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3 1 =

THE LIBRARY

HOME ECONOMICS

A COMPLETE HOME-STUDY COURSE

VA:4CES 1H TtlE ARTU AND BC1EKCE8 TO HOUE AMD HEALTH

ntEPAUJlD l!V TKACHEliS OF.
I}Ef'OGNI/K[) ArTIIOHITY

TWELVE VOLUMES

CHICAGO

AMERICAN SCHOOL OF HOME ECONOMICS

1911

CX>FYBIGHT. 1907

Ron XOONOMIOS Absooiatioh

Bntered at Stationers* Hall. London
JUmghUMemrved

AUTHORS

ISABEL BEVIER, Ph. M.

Professor of Household Science, University of Illinois. Au-
thor U. S. Government Bulletins, "Development of the Home
Economics Movement," "Selection and Preparation of Food,"
etc. President American Home Economics Association.

ALICE PELOUBET NORTON, M. A.

Assistant Professor of Home Economics, School of Education,
University of Chicago ; Director of the Chautauqua School of
Domestic Science ; Author ' "Teaching of Home Economics."

S. MARIA ELLIOTT

Instructor in Home Economics, Simmons College ; Formerly
Instructor School of Housekeeping, Boston.

ANNA BARROWS

Teacher of Cookery, Teachers' College, Columbia University,
Director Chautauqua School of Cookery : formerly Editor
"American Kitchen Magazine" ; Author "Home Science Cook
Book."

ALFRED CLEVELAND COTTON, A. M., M. D.

Professor Diseases of Children, Rush Medical College, Uni-
versity of Chicago : Vis'ting Physician Presbyterian Hos-
pital, Chicago : Author of "Diseases of Children."

BERTHA M. TERRILL, A.B.

Professor of Home Economics and Dean of Women, Univer-
sity of Vermont ; Author of U. S. Government Bulletins.

KATE HEINTZ WATSON

Formerly Instructor in Domestic Economy, Lewis Institute ;
Lecturer University of Chicago.

MARION FOSTER WASHBURNE

Editor "The Mothers* Magazine ;" Lecturer Chicago Froebel
Association ; Author "EVeryday Essays," "Family Secrets,"
etc.

MARGARET E. DODD

Graduate Massachusetts Institute of Technology; Teacher of
Science, Woodward Institute.

AMY ELIZABETH POPE

With the Panama Canal Commission; Formerly Instructor
in Practical and Theoretical Nursing, Training School for
Nurses, Presbyterian Hospital, New York City.

MAURICE LE BOSQUET, S. B.

Director American School of Home Economics ; Member
American Public Health Association and American Chemical
Society.

CONTRIBUTORS AND EDITORS

ELLEN H. BICHABDS

Author "Cost of Food," "Cost of Living," "Cost of Shelter,"
"Food Materials and Their Adulteration," etc., etc. ; Chair-
man Lake Placid Conference on Home Economics.

MABY HINMAN ABEL

Author of U. S. Government Bulletins, "Practical Sanitary
and Economic Cooking,'* **Safc Food," etc.

THOMAS D. WOOD, M. D.

Professor of Physical Education, Columbia University.

H. M. LUFKIX, M. D.

I'rofessor of Physical Diagnosis and Clinical Medicine, Uni-
versity of Minnesota.

OTTO FOLIN, Ph.D.

Special Investigator, McLean Hospital, Waverly, Mass.

T. MITCHELL PBUDDEN, M.D., LL. D.

Author "Dust and Its Dangers," "The Story of the Bac-
teria," "Drinking Water and Ice Supplies," etc.

FRANK CHOUTEAU BROWN

Architect, Boston, Mass. ; Author of "The Five Orders of
Architecture," "I-.etters and Lettering."

"MBS. MELVIL DEWEY

Secretary Lake Placid Conference on Home Economics.

HELEN LOUISE JOHNSON

Professor of Home Economics, James Milllkan University,
Decatur.

PBANK W. ALLIN, M. D.

Instructor Rush Medical College, University of Chicago.

MANAGING EDITOR

MAUBfCE LE BOSQUET, S. B.

Director American School of Home Economics.

BOARD OF TRUSTEES

OF THE AMERICAN SCHOOL OF HOME ECONOMICS

MRS. ARTHUR COURTENAY NEVILLE
President of the Board.

MISS MARIA PARLOA

Founder of the first Cooking School in Boston; Anthor of
"Home Economics," "Young Housekeeper/' U. S. Govern-
ment Builctins, etc.

MRS. MARY HINMAN ABEL

Co-worker. In the "New England Kitchen," and the "Rum-
ford Food Laboratory ;" Author of U. S. Government Bul-
letins, "Practical Sanitary and Economic Cooking," etc.

MISS ALICE RAVENHILL

Special Commissioner sent by the British Government to re-
port on the Schools of Home Economics in the lUnited
States ; Fellow of the Royal Sanitary Institute, London.

MRS. ELLEN M. HENROTIN

Honorary President General Federation of Woman's Clubs.

MRS. FREDE'feiC W. SCHOFF

President National Congress of Mothers.

MRS. LINDA HULL LARNED

Past President National Household Economics Association ;
Author of "Hostess of To-day."

MRS. WALTER McNAB MILLER

Chairman of the Pure Food Committee of the General
ITederatlon of Woman's Clubs.

MRS. J. A. KIMBERLY

Vice President of National Household Economics Associa-
tion.

MRS. JOHN HOODLESS

Government Superintendent of Domestic Science for the

£rovlnce of Ontario ; Founder Ontario Normal School of
domestic Science, now the MacDonald Institute.

Wt V^imt

T^HAT right Kving should be the fourth "R" in edu-
•*' cation.

npHAT home - making should be regarded as a pro-
fession.

npHAT health is the duty and business of the individual;
illness of the physician.

npHAT most illness results from carelessness, ignorance, or
intemperance of some kind.

npH AT as many lives are cut short by unhealthful food and
^ diet as through strong drink.

npHAT on the home foundation b built all that is good
in state or individual.

npHAT the upbringing of children demands more study
than the raising of chickens.

TpHAT the spending of money is as important as the
earning of the money.

npHAT economy does not mean spending a small amount,
but in getting the largest returns for the money expended.

npHAT the home-maker should be as alert to make pro-
gress in her life-work as the business or professional
man.

for
issues of
life.

TpHAT the study of home problems may be made of no
less cultural value than the study of art or literature and
of much more immediate value.

— American School of Home Economics

TpHAT the most profitable, the most interesting study
women is the home, for in it center all the issues

Home Care of the Sick

AMY ELIZABETH POPE

Entered at Stationers Hall, London
All Rights Reserved

CONTENTS

Letter to Students ...... v

Symptoms of Disease ..... a

Choice, Furnishing, and Care of the Sick-Rooh . 9
Care of the Patient ..... 13

Lifting and Handling the Patient .20

Convalescence . . . 29

Care of the Hair, Mouth, Teeth . .32

Baths and Bathing ...... 34

SicK-RooM Methods . 41

The Giving of Medicine ..... 48

Purgative, Enemata, Douches, and Catheterization 54
Poultices AND Fomentations . . . . 59

Contagion, Disinfection, Nursing in Contagious

Diseases ........ 63

Contagious Diseases ...... 67

Disinfection of the Room and Contents 71

Surgical Operations at Home .... 73

Obstetrics ........ 80

Food for the Sick ...... 93

Recipes ......... 97

Emergencies; First Aid to the Injured 105

Foreign Bodies in Eye, Ear, Nose, Throat . .112

Poisons and Antidotes . . . . .113

Bandages and Bandaging . . .114

Bibliography ....... 122

Preventable Diseases ...... 125

Consumption . . . . . .126

Change of Climate in Consumption . . -139

Pneumonia . . . . .141

Diphtheria . . .153

Typhoid Fever ....... 165

Formaldehyde Disinfection — A New Process . 177
Program for Supplemental Study . . 183

Index . . . . . . . . 187

Juxraary 1. 1907.

Good imrsing conaiats chiefly in
being able to render certain assistance deftly
and correctly and to derive the fall benefit
fron this course you must^ so far ae practice*
ble» try to carry out the instructions given, in
the lessons.

Practice should not wait until you have a
eick person on ffhcm to experiment— your attempts
might not be appreciated— -but have someone "play
patient* while you change the bed clothes, the
gown» lift her up and down in bed. to another
bed, to a chair* change the mattress* etc*

Do all this not once but many times until
you can follow out the directions softly and
q;uickly* It would be best to do this before the
answers to the tests are sent in> so that if
there is anything in which you fail or that is
not perfectly clear* you can ask for explanations.

I resrot that my iwv duties vith tte PanuM
Canal Coatoiasion will 'not permit me to look orar
your tea la paraonally, but aqr aubatituto miU.
I know, give you all aaaiatanea naadad. If I caii
bo of ariy further help» I ahall be glad to have
you vrite to me even though an exchange of letters
takea aome time.

With beat wiahea for your auceeaa, I am

Sincerely your a »

z. r.

Superrlaor

TWELVE CHIEF CAUSES of DEATH iW CHICAGO.

BV DeCADU. WiO-«09

CA06E6 MAhED IN ORDER OF H1GHE6T DEATH RATE.

^EVA6t RaTCA PCtt KX>.000 W- PoMMJ^TIOfl In PA»eMV««d

DCCAiDeS

THft PIWVtnTl^aiA Dt«CA4U AVI inOICATtb BY 4HADtn«

HOME CARE OF THE SICK.

IT IS the minority, not the majority of people, who
* can afford the luxury of a trained nurse, especially
in cases of protracted and chronic illnesses.

These lessons are intended to help those who cannot
always command the services of a trained nurse, to
teach how to carry out the doctor's orders, what to
look for and observe in his absence, so that by giving
him a definite report of what the patient's condition
has been he may be able to work more understand-
ingly, be able to diagnose the disease more quickly,
be surer of how the patient is progressing, and of the
influence the medicine ordered is having. And to
teach above all how to handle and move patients with-
out tiring them, how to render them comfortable, there-
by ensuring rest of nerve and body.

What to do in illness is purposely omitted in these
lessons, except in very simple troubles and in cases of
emergency. The "what to do" is for the doctor to de-
cide, the "how to do" for the mother to know. Incal-
culable harm is continually being done by the latter
encroaching on the doctor's prerogative. Many a
mother has treated her child for supposed colic and
only called the doctor in after some days when the
pain has refused to yield to her treatment. In very

Ainu of
the Lettoni

The Doctor' c
Province*

Know

2 HOME CARE OF THE SICK

many cases the treatment has been the worst thing
possible for what has proved to be appendicitis, gastro-
.enteritis, or other serious abdominal trouble,
■^^hut There are few who can afford to run up the doctor's
*^* Souid bill by calling him in unnecessarily. To avoid this,
and yet not run the risk of endangering the lives of
those entrusted to her care, especially the little chil-
dren who cannot tell clearly where the pain is or how
badly they feel, it is imperative that every mother
should know how to count the pulse, take the tempera-
ture, and be cognizant of at least a few of the primary
symptoms of the most common diseases, especially the
contagious ones, where the lack of early recognition
and isolation may imperil the health or life of others.
The following table gives the primary symptoms,
period of incubation, and usual time required for iso-
lation of the most common contagious diseases. The
number of days between exposure to and the develop-
ment of a disease is called the period of incubation.

FIBST SYMPTOMS IN SOME OF THE MOST COMMON

DISEASES

COVTAOIOXTS DISEASES

DISEASE f™??,!2f,^ SYMPTOMS ^'J^^J^L

INCUBATION ISOLATION

Mumps Days 14-21 Swelling of the From day when

average 18 glands between swelling first ap-

ear and jaw, on pears till 10 days

either side or after, usually 3

both. weeks.

FIRST SYMPTOMS OF DISEASES

COKTAOIOUS DISEASES (Continued)

DISEASE

PERIOD OF
INCUBATION

SYMPTOMS

Chicken- Days 12-16 Slight fever, after
pox average 14 24 hours small

pimples appear
on back and
face.

German Days 6-18
Measles average 14

Measles Days 9-16
average 12

Small-
pox

Days 9-16
average 16

Very slight fever,
rash (if any)
appears first on
face, may only
last a few hours.
There may be
headache and
nausea.

Sneezing, running
from eyes and
nose, face swol-
len, sore throat,
cough, f e v^ e r
gradually rising,
rash appears
first on face and
neck.

Chill, rapidly ris-
ing temperature,
intense head-
ache, pain in
back and legs,
rash, small, red,
hard pimples,
appearing first
on face and
wrists.

TIME OF
ISOLATION

From onset until
last crust has
fallen, usually 14
days.

From 2 days be-
fore rash till
symptoms are
gone. S o m e -
times 2 weeks.

From first ca-
tarrhal s y m p -
toms until des-
quamation ceas-
es, usually 24
days.

From onset until
last crust has
fallen, usually 6
weeks.

Children's
DiBeases

HOME CARE OF THE SICK
CONTAGIOUS DISEASES (Continued)

DISEASE

PERIOD OF
INCUBATION

TIME OF
ISOLATION

Scarlet- Days 1-7
fever average 7

From appearance
of rash till des-
quamation has
entirely ceased ;
usually 6 weeks.

Diph-
theria

Days 1-6
average 6

From onset till
germs have en-
t i r e 1 y disap-
peared.

SYMPTOMS

Sudden vomiting,
sometimes chill
or convulsions,
high tempera-
ture, sore throat,
tongue coated on
edges, bright red
in center, gener-
al malaise, typ-
ical rash appear-
ing first on chest
and shoulders.

Especially in the
beginning of the
disease the tem-
perature is not
as high as in
tonsillitis; head-
ache, nausea,
sore throat, with
white patches on
the tonsils.

As it is sometimes difficult even for the physician to dis-
tinguish between diphtheria and tonsillitis without taking a
culture for examination, when white patches appear on a
child's throat it should be isolated and a doctor called in
at once.

DISEASES NOT CONTAGIOXTS

Colic. Give castor oil, then a few drops of pepper-
mint in hot water (never soothing syrup) ; keep the
baby warm and lying on his abdomen. Gentle rubbing
in a circular direction, and the application of hot flan-
nels will generally relieve it. If not, a physician

FIRST SYMPTOMS OF DISEASES $

should be notified as continued abdominal pain is a
symptom of many serious disorders.

Cholera Infantum, Caused by over or improper
feeding, heat and impure air. Symptoms : Diarrhoea
and intestinal pain, excessive thirst, but no appetite.
Try no home remedies, seek medical aid at once.

Intestinal Obstruction, Symptoms : Obstinate con-
stipation, followed by vomiting and abdominal disten-
tion ; usually not much temperature. Get medical ad-
vice promptly, as immediate operation may be im-
perative.

Convulsions. Caused by indigestion, worms, difficult
dentition, or fright. Muscular twitchings coming on
suddenly, sometimes even during sleep. Send for the
doctor immediately, but do not await his arrival to put
the baby in a hot bath. Give castor oil and an enema,
according to directions given on page 55, using, if
the child is small, a rubber catheter for a rectal tube.

Pneumonia. Primary symptoms: Chill followed
by high temperature, cough, pain in chest, expectora-
tion which gradually becomes rust colored and bloody.
Put patient to bed and send for the doctor imme-
diately.

Typhoid Fever, Primary symptoms : Temperature
rising a little higher each day, nausea, headache, pain
in back and limbs, nose bleed, sometimes constipation,
sometimes diarrhoea, watery, yellow stools, abdominal
pain. Put patient to bed and only allow liquid diet
until the doctor comes.

6 HOME CARE OF THE SICK

Meningitis. May develop suddenly with continuous
convulsions, or come on gradually with symptoms of
fretfulness, restlessness, headache, vomiting, and in-
tolerance of light and noise. Put patient to bed in a
quiet, dark, well-aired room and only allow liquid
diet till the doctor comes.

Croup. There are two forms of croup — ^the true or
membranous and the false or spasmodic. The former
is always associated with diphtheria, but since the use
of antitoxine it has become a much rarer complication,
seldom occurring when antitoxine is used. It comes
on gradually.
Paiie Croup False croup comes on suddenly, generally in the

middle of the night; it is as a rule the result of ex-
posure to damp and cold, excitement, or indigestion.

The spasm is the result of the spasmodic closing of
the glottis. Though not dangerous, it is very distress-
ing and calls for immediate treatment. Relief usually
can be obtained best by applying hot fomentations to
the throat, inducing vomiting by giving a drink of
tepid water and salt — a teaspoonful to the glass — ^and
by steam inhalations.

The most effective way of giving inhalations is with
the croup kettle and canopy. The quickest way to im-
provise these is to tie an umbrella to the top of the
child's crib and over this drape two sheets, pinning
them to the sides of the bed. They must overlap
about one inch and hang down far enough over the
sides and back of the bed to be tucked under the mat-

tress. The lower third of the front space is left open
for the admission of fresh air. Water is kept boiling
in a kettle at the back of the bed by a gas or oil stove

and a cone of cardboard or stiff paper is attached to
the spout and inserted between the overhanging sheets
to carry the steam over the child's head.

8 HOME CARE OF THE SICK

In nearly all cases of slight indisposition, even
diarrhoea, a cathartic such as castor oil or calomel, fol-
lowed by salts such as Rochelle salts, magnesium sul-

Rear View ol Croup Caaop; ShowlUK Stove. Kettle, and Tube
tor Steam

phate, or seidlitz powder, five or six hours later, to-
gether with rest and fluid or soft diet is indicated.
Give as liltle medicine as possible without a doctor's
order.

