely has it been our fortune to read a work of this nature where, from the beginning to
the end, definitions are so exact and rules for guidance so safe."—American Journal of
Obstetrics, New York.
SYLLABUS OF OBSTETRICAL LECTURES in the Medical
Department, University of Pennsylvania. By Richard C. Norris,
A. M., M. D., Demonstrator of Obstetrics in the University of Pennsyl-
vania. Third edition, thoroughly revised and enlarged. Crown 8vo.
Price, Cloth, interleaved for notes, $2.00 net.
" This work is so far superior to others on the same subject that we take pleasure in call-
ing attention briefly to its excellent features. It covers the subject thoroughly, and will
prove invaluable both to the student and the practitioner. The author has introduced a
number of valuable hints which would only occur to one who was himself an experienced
teacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially
pleased with the portion devoted to the practical duties of the accoucheur, care of the child,
etc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc-
tions given. No details are regarded as unimportant; no minor matters omitted. We ven-
ture to say that even the old practitioner will find useful hints in this direction which he can-
not afford to despise."—New York Medical Record.
A SYLLABUS OF LECTURES ON THE PRACTICE OF SUR-
GERY, arranged in conformity with " An American Text-Book
of Surgery." By N. Senn, M. D., Ph. D., Professor of Surgery in Rush
Medical College, Chicago, and in the Chicago Polyclinic. Price, $2.00.
This, the latest work of its eminent author, himself one of the contributors
to "An American Text-Book of Surgery," will prove of exceptional value to
the advanced student who has adopted that work as his text-book. It is not
only the syllabus of an unrivalled course of surgical practice, but it is also an
epitome of or supplement to the larger work.
" The author has evidently spared no pains in making his Syllabus thoroughly comprehen-
sive, and has added new matter and alluded to the most recent authors and operations. Full
references are also given to all requisite details of surgical anatomy and pathology."—British
Medical Journal, London.
i6
W. B. SAUNDERS'
AN OPERATION BLANK, with Lists of Instruments, etc. re-
quired in Various Operations. Prepared by W. W. Keen, M. D.,
LL.D., Professor of Principles of Surgery in the Jefferson Medical Col-
lege, Philadelphia. Price per Pad, containing Blanks for fifty operations,
50 cents net.
SECOND EDITION, REVISED FORM.
A convenient blank, suitable for all operations, giving complete instructions
regarding necessary preparation of patient, etc., with a full list of dressings and
medicines to be employed.
On the back of each blank is a list of instruments used—viz. general instru-
ments, etc., required for all operations; and special instruments for surgery of
the brain and spine, mouth and throat, abdomen, rectum, male and female
genito-urinary organs, the bones, etc.
The whole forming a neat pad, arranged for hanging on the wall of a sur-
geon's office or in the hospital operating-room.
" Will serve a useful purpose for the surgeon in reminding him of the details of prepa-
ration for the patient and the room as well as for the instruments, dressings, and antiseptics
needed "—New York Medical Record
" Covers about all that can be needed in any operation."—American Lancet.
" The plan is a capital one."—Boston Medical and Surgical Journal.
LABORATORY EXERCISES IN BOTANY. By Edson S. Bastin,
M. A., Professor of Materia Medica and Botany in the Philadelphia Col-
lege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price,
Cloth, $2.50.
This work is intended for the beginner and the advanced student, and it fully
covers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers,
bulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross
and microscopical structure of plants, and to those used in medicine. Illustra-
tions have freely been used to elucidate the text, and a complete index to facil-
itate reference has been added.
TEXT-BOOK UPON THE PATHOGENIC BACTERIA. Specially
written for students of medicine. By Joseph McFarland, M. D., Demon-
strator of Pathological Histology, and Lecturer on Bacteriology, in the
Medical Department of the University of Pennsylvania. Price, Cloth,
$2.50 net.
A concise account of the technical procedures necessary in the study of Bac-
teriology. Finely illustrated.
A GUIDE TO THE BACTERIOLOGICAL LABORATORY. By
Langdon Frothingham, M. D. Illustrated. Price, 75 cents.