THE CHOICE, FUBMISHtKa AND CABE OF THE SICK>

BOOM

Sunshine, pure fresh air, and freedom from noise
and odors are the principal things to be considered in
choosing the sick-room. When possible it is advisa-
ble to have a room with a southern exposure. If there
is a fireplace or grate in the room so much the better,
as a chimney is an excellent medium for ventilation.

Despite the fact that the sick-room at the top of
the house gives many stairs to climb, it is better to
have it there. It is further removed from the noises
of the street and house and the air is generally purer.

Only necessary articles of furniture should be re-
tained ; all heavy hangings, draperies, and upholstered
furniture must be removed. Care must be taken, how-
ever, that the room is not made too bare and unat-
tractive. Short, washable curtains; clean, white linen
covers for the tables; a few fresh flowers will help
to make the sick-room bright and cheerful. Flowers
should be removed at night, the water they are in
changed daily, and they should never be tolerated after
they begin to fade.

The ideal bed is iron or brass; single or three-
quarter width. The double bed is unadvisable, for
owing to its width, the mattress is apt to sink in the
middle and it is then almost impossible to keep the
under sheets drawn tightly enough to prevent wrinkles.
The bed should be at least twenty-five inches in

FnrniBhingi

The Bed

10* HOME CARE OF THE SICK

height, but if it is not, can easily be made so by plac-
ing heavy blocks of wood under each leg. Hollows
about two inches in depth should be made in the
blocks to fit the ends of the legs. Especially if the
patient is liable to be ill long, the trouble of doing this
is well repaid by the added convenience in lifting and
working over the patient.
The A hair mattress is by far the best kind to have ; the

Va t^v asm

feather one the worst. Not only is the latter too heat-
ing, but when occupied it is almost impossible to make
the bed properly.

The bed should be placed far enough from the walls
to give access on all sides, care being taken to avoid
having the light in the patient's eyes.
Lighting The best plan is to have the window behind the

bed ; then more sun and light can be admitted without
disturbing the patient. Except in certain cases, it is
a mistake to keep the sick-room darkened.

Besides the bed, there should be two or three chairs
in the room ; one a comfortable arm chair with high
back. If upholstered, it should be encased in a pretty,
light, washable cover. Rocking chairs should never
be permitted in the sick-room; when sitting in them
one is almost sure to rock, and the motion is very
apt to irritate the patient.

Two tables are necessary; on one should be kept
writing material, where the doctor can write his orders
and the nurse keep the record of the patient's condi-

THE SICK ROOM

tion. The second table can be near the bedside to hold
the patient's bell; also her food-tray; the latter must
always be removed as soon as the meal is finished.
Never leave empty or half empty glasses of milk, cups
of broth, etc., standing by the patient.

There is a bedside table — made on purpose for use
in the sick-room — which is very convenient. The top
extends over the bed in front of the patient; it is ad-
justable and has a foot piece which goes under the
bed and keeps the table from upsetting. (See page 30.)

Medicine bottles and all necessarv utensils should
be kept in an adjoining room, if possible.

The floor should be swept with a soft broom cov-
ered with cheese cloth, or other soft material which
is free from lint. Carpets are very objectionable;
small rugs which can be removed and shaken daily,
being preferable. If the carpet must remain, see that
it is kept well dusted, and that no dust is raised while
doing so. The best way to do this to to sweep with
a damp broom, going over it afterwards with a damp
cloth pinned over the broom. Do not have this too wet
or it will injure the carpet.

When it is necessary for the nurse to sleep in the
room, the cot is the most convenient arrangement, as
it is comfortable, inexpensive and can be easily re-
moved in the day time.

Never use a feather duster but clean, soft dust cloths
which may be washed out every day. Except for the

Bedildt
Tabio

Dusting

HOME CARE OF THE SICK

Yentllation

Airln;

varnished furniture, it is better to have the duster
sHghtly damp, as this will prevent scattering of the
dust.

The air in the sick-room must be as pure as the air
outside. The value of fresh air as an aid to recovery
is sadly underrated. The open fireplace is one of the
best methods of ventilation. A current of air can be
created in summer by placing a lamp or a candle in
the chimney place, and in winter a wood or a coal fire.
Next to a fireplace, an open stove gives the best means
of ventilation.

Window ventilation is best obtained by double win-
dows with double sashes. The lower sash of the outer
window is raised about two feet; the upper sash of
the inner window lowered about the same distance.
The passage of air being thus directed upward, a di-
rect draught upon the patient will not be produced, if
windows and doors on the opposite side of the room
are kept closed. Where there are single windows, the
same eflfect can be obtained by tacking the lower end
of a piece of cotton, about twelve inches in depth, td
the frame of the upper sash and to the top of the win-
dow frame; then lower the sash about ten inches.
When less air is desired the lower sash can be raised
and a board fitted to the opening; the air then passes
upward between the sashes.

In addition to this slight continuous ventilation, the
window must be opened and the entire air of the sick-
room changed at least twice a day. In doing this, be

CARE OF THE PATIENT

careful that there is no draught and that the patient
has extra blankets. If there is no screen at hand, a
large, umbrella will prove quite effective in protecting
the patient's head from the direct current of air. If
it is necessary to warm the air before it enters the
patient's room, the window in an adjoining, well-heat-
ed room may be opened, the door between the rooms
being left slightly ajar. The corridor or bath room
(especially the bath room) should not be used for
this purpose.

Hard coal should be used if the room is heated by
a stove on account of its freedom from dust.

In removing the ashes, they should be sprinkled with
water first to prevent flying, then quietly shoveled up.
The coal can be added in paper bags filled outside,
thus avoiding all noise likely to disturb the patient.

The temperature of the sick-room should be 68 de-
grees F at night and 70 degrees F during the day.

CABE OF THE PATIENT

A few essential points to be remembered in caring
for the sick may be stated briefly.

To properly care for a patient those undertaking the
responsibility of the nursing must take proper care of
themselves. Rest, recreation, and out of door exer-
cise are positive necessities.

If the same member of the family has both day and
night nursing to do she should always dress herself
as comfortably as possible for the night. A cold bath

Fuel

and

Ashes

Care of
the Nurse

HOME CARE Of THE SICK

in the morning, with complete change of clothing, will
be found very refreshing.

Dresses of light wash material should always be
worn when attending the sick, but dresses and skirts
must never be stiffly starched, as the rustling noise
they make is very annoying to patients. Squeaking
shoes are another abomination.
»«veri" Never whisper in or near the sick-room.

Never discuss the patient's condition with her, or
with anyone else in her hearing.

Never tell the patient what her temperature, pulse,
etc., are, not even when they are normal.

Never tell the patient what medication you are giv-
ing her.

Never lean nor sif on the patient's bed, and be care-
ful not to knock against it in passing.

When speaking to a patient always stand in front
of her, where she can see you ; be particularly careful
not to speak to her suddenly from behind, for when
people are ill and nervous they are easily startled.

Keep door and window hinges well oiled ; nothing is
more aggravating than a squeaking door.

When windows rattle, wedge them apart between the
sashes with pieces of wood or newspaper.
At Night Especially at night, or, rather, when getting ready

for the night, attention must be paid to anything likely
to prove a disturbing element to the patient's rest.

Before the patient goes to sleep see that you have
everything at hand that you are likely to need for the

When
Speaking

Bed

CARE OF THE PATIENT 15

night : Extra blankets — a shade for the light, if neces-
sary — coal prepared in paper bags, as previously de-
scribed — milk — water — all the medicines you will re-
onire — ice, etc. Wrapping the ice in flannel or news-
paper will keep it from melting. A hat pin makes an
excellent and noiseless ice-pick. A large tin pan, en-
veloped ip a blanket, will make a serviceable refriger-
ator in which to keep your ice, broth, milk and water.

A shade for the lamp or gas can be easily made out
of green or other dark colored cambric, but be sure
that the globe over which it is pinned is far. enough
from the flame to avoid scorching the cambric.

An uncomfortable bed is a great addition to the mis-
eries of an invalid, therefore, one of the first essentials ^^^^9
to be learned is how to make a bed.

The mattress is covered by a sheet, stretched tightly
and tucked firmly as far under it as possible; folding
the corners like an envelope helps to keep it firm.

Another sheet called the "draw sheet" is also used j;Yie
under the patient ; this is put on with the length across
the bed, thus allowing a considerable fold under the
mattress, thereby securing a further means of keep-
ing the sheet tight. When putting the draw sheet on
care must be taken to have it perfectly straight; it is
first tucked in on one side, well under the mattress.
In tucking in the second side it is best to begin in the
middle, going first towards the bottom, then from
the middle to the top, pulling it very tightly. The top
sheet and blankets (single blankets are preferable to

Draw Bheat

i6 HOME CARE OF THE SICK

double) should be put on separately, the corners being
folded in, in the same manner as the under sheet. If
it is not convenient to obtain a spread of dimity, or
other light material, it is better to use a sheet, as the
ordinary spread is heavy and gives comparatively lit-
tle warmth.
Protecting When it is necessary to protect the mattress a rub-

the Mattress *

ber sheet is placed between the lower and draw sheets.
White double faced rubber is the nicest for home use.
The single faced rubber will answer the purpose and
is cheaper, but it is not so easily kept clean. Either
can be obtained at any rubber store.

When impossible to get the regular rubber sheet-
ing thin oil cloth, -such as is used for covering tables,
will serve. In cases of emergency, several thicknesses
of newspapers may be used until something better can
be obtained.

CHANGING THE BED OF A HELPLESS PATIENT

Before starting to change the bedding be sure that
you have everything necessary near at hand, and that
the bed clothes are all well aired, perfectly dry and
warm.

First take off the spread, fold it neatly; next talce
off the top blanket, and hang it out to air. Fold the
other blanket and upper sheet over the patient, leav-
ing the ends just long enough to cover her when you
turn her over. This method answers a threefold pur-
pose: (i) it has a neat appearance; (2) it replaces the

CHANGING THE D

Changlwc

i8 HOME CARE OF THE SICK

discarded blanket, and (3) the clothes are not in the
way while you work. Loosen the lower sheets by rais-
ing the mattress with one hand while drawing out the
sheets with the other. Raising the mattress is impor-
tant, because the draw sheet has been tucked so far
under the mattress that otherwise you risk not only
>Dlting the patient but also tearing the sheets. Re-
move the pillows and if the patient does not object
to lying flat for a while leave them out; if she does,
one can be replaced. It is necessary to take them out
to turn them and to make sure that there are no crumbs
caught between them or in the pillow cases.

The night gown is the next thing changed. Have
Hicht Qoira ^^^^ patient lie oh her back and flex her knees ; if she

is well enough she can easily raise herself while in this
position ; if not, place one hand under the buttocks
and raise her, as you draw the gown up with the other
hand, then raise the shoulders in like manner, drawing
the gown up over them and the head before taking
out the arms.

In putting on the clean gown roll the skirt up, and
put the patient's head through the hole. Putting your
hand through one sleeve grasp the patient's hand and
draw it through ; then do likew ise with the other sleeve.
The gown is then pulled down in the same manner as
the soiled one was taken off.

The easiest way to change the under sheets is first
to turn the patient on her side.

To do this, stand on the side towards which you will

CHANGING THE BED

mrn her, slip one hand over and under her, with your
arm slightly crooked, so that the hand and forearni
will support and control one shoulder, the elbow sup-
port the back of the head, and the arm the other shoul-
der. Slip your other arm under the patient slantwise
across the buttocks, so that the hand is under the
small of the back. In this v/ay the patient is well sup-
ported as you gently turn her towards you. If there
is an assistant, one can hold her thus while the other
manipulates the sheets; if not, and the patient needs
to be supported, a pillow placed well up against her
back will answer the purpose.

The sheets to be changed are folded close to the
back of the patient, making the fold as flat as pos-
sible. The clean sheet is either folded fan shape or
rolled to its centre, the roll or fold, as the case may
be, is placed close to the sheet being removed, the
loose edge is tucked in, as far under the mattress
as possible, the patient is then rolled gently over on
to the clean sheet, the soiled one removed, and the clean
sheet well stretched, and tucked in according to the
directions given in the making of the bed.

The top sheet is next changed. Placing the clean
sheet over the sheet and blanket which are still over
the patient; on top of this put the blanket which has
been airing, draw the other blanket and sheet from
underneath, then tuck in the clean ones, put on the
second blanket, if one is necessary, then the spread,
and arrange the pillows.

Turning:

the

Patient

Changing

the

Draw Sheet

Changing

the

Top Sheet

20 HOME CARE OF THE SICK

The draw sheet, upper sheet, and night gown should
be changed twice a day when the patient is not too
ill; if they are not soiled when removed, air them
well, after which they may be used again.

When the patient is not allowed to be bathed, her
back should be washed with soap and warm water,
rubbed with alcohol and powdered with talcum pow-
der. This should be done while she is turned on her
side for the changing of the sheet. When the night
gown is closed in the back it is sometimes more con-
venient not to put the clean gown on until the pa-
tient's back has been washed. In such circumstances
wrap a small shawl around the patient.
SpMBciai When for any reason it is inadvisable to move the

patient, and it is necessary for her to lie on her back,
it is convenient to have short gowns, open in the
back, buttoned at the back of the neck and shoulders.
The skirts can be drawn from under, the patient, enab-
ling her to lie on the sheet, which it vs comparatively
easy to keep free from wrinkles. Another important
advantage of the short gown is the ease with which it
can be changed. Large collars or ruffles at the neck
of the gown are very objectionable in illness.

When changing the gown of a patient whose arm is
disabled, the sleeve should be taken from the affected
arm last, and the sleeve of the fresh gown put on first.

LIFTING AND HANDLING THE PATIENT

When lifting a patient it is important to stand
firmly ; to do this the feet should be placed well apart.

LIFTING THE PATIENT 21

bracing one foot against the leg of the bed. Try to
bend the back as little as possible, make the knees
do the bending. In lifting, endeavor to have the
weight come on your shoulders, not on your back. For
example, when a patient is to be helped into a sitting
position, bend your knees till your shoulder is only

A BACK REST, CANVAS COVERED.

slightly higher than the patient's, then have her put her
arm across your shoulders, have your shoulder di-
rectly under her armpit, your elbow supporting her
head, your hand under her other armpit — your other
hand is thus free to arrange the pillows. Now raise
the patient. By using this method your shoulder
bears the burden, whereas if you attempt to raise the
patient by bending your back, or if you have the pa-
tient's arm around your neck, the entire weight must

22 HOME CARE OF THE SICK

be sustained by your back, which will soon become'

straineil.

A back rest slioiild always be provided when tlie
]iatient sits up in be<l for the first time. Many varieties
of these are to be had, and they are inexpensive ; some
are made entirely of wood, others have a wooden
framework with canvas stretched across it. A good
substitute for the back rest is a straight back chair
turned upside down. The pillows should be placed
across the rest in such a way that the head will'not
be thrown forward and that the small of the back will
be well supported.

When the patient is obliged to sit up all, or nearly
all the time, something should be provided for her
to brace her feet against. A convenient arrangement
for this purpose is a board the same length as the
width of the bed and about twelve inches wide, placed
between double folds of strong muslin which must be
long enough to tie around the head of the bed when
he board is supporting the patient's feet. The board
nay be padded on one side if desired.

When a patient has slipped down in bed and needs
o be drawn up, place one arm under the shoulders
n the usual crooked position so that your elbow may
iupport her head, and taking a firm grip under the up-
Der part of her arm, put your other arm under the
highs, and move the patient gently upwards. If well
mough the patient can flex her knees and help in the
novement.

HANDLING THE PATIENT

2.^

If a patient is so heavy that two persons are re-
quired to move her, they should stand on opposite sides
of the bed and reaching across the patient's back firmly
grasp her under the armpits, their crossed arms thus
forming a V-shaped rest for her head while they clasp
each other's hands under her thighs.

When the patient is well enough to help herself, put-
ting a stout, broad piece of muslin round the foot of
the bed with the ends long enough to be grasped, will
help her to assume a sitting position ; one round the top
of the bed will help her to pull herself up higher in
bed.

If necessary to change your charge from one bed
to another, place the beds about five feet apart, parallel
with each other, with the head of one on a line with
the foot of the other. Unless the patient is very light
there should be two to lift, hoth standing on the same
side (between the beds). One puts her arms under
the shoulders and buttocks, the other under the back
and thighs. If possible have the j)aticnt hold herself
stiflf. Lift her gently in unison, turn round and place
her on the fresh bed.

If the pati(;nt is heavy three may be required to do
this well. Under these circumstances the first lifter
supports the head and small of the back, the second
the shoulders and thighs, the third the buttocks and
under the knees.

When the lighting of the room or other considera-
tions render it unadvisable to change the position of

Clianging
the Patient
from One Bod
to Another

CHANGING THE MATTRESS 25

the head of the bed, they are placed near together with
the heads on a Hne. The patient is Hfted from the far
side of the first bed, carried around between the two,
and laid down in the second bed. This entails a
longer carry, but if all work in unison it is not dif-
ficult.

TO CHANGE TEE ICATTBESS WITH THE
PATIENT IK BED

To the uninitiated this seems an almost impossible
feat. In reality, if done according to rule, it is not
much harder than changing the under sheets. If the
patient is heavy four people will be required to ac-
complish this deftly, two on either side of the bed.
The sheets are loosened on all sides; the top sheets
and the blankets treated in the same manner as when
the bed clothes were changed; the under sheets are
rolled tightly up to the patient's side (the roll being
undermost). Using these rolls for support, the patient
is moved to one side of the mattress ; this side is then
pulled to the centre of the bed, curving the mattress
upwards ; the fresh mattress is placed alongside, the
patient lifted by the bed-clothes on to it, the dis-
carded mattress removed, the fresh one drawn into
place, and the patient lifted to the centre; the sheets
are again unrolled and tucked in place.

THE PREVEKTIOK AND CTTBE OF BED SOBES

A bed sore is gangrene, or death of the tissue of
the affected parts. The bony prominences such as the
lower part of the spine, the shoulder blades, elbows,

BED SORES

and heels are the parts most likely to be affected.
Moisture, wrinkles, crumbs, and a too long continu-
ance in one position are the pre-disposing causes,
therefore these conditions must all be guarded against.

The presence of moisture is generally due to per-
spiration, or discharge from wound, bowels or blad-
der. When the two latter are the causes pads made
of oakum or jute placed in cheese-cloth or old muslin,
put on the patient like a child's diaper, will save the
bed linen. These must be changed as often as neces-
sary, and the patient well washed with warm water
and soap; dusting with a little talcum, starch, or rice
powder will help to keep the skin dry and soft and it
will also prevent chapping. Crumbs and wrinkles
must also be guarded against. By keeping the draw
sheet tightly drawn and tucked far under the mattress
the latter will be overcome ; the former must be looked
for after every me^l ; brushing them out with the hand
is the most efficient way, but a small whisk-broom may
be used.

At least twice a day all parts likely to be affected,
especially the back, should be washed with warm water
and soap, rubbed with 50 per cent alcohol, and dusted
with talcum. This not only helps to prevent bed-
sores but is unspeakably refreshing to the weary in-
valid. Avoid using too much powder or it will cake
and do more harm than good.

A preparation of equal parts collodion and castor
oil painted over the surface will often prevent a break-
down of the tissue, by forming an artificial skin.

Avoid
Moiiture

ArtiAoial
Skin

HOME CARE OF THE SICK

Xelieyliir
PreMoro

Care of
a Sore

Frequent change of position is another important
means in the prevention of bed-sores. Prop the pa-
tient over on her side by putting a couple of pillows
lengthwise behind her, one under her shoulders, the
other under the lower part of her back. Rings made
of batting or sheet wadding wound with bandages art
excellent mediums for relieving pressure. They should

be made with the hole just
large enough to permit of
the bony prominence fitting
into it. When the patient
has to lie for some time on
her back, often consider--
able relief is given by flex-
ing the knees. They can be
supported either by a pillow
doubled and tied to hold it
so (the pointed side placed
next the body), or a cylin-
drical pillow made like the old-fashioned bolster, only
smaller and stuffed with hair. Small pillows or hot
water bags filled with cool water, placed under the
small of the back, will help to make a long continu-
ance of the dorsal position bearable.

All pillows should be shaken and turned frequently.
If the skin should become broken, the resulting sore
should be washed daily with bichloride of mercury
I-2000, and a dressing applied. Gauze soaked in
balsam of Peru or an ointment made of castor oil and
zinc oxide powder are generally found efficacious.

Wadding Ring,
to Relieve Pressure

0OHTAI£SOENCE

The most anxious moments in nursing are certainly
when the disease is at its height, hut hy far the most
trying are, as a rule, during the time of convalescence.
It is then that the greatest exercise of tact, discern-
ment, self-control and patience on the part of the at-
tendant are necessary.

Relapse, except in the
germ diseases, is nearly al-
ways due to over-feeding,
over- exertion, or nervous
excitement.

The diet is a very impor-
tant factor in the treatment
of convalescents. Carry out
the doctor's orders minute-
ly regarding it. Have, so
far as you can, things that Enbbar ah cushion

you know the patient likes. If she expresses a prefer-
ence for a certain dish have it if allowable, but as a
rule it is not wise to consult her on the subject.

Always serve your patient's meals as daintily as pos-
sible; have the tray covered with a spotless table nap-
kin or tray cover; use the prettiest china available
even one bright flower with a little green is a greal
attraction. But above all see that the food is properly
cooked and properly served ; that all hot things arc
very hot, and cold ones really cold. More salt and
less sugar will generally be wanted than when in

tiOME CARE of the sick

health. Highly seasoned food is not advisable or often
desired even by those who like it when well.

It is better to set before the invalid too little than
too much, for it is easy to get more, and the sight of
too much food on the tray is apt to imbue anyone

A Bedside Table Convenient for Serving Meals

whose appetite is poor with a dislike for it. Besides,
as the digestive functions are weakened during and
after illness, it is better for a time to serve food in
smaller quantities and oftener; for instance, give an
Ggg nog, milk punch, egg lemonade, egg albumen, or
other light, easily digested drink between breakfast

CONVALESCENCE

and the noonday meal, and again at three or four
o'clock in the afternoon. A glass of hot milk given at
bed-time will often induce sleep.

Keeping the patient amused is another important
item in the care of the convalescent. A few visitors
(provided they do not stay too long, talk too much,
or give any worrying or disagreeable news) will of-
ten help to brighten tip the patient. Playing cards or
games, reading aloud to her, etc., will help to pass
away the time and tire her less than talking.

When people have been ill for some time the muscles
of the eyes are apt to be weak and will be easily
strained, so they ought not to be allowed to read much
themselves, especially while they are in the recum-
bent position.

Those who are strong and well little realize the ex-
ertion and excitement caused by the first sitting up,
after being confined to the bed for some time.

The period is usually limited to half an hour the
first day, gradually increasing the time as the patient
can stand it. Do not wait for her to complain of
fatigue; on showing the first signs of it she should
be put to bed. Of course there are patients who think
themselves a great deal worse than they really are,
and who have to be encouraged to sit up longer than
they think they can. At such times the pulse is a
good guide.

Do not really dress the patient until she is well
enough to walk around. Warm stockings, bed slip-

Amusinff
the Patient

Sitting Vp
for the
First Time

32 HOME CARE OF THE SICK

pers, a warm wrapper and blankets are all that are
necessary.
Lifting If the patient has been seriously ill she should not

a Chair be allowed to stand or exert herself in the least when
sitting up the first few times. If not too heavy she
can be lifted by one person. The arms of the patient
are locked about the neck of the attendant, who, plac-
ing one arm under the thigh, the other under the back,
lifts the patient into the chair, the back of which is
parallel with the foot of the bed.

When two people are required to do the lifting they
should stand at the same side of the bed, placing the
hands, one under the shoulders and buttocks, the
other under the thighs and ankles, and lifting in uni-
son, turn and seat the patient gently in the chair. The
chair should be made comfortable with pillows, and
the patient kept warm with blankets. When possible
the chair should be carried carefully into an adjoining,
well-aired room. The sick-room and bed should be
well aired and made ready immediately for the patient's
return, as it may be necessary for her to be put back
to bed sooner than expected.

CARE OF THE HAIB, MOUTH, TEETH

While caring for the hair protect the pillow-case
with a towel. When the hair is tangled always hold
it between the tangle and the head to avoid pulling it.
Rubbing a little vaseline into the scalp will help to
get the snarls out more easily. To avoid tangles the

CARE OF THE HAIR, MOUTH, TEETH

hair should be brushed twice daily and braided in two
plaits.

If the scalp is kept clean by rubbing it occasionally
with a little alcohol and water (equal parts) the hair
always well brushed, and rubbed once in a while be-
tween a damp wash-rag, it may not be necessary to
wash it for quite a while.

When it must be washed, protect the pillow and
upper part of the bed with a rubber sheet covered
with a bath towel. Pull the pillows down under the
back so that the head extends somewhat beyond them
and over a basin of water. Have a slop jar at hand
in which to empty the water, and plenty of warm
water to wash the soap out thoroughly. Support the
head with one hand while you wash it. Dry the hair
well after washing. A little alcohol or hair tonic con-
taining it, well rubbed into the scalp, will lessen the
chance of the patient taking cold.

When the pat-ient is unable to brush her own teeth
it is often easier to do it for her with clean gauze
wrapped around the index finger or the end of a piece
of whalebone, than with a tooth-brush. In illness
sordes (tartar) is apt to collect between the teeth un-
less they are very frequently and carefully cleansed.

Clean not only the teeth but also the gums, the roof
of the mouth and the tongue. Whalebone and gauze
^re far better for this purpose than the brush. When
a patient is on milk diet her tongue and mouth should
b? cleansed after each feeding.

Washing
the Hair

Care
of the
Teeth

Care
of the
Mouth

34 HOME CARE OF THE SICK

Some good ^nouth washes are :
(i) Equal parts of listerine, boric acid 4 per cent,
lemon juice and water.

(2) Listerine, one ounce; peroxide of hydrogen,
three drachms ; alboline, one drachm.

(3) Tincture of myrrh, half a drachm; soda bi-
carbonate, grains twenty ; aboline, one drachm.

(4) Listerine and water, equal parts.

BATHS AND BATHING

Perhaps there is nothing that will give greater re-
freshment to the invalid, obliged to lie in bed day
after day, than a bath. Unless contrary to the physi-
cian's orders, one should be given every day. If given
in a warm room, without exposure, there is absolutely
no danger of the patient taking cold. To make mat-
ters doubly sure, before taking out of the bath blank-
ets, rub the patient all over with 50 per cent alcohol.
The Never give a bath until an hour after a meal. Be-

**BiSh fore beginning see that the room is not only warm but
free from draughts, also that you have everything
needed at hand. It is best to have the water in a foot
tub ; it will keep warm longer than in a shallow basin.
Have a pitcher of hot water to keep the bath the re-
quired temperature.

A large blanket, face and bath towels, wash cloths,
alcohol and powder are the other necessary articles.
Slip the blanket under the patient. If it is not wide
enough to come well round her and also for the ends

BA THS AND BA THING 35

to overlap, use two. The blanket may be covered by
a sheet if necessary but the wool next the body is de-
sirable.

Take off the night-gown and fold down the upper
bed clothes — the face and neck are washed first and
well dried, then the arms and hands. Be particular
about drying between the fingers, also around and in-
side the ears. Especially while washing the face have
a firm touch. Expose only one portion of the body
at a time, and that not longer than necessary. Dry
each part well before going on to the next; in order
not to fatigue the patient, work as quickly as possible.
It should be necessary to turn her only once. The
towels should be warmed by wrapping them around a
hot ^yater bottle. It is well to give hot broth or milk
soon after the bath.

To give a foot bath, loosen the bed clothes at the
bottom, protect the bed with a blanket, put the foot Foot Bath
tub, half full of water lengthwise on the bed, flex
the patient's knees, raise her feet with one hand while
you draw the tub under them with the other; wrap
a blanket round tub and knees.

When mustard is desired, make a paste of the
mustard — about two tablespoonsful to a large foot
tub. The feet remain in about twenty minutes, the
bath being kept at the same temperature by the addi-
tion of hot water from time to time. Be careful in
fidding the hot water not to pour it in near the feet.

The

HOME CARE OF THE SICK

Batlis for
Bednction of
Tempenturo

Treatmoit

When the bath is over wrap the feet in the blanket for
a few minutes, then dry.

To give a bath for the reduction of temperature a
large rubber (covered with a sheet) is necessary to
protect the bed, as a considerable amount of water must
be used.

There are several different kinds of bed baths given
for this purpose. Sometimes the patient is simply
sponged off with cold water, at others a hot sponge
comes first, followed by the cold which often consists
of equal parts of alcohol and water, made colder at
times by the addition of ice. The doctor always orders
the temperature of the bath, and also the duration,
which is generally from ten to twenty minutes.

In giving these baths, use slow, long, curving, down-
ward strokes, and plenty of water. Where there is a
high temperature there is no danger of catching cold,
and as eradiation of heat is the effect sought, the pa-
tient should be exposed as much as possible. It is
often desirable, when the sponging is over, to rub the
patient with alcohol, and fan till dry.

When possible, the "Brand" treatment is used for
the reduction of temperature (especially in typhoid).
For this, a portable tub, which can be wheeled to the
bedside, is required. It would not be safe to give such
a bath without the assistance of a doctor or trained
nurse ; it is, therefore, not worth while going into de-
tails, and, except in cases of long continued fever,
the bed bath is generally all that is necessary.

BATHS AND BATHING

When given a hot bath in a tub, fill the tub three-
fourths full of water; the exact temperature will be
ordered by the doctor, usually it is from io6 degrees
F to no degrees F. The doctor also states how long
he wishes the patient to remain in the bath. When
giving a hot bath of any kind, for any purpose, al-
ways apply cold cloths or an ice cap to the head. A
hot drink given either while the patient is in the tub

Hot Baths
to Induce
PereplratioB,
or Quiet
the Nerves

BATH THERMOMETER

or after the return to bed will further induce perspira-
tion. Mustard is sometimes added to these baths, just
as it is to the foot bath.

While in the tub the patient's pulse must be noted
carefully, as such baths are sometimes very depressing
to the heart. After the bath the patient must go to
bed immediately, and remain there well covered, and
care must be taken to have warm clothing going from
the bath to the bed. These baths are also given to
children in convulsions.

The hot-pack, or sweat, is generally considered a bet-
ter medium for inducing perspiration. To give this
protect the bed with a rubber sheet or oil cloth, wring
out two old blankets in water 130 degrees F, put one
under the patient and around one arm and leg, thq

Precautions

The Hot-pack
or Sweat

38 HOME CARE OF THE SICK

other over the patient and around the other arm and

GIVING A HOT-PACK

leg; put an ice cap or cold compress on the head, a
hot water bag at the feet, another over the heart,

CCKPLETED

otherc aicng if.t side, over all wrap a couple of dry
blankets ; give a hot drink. The patient jjenerally re-

BATHS AND BATHING ^

mains in the pack from twenty minutes to half an hour.
The pulse should be taken every five minutes, and as

HOT WATER BOTTLES

the hands are under the blankets it must be taken at
the temporal artery.

HOT WATEK BOTTLE FOR THE SPINE

After being taken out of the pack the patient should
be roiled in a dry blanket and remain so for an hour.

40 HOME CARE OF THE SICK

Except where a light weight is desirable, as over
the heart and abdomen, a good substitute for the rub-
ber hot water bag is a stone bottle ; even a glass one can
be used, and if a wire a couple of inches longer than
the bottle is put into it
to act as a heat con-
I ductor, it can be filled
I with quite hot water
without breaking. When
using hot water bags or
bottles of any kind, pre-
cautions must be taken
waMT Bottle (or the Throat to avoid burning the
patient, which is very easily done, especially with old
people, or where from any cause, the circulation of the.
blood is sluggish or the tissues in poor condition ;
therefore, see that the bottles are tightly corked, that
they are well and securely covered (flannel bags slight-
ly larger than the bottles make the best covering) :
never put them too near the patient, and remember that
when the patient is restless the bags are apt to slip
nearer than you intended them to be.

Salt baths are given for their tonic effects. A bath
sufficiently strong to redden the skin and have an ex-
hilarating effect will require ten pounds of ordinary
sea salt to a bath tub about half full of water.

The average standard temperature for baths is as
follows :

StCK kOOM METHODS 4t

Cold 33'-65° Fahr. Tepid.85°- 92° Fahr.

Cool 67°-75° Fahr. Warm92"- 98' Fahr.

Temperate. 75^-85° Fahr. Hot. .98°-ii2° Fahr.

The regular bath thermometer is encased in wood
to protect it from hard usage, but the ordinary atmo-
spheric thermometer will answer the purpose just as
well. Mix the water well before taking the temper-
ature.

SICK BOOM METHODS
Taking and Becording Temperature, Pulse and Bespiration
Observation and Becording of Symptoms

The heat of the blood is ascertained by means of the cunicai
clinical thermometer. These thermometers are self Thermometos
registering and vary in delicacy, the finest ones regis-
tering in one minute, others in from three to five min-
utes. The more expensive ones magnify the scale,
and are therefore easier for the novice to read. Hick's
thermometer is probably the best.

The temperature is taken either in the mouth, rec-
tum or armpit. Before using the thermometer the
mercury must be shaken down to 95°. Be careful not
to shake it into the bulb, or the thermometer will be
rendered useless and also be careful not to hit it
against anything, as it will break very easily. While
in constant use it is best kept in a glass containing a
little boric acid or listerine, with some soft cotton in
the bottom of the glass.

HOME CARE OP THE SICK

Temperature
by Mouth

When taking the temperature by mouth be sure
that the patient has not had anything to eat or drink
recently. Place the end of the instrument
containing the mercury under the tongue,
on either side. See that the lips are tightly
closed all the time the thermometer is in the
mouth, and do not leave it in place longer
than necessary.

Never take the temperature of a de-
lirious patient nor a child by the mouth;
they are likely to bite off the bulb and
swallow the mercury. If this accident
should occur give white of egg immediately
and notify the physician. In such cases it
is always safer to take the temperature by
rectum and it is also expedient to take a
rectal temperature when the patient is very
ill, for this is the most accurate method.

Before inserting the thermometer, the
bulb should be oiled and precautions taken
to have the rectum free from faeces. Five
minutes should be allowed for registration.
The temperature will be one degree higher
than when taken by mouth.

The axillary temperature will be from
three-tenths to half a degree lower than the mouth.
The armpit must be wiped thoroughly before taking;
the thermometer is then placed in the hollow, and kept
in place by holding the arm close to the side and flex-

Clinical
Thermometer

SICK ROOM METHODS

ing the elbow so that the hand rests on the opposite
shoulder. It will take ten minutes for the thermometer
to register.

The normal temperature of the human body is from
98'' F. to 99° F. The temperature is apt to be high-
est between 4 p. m. and 8 p. m. and it reaches the
lowest ebb about 3 a. m. This fact makes it essential
that special care be taken of the sick in the early hours
of the morning, the lowering temperature indicating
a lower vitality.