The technical methods involved in bacteria-culture, methods of staining and
microscopical study are fully described and arranged as simply and concisely as
possible. The book is especially intended for use in laboratory work
CATALOGUE OF MEDICAL WORKS. 17
HOW TO EXAMINE FOR LIFE INSURANCE. By John M.
Keating, M. D., Fellow of the College of Physicians and Surgeons of
Philadelphia; Vice-President of the American Paediatric Society; Ex-
President of the Association of Life Insurance Medical Directors. Royal
8vo, 211 pages, with two large half-tone illustrations, and a plate prepared
by Dr. McClellan from special dissections; also, numerous cuts to elucidate
the text. Second edition. Price, Cloth, $2.00 net.
PART I., carefully prepared from the best works on Physical Diagnosis, gives a
succinct account of the methods used in making examinations, and a
description of the normal condition and of the earliest evidences of disease.
Part II. contains the Instructions of twenty-four Life-insurance Companies to
their medical examiners.
" This is by far the most useful book which has yet appeared on insurance examination, a
subject of growing interest and importance. Not the least valuable portion of the volume is
Part II., which consists of instructions issued to their examining physicians by twenty-four
representative companies of this country. As the proofs of these instructions were corrected
by the directors of the companies, they form the latest instructions obtainable. If for these
alone, the book should be at the right hand of every physician interested in this special branch
of medical science."—The Medical News, Philadelphia.
NURSING: ITS PRINCIPLES AND PRACTICE. By Isabel
Adams Hampton, Graduate of the New York Training School for
Nurses attached to Bellevue Hospital; Superintendent of Nurses and
Principal of the Training School for Nurses, Johns Hopkins Hospital,
Baltimore, Md.; late Superintendent of Nurses, Illinois Training School
for Nurses, Chicago, 111. In one very handsome i2mo volume of 484
pages, profusely illustrated. Price, Cloth, $2.00 net.
This original work on the important subject of nursing is at once comprehensive
and systematic. It is written in a clear, accurate, and readable style, suitable
alike to the student and the lay reader. Such a work has long been a desidera-
tum with those entrusted with the management of hospitals and the instruction of
nurses in training-schools. It is also of especial value to the graduated nurse
who desires to acquire a practical working knowledge of the care of the sick
and the hygiene of the sick-room.
PRACTICAL POINTS IN NURSING. For Nurses in Private
Practice. By Emily A. M. Stoney, Graduate of the Training-school
for Nurses, Lawrence, Massachusetts; Superintendent of Training-school
for Nurses', Carney Hospital, South Boston. 121110., 400 pages. Price,
Cloth, #1.75 net.
A vade mecum for the private nurse, and an efficient teaching-book for train-
ing-schools. A valuable feature is the instructions for quickly improvising
needed sick-room appliances.
18 W. B. SAUNDERS'
THE CARE OF THE BABY. By J. P. Crozer Griffith, M. D.,
Clinical Professor of Diseases of Children, and Instructor in Clinical
Medicine, Medical Department University of Pennsylvania; Physician to
St. Agnes', Howard, St. Clement's, and the Children's Hospitals, Phila-
delphia, etc. 392 pages, with 67 illustrations in the text, and 5 plates.
l2mo. Price, $1.50.
A reliable guide not only for mothers, but also for medical students and
practitioners whose opportunities for observing children have been limited.
THE NURSE'S DICTIONARY of Medical Terms and Nursing
Treatment, containing Definitions of the Principal Medical and Nursing
Terms, Abbreviations, and Physiological Names, and Descriptions of the
Instruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods,
Appliances, etc. encountered in the ward or in the sick-room. Compiled
for the use of nurses. By Honnor Morten, author of " How to Become
a Nurse," "Sketches of Hospital Life," etc. i6mo, 140 pages. Price,
Cloth, $1.00.
This little volume is intended for use merely as a small reference-book which
can be consulted at the bedside or in the ward. It gives sufficient explanation
to the nurse to enable her to comprehend a case until she has leisure to look up
larger and fuller works on the subject.
DIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas,
M. D., Visiting Physician to the Home for Friendless Women and Children
and to the Newsboys' Home; Assistant Visiting Physician to the Kings
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DIETS FOR INFANTS AND CHILDREN IN HEALTH AND
IN DISEASE. By Louis Starr, M. D., Editor of " An American
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perforated and neatly bound in flexible morocco. Price, #1.25 net.
The first series of blanks are prepared for the first seven months of infant
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Practical, Exhaustive, Authoritative.
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Mr. Saunders is pleased to announce as now ready his NEW AID
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This study has manifested that, while the published " Question Compends"
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19
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VOLUMES PUBLISHED.
PHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor
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SYPHILIS AND THE VENEREAL DISEASES. By James
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gist to St. Agnes' Hospital, Philadelphia; Instructor in Clinical Microscopy
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21
SAUNDERS' QUEST10N-C0MPEND SERIES,
Price, Cloth, $1.00 per copy, except when otherwise noted.
I. ESSENTIALS OF PHYSIOLOGY. 3d edition. Illustrated. Re-
vised and enlarged by H. A. Hare, M. D (Price, #1.00 net.)
2. ESSENTIALS OF SURGERY. 5th edition, with an Appendix on
Antiseptic Surgery. 90 illustrations. By Edward Martin, M. D.
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illustrations. By Charles B. Nancrede, M. D.
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6th thousand. 46 illustrations. By C. E. Armand Semple, M. D.
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AND PRESCRIPTION-WRITING. 4th edition. By Henry
Morris, M. D.
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Morris, M. D. An Appendix on Urine Examination. Illustrated.
By Lawrence Wolff, M. D. 3d edition, enlarged by some 300 Es-
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M. D. (Double number, price $2.00.)
10. ESSENTIALS OF GYNECOLOGY. 3d edition, revised. With
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By Henry W. Stelwagon, M. D. (Price, #1.00 net.)
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VENEREAL DISEASES. 2d edition, revised and enlarged. 78
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HYGIENE. 130 illustrations. By C. E. Armand Semple, M. D.
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THROAT. 124 illustrations. 2d edition, revised. By Edward
Jackson, M. D., and E. Baldwin Gleason, M. D.
15. ESSENTIALS OF DISEASES OF CHILDREN. 4th thousand.
By William H. Powell, M. D.
16. ESSENTIALS OF EXAMINATION OF URINE. Colored
" Vogel Scale," and numerous illustrations. By Lawrence Wolff,
M. D. (Price, 75 cents.)
17. ESSENTIALS OF DIAGNOSIS. By S. Solis-Cohen, M. D., and
A. A. Eshner, M.D. 55 illustrations, some in colors. (Price, $1.50 net.)
18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E.
Sayre. 2d edition, revised.
20. ESSENTIALS OF BACTERIOLOGY. 2d edition. 81 illustra-
tions. By M. V. Ball, M. D.
21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY.
48 illustrations. 2d edition, revised. By John C Shaw, M. D.
22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d
edition, revised. By Fred J. Brockway, M. D. (Price, $1.00 net.)
23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations.
By David D. Stewart, M. D., and Edward S. Lawrance, M. D.
24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Glea-
son, M. D. 89 illustrations.
RECENT PUBLICATIONS.
AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by
William H. Howell, Ph. D., M. D., Professor of Physiology in the
Johns Hopkins University, Md. One handsome octavo volume of 1052
pages, fully illustrated. Prices : Cloth, #6.00 net; Sheep or Half-Morocco,
$7.00 net.
AN AMERICAN TEXT-BOOK OF APPLIED THERAPEUTICS.
For the Use of Practitioners and Students. Edited by James C.
Wilson, M. D., Professor of the Practice of Medicine and of Clinical
Medicine in the Jefferson Medical College. One handsome octave volume
of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or Half-
Morocco, $8.00 net.
A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS,
AND PHARMACOLOGY. By George F. Butler, Ph. G, M. D.,
Professor of Materia Medica and of Clinical Medicine in the College of
Physicians and Surgeons, Chicago, etc. 8vo, 858 pages. Illustrated.
Prices : Cloth, #4.00 net; Sheep or Half-Morocco, $5.00 net.
A TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC-
TICAL. For the Use of Students. By Arthur Clarkson, M. B.,
C. M., Edin. Large 8vo, 554 pages, with 22 engravings in the text, and
174 beautifully colored original illustrations. Price, strongly bound in
Cloth, $6.00 net.
ESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX.
By Arthur M. Corwin, A. M., M. D., Demonstrator of Physical Diag-
nosis in the Rush Medical College, Chicago; Attending Physician to the
Central Free Dispensary, Department of Rhinology, Laryngology, and
Diseases of the Chest. 200 pages. Illustrated. Cloth, flexible covers.
Price, $1.25 net.
ARCHIVES OF CLINICAL SKIAGRAPHY. By Sydney Rowland,
B. A., Camb. A series of collotype illustrations, with descriptive text,
illustrating the applications of the new photography to Medicine and Sur-
gery. Price, per Part, $1.00. Parts I- ^d H- now ready.
OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA-
TIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of Ob-
stetrics in the St. Louis Medical College. 381 pages, handsomely illus-
trated. Price, $2.00 net.
WATER AND WATER SUPPLIES. By John C. Thresh, D. Sc,
M. B. D. P. H. i2mo, 438 pages, illustrated. Handsomely bound in
Cloth, with gold side and back stamps. Price, #2.25 net.
NOW READY, VOLUME FOR 1896.
©
SA/tTZLSTIDIEIE^S7
AMERICAN YEAR-BOOK OF MEDICINE and SURGERY.
Edited by GEORGE M. GOULD, A.M., M.D.
Assisted by Eminent American Specialists and Teachers.
cannot but command his highest appreciation. It is this critical and judicial
.g function that will be assumed by the Editorial staff of the " American Year-
's Book of Medicine and Surgery."
~ It is the special purpose of the Editor, whose experience peculiarly qualifies
§ him for the preparation of this work, not only to review the contributions to
°* American journals, but also the methods and discoveries reported in the leading
fe medical journals of Europe, thus enlarging the survey and making the work
5 characteristically international. These reviews will not simply be a series of
undigested abstracts indiscriminately run together, nor will they be retrospective
g of " news " one or two years old, but the treatment presented will be synthetic
^ and dogmatic, and will include only what is new. Moreover, through expert
,> condensation by experienced writers these discussions will be
Comprised in a Single Volume of about 1200 Pages. '
The work will be replete with original and selected illustrations skilfully
reproduced, for the most part in Mr. Saunders' own studios established for the
purpose, thus ensuring accuracy in delineation, affording efficient aids to a right
comprehension of the text, and adding to the attractiveness of the volume.
Prices: Cloth, $6.50 net; Half Morocco, $7.50 net.
W. B. SAUNDERS, Publisher,
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JUST ISSUED.
PENROSE'S DISEASES OF WOMEN.
A Text=Book of Diseases of Women. By Charles B. Penrose, M. D., Ph. D.,
Professor of Gynecology, 1'niversity of Pennsylvania: Surgeon to the Gyneeean
Hospital, Philadelphia. Octavo volume of 029 pages, handsomely illustrated.
Price, $0.50 net.
MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE.
Pathological Technique. Uy Frank B. Mallory, A.M., M.D., Asst. Professor
of Pathology, Harvard Medical School; and James H. Wright, A. M., M. D., In-
structor in Pathology, Harvard Medical School. Octavo volume of 396 pages,
handsomely illustrated. Price,
SENN'S GENITOURINARY TUBERCULOSIS.
Tuberculosis of the Genito=Urinary Organs, Male and Female. By Nicholas
Sunn, M. D., Ph. D., LL.D., Professor of the Practice of Surgery and of Clinical
Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320
pages. Illustrated. Price,
SUTTON AND GILES' DISEASES OF WOMEN.
Diseases of Women. By J. Bland Sutton, F. R. C. S., Asst. Surgeon to Middle-
sex Hospital, and Surgeon to Chelsea Hospital, London ; and Arthur E. Giles,
M. D., B. Sc. Loud., F. R. C. S. Edin., Asst. Surgeon to Chelsea Hospital, London.
436 pages, handsomely illustrated. Price, 82.50 net.
IN PREPARATION.
ANDERS' PRACTICE OF MEDICINE.