Though a rise of temperature is always to be re-
garded with suspicion it must be remembered that
many causes (especially with children) may create a
slight deviation from the normal, without anything
serious being the matter. Constipation will often cause
a rise of temperature, sometimes even a slight cold,
attack of indigestion, or undue excitement will do the
same, while profuse perspiration or diarrhoea is apt
to cause a sub-normal temperature.

A sub-normal temperature is far more dangerous
than the same number of degrees above normal. If a
patient's temperature drops to 97.5° or 97*^ she should
be rolled in blankets, a hot water bag put at the feet,
another over the heart, and a cup of hot coffee or milk
given. If the temperature does not soon respond to
this treatment the doctor should be notified.

The following table gives the different variations
of temperature :

Kormal
Temperature

Higli
Temperature

Bub-Hormal
Temperature

Temperature
Record!

Che Pulie

44 HOME CARE OF THE SICK

Hyperpyrexia 105** and over, extremely dangerous

High Fever 103** 105 **

Moderate Fever loi** 103"*

Sub-febrile 99/4** loi"*

Normal 98° ggyi""

Subnormal 97** 98**

Collapse 95** 97**

Algid Collapse Below 95°, extremely dangerous

A record of the temperature is of great value, not
only in diagnosis, but also in watching the course of
the disease ; it should therefore be charted every time
it is taken. This can be done in figures, but the reg-
ular clinical temperature chart conveys a clearer idea
of how the temperature is running. The temperature
should be taken at the same time each day ; when it
does not deviate much from the normal twice a day,
morning and evening, is sufficient ; otherwise it should
be taken every three or four hours, according to the
nature of the case.

A thorough knowledge of the pulse can only be
gained by constant study and practice. It takes many
months of careful observation of the numerous cases
in the hospital ward, before the medical student or
nurse can readily discern between the various charac-
teristics of the different pulses. It is, therefore, im-
«. possible to go very deeply into the subject here.

The three principal things to be learned are: (i)
How to count it; (2) to discern if it is regular or ir-
regular; (3) if strong or weak.

SICK ROOM METHODS 45

To count the pulse place the index and middle fin-
gers on the wrist, on the thumb side, where the radial
artery can easily be felt. Count it for a full minute, di-
viding the minute into quarters, as you can then tell
if the frequency of the pulse is regular or irregular.
For instance, if you count fifteen beats in one quarter
and twenty in another, you will know that the fre-
quency of the pulse is irregular.

If some beats are strong and others weak the^ qual-
ity of the pulse is irregular. By careful considera-
tion of the pulse every time you take it, it soon becomes
possible to realize where there is a diflference in the
quality of the pulse; that is, when it is stronger or
weaker.

The pulse can be taken at the temporal artery when
for any reason it is impossible to take it at the wrist,
it also can be felt in the groin.

The average normal pulse is :

In men from 60 to 70 beats per minute

In women from 65 to 80 beats per minute

In children from 90 to 100 beats per minute

Just as the temperature, even in health, is aflFected
by certain conditions, so is the pulse; food, exercise,
excitement, will all cause an increase in the pulse rate.

The pulse should always be taken and recorded at
the same time as the temperature. The pulse is gen-
erally written in figures. When there is any differ-
ence in the quality, or if it is irregular this also should
be recorded.

To Count
the Pulse

Pulse by
Temporal
Artery

46 HOME CARE OF THE SICK

A record of the respiration is also often required
The respiration being more or less under the control
of the patient it is never wise to let her know that you
are taking it ; therefore, keep hold of her wrist, as
though you were still counting her pulse, and watch
the rise and fall of the chest. If you find it hard to

TEMPBRATDRB, Pin.SE, AND RESPIRATION CHART

count by simply looking, hold the patient's hand on
her chest, then you can feel the motion as well. This
is generally the easier method for the beginner. Count
it as you do the pulse, for a full minute in quarters.
The inspiration and expiration count as one breath.

Besides the temperature, pulse and respiration, a
record must be kept of all medication given, and also
of all changes in the patient's condition. If the pa-
tient has pain note it, stating where the pain is and

■ y

SICK ROOM METHODS

if it be continuous or only in paroxysms. When medi-
cine is given to relieve the pain state with what re-
sult. When the patient is on liquid diet, the amount
of fluids taken during the twenty-four hours should
be charted every morning.

Mark every movement of the bowels; observe the

WnO»

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ln4V^W "iW>t.v^ VinXwy*

«y«m.\^v««, «C«Jlf«« S 'M^t'C^tlDvSf^lOvax

It.

a)C«;\|l( IL^MT*. dM/*%i«va >V^<i«4(, Wm£«~V «% T~^

4.jw« "^ V*< ■W^Vttb' «MV%* <Kv(fv \ji. O0l^'<w»<

(^ ^*'

yLf\

tMY)^ >K mO^ <«ttt* i6vM> »»%n d«>'«> am^d •% ^xn.<b

f'»«liWlA|J> < *> » R«»» T"*^ ^i'ft WconM yri ^ i.Cl»«i<«3

ii 'VwXIk^u 'kS^'vCv%A* \x«j*r^k^

v*^

»: j<%v«^«n«. Vjyuvir ^f^iw i^*.fk

BEDSIDE NOTES AS MADE IN A HOSPITAL

movements carefully to see if there is anything abnor-
mal in their appearance. If so, not only describe it in
your record, but save the movement for the doctor's
inspection. The same thing should be done if the
patient vomits.

When there is not sufficient urine voided, report it;
also if there is anything untoward in its appearance.

HOME CARE OF THE SICK

Important
Items

Forty ounces is the amount that should normally be
voided in twenty-four hours. In fevers there is apt
to be less, and what is passed will be highly colored.
In nervous diseases, on the contrary, there is likely
to be a larger amount of a pale color. Perspiration, a
chill or chilly feeling, coughing, expectoration, restless-
ness, the amount of discharge from wounds, are all
items of import of which the doctor must know the
details to treat the patient understandingly. He never
will fully know them unless they are clearly and con-
cisely written down at the time they happen.

The accompanying temperature chart and record is
an example of hospital practice.

Bulei

THE GIVXNG OF MEDICINE

A few rules to* be remembered in giving medicines
are:

1. Always give exactly what the doctor orders,
neither more nor less.

2. Always give medicine orutime — if a dose is due
at twelve, give it at twelve and not at half past.

3. Medicines intended to be taken before meals
should be given twenty minutes before meal-time,
those to be taken after eating, twenty minutes after
the meal is finished.

4. Never give medicine without reading the label
on the bottle twice; before and again after pouring
it out.

GIVING OF MEDICINE

5. When pouring medicine always hold the label
on the upper side, to avoid defacing it.

6. Do not use spoons for measuring for they are
never accurate; small graduated glasses, which are
infinitely better, can be bought at any drug store for
about ten cents.

7. When pouring hold the mark of the quantity you
require on a level with your eye.

8. Always shake the bottle before pouring out the
medicine.

9. The bottle should always be recorked immedi-
ately after use, for many medicines contain volatile
substances and are apt to become either stronger or
weaker than intended, if left uncorked

10. Medicines containing iron shoulo be taken
through a glass tube or straw, as they discolor the
teeth.

11. Some medicines, notably several that are given
for coughs, should be given undiluted, while others
on account of their irritating properties should be
very well diluted. Never dilute more than necessary,
for the addition of a large quantity of water often
renders a disagreeable dose still more unpleasant to
take.

12. Holding a piece of ice in the mouth for a short
time before taking medicine will often render a dis-
agreeable fla^^or less noticeable ; a drink of seltzer aft-
erward will help to "take away the taste." Castor oil
given with lemon juice, a piece of ice small enough to

Xeasuring

To take
away
the Taste

HOME CARE OF THE SICK

Powders
And Fills

Injections

swallow, seltzer added just before taking, and a drink
of seltzer after, is not at all unpalatable. Holding
the nose while taking medicine will also diminish the
taste.

13. Insoluble powders such as calomel, bismuth and
acetanilid should be placed far back on the tongue
and washed down with a swallow of water. Those
with a disagreeable taste can be given in jam or bread
or encased in wafers or capsules which can be bought
for the purpose.

14. Pills also can be made easier to swallow by
giving in bread or jelly. Unless pills are freshly made,
they should be pulverized, as they soon become so dry
and hard that they will not readily dissolve in the
stomach.

15. Never buy a large quantity of medicine at a
time, there are very few kinds that will not deteriorate
by keeping; and because a medicine is beneficial in
one case, do not imagine that you can give it to every-
one whom you may think has the same ailment.

16. Medicines should be kept in a cool, dry place
. and properly labeled. All poisons should be marked as

such and kept under lock and key.

Medicine is occasionally given by rectum, either
when a local effect is desired or when the stomach is
unable to retain it.

When medicine is given by rectum it is generally or-
dered well diluted. The water, added for this purpose,
should be warm enough to make the injection about

GIVING OF MEDICINE 51

100° F. A rubber rectal tube, or a large size rubber
catheter, connected by a glass connecting tube with a
piece of rubber tubing about eighteen inches long,
into the further end of which has been fitfed a small
glass funnel, are the best in giving medicinal enemata.
Let warm water run
through the tube to be sure
that it is in working order ;
this will also heat it and
thus avoid cooling the med-
porceiain Feeding Cup jcation. Grease the tube

well, with oil or vaseline, and before inserting it fill
the funnel with the solution, allow half of it to run

GLASS DKINKITJQ CUP

through, back into the pitcher, pinch the rubber to pre-
vent the rest running through. This is done to avoid
getting air into the intestine.

For sedative enemata (these generally consist of
bromide or chloral) the tube is only inserted about six

HOME CARE OF THE SICK

Kutrltlya
Enemata

Suppositories

inches, but for stimulating enemata (brandy or whisky
and salt solution) and nutritive enemata, the tube is in-
serted about fourteen inches, and a small pillow placed
beneath the hips to help the upward flow. When giv-
ing these enemas have the patient lie on her back.
Holding a folded towel to the anus, after the removal
of the tube, will help the patient to retain the in-
jection.

Nutritive enemata generally consist of peptonized
milk, white of egg, salt and one of the beef prepara-
tions made especially for that purpose; but every
doctor has his own formula and will specify how he
v/ishes it prepared. When patients are having nutri-
tive enemata constantly they must have a cleansing
enema daily, and this must be given at least an hour
before the next nutritive one is due, and not till two
or three hours after the last one has been given.

Starch and other emollient enemata are sometimes
given in diarrhoeas and dysentery. To prepare the
starch mix a teaspoonful of laundry starch in cold
water, add a teacupful of hot water, let it come to the
boil. A few drops of laudanum are sometimes added
to this ; when it is ordered, be very accurate in count-
ing the drops.

The suppository is another method of giving rectal
medication. This is a conical shaped preparation of
cocoa butter in which the required drug is incorpo-
rated. It is oiled and gently inserted, pointed end fore--
most, the patient lying on the left side.

GIVING OF MEDICINE

Medication for the throat is often given by means
of the atomizer. When using this see that the pa-
tient's tongue is held down sufficiently to allow the
spray to reach the affected parts, and be careful not
to let the end of the atomizer touch the back of the
patient's throat, as this tends to induce vomiting.

The inhalation of vapor is another method of con-
veying medication to the throat and also to the bron-
chial tubes and lungs. Mix the medicine with boiling

««H|l

HYPODERMIC SYRINGE

water and put in a small kettle over an alcohol lamp.
With stiff brown paper, make a cone, one end to fit
over the mouth and nose, the other over the spout of
the kettle.

When rapid absorption is necessary medicine is
sometimes given hypodermically. The hypodermic is
a graduated syringe to which a hollow needle is at-
tached. As hypodermic injections are attended with
great danger unless properly given, no one should at-
tempt to administer medicine this way without being
personally instructed by a physician or nurse. In
giving medication hypodermically, the greatest clean-
liness should be observed; the flesh, where the injec-

Inbalations

Hypodermic
Injeotioni

54 HOME CARE OF THE SICK

tion is to be made, must be well washed with alcohol,
the needles should be attached to the syringe and alco-
hol drawn into the syringe and expelled several times
before the medicine is drawn in. When the syringe is
filled with the required amount, expel the air by point-
ing the needle upward and gently pressing the piston
till a drop appears at the point of the needle. Be care-
ful not to let the needle touch anything after it has
been cleaned — if it should, hold it in the alcohol again
for a minute before inserting. The injection may be
given in the outer side of the arms, thighs or abdomen.
Hold the flesh between the thumb and first finger of
the left hand, plunge the needle in with one quick
downward movement, inject the fluid slowly by gently
pressing the piston. Draw the needle out quickly. Rub
the spot where the injection was made for a few sec-
onds to hasten absorption.

Clean the instrument with alcohol before putting
it away.

PUBaATIVE, ENEMATA, DOUCHES AND CATHETER-
IZATION

cieuiBinff The purgativc, or as it is also called, cleansing en-
ema, is given as its name indicates for the purpose of
washing out the intestines. It is generally resorted to
when cathartic medicine fails to act, when immediate
catharsis is necessary, or when for any reason the pa-
tient is unable to take a cathartic by mouth.
The long rubber rectal tube is the best appliance for

Enema

ENEMAS

the giving of such enemata; the water is injected
higher into the bowel and there is a steadier flow than
when any of the bulb syringes are used. This can be
attached by means of a connecting tube to the tube of
the ordinary fountain syringe bag. See that the stop
cock is on the tube.
The cleansing enema generally consists of a soap

Soap Enema

GLASS DOUCHE NOZZLES

suds made with "ivory" or castile soap; the froth of
which should be removed as it contains too much air ;
the temperature should be about 98** F. Make the soap
suds in a pitcher, pour it into the bag, let some run
through the tube to warm it and expel the air, shut
the stop cock, grease the rectal tube. Hang or hold
the bag not more than three feet higher than the
patient.

The bed should always be protected with a rubber
sheet and large towel, the patient lies on her left side
with the knees well flexed. The tube should be in-

56 HOME CARE OF THE SICK

serted very gently, never use force, let the water run
in slowly. If much pain is given shut the water off
occasionally, for a minute or two. When a sufficient
quantity has been given (two to three pints for an
adult, one for a child) remove the tube quickly, but
gently, and press a folded towel to the anus. The
fluid to do much good should be retained from fifteen
to twenty minutes.

After use the tube must be carefully cleansed, wash
it in warm soap suds and water, afterward let a quan-
tity of hot water run through it, hang it up lengthwise
to drip till perfectly dry.

When used for more than one person the tube
should always be boiled for five minutes after use.
Vaginal Douches are given, as a rule, either for cleanliness

Douches Qj. ^Q relieve inflammation. When used for the former
purpose the solution should be of a temperature rang-
ing from 100** F. to iio° F. When given to relieve in-
flammation it is generally required very hot even Ii8°
or 1 20** F., and great care must then be taken not to
burn the patient by having it any hotter; mix the
water well before you test it. Some disinfectant is
often added, carbolic or bichloride being the ones most
frequently used; they should, however, never be used
without a doctor's order. In giving, the patient lies
on her back, have the douche pan placed under her
properly so that the return flow of the water will run
into it. Put a pillow under the small of the back.
Before inserting the nozzle let the water flow through

DOUCHES 57

the tube, to expel the air. Insert gently and move
it around while in.

The douche nozzle should always be boiled or
washed in boric acid, or other disinfectant, after use.
Glass douche nozzles are preferable to any other. They
can be attached to the ordinary fountain syringe.

Catheterization improperly performed is fraught catheteriBation
with so much danger to the patient that it must not be

GLASS CATHETER

attempted till further instruction than can be given in
writing is obtained.

Catheterization is necessary when the patient is un-
able to void urine naturally, but there are many simple
devices which should all be tried before this is resorted
to; for instance, put hot water in the bed pan, allow
water to run from a faucet within hearing (if this is
impossible pour water from one vessel to another),
squeeze a sponge dipped in warm water over the lower
part of the abdomen, or hot stupes can be applied, and,
this failing, the stupes can be alternated with ice.

58 HOME CARE OF THE SICK

In preparing to catheterize it is necessary to exer-
cise not only the greatest cleanliness but asepsis. The
catheter (glass ones are preferable for women) should
be boiled for five minutes. Have at hand some small
sterile swabs (see chapter on asepsis) in a solution of
boric acid. Put the patient on the bed pan (leaving it
further in front than for ordinary use), have the pa-
tient's knees flexed and separated, drape a sheet
around her legs, leaving the vulva exposed. Then
wash the hands well with soap and hot water, soaking
Oare to them afterwards in a solution of bichloride of mer-
be Taken axvy^ i-iooo. With the left hand separate the labia,
and carefully wash all around the meatus (the open-
ing to the urethra, the tube leading to the bladder) ;
into this opening the catheter is then carefully intro-
duced, it must not be forced forward if any obstruc-
tion is met with, but withdrawn slightly and the course
changed.

When the bladder is very much distended it should
not be emptied entirely at one time; when a pint or
a pint and a half has been withdrawn remove the
catheter and insert it again four or five hours later.

Before removing the catheter, the index finger is
placed over the end; this prevents drops of urine
falling upon the bed.

HOME CARE OF THE SICK

POULTICES AKD FOMENTATIONS

Poultices and fomentations are applied for the relief
of localized pain, when caused by inflammation. The
heat, by dilating the superficial blood vessels, draws
the blood from the congested area.

The linseed poultice is the one most generally used.
To make it, stir the meal slowly and evenly into water
while it is boiling. When it is thick enough not to
run, boil it a minute more; remove from the fire and
beat it briskly. When properly made it is perfectly
smooth, and just stiff enough to drop away from the
spoon. Spread it on a piece of muslin the required
size and shape, leaving an inch margin all round to
turn over. The side which is to go next to the patient
is best covered with cheesecloth or gauze. This is cut
slightly larger than the muslin, so as to turn back
over it to keep the contents of the poultice in place.

Few poultices should be more than half an inch
thick. They should always be applied as hot as the
patient can possibly stand them. To keep the poultice
warm while taking it to the bedside it can be placed
between two hot plates or rolled in a piece of hot
flannel. The flannel can be left over it when applied
if there is no oil muslin or oil paper to be obtained;
these latter are preferable, however, as they are very
light and keep in the heat and moisture better.

The poultice is kept in place by a bandage. A muslin
binder is the best means for keeping a chest poultice
in place. Poultices should always be shaped to fit the

Linieed
Poultice

Applylnff

HOME CARE OF THE SICK

Starch
Poultice

SinaplBxng

affected part. They should be changed at least every
two hours.

Starch poultices are used in certain skin diseases.
The starch is mixed with a little cold water, then
enough boiling water added to make a thick paste.
It is boiled,, spread and applied in the same manner as
the flaxseed.

The cotton jacket or "dry poultice" is made by
tacking a layer of non-absorbent cotton or wadding
between two pieces of cheesecloth, shaped for the
chest, and is excellent to keep on for a few days after
other poultices have been discontinued.

Sinapisms relieve pain through the agency of the
mustard which, by irritating the sensory nerves, causes
the dilatation of the superficial blood vessels — ^under
the point of application — and the consequent lessening
of the congestion in the inflamed tissue. Sinapisms
are made of flour, mustard, and tepid water, in vary-
ing proportions. Those for a man are generally made
one part mustard to four of flour; for a woman one
part mustard to six of flour; for a child one part
mustard to ten of flour. The water used should always
be tepid; cold water feels uncomfortable to the pa-
tient, while hot destroys the virtue of the mustard.
The flour and mustard are first mixed well together,
care being taken to crush all lumps of mustard ; enough
water is then slowly added to make a thick paste,
which is spread on muslin and covered with gauze.
The sinapism is generally left on from fifteen to

FOMENTATIONS

twenty minutes, but it must be watched carefully, and
removed as soon as the surface of the skin is well
reddened, as otherwise it will blister. After the re-
moval of the sinapism the skin must be washed, and
if a little vaseline be rubbed on, this will allay the
irritation.

The usual method of applying fomentations is to
have two pieces of flannel in use, applying them alter-
nately and changing every three minutes for twenty
minutes. The easiest way is to have the water boiling
over an alcohol or gas lamp near the bedside.

Put two layers of coarse, soft flannel (an old blanket
is good) in the center of a towel ; dip this into boiling
water, wring it out by twisting the ends of the towel,
give the flannel a quick shake, and apply the flannel ;
cover with oiled muslin or oiled paper.

As hot applications promote suppuration there are
conditions when their use is contra-indicated and cold
applications are ordered.

The most effectual way of applying continuous cold
is by means of the ice cap. The pieces of ice put into
the cap should be about the size of a walnut ; it should
never be more than half filled, and the air should be
expelled before putting on the cover. Salt is some-
times mixed with the ice to intensify the cold. The
cap should be tied in an old handkerchief or piece of
gauze to prevent the rubber from coming next the skin,
as the extreme cold is very irritating, and may even
produce frost bites.

Fomentationi

Cold
ApplicatlonB

62 HOME CARE OF THE SICK

Zoe Oapi When ice caps are being used all the ice must not
be allowed to melt before the cap is refilled, as the
reaction caused by the resulting change of temperature
is very injurious, especially if there is any inflamma-
tion.

ICE CAPS

CompresBes For the application of cold to the head, old hand-

kerchiefs or pieces of soft gauze can be used, folded
so that they will come down well over the temples, but
not touch the pillow. They must not be wide enough
to wet the hair, or come far down over the eyes. Com-
presses should not be made too wet. The best scheme
is to have a piece of ice in a basin, and two compresses,
then while one is on the forehead the other can remain
rolled round the ice.

Compresses for the eye should be small and very
light. If both eyes need the compresses two separate
ones should be used. If only one eye is affected be
careful that the compress on it does not touch the
other, lest it should become infected. If gauze is used
for compresses always turn the ends in, that the
ravellings may not annoy the patient.

TEST QUESTIONS

The following questions constitute the "written reci^
tation'' which the regular members of the A. S. H. E.
answer in writing and send in for the correction and
comment of the instructor. They are intended to
emphasize and fix in the memory the most important
points in the lesson.

HOME CARE OF THE SICK.

PART I.

Read Cafefully* Place your name and address on the
first sheet of the test. Use a light grade of paper and write
on one side of the sheet only. Do not copy answers from
the lesson paper. Use your own words, so that your in-
structor may know that you understand the subject. Carry
out the directions given in the text^ if possible, before answer-
ing the questions, • '

1. What is expected of the nurse?

2. Give the period of incubation, first symptoms,

and time required for isolation for: (a)
Mumps, (b) Measles, (c) Smallpox, (d^
Scarlet fever, (e) Diphtheria.

3. What are the causes of cholera infantum?

Symptoms? What are the symptoms of in-
testinal obstruction?

4. What are the most common causes of convul-

sions in children ? What should be done ?

5. What are the primary symptoms of typhoid

fever? Of pneumonia? Of meningitis?

6. What is the difference between false croup and

true croup in symptoms, danger, and treat-
ment?

7. Describe the ideal sick room.

8. How should the sweeping and dusting be done?

How prepare for the night ?

9. Why is ventilation in the sick room important?

Describe different methods.

10. Make the bed as explained in the lesson and then
describe the process.

HOME CARE OF THE SICK

11. Endeavor to change the bedclothes with a per-

son in bed and report your success.

12. The points suggested in the section on the "Care

of the Patient" are all essential. What ones
might you neglect if you had no experience ?

13. What must be guarded against in lifting and

moving a helpless patient ?

14. How would you change a patient from one bed
• to another?

15. What are bed sores and how can they be guarded

against ?

16. How would you wash the hair?

17. Describe th^ process of giving a bath in bed.

^8. How can the heat of the blood be found? Why
is it important ?

19. How would you count the pulse?

20. Mention some of the points in a patient's condi-

tion that should b^ noted and recorded ?

21. What rules should be observed in giving medi-

cines ?

22. What are the different kinds of enemata? How

given ?

23. What devices can be tried before catheterization

is attempted?

24. How is a linseed poultice made and applied?

25. What is a sinapism? A fomentation?

26. How is cold applied to relieve pain?

27. Do you understand everything in this lesson?

What questions occur to you?

Note. — After completing the test sign your full name.

LOUIS PASTEUR. FATHER OF BACTERIOLOCT

HOME CARE OF THE SICK

PART II

CONTAGION; DISINfIsCTION— NUB8ING IN CONTA-
GIOUS DISEASES

We have learned in our study of Household Bac-
teriology that nearly all diseases, especially those com-
ing under the head of infectious and contagious, are
caused by certain species of bacteria.

If we would be immune from these diseases, then
we must do everything in our power to exclude these
germs. Cleanliness, plenty of sunlight and fresh air,
are the first requisites for their exclusion; and, wher
disease has entered, proper isolation and disinfection to
prevent their spread.

By disinfection we mean destruction of the bacteria
by use of certain chemicals or heat. Heat, when it
can be used, is always the surest and quickest method.
The rules for disinfection, or sterilizing by heat, will
be given under the head of "Surgical Operations at
Home."

The disinfectants most commonly used in illness
are bichloride of mercury, i-iooo, for the hands and
utensils, and carbolic acid, 1-20, for the clothes, instru-
ments, etc. Bichloride is the stronger disinfectant,
but as it discolors clothes and instruments it should
not be used for them.

Disinfeotloii

HOME CARE OF THE SICK

BioUoride
of Kereury

Carbolic
Acid

Infection

and

Ck>ntaffion

XAXINO DISnrFECTAHT SOLUTIONS

A bottle of blue bichloride tablets can be bought at
any chemist's; this is the safest form to use it in the
home, as the tablets make a blue solution. The bi-
chloride is perfectly odorless, and if the clear, uncol-
ored solution were used it might be mistaken for
water. As this is a very strong poison the tablets
should be kept always under lock and key, and out of
the reach of children. It is well to have a bottle
of tablets in the house at all times, to use in case of
cuts, etc. They contain salt, which is always required
in making bichloride solution.

To make bichloride solution dissolve one tablet in
a quart of hot water.

When a large quantity of carbolic acid solution
will be required continually, it is cheaper to buy the
95 per cent solution, which can be reduced as needed
to the required strength. To make five pints of 1-20,
mix four ounces of the 95 per cent carbolic with five
pints of boiling water and shake the bottle well.

As 95 per cent carbolic is not only a strong poison,
but also very corrosive to the skin, so be careful not to
spill even a drop on your hands, but if you should,
wash the spot immediately with alcohol or warm water
and soap.

An infectious disease is not always a contagious
one; that is, it cannot be contracted by being in the
same room with the patient, but it is transmittable
by some intermediate means of communication.

CONTAGION AND DISINFECTION

Tuberculosis is not contracted by coming in contact
with a patient suffering from that disease, but by
inhaling dust containing the germs derived from the
dried sputa of some consumptive person.

The germs of typhoid fever are disseminated when
the stools and other excreta of the patient are not
properly disinfected by those in charge.

It is not necessary to isolate patients suffering from
diseases of this kind, but it is necessary to disinfect,
according to the nature of the infection; thus, know-
ing that the germ of typhoid fever is in the stools,
and to some extent in the urine, the stools and urine
must always be disinfected by covering with bichloride,
i-iooo, and letting stand half an hour before empty-
ing. The bed pan must be well washed and disin-
fected afterward. It is also a wise precaution to
disinfect the bed-clothes by soaking in carbolic, 1-20,
for twelve hours, and then boiling ; also to keep uten-
sils and dishes used for the patient separate, boiling
them before they are again mixed with the household
supply.

Consumption, or tuberculosis of the lungs, is per-
haps the most dreaded disease of the present day.
There are more deaths from it than from any other,
except in times of epidemic. The sputum of patients
suffering from this disease contains many millions of
the bacilli. If this is deposited in places where it is
allowed to dry and become pulverized, it is a source of
danger to others. The sputum must, therefore, be
disinfected.

DUinfection

Without

Isolation

Oonramption

66 HOME CARE OF THE SICK

Patients suffering from this disease should be pro-
vided with sanitary cups. The best for this purpose
are made of prepared paper and are
very cheap. These should be burnt
after being in use for twelve hours
at most. If these cannot be obtained,
porcelain ones with covers may be
used, but bichloride or carbolic must

SaalUryCop. ^j^^^^ ^^^^^^ .^ ^^^ ^^p^ ^^^ j^

should be emptied and scalded frequently. The patient
should not use ordinary handkerchiefs, but gauze or
Japanese paper, which should be burnt. All clothing

Paper Sanitary Cap.

and bedding soiled by the sputa should be disinfected
in the usual manner, and the sufferer should wash
and disinfect the hands frequently.

Perfect cleanliness, plenty of sunlight and fresh

CONTAGION AND DISINFECTION

air, and nourishing food are the most important points
in the modern treatment of consumption. Special care
should be taken by consumptives to smother every
cough when close to other people.

CONTAaiOTTS DISEASES

Measles, scarlet fever, smallpox and diphtheria are
not only infectious but also contagious, and can be
taken by touching the person or anything that has
come in contact with the patient.

Anyone who has been in the room with a patient
suffering from any one of these diseases can scatter
the germs far and wide; this must be remembered,
especially by those who do the nursing. It is an abso-
lute necessity for them to go out every day, but before
doing so they should change all their clothes, and wash
face and hands with bichloride, i-iooo. As it would
be impossible to wash the hair every time, it should
be covered by a cap, while on duty. Even when all
these precautions have been taken, shops, theaters, and
street cars should be avoided.

The rules of isolation are these:

(i) The patient should be removed to a room as
remote as possible from the rest of the house.

(2) No one should be allowed to enter the room
except the physicians and attendants.

(3) Long-sleeved aprons and caps which will cover
the hair should be worn by physicians and attendants
while in the room. (These can be made of cheap
muslin.)

The Spreading
of Oermi

Bules of
leoUtioB

HOME CARE OF THE SICK

Dislnfeotlon
of Clothei

Dishes

and

Utensils

(4) A solution of bichloride, i-iooo, should be
kept by the wash basin for the disinfection of hands,
and they should be disinfected every time after touch-
ing or doing anything for the patient. For proper
isolation there should be two rooms, — the wash stand,
gowns, disinfectants, etc., being kept in the outer
room.

(5) A foot tub or other receptacle containing car-
bolic, 1-20, should be placed near the bedside when
the clothes are about to be changed, and they should
be put immediately into this, remaining there well
covered for twenty-four hours. They should, even
then, be boiled before being washed.

(6) The advice given earlier as to the furnishing
and care of the sick-room is especially applicable in
cases of contagious diseases. When dusting, the
duster should be dampened in 1-40 carbolic. As bare
floors are apt to be noisy, a small rug or two may be
retained, but they should be old ones, as they ought
to be burned at the termination of the disease. They
must not be shaken, as at other times, but kept well
dusted with the damp duster. '

(7) It is well to keep sheets, wrung out in car-
bolic, 1-20, both between the two rooms set apart for
the nursing and at the entrance of the outer room.
The door of the latter must be kept closed.

(8) The dishes and utensils used by the patient
and attendants must not be removed from the room;
they must be washed there, the patient's always being

CONTAGION AND DISINFECTION

washed and kept separate. When food is brought it
should be left at the door of the outer room. The
attendant, first taking off her cap and apron and disin-
fecting her hands, should remove the food from those
dishes to the ones she has in the room; the others
should be removed immediately.

(9) Whenever it can be managed the isolated
rooms should be in close connection with a bath-room,
which should be set apart for the use of the inmates
of the sick-room. When this is impossible the attend-
ant must, when it is necessary to go there, first remove
her cap and apron and disinfect her hands. When her
object is to empty the slop jar or bed pan they should
be completely covered with a large towel wrung out in
carbolic.

(10) The bed pan should always have bichloride,
I -1000, in the bottom, and after use more of the same
solution should be added. It should stand thus for
half an hour before being emptied. When there is no
separate bath-room a tightly covered box nailed on the
outside window sill of the outer room will be found
convenient to hold the bed pan, while its contents are
being disinfected.

Besides the general rules for disinfection there are
in som.e contagious diseases special rules, incidental to
the nature of the disease.

In scarlet fever the greatest danger of infection lies
in the dissemination of the skin, while it is peeling.
To prevent this the patient should be rubbed all over.

Separate
Batli Room

Special
Rules

HOME CARE OF THE SICK

night and morning, with carbolized vaseline or boric
ointment.

In diphtheria the most virulent contagion is in the
expectoration, especially when the membrane loosens.
Soft gauze should be used instead of handkerchiefs,
and if there is no grate in the room a pan must be at
hand, in which these can be burnt immediately after
use.

DIBIlTFECTIOir AT THE TERMIlTATIOir OF THE DISEASE

Time of
Quarantine

Difinfeoting
the Patient

Even after the fever has abated it is necessary to
keep the patient isolated, or "in quarantine," as it is
called, for some days. A rough estimate of the time
required for quarantine in the different diseases is
given in the table in the first section, but the doctor
should always be the one to decide when it may be
raised, as circumstances or complications may arise
which might make it allowable to shorten or neces-
sary to lengthen the time.

When the doctor does allow the patient to be moved,
a warm cleansing bath (including the washing of the
hair) must be given. This is followed by a bichloride
bath, i-iooo, and an alcohol rub. The patient is then
wrapped in a clean sheet and taken to a different
room, where fresh clothes which have not been in the
sick-room are put on. Those who have done the nurs-
ing must go through the same procedure.

CONTAGION AND DISINFECTION 71

TEE DISIKFECTION OF THE ROOM AND ITS CONTENTS

The use of sulphur fumes as a disinfectant has been
proved to be practically useless, and formaldehyde has
almost entirely replaced it. The easiest form of using
this is the "Pure Formaldehyde Gas" put up by Sea-
bury & Johnson. It can be procured at most drug-
gists. In appearance it looks like a stone, cone shaped.
There are two sizes ; the smaller, 2 inches square, will
disinfect a room 500 cubic feet, and the larger one,
1000 to 1500 cubic feet. Close the windows, pasting
paper over all the cracks ; pull down the blinds ; open
cupboards, drawers, bundles, etc., that everything may
be exposed to the fumes of the gas; place the fumi-
gator on the top of an inverted pail — it must not be too
near the floor, or it may scorch it — set fire to the top
of it, and leave the room ; lock the door and paste up
the cracks and key hole.

Leave the room thus for five or six hours, then
open all the windows, if possible allowing them to
remain open for twelve hours.

Books and toys used in the sick-room should be
burned, as they are hard to disinfect.

Unless the mattress can be baked it should be
opened, so that the formaldehyde can penetrate
through to its center. In all large cities there are bake
houses where such things may be sent for disinfection
at comparatively small cost. They should be carefully
wrapped up.