A Text=Book of the Practice of Medicine. By James M. Anders, M. D., Ph. D.,
LL.D., Professor of the Practice of Medicine and of Clinical Medicine, Medico-
Chirurgical College, Philadelphia. In press.
MACDONALD'S SURGICAL DIAGNOSIS AND TREATMENT.
Surgical Diagnosis and Treatment. By J. W. Macdonald, M. D., Professor of
the Practice of Surgery and of Clinical Surgery, Minneapolis College of Physi-
cians and Surgeons. In press.
AN AMERICAN TEXT BOOK OF GENITO=URINARY AND SKIN
DISEASES.
Edited by L. Bolton Bangs, M. D., Late Professor of Genito-Urinary and Venereal
Diseases, New York Post-Graduate Medical School and Hospital, and William
A. Hardaway, M. D., Professor of Diseases of the Skin, Missouri Medical College.
AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE,
EAR, NOSE, AND THROAT.
Edited by G. E. de Schweinitz, M. D., Professor of Ophthalmology in the Jeffer-
son Medical College, and B. Alexander Randall, M. D., Professor of Diseases
of the Ear in the University of Pennsylvania.
HIRST'S OBSTETRICS.
A Text-Book of Obstetrics. By Barton Cooke Hirst, M. D., Professor of Obstet-
rics, University of Pennsylvania.
MOORE'S ORTHOPEDIC SURGERY.
A Manual of Orthopedic Surgery. By James E. Moore, M. D., Professor of
Orthopedics and Adjunct Professor of Clinical Surgery, University of Minnesota,
College of Medicine and Surgery.
HEISLER'S EMBRYOLOGY.
A Text=Book of Embryology. By John C. Heisler, M. D., Prosector to the Pro-
fessor of Anatomy, Medical Department, University of Pennsylvania.
NOW READY, VOLUMES FOR 1890 AND 1897-
AMERICAN YEAR-BOOK OF MEDICINE and SURGERY,
Edited by GEORGE M. GOULD, A. M., M. D.
Assisted, by Eminent American Specialists and Teachers.
Comprised in a Single Volume of about 1200 Pages.
The work will be replete with original and selected illustrations skilfully
reproduced, for the most part in Mr. Saunders' own studios established for the
purpose, thus ensuring accuracy in delineation, affording efficient aids to a right
comprehension of the text, and adding to the attractiveness of the volume.
Prices : Cloth, $6.50 net; Half Morocco, #7.50 net.
W. B. SAUNDERS, Publisher,
925 Walnut Street, Philadelphia.
» ---------•---------
f>
5 Notwithstanding the rapid multiplication of medical and surgical works,
© still these publications fail to meet fully the requirements of the general physician, *?
^ inasmuch as he feels the need of something more than mere text-books of well- ^.
5* known principles of medical science. Mr. Saunders has long been impressed 2
,2 with this fact, which is confirmed by the unanimity of expression from the pro- "
6 fession at large, as indicated by advices from his large corps of canvassers. ?
& This deficiency would best be met by current journalistic literature, but most St
"S§ practitioners have scant access to this almost unlimited source of information, «*
5^ and the busy practiser has but little time to search out in periodicals the many ^
g interesting cases whose study would doubtless be of inestimable value in his J
© practice. Therefore, a work which places before the physician in convenient &*■
^ form an epitomization of this literature by persons competent to pronounce upon ~
§ The Value of a Discovery or of a Method of Treatment 2.
» cannot but command his highest appreciation. It is this critical and judicial ;
,g function that will be assumed by the Editorial staff of the " American Year-
's Book of Medicine and Surgery." ^
<* It is the special purpose of the Editor, whose experience peculiarly qualifies «.
g him for the preparation of this work, not only to review the contributions to fcg
• American journals, but also the methods and discoveries reported in the leading §
fe medical journals of Europe, thus enlarging the survey and making the work ^
» characteristically international. These reviews will not simply be a series of ^
§ undigested abstracts indiscriminately run together, nor will they be retrospective «
g of " news " one or two years old, but the treatment presented will be synthetic £■
* and dogmatic, and will include only what is new. Moreover, through expert ?
2 condensation by experienced writers these discussions will be
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