Diginfecting
with Formalde.
liyde

The
Mattresi

72 HOME CARE OF THE SICK

PERSONAL PRECATTTIOITB TO BE TAkEN BT THOSE NirBSIHG

CONTAOIOTTS DISEASES

(i) Take sufficient sleep and rest; never in the
patient's room. It is when the muscles are relaxed,
as they are when resting, that the greatest danger of
infection comes.

(2) A daily walk in the fresh air is necessary.

(3) A daily bath; change of all clothing at least
three times a week. The clothing must be disinfected.

(4) When working over the patient never stoop
so that you inhale her breath. Never kiss your pa-
tient.

Porsonai (s) Never put your hands to your face, especially

.Oisinfection your mouth or eyes, without first disinfecting them.

(6) Disinfect your hands frequently in bichloride
of mercury, i-iooo. Keep the nails short and scrupu-
lously clean. When washing the hands wash the
soap off before putting them into bichloride, or they
will soon become sore.

(7) Before meals wash and disinfect your hands
well, rinse your mouth with boric acid solution or
listerine. Never eat in the patient's room.

(8) When irrigating & diphtheria patient's throat
tie a handkerchief over your mouth, and wear glasses
to protect the eyes.

The nursing in infectious and contagious diseases
is the same as in all other cases of fever. While the
temperature is high the patient should be kept in the
recumbent position to avoid strain upon the heart.

Kouriflliment

SURGICAL OPERATIONS 73

In typhoid this position is particularly necessary, as
hemorrhage from the intestines is liable to occur if it
is not strictly adhered to.

Nourishment and medication must be given exactly
as ordered. When the doctor orders fluids give noth-
ing solid; many a life, especially after typhoid, has
been lost by so doing.

Except when the patient is nauseated, unless con-
trary to orders, give plenty of water, every two hours
at least. See that the patient drinks it slowly.

Remember the rules already given about the care of
the mouth, especially with typhoid patients. Vaseline
appHed to parched lips gives relief.

In measles and scarlet fever the eyes are apt to be care of
affected, so the room should be kept darker than in *^* ^^•^
other cases, and the €yes should be washed with boric
acid, always bathing from the inner angle outward.

In all diseases where the skin is not working prop-
erly, as in measles, scarlet and other eruptive fevers,
be especially observant of the urine as various kidney
complications are liable to ensue.

There is little danger of the patient catching cold
while the temperature is high, but when it begins to
lower be doubly careful.

SUBOIOAL OPEBATIONS AT HOME *

For twenty-four hours previous to operation the
patient should be given broths every two hours, but
neither milk nor solid food. A cathartic is given, if
possible, thirty hours prior to operation, and repeated

*This section is optional.

74 HOME CARE OF THE SICK

in six hours ; a soap suds enema is given three hours
after the first cathartic, and repeated twelve hours
before operation. A bath is also given the afternoon
before, and after the bath the field of operation is
Preparation shaved, then thoroughly cleansed with green soap,
for an and a compress wet with green soap solution, 25 per
cent to 50 per cent, applied (the liquid green soap
which is used for this purpose can be obtained at any
druggist's) ; this is covered with a protector — oil mus-
lin or oil paper — ^and left on from three to six hours, as
the skin will bear. When removed, the surface is
washed in the following order, with green soap, ether,
alcohol, and solution bichloride of mercury, i-iooo; a
compress wet in the latter is applied covered with a
protector, and left on till an hour before operation,
when the process is repeated and the fresh bichloride
compress is left on till the doctor removes it on the
operating table, after the patient is under the influ-
ence of the anaesthetic; then he re-scrubs it, and the
ether, alcohol, and bichloride must be ready for him
to use. All these precautions are taken to kill or re-
move every bacterium or spore.

For a vaginal operation the rules for diet, catharsis,
enemata and bathing are the same as for any other.
In addition a green soap douche is given on the pre-
ceding day, followed by one of bichloride of mercury,
1-5000. The vulva is then covered with a pad wet in
solution of bichloride of mercury, i-iooo, until two
hours before operation, when another bichloride douche

SURGICAL OPERATIONS

is given, the parts cleansed and a fresh bichloride pad
applied.

Just before the anaesthetic is given, the patient
should void urine. If she has false teeth they should
be removed.

The Room. In the choice of the room the light is
one of the first considerations, a good light being a
positive necessity. If possible the operation should
take place in a different room from the one the patient
is occupying beforehand. Remove rugs, carpets, all
unnecessary furniture, curtains and draperies. A piece
of cheesecloth tacked across the lower sash of the
windows will keep the light from being too glaring
and obstruct the view from outside.

The day before the operation the walls should be
dusted, especially the cornices and mouldings; the
floor should be scrubbed if possible, or at least wiped
with a damp cloth and it should be washed over again
the morning of operation after the furniture is in
place.

If the patient is to remain in the room after the
operation, have the bed as nearly in the position it is to
occupy later as possible, but out of the way.

Protect the floor under and around the operating
table with several thicknesses of paper, covered with a
sheet tacked down at the corners.

A kitchen table covered with a couple of old blankets
protected by a rubber pinned or tacked under the
table will answer for the operating table. Three small

The Room

Operating
Table

76 ■ HOME CARE OF THE SICK

taSles should be at hand, protected with papers, cov-
ered with large sterile towels. On one table, con-
venient to his right hand, the surgeon will need his
instruments. On the second table have three bowls
which have been well washed first with soap and hot
water, then bichloride, i-iooo. The inside of the
bowls should not be dried. One bowl is intended to
hold the solution for the disinfection of the surgeon's
and his assistant's hands, the other two for washing
the sponges. The third table is required for the
dressings and sterile towels. The former, the doctor
will provide or tell you where to get them. Very
reliable sterile dressings are now put up by Ellwood
Dressings Lee, and can be procured at any drug store. They
are really better than anything that can be prepared
without a sterilizer. If it is impossible to obtain these,
the dressings should be prepared in the same manner
as the towels, namely, rolled in bundles not more than
9 inches square (or the heat will not penetrate) and
steamed in the clothes boiler for at least one hour.
If there is no tray to keep them out of the water a
hammock of gauze will answer the purpose. They are
then dried in the oven, which must not be hot enough
to scorch them.

At least a dozen and a half towels will be required.
The surgeon will bring the instruments and anaesthetic.
If chloroform is administered, some vaseline will be
required to grease the patient's face.

sterile

SURGICAL OPERATIONS

An ether cone can be made out of paper, covered
with a towel.

An irrigator or douche bag must be at hand for the
irrigation. This should be sterilized by boiling for five
minutes, as are also the surgical instruments.

There must be plenty of sterilized water prepared,
six gallons at least, two gallons
of which must be boiled long
enough beforehand to be cold.
This must be kept tightly cov-
ered after it is boiled, or it will
not remain sterile. Water must
boil at least thirty minutes to be
properly sterilized.

Bichloride, carbolic and salt
solutions may be needed and

»v,«o4. u^ «4. u^*^A oc «r«ii oo 4.,„^ Ether Cone, made from Stiff

must be at nana, as well as two paper, covered with
sterile pitchers, a pus basin, a atowei.

chair, a blanket or two to cover the patient, two rub-
bers to protect the blanket, a slop jar, hypodermic
syringe, and stimulants — ^the doctor will give definite
instructions regarding the last.

The bed is made according to the directions already
given for bedmaking, with the exception that no pillow
will be required as the patient's head must be kept low.
Instead, a small rubber covered by a towel is desirable
to protect the bed if the patient is nauseated. A
blanket is put over the patient, before the upper sheet ;
hot water bottles should be in the bed all the time she

SterUlied
Water

The Bed

78 HOME CARE OF THE SICK

is on the table; a couple of towels and pus basin
should be on a table near the bed in case of nausea,
also small pieces of gauze to wipe the mucus out of
the mouth, and a wedge-shaped piece of wood to put
between the teeth if they become clenched.

If necessary to assist the surgeon during the opera-
tion, scrub the hands for ten minutes with hot water
and soap, using a new stiff nail brush which has been

POBCEIJLIN BED PAN

soaked in carbolic, 1-20. Be particularly careful of the
finger nails, which should be cut very short. After
scrubbing, the hands should be soaked in bichloride,
I- 1000.

Nobody, whose hands have, not been so treated,
must touch the dressings or instruments, and after
washing nothing but the sterile things must be touched.

When the operation is over, if the patient's night-
gown is wet it must be changed. She is then covered
with a warmed blanket, and put into bed. She should
lie on her back without pillows and be kept very quiet.

SURGICAL OPERATIONS 79

If she vomits, hold her head on one side to prevent
strangulation.

Washing the mouth out, as previously directed, will
help to relieve the thirst which is generally intense
after an anaesthetic.

After a few hours either crushed ice or very hot
water, in teaspoon doses, may be given.

The PulM

Bed Pan, ** Eureka" Pattern

The pulse must be watched carefully, and if its rate
increases should be reported to the doctor, as this,
together v/ith pallor, restlessness, longing for fresh air,
sighing respiration, and fall of temperature is a sign
of hemorrhage. As the hemorrhage does not always
show through the dressing these signs must be watched
for.

For treatment of hemorrhage see the section on
"Emergencies." As the after treatment depends alto- cioaniineii
gether on the nature of the operation, and subsequent
condition of the patient, no rules for it can be given
here further than to emphasize the fact that the first
requisite for success in surgical work is perfect clean-
liness. The gauze used for dressing the wound after
the operation, the instruments and the hands of those

Perfect

8o HOME CARE OF THE SICK

touching these things, must always be as carefully
sterilized for the dressing as for the operation.

The diet, like the treatment, will depend upon cir-
cumstances. For the first day or two the patient is
generally on fluid diet, and care must be taken thai; it
is given slowly and in small quantities, but as soon as
possible plenty of nourishing food should be given to
build up the system.

OBSTETRICS

The average duration of pregnancy is 280 days.
The most accurate way of calculating the probable date
of confinement is by counting back three months from
the date of the cessation of the last menses and adding
seven days,
prdiminary The expectant mother should place herself under
the doctor's care in the early stages of pregnancy, as
not only her own but the infant's after health depends
largely on the care the mother takes of herself at this
time. The principal rules of hygiene to be followed
are:

1. Daily exercise in the open air.

2. At least eight hours' sleep out of twenty-four.

3. A daily bath, a sponge bath if the tub bath is
too exhausting. A brisk rub after the bath will cause
a good reaction.

4. The bowels should be moved daily, with mild
cathartics if necessary.

Care

OBSTETRICS 8i

5. The urine must be carefully watched and any
abnormality reported to the doctor. Frequent speci-
mens should also be sent him, as there may be danger
of serious kidney troubles.

6. Freedom from excitem^t, worry, hurry, and
too heavy manual labor.

7. The clothing should be worn loose enough to
allow of free circulation.

8. A nourishing, but not too stimulating diet
should be adhered to.

9. The nipples require attention, especially during
the last two months, and should be washed twice daily
with boric acid solution and treated with fresh cocoa
butter or albolene.

What to provide : yo, the

1. Two large rubber sheets.

2. If possible, a Kelly Pad, if not, make an obstet-
rical pad, consisting of four thicknesses of cotton wad-
ding, covered with a layer of absorbent cotton, the
whole encased in absorbent gauze and tacked to keep
the cotton in place. This pad should be three-quarters
of a yard square.

3. Two dozen pads for dressings, half a yard long,
ten inches wide and two inches thick, made of the
same materials.

4. Two dozen smaller pads.

5. Five boxes of sterile gauze (each containing one
yard of gauze), to be used both for the mother's
dressing and to cover the baby's cord.

Mother

82 HOME CARE OF THE SICK

6. One roll of adhesive plaster.

7. Six abdominal binders of unbleached muslin.

8. Six breast binders of unbleached muslin.

9. One pair long stockings made of flannel or an
old blanket. .

10. Two dozen paper bags in which soiled dress-
ings can be put and burnt.

11. At least two hot water bottles.

12. Bed pan — "Perfection" is the best.

13. Douche pan.

14. Douche can or new fountain syringe bag.

15. Two glass douche nozzles.

16. Two glass catheters.

17. One agate basin to boil nozzles and catheters in.

18. Two large agate pitchers in which water can
be sterilized, solutions made, etc.

19. Clinical, room, and bath thermometers.

20. One bottle carbolic, 4 per cent.

21. One bottle Lysol.

OBSTETRICS 83

22. One bottle bichloride tablets.

23. New nail brush and fresh cake of soap for the
doctor's use.

For the baby: ww ttM

1. A tube of sterile tape. ■•^y

2. A rubber sheet, or, preferably, a nursery cloth
to protect the crib mattress.

3. Talcum powder.

4. Sweet oil or sterile vaseline.

5. Pure castile soap (never use perfumed soap of
any kind).

6. Bath tub — ^good rubber ones are the best.

7. Old table linen makes excellent towels and wash
cloths for the baby.

8. A large square of soft, thick flannel to roll baby
in after it is greased.

9. Basket containing sewing materials and safety

oins.

10. Crib and bedding.

11. Scales to weigh the baby in are very desirable.

12. A rubber or padded lap protector for the at-
tendant to use while bathing the baby.

13. A large flannel apron for the same purpose.
The latter is especially desirable as the baby can be
rolled in it, when taken from the bath.

14. Baby's clothing: Six flannel bands, not (ji^,^^,^
hemmed, 6 inches wide, three-quarters of a yard long. '« ^y
Four knitted or woven shirts. Six flannel petticoats.

Six white petticoats ; these should all be made without

The Bed

84 HOME CARE OF THE SICK

bands, and the fastening on the shoulders, running a
draw tape through the hem of the flannel petticoat,
will keep the baby's feet warm without confining them.
Six slips for night wear. Six dresses. Diapers, two
sizes, eighteen and twenty-two inches square.

As in other cases of sickness, the room should be as
large, light, and airy as possible, scrupulously clean,
and have no superfluous furniture.

In this instance the foot of the bed should be to-
wards the light. It should be made as shown in the
section on bed-making, with the addition of a second
rubber covered with a clean sheet, and either a rubber
Kelly pad or an obstetrical pad (made as already
described).

The furniture and floor should be protected in the
same manner as they are for operations.

Besides the bed a table for the doctor, wash stand,
nurse's table, extra table or bureau and chair will be
required. See that there is a hook on which to hang
the douche bag.

On the wash stand have hot and cold water, soap,
nail brush, scissors, and nail cleaner, towels, and bowl
of bichloride, i-iooo.

On the doctor's table, bowl of bichloride, 1-3000,

Table with towels and sponges in it; bowl of lysol, sterile

towels, sterile douche tip, also rubber and glass

catheter.

Hnrge'B ^^ *^^ nurse's table have (for baby) sterile scis-

TaMe gors and tape wipes in boric acid (these consist of

Doetor'i

OBSTETRICS 85

small squares of gauze), two large squares of gauze
to put over the baby's mouth if necessary to blow into
it, soft flannel square to wrap baby in, dressing for
cord as ordered by the doctor.

For the mother— chloroform, mask, pus basin, ster-
ile dressing and pads. Under the table the douche pan
(which has been washed in bichloride and kept cov-
ered with towel, wrung out in same), slop pail and
basin, paper bags for soiled dressings and placenta,
foot tub, hot and cold water.

On the bureau — room, bath and clinical thermom-
eters; salt, vinegar, alcohol, whisky, hypodermic
syringe, binders, pins, hot water bag, tray and alcohol
lamp.

The signs of beginning labor are pains in the lower
part of the abdomen and back, occurring at regular **»"»
intervals, about once every half hour, and a discharge
of mucus tinged with blood from the vagina.

True pains can be distinguished from false by plac-
ing the hand over the lower part of the abdomen ; in
true pains the contractions of the uterus are to be
readily felt through the abdominal wall. As the labor
advances the pains grow more severe and the intervals
shorter. The first stage of labor consists in the dila-
tion of the uterus, and ends when the membranes have
ruptured and the uterus is completely dilated.

The second stage or stage of expulsion ends when
the child is born.

First

86 HOME CARE OF THE SICK

The third stage ends when the placenta is expressed
and the uterus contracted to the size of a closed hand.

At the beginning of the first stage, the patient
should have a bath, and her hair braided in two
braids. Her bowels are emptied by the giving of a
soap suds enema. After this the external parts are
washed with bichloride solution, 1-5000, and a pad
wet with bichloride solution, i-ioooo, or boric acid
applied. She is as a rule allowed to walk around
the room during the first stage, which may last from
ten to twelve hours, and even longer.

She is best clad at this time in a night gown, warm
wrapper, and long stockings made of flannel or an old
blanket, coming well up over the thigh.

Milk and broths should be given every two hours;
alcohol and other stimulants must be withheld.

The patient must be instructed not to bear down
during the pains of this stage, and to sit or lie down
when a pain occurs.

During the second stage the patient must be kept
*Su"* strictly in bed. The wrapper is removed and a short
dressing sack put on in its place, the night gown is
tied up under the arms, and with it a sheet, the end
of which comes down over the legs covering the
blanket stockings, which are left on; it can be folded
up in the center when necessary.

The patient usually lies on her back. A strong band
of muslin around the foot of the bed, with the ends so
that she can hold them to pull on, will help the patient
during pains.

The

OBSTETRICS ^

The attendant's hands must be well scrubbed and
disinfected with bichloride, i-iooo, that she may be
ready to help the doctor.

If the doctor does not arrive in time, the attendant,
taking all antiseptic precautions, must place her hand
against the head as soon as it appears and hold it
back during the pains, thus preventing too rapid
descent. When the head is delivered insert the finger
into the passage to see if the cord be around the neck,
if so, pull it carefully over the head. The right hand
supports the child as it comes, and the other is placed
on the abdomen and pressed firmly but gently down-
ward till the child is expelled. One hand must be held
over the uterus from this time until at least half an
hour after the placenta is expelled.

Place the child on its right side between the mother's
thighs, wipe out its eyes and mouth with swabs wet *^* ^^^^
in boric acid; place gauze over the mouth and blow
into it ; if it does not cry, slap it on the back and chest ;
if the color does not improve the cord will have to be
tied and cut immediately (it is generally better to wait
five minutes before doing this) and the child plunged
into a hot bath. It is rarely necessary to do this, how-
ever. The cord should be tied tightly with the sterile
tape about an inch and a half from the navel, and
again an inch further on; it is then cut (with sterile
scissors) between the two knots. The baby is rubbed
with vaseline or olive oil, rolled in the flannel square,
and a warmed blanket, then put in its crib with at least

Oare of

HOME CARE OF THE SICK

Tliird
SUf«

one hot water bottle until the mother is attended to.
The placenta is generally expressed about fifteen or
twenty minutes after the birth of the child ; but even
if it take longer, the cord should not be pulled upon —
it is better to gently manipulate the abdomen above
the uterus, and continue doing this very gently with
one hand as the placenta comes out, while with the
other hand twist slowly to aid its coming. Even after

Binder

ENDS OP THE Y BREAST BINDER

the placenta is expressed, the hand must remain
pressed downward over the uterus until it feels hard
and firm. An assistant can in the meantime be wash-
ing the patient with bichloride, 1-2000, and removing
the soiled linen. When the uterus is firm and hard a
binder should be applied, a dressing of sterile gauze
and a pad being first placed over the vulva; this is
afterward pinned on to the binder to keep it in place.
The binder is best made of unbleached muslin. One
for a medium size woman should be a yard and a

OBSTETRICS 89

quarter long and half a yard wide. It should, when
pinned in place, extend from the border of the ribs
to below the prominence of the hips, and should be
made to fit the contour of the body by taking in darts
over the hips on the upper and lower edges.

A binder is also used to make compression upon ^
the breasts. There are a variety of these, but the Y Binder

Y BREAST BINDER (a) AND ABDOMINAL
BINDER (ft) IN PLACE

breast binder originally used in the Boston Lying-in
Hospital is perhaps the easiest one to manage, and
has the advantage of leaving the nipples exposed. A
bandage shaped like a T is made by folding muslin
lengthwise and pinning it at right angles to another
strip folded in the same way. The T is then made into
a Y by making a diagonal fold in the middle of the
cross piece and fastening the middle of the plait with
safety pins.

To apply, dust the surface of breasts with powder,
draw base of Y beneath the patient's back until apex

90 HOME CARE OF THE SICK

of the fork is external to the outer edge of breast.
Lift breasts upward and toward each other. Draw
lower arm of fork snugly across chest beneath breasts,
the inferior border of this arm extending at least one
inch below margin of breasts; the end of arm is
pinned to end of strap, which has been passed beneath
back; the lower border is pinned in the center to
abdominal binder. The upper arm of fork is then
drawn across chest above the breasts and pinned like
the lower to the main strap.
HemorrbAge Watch for the signs of hemorrhage already de-
scribed. Should hemorrhage occur send for the doctor
immediately; induce contractions of the uterus by
grasping the fundus and employing a firm but gentle
kneading (no doctor would leave the case in your
charge without showing' you exactly how to do this).
Elevate the foot of the bed, and give a hot douche of
sterile water, 120** F. Sometimes astringents such as
vinegar are added to the douche, but unless the case
is very urgent it is best not to use it without the
doctor's order.

The patient must be kept quiet and on her back for
the first six or seven hours, afterward she can turn on
her side but should not sit up for at least five days.
She is generally allowed to sit up on fourteenth day,
if all discharge has ceased. In no case should the
usual routine of life be resumed under four weeks.

The diet is usually liquid for the first twenty-four
hours, after which all symptoms being normal, the
patient is allowed almost any easily digested food.

CARE OF THE CHILD 91

The dressing and pad should be changed every two
hours until the discharge diminishes, later every three
to five, as the case demands. After the third day it is
usually necessary to change it only after it has been
removed for the requirements of the patient. These
dressings must all be sterile and the hands disinfected
before applying them. If douches are ordered, boil
the douche nozzle for five minutes before and after use.

The breasts must be washed with boric acid solution
before and after nursing.

THE OABE OF THE CHILD

After its birth the child's eyes and mouth are
cleansed with 2 per cent boric acid solution and its
whole body greased with sweet oil or sterilized vase-
line. It is then wrapped in warm flannel, put in a crib
or basket, heated with hot water bags if necessary, and
covered with a warmed blanket. It can then be left
until the mother is cared for. Watch the cord care-
fully as there is danger of hemorrhage.

The first bath is often given at once, although some
doctors prefer to have the baby rubbed with oil only Bath
for the first few days. Before beginning have every-
thing necessary together — a foot tub containing water,
100** F., bath thermometer, warm, soft towels, wash
cloth, castile soap, dusting powder, a dressing for the
cord, boric acid solution, small squares of gauze, a
rubber lap protector, two diapers, flannel band, shirt,
flannel petticoat, and a simple, soft white dress.

Flrit

92 HOME CARE OF THE SICK

The head is first washed, using very little soap,
rinsed and thoroughly dried; then wash behind the
ears, the crevices of the neck, axilla, joints, and be-
tween the buttocks and thighs carefully. Only the
part being bathed should be exposed. The baby is
now put down into the tub and rinsed, supporting the
head and back firmly with the left hand and arm.
Cover the lap protector with flannel apron or warm
towel and when you lift the baby out, roll this around
it. Dry by patting; use very little powder and only
when it is necessary to prevent chafing. Some doctors
consider it better not to put the baby in the tub until
after the cord is off.
yf^y^i The navel is now dressed by cutting a hole with

DroMiiiff sterile scissors in a piece of sterile gauze, which is
slipped over the cord and folded about it. The cord is
laid toward the left side and a pad of sterile absorbent
cotton put over it. A soft flannel binder holds the pad
in place and must be put on firmly and smoothly, but
not too tightly. It is best sewn on with a few large
stitches. After the bath the baby should be rolled in
warm flannel and laid on its right side in its crib.

Hurling The Feeding. The first six weeks the baby should
nurse every two hours during the day and every three
hours at night ; afterward this may be changed to every
three hours during the day and twice at night. These
hours should be rigidly adhered to. If the baby seems
thirsty between meals a little plain water may be given.
The baby's mouth should be washed with 2 per cent
boric acid solution before and after feeding and also
the mother's nipples.

FOOD FOR THE SICK 93

When for any reason it is impossible for the mother
to nurse the child, great care must be exercised in the
preparation of its f6od. First the bottle and nipples
must be thoroughly cleansed immediately after each
feeding by rinsing in cold water, then washing in hot
water and soap suds and rinsing in hot water. The
bottle is kept turned upside down and the nipples in
a 2 per cent solution of boric acid. Both bottle and
nipples should be boiled for five minutes twice a day.

Every doctor has his own formula for prepared
milk, but whatever the preparation used it is best
pasteurized if not above suspicion.

FOOD FOB THE SICK

In many diseases, especially those accompanied by
fever, the powers of digestion are much impaired. For
this, as well as other reasons, it is necessary that all
food given should be in a liquid form. Milk, except m^^
under certain conditions, is at such times considered
the best food, as it contains in a dilute form all the
constituents of the solids, namely : albumen, fat, sugar,
the inorganic salts of lime and potash, and water.

If curds appear in the stools, or vomiting ensues,
it shows that the milk is not being properly digested.
This difficulty may often be overcome by diluting it
with seltzer or other effervescent water, by the addi-
tion of lime water or bicarbonate of soda (ten grains
to a pint), or by peptonizing the milk. (The recipe
for the latter will be found at the end of the section.)

HOME CARE OF THE SICK

Amount

and

Frequency

Feedinff
Cups

A good substitute for milk is white of egg, beaten
to a froth, diluted with an equal quantity of water,
and flavored with lemon juice.

Beef tea and broths contain very little nourishment,
and should, therefore, be given only occasionally, for
a change.

Patients on fluid diet should, as a rule, be given six
ounces every two hours, or half the quantity every
hour. Of course there are times — as after operation,
or when the patient is nauseated — when less must be
given.

When a patient is on liquid diet it is especially im-
perative to give her nourishment at stated times and
regular intervals. In giving see that it is taken very
slowly.

As a rule, when a patient is sick enough to be on
fluid diet it is necessary for her to maintain the re-
cumbent position, even while drinking, and there are
several devices to facilitate this. There is the old-
fashioned feeder with the spout, but the drinking tube
or "ideal glass" are preferable. When raising the
head slip the arm under the pillow; take care not to
throw the head forward, and by so doing make it
difficult to swallow. Never bring a glass to the patient
in your hand, but on a small tray or plate, and with
it a napkin to fold under the patient's chin and pre-
vent drops soiling the sheet.

When a patient is on milk diet her mouth should be
washed out after every feeding, with listerine or boric

Food

FOOD FOR THE SICK 95

acid, otherwise it will soon become coated and sore.
Directions for doing this were given in the section
on the care of the teeth.

A convalescent patient should be given solid food goud
only by degrees, beginning with the so-called soft diet,
which includes broths, strained vegetable soups, soft
cooked eggs, milk toast, junkets, custard, jellies, and
raw beef sandwiches. Then comes "light diet," which
means the addition to the "soft diet" of underdone
steak, chops, chicken, baked potatoes, and farinaceous
puddings.

Pastry and all rich or highly seasoned food should
be avoided until the patient has, in every respect, re-
sumed her usual routine of life.-

In diseases such as rheumatism, Bright's disease,
diabetes, dyspepsia, etc., where fever is not the most ^^^^
important symptom, but where the effect of certain
foods must be taken into account, a special diet is
prescribed. As the patient's general condition must
be considered in the prescribing of such, I think
it wise to make only a few general remarks on the
subject, as a great deal of harm is frequently done by
following set rules for medication and food, by those
who are unable to recognize symptoms contra-indi-
cating their use.

In many forms of febrile disease, as for instance
tuberculosis, light diet can be given even while there
is fever, nourishing food being a most important item
in the treatment.

Special

96 HOME CARE OF THE SICK

In diabetes, sugar and starchy foods, most fruits,
and alcoholic drinks must be avoided. Gluten bread
should be used, and that not too fresh; saccharine
should be used instead of sugar for sweetening not
only tea and coffee, etc., but also in cooking. Fresh
milk should not be taken, but buttermilk and koumyss
are allowed.

In rheumatism and gout, as in diabetes^ all sweeten-
ing should be done with saccharine, and sweets of all
kinds are prohibited, also pastry, puddings, jellies,
pork, veal, and all fried meats. Fruit except straw-
berries and bananas, is allowed.

TRAY WITH FEET

©aintj '^^^ great stress cannot be laid on the necessity for
Bervinr ^ dainty serving of the patient's meals. They should
be either very hot or perfectly cold, as the case re-
quires. Have clean napkins, spotless china, and shin-
ing silver and glass. Be careful in carrying the tray
not to spill any of the fluids, and, as has been said
before, do not have too much on the tray at a time.
Furthermore, that the patient may thoroughly enjoy
the meal, it is necessary that she should be perfectly

FOOD FOR THE SICK

comfortable. Therefore, before bringing in the tray,
wash her face and hands, shake up the pillows, and
decide where it is best to set the tray. If there is no
bedside table or tray with feet, it is a good plan to
have two blocks of wood to put on each side of the
patient. They should be about the width of the tray,
and high enough to hold it off the patient's chest.
Magazines will answer the purpose if the blocks can-
not be obtained. Always protect the night-gown and
bed clothes with a towel or table napkin.

BECIFES

Milk

In warming milk for drinking never allow it to
boil, and always keep it covered. It is the coagula-
tion of the casein by boiling, and the evaporation of
certain gases, that renders it indigestible.

Brandy Hilk with Egg

Beat one egg with one tablespoonful of sugar; add
two tablespoonfuls of brandy and a cup of cold milk.

Eoumyss

I qt. perfectly fresh milk.

I -5th of a 2-cent cake of Fleischmann's yeast.

I tablespoonful of sugar.

Dissolve the yeast in a little water ; mix it with the
sugar and milk. Put the mixture into strong bottles ;
cork them with tightly fitting stoppers; tie down se-
curely with stout twine. Shal^ the bottles for a full

Never
BoU

Five
Days
Required

98 HOME CARE OF THE SICK

minute; place them on end in a refrigerator; at the
end of three days lay them on their sides; turn them
occasionally. Five days will be required to perfect
fermentation. Kept in the refrigerator and well corked
koumyss will keep indefinitely.

mik Lemonade

I tablespoonful sugar.
I cup boiling water.
J4 cup lemon juice.
54 cup sherry.
154 cups cold milk.

Pour the boiling water over the sugar; add the
lemon juice and sherry. Stir it until the sugar dis-
solves; add the cold milk; stir again until the milk
curdles ; strain through muslin.

Milk Pnxkcli

Sweeten i cup of milk with i teaspoonful of sugar;
stir in 2 tablespoonfuls of brandy; beat with egg-
beater ; pour into glass and grate nutmeg over the top.

Milk Rennet

jj^ Stir I teaspoonful of rennet and 2 teaspoonfuls of
^Ctoa sherry together with i teaspoonful of sugar. Heat i
pint of milk until it is exactly 100** F. ; pour into bowl
containing rennet and wine; stir quickly and only
enough to mix ingredients ; grate nutmeg over the .top,
and set on ice till solid.

FOOD FOR THE SICK 99

Peptonized Milk

Mix 5 grains of pancreatic extract and 15 of soda
bicarbonate with cold milk; warm a pint of milk and
add ; stir well and put on ice to cool.

Barley Oruel

Mix I tablespoonful of Robinson's barley-flour with
half a teaspoonful of sugar; pour over this a cup of
boiling water; boil ten minutes; add a cup of milk;
bring to boiling point ; serve very hot.

Arrowroot Oruel

Mix half a tablespoonful of arrowroot with i salt-
spoonful of salt, half a teaspoonful ot sugar, wet with
2 tablespoonfuls of cold water ; pour on a cup of boil-
ing water, stirring constantly. Boil for twenty min-
utes ; add the milk, and bring to boiling point ; strain ;
serve immediately. A little port wine is often added.

Oatmeal Oruel

Mix 2 tablespoonfuls of oatmeal, half a teaspoonful
of sugar and a saltspoonful of salt. Pour this slowly
into boiling water; cook in a saucepan for thirty
minutes, or, preferably, in a double boiler for two
hours; strain; add the milk, and bring to boiling
point.

Cracker Oruel

Mix 2 tablespoonfuls of cracker crumbs with half a
saltspoonful of salt and half a teaspoonful of sugar.
Pour over this a cup of boiling water, add one cup of
milk and simmer for two minutes.

Orueli

■* t
i ^

100 HOME CARE OF THE SICK

Beef Tea

Cut two pounds of round steak into half-inch
squares; put into double boiler and add one quart of
water; let stand one hour, then place over fire and let
simmer two hours; flavor to taste.

Chicken Broth

Broths ^^^ up a fowl (which has been properly cleaned)
into small pieces ; add a quart or a quart and a half of
cold water, according to size of fowl. Let stand for
one hour and simmer for two hours, then boil slightly
for one. Strain it, remove fat, and flavor to taste.

Mutton Broth

Cut one pound of loin or neck of mutton into small
pieces; put with one teaspoonful of chopped onion
into one quart of water. Let stand one hour, and
simmer three; strain; let cool; then remove the fat
which rises to the top. Heat when ready to serve;
. season with salt and white pepper.

Flaxseed Tea

Drinks Boil one tablespoonful of flaxseed in a pint of water
for one hour ; strain ; add one tablespoonful of lemon
juice and one tablespoonful of sugar; serve either hot
or cold. The loss by evaporation should be made good
from time to time, so that at the end of the cooking
there shall be one pint of tea.

Coffee
For every cup of water use a heaped tablespoonful
of coffee. Soak the coffee for several hours in cold

FOOD FOR THE SICK loi

water; bring to boiling point and let simmer for a
few minutes ; let stand on the back of the stove for a
minute to settle before serving.

Candle

To a cupful of thin oatmeal gruel add a tablespoonful
of sherry, one egg well beaten, sugar to taste; it can
be served either hot or cold.

Toast Water

Toast till dry three slices of bread an inch thick;
break into small pieces ; add a pint of cold water ; soak
for an hour; strain, and squeeze the water out of the
toast with the back of a spoon. Serve cold ; if desired
a little cream and sugar may be added.

Barley Water

Boil one tablespoonful of barley flour, a teaspoonful
of sugar, a saltspoonful of salt and a quart of water
together for fifteen minutes ; strain ; it can be flavored
either with lemon juice or port or sherry wine.

Rice Water

This is made in the same manner as barley water,
except that two tablespoonfuls of rice will be required
to a quart of water.

Ojiter Soup

Heat a cup of milk; add two tablespoonfuls of
cracker crumbs, a saltspoonful of salt, a sprinkle of
pepper, a fourth of a teaspoonful of butter ; when this
IS warm through add a cup of fresh oysters and juice;

IQ2 HOME CARE OF THE SICK

allow to simmer for about two minutes, or till the gills
of the oysters curl.

Milk Toast

Toast three slices of bread a delicate brown ; butter
them and put them into a covered dish. Cover them
with milk which has been brought almost to boiling
point.

Soft Custard

Beat together the yolks of two eggs, a saltspoonful
of salt, and two tablespoonfuls of sugar; add this
slowly to a pint of milk which has been brought to
boiling point ; boil three minutes. Flavor with vanilla
or sherry wine; serve cold.

Egg-nog

Egg Break one Ggg into a bowl; add one saltspoon-

ful of salt and two teaspoonfuls of sugar; beat
until light ; add one cup of milk, one or two tablespoon-
fuls of good brandy or whisky ; serve immediately.

Sherry and Egg

Break an egg into a bowl; add a teaspoonful of
sugar; beat the two together until well mixed; add
two tablespoonfuls of sherry wine and a fourth of a
cup of cold water; mix thoroughly; strain, and serve
immediately.

Scrambled Eggs

Beat two eggs, a saltspoonful of salt, a sprinkle of
white pepper, with a Dover egg-beater, until quite
light ; add four tablespoonfuls of sweet cream or milk ;

Dishes

FOOD FOR THE SICK 103

turn the mixture into a double boiler; cook, stirring
constantly until the albumen is coagulated.

Foamy Omelet

Separate the yolks from the whites of two eggs. To
the yolks add a saltspoonful of salt and one-fourth of
a saltspoonful of pepper. Beat with a Dover egg-
beater until light; add two tablespoonfuls of milk.
Beat the whites until fairly stiff, and fold them into
the yolk ; pour the mixture into a hot buttered omelet
pan ; cook for about two minutes ; put into the oven for
one minute to cook the upper surface.

Egg Cream

Separate the yolks of two eggs from the whites;
add two tablespoonfuls of sugar to the yolks; beat
until well mixed ; add the juice and grated rind of half
a lemon ; place the bowl in a dish of boiling water on
the fire ; stir slowly until the mixture begins to thicken ;
add the beaten whites of eggs, and stir for two minutes.
Serve cold.

Poached Eggs

Pour some boiling water into a small saucepan ; salt
it and add half a teaspoonful of vinegar ; break a fresh
egg gently into this. As soon as the white is firm lift
out the ^gg with a skimmer, and put on crustless but-
tered toast.

Soft Cooked Eggs

Never boil eggs for the sick. Boil enough water to
cover the eggs ; put them in ; remove the saucepan to

JeUlM

104 HOME CARE OF THE SICK

the back of the stove where the water will not lose its
warmth too soon, and let them stand ten minutes.

JelUes

The order for making nearly all jellies is as follows:
The gelatine is hydrated, or softened, by soaking in the
cold water for half an hour. The boiling water, sugar
and flavoring are then added, in the given order.
Strain and cool.

■ Lemon Jelly

%. box of gelatine.
J4 cup of cold water.
i}i cups of boiling water.
, yi cup of sugar.

J4 cup of lemon juice.
I tablespoonful of brandy.

Orange Jelly

j4 box of gelatine.
% cup of cold water.
y2 cup of boiling water.
yi cup of sugar.
I cup of orange juice.
Juice of half a lemon.

As soon as the latter begins to stiffen it can be
whipped till stiff, making orange sponge, which,
served with custard, makes a very dainty dish.

Velvet Cream

Soak % box of gelatine in % cup of cold water for
half an hour ; then pour in J4 cup of sherry wine ; set

FOOD FOR THE SICK 105

the bowl in a dish of boiling water over the fire. When
the gelatine is dissolved add a teaspoonful of lemon
juice and J/2 a cup of sugar ; strain ; set the bowl in a
dish of ice and water to cool. As soon as it begins to
thicken turn in the cream. Stir this until it also thick-
ens; mould and put on ice. Serve with cream.

Wine Jelly

J4 box of gelatine.

J4 cup of cold water.

1% cups of boiling water.

J/2 cup of sugar.

yi a square inch cinnamon.

I clove.

j/i cup of sherry wine. ,

Coffee Jelly

% box gelatine.
54 cup of cold water.
I cup of boiling water.
J/2 cup of strong coffee.
J^ a teaspoonful of vanilla.
J^ a cup of sugar.

EMERGENCIES. FIBST AID TO THE IKJXTEtED

In all emergencies one of the chief requisites is
coolness. Do not get excited, or you will be perfectly
useless. When the doctor's services are necessary send
him a written statement of the case, that he may come
prepared with the proper appliances. Severe injury

the Air

io6 HOME CARE OF THE SICK

of any kind is apt to be' followed by that complete
prostration of the vital powers known as "shock."
Therefore, after such, the patient should be put into a
warm bed, and hot water bags applied to the feet and
over the heart.

Exclude Scalds and Burns. In the treatment of scalds and
burns the first object is to allay the pain by excluding
the air. This is done best by the application of clean,
soft, white linen or cotton cloths wrung out in a solu-
tion made by dissolving a tablespoonful of bicarbonate
of soda (baking soda) in a pint of boiled water. This
treatment can be continued for the first few days;
afterwards boric acid ointment spread on lint or soft
sterile cotton will be found healing. Do not try to
treat a burn of any extent without a doctor's advice,
as many complications are likely to ensue. In fact, in
such cases, it is always best to send for the doctor
immediately, as many people have died from shock
after comparatively small burns.

Frost Bites. Rub with snow, or cloths wrung out in
ice-water. The rubbing must be very light at first, and
the patient kept away from the heat.

Syncope or Fainting. Place the head lower than the
feet if possible; give plenty of fresh air. Ammonia
may be given by inhalation, but it should not be very
strong, as it is irritating to the bronchial tubes. If
these measures are not successful treat as in case of
shock.

EMERGENCIES 107

Shock. Put the patient into a warm bed; undress
and roll in blankets ; apply heat to the extremities and
over the heart; raise the foot of the bed, so that the
patient's head will be considerably lower than the feet.
If possible avoid giving stimulation till the doctor
arrives ; if, however, he cannot be found, and the case
is urgent, give a rectal injection of whisky i oz.,
water 5 ozs. (105° F.), salt 5 grains. Coffee may be
used instead of water and salt.

Epilepsy. Loosen all clothing; put something be-
tween the teeth to prevent the tongue being bitten;
have the head on a level with the feet; give plenty
of fresh air but no stimulants.

Drozvning. In cases of drowning where a person is
apparently lifeless, eflforts to restore life should be
commenced at once by loosening all tight clothing
around neck, chest, and waist. Turn the patient over
quickly on his face, raising the body slightly at the
waist to allow any water in the throat or air passages
to run out. Wrap a handkerchief or a towel around
the forefinger and gently cleanse the mouth. All this
should take only a minute or two. Place the person
upon his back with a folded coat or a firm pad of any
kind under his shoulders to raise them a little. Be
careful that the tongue does rot slip back and shut
off the air from the trachea. If it shows any tendency
to do so, have some one hold it out, or tie a hand-
kerchief around it and then around the neck.

io8 HOME CARE OF THE SICK

Now artificial respiration should be produced until
the natural breathing is restored. To do this kneel

ASTIFICIAL RESPIRATION (First HovemeDt)

behind the patient and grasping his arms just below
the elbows, draw them slowly upward above hi^ head
until they nearly touch. Give a firm pull for a mo-
ment. This movement tends to fill the lungs with air
by raising the ribs and increasing the chest cavity.

ARTIPICIAL RESPIRATION (Second MoTement)

Then carry the arms slowly back to the sides of the
body and press them against the ribs. This movement
forces out the air which was drawn into the lungs and
makes artificially a complete respiration. These two

EMERGENCIES log

movMnents should be rqjeated slowly and steadily
about sixteen times in a minute, until respiration takes
place naturally. This may require an hour or more.

Asphyxiation, Caused by Gas, Smoke, etc. Remove
the patient into the fresh air, loosen the clothing,
throw cold water in the face, neck, and chest; apply
heat to the feet and over the heart. If respiration is

EXFELLINO THE AIH {Third Movement)

shallow, artificial respiration should be performed, and,
if necessary, treat as for shock.

Contusions, or Bruises, are best treated by rest and
cold applications.

tVounds. When there is a cut, the first procedure,
provided there is no hemorrhage, is to wash out the
wound well with bichloride, 1-5000, and bind it up
with sterile gauze. A wound will heal without the
formation of pus if all bacteria are killed or kept out.
When the cut is long, or the ends of the wound do not
come together well, the doctor should be summoned,
as putting in a few stitches may prevent an unsightly

Ou&rdlnt
Amnit
Blood
polMutnf

no HOME CARE OF THE SICK

scar. (Having bichloride and sterile gauze always in
the house would save many a case of blood poison,
infected fingers, etc.) Collodion is useful in keeping
bacteria out of small cuts and in applying absorbent
cotton over wounds in places where bandages cannot
be used.

Hemorrhage. Elevate the affected part ; make com-
pression over the wound by applying clean compresses
and bandaging tightly. If this does not check it, and
you do not know the course of the arteries well enough

-terr witti > bandkcnhkr und stick.

to make compression upon the required one, tie on a

bandage very tightly above the wound. A pencil or a

piece of wood stuck under this, and turned around,

will act as a tourniquet. When possible, in addition

tn ttii's it is always better to place a hard pad over the

e of the artery. A doctor's aid must be sought

diately, for if the blood is shut off in this n

r than an hour gangrene is likely to set in.

EMERGENCIES

III

Epistaxis (bleeding from the nose). Make the pa-
tient stand or sit erect; throw the head back and
elevate the arms, while you apply ice or ice-cold com-
presses to the forehead and back of neck. If the
bleeding still continues the nostrils should be syringed
with salt and water, ice cold. Avoid blowing the nose,
and so disturbing the formation of clots.

Hemorrhage from the Lungs, Keep the patient
quiet, give crushed ice, and put ice-cap on chest. Salt
solution made by dissolving a teaspoonful of salt in a
small cup of water may also be given.

Sprains occur most frequently at the wrist and ankle
joint. Soak the affected part in hot water, or apply
hot compresses. The joint should then be supported
by strapping, and given moderate use. A surgeon
should do the strapping, for if it is not properly done
serious trouble may result.

Fractures. It is a mistaken impression that a frac-
ture must be set immediately. It will do less harm
for it to be left a day or two without splints than for
them to be applied awkwardly. Handle the injured
limb as little as possible, and keep the patient quiet
until a competent surgeon can be obtained. Temporary
splints made of pasteboard, shingles, etc., may be
bound on to prevent the spasmodic twitching of the
muscles; cold or hot compresses applied will keep
down the swelling and relieve the pain.

Dislocations should be reduced as soon as possible,
but only a surgeon can do this properly.

Cold
ApplioatloiiB

Btrappinf

Fraeturet

Kot Be Bet
At Onoe

n^ HUME LAKE at THE SitK

FOBSZOH BODIES ZV TEE EYE, EAB, HOSE, THBOAT

The Eye. If anything gets under the lower lid, draw
the lid down by the lashes, direct the patient to turn
the eyeball toward the nose, and the offending body
can then be wiped out with a soft handkerchief. If it
is under the upper lid, this can be turned up over a
thin pencil or knitting needle, and treated in the same
way, except that the patient is directed to look down.
Always wipe the eye towards the nose. If the particle
is imbedded in the surface of the eyeball a surgeon
must be notified immediately ; do not make any effort
to get it out.
I7s6 Hothing Foreign Body in the Ear, Unless the object is

something that will swell with moisture, syringe gently
with warm water, taking care not to close the opening
with the nozzle of the syringe. If this method fails go
to a doctor ; any unskilled effort to poke or probe the
object out is likely to result in permanent injury to
the ear.

The Nose, When a foreign body is in the nostril
make the patient take a full breath, then close the
mouth and the other nostril firmly — ^the air will prob-
ably expel the obstruction. If this fails, and the object
is in sight, compress the nostrils above and hook it
out with a hairpin or piece of bent wire.

A Foreign Body in the Throat may be hooked out
in the same way; if not, a piece of bread should be
swallowed ; this may carry down the obstruction. Do
not give purgative medicine, as is often done, but

POISONS AND ANTIDOTES li^

rather plenty of solid food, especially potatoes and
bread.

A Foreign Body in the Windpipe will usually be
dislodged by the coughing which its presence excites;
if not, a blow on the back, or, in the case of a child,
holding it up by the feet and administering a succes-
sion of blows between the shoulders will generally
produce the desired effect.

POISONS AND ANTIDOTES

The treatment has three objects in view: to re- Give an
move the poisonous substance, neutralize its further 5?*oiice
action, 'and remedy the ill effects already produced.
An emetic is the first consideration. A tablespoonful
of salt or mustard stirred into a glass of lukewarm
water will usually prove effective. This dose should be
repeated three or four times. An enema should also
be given, the patient kept warm, and, as soon as vomit-
ing ceases, the chemical antidote given.

The following table of the chemical antidotes and
further treatment of the most common poisons should
be learned and remembered.

Carbolic Acid. Lime water and milk, equal parts,
a pint to a pint and a half. Atropine and heart stimu-
lants, such as whisky and strychnine, may be required,
given hypodermically.

Nitric or Oxalic Acid. Chalk or whiting, the plaster
from walls, milk and lime water. Give whichever can
be obtained quickest.

114 HOME CARE OF THE SICiC

Ammonia. Vinegar or lemon juice, followed by
castor or olive oil.

Arsenic. The best antidote is tincture of iron, di-
luted with v/ater, and either baking or washing soda.
Lacking this, or till it can be obtained, give milk and
white of eggf or flour and water.

Aconite or Belladonna. Strong, hot coffee. Give
artificial respiration if necessary.

Bichloride of Mercury (corrosive sublimate). White
of egg — white of two eggs to a pint of water.
Calomel. The same as bichloride of mercury.

Opium. Strong, hot coffee. Keep the ^ patient
awake, using artificial respiration when necessary;
permanganate of potash and tannic acid are the best
chemical antidotes, but they can rarely be obtained
in a hurry.

BANDAGES AND BANDAGING.

Materiaii ^^^ materials most commonly used for making
bandages are either unbleached muslin or gauze. Mus-
lin bandages are best when necessary to keep a splint
in place, or make firm pressure. Gauzes are infinitely
preferable when the object is only to keep a surgical
dressing in position; they adapt themselves more
neatly to the part, and are much cooler.

Bandages should be six to eight yards long; they
vary in width from one inch to four; one inch for
finger bandages, two for hands and feet, two and a

BANDAGING

half to three for head and arms, three to four for legs,
spicas, etc.

The three fundamental forms of bandaging are : the
spiral, reverse, and figure eight.

The figure eight principle is the one most used, and
is the easiest method to learn. It is made by turning
the bandage round the limb in the form of the figure
8, each figure being higher than the preceding one,
but overlapping it one-third of its width. A bandage
must lie smoothly without wrinkles, making an even
but not too severe pressure. It must not be loose
enough to slip, yet not tight enough to be painful or
impede the circulation.

When finishing a bandage always put the pin on the
outer side of a limb, and in all cases where it will
least interfere with the patient's comfort. Safety pins
should always be used.

In bandaging a limb begin at the extremity, and
work upwards from left to right. Hold the bandage
with the roll side upward.

To bandage a foot start the free end of the bandage
at the instep, make a turn around the base of the toes,
carry the bandage diagonally over the foot, across the
point of the heel, and back from the other side till it
coincides with the first turn. Cover this, and carry a
second turn around the heel, half an inch higher than
the first. Continue making alternate turns under the
sole and behind the heel, crossing over the instep, until
the foot is covered. Finish with a couple of circular

Fiflmre

Eight

Bandage

FiniBhing

Foot
Bandage

ii6

HOME CARE OF THE SICK

'eg
Bandage

turns around the ankle, or, if desired, continue up the
leg.

The beginning of the leg bandage is placed obliquely
across the leg above the ankle; a circular turn keeps
it in place; then the bandage is inclined up th§ leg,
and a turn taken around it. It is then broughrdown-
ward, and another turn taken around the ankle. Suc-

FIGURE 8 OP THE FOOT.

cessive turns are to be made, each one higher than
the preceding, till the entire limb is covered.

To bandage a hand begin at the top of the first
finger and cover it by a succession of oblique circular
turns, or figures of eight, to its base. Then make a
turn around the wrist to keep these from slipping, and
return to the root of the second finger. Lead the

BANDAGING 117

bandage by one or two spirals to the top of this, then
proceed down it, as upon the first finger, concluding
with another turn upon the wrist. Cover each finger
successively in the same way; then take a wider
bandage, start at the back of the
hand and wind it around the base
of the fingers, carry it obliquely
across the back of the hand around
the wrist, back to the further side,
and again around the palm. Con-
tinue these turns alternately till the
hand is covered. The arm is ban-
daged in the same manner as the

When it is only necessary to cover
the forehead or back of the head the
figure-of-eight is all that is required.
Start the bandage over the ear, carry it across the
eyebrows and around the back of the head as high as
Continue to wind it round thus, making

Buk of Haad

FIQURE 8 OF the: ARM.

each turn a little higher in the front, and lower in the
back, until you have covered as much surface as
required. When the whole head needs covering
the capeline is better. This is put on by a

iiS HOME CARE OF THE SICK

double roller (join two bandages by rolling). Stand
behind the patient, and, taking one roll in each hand,
begin low on the forehead and carry them round the
head, far down on the nape of the neck ; then transfer
the bandage in the left hand to the one in the right,
and continue it round, while the other is folded over
at right angles with it, and brought across the top of
the head to the front. Here it meets the other and
crosses it again, running backward and overlapping
the former folds. These turns are continued until the

Baadoge of the Band

whole head is covered, one bandage going round and
round it, and the other going back and forth across
it ; all the folds leading from the front of the head to
the back should be on the left of the middle, while
those leading toward the front should be on the right.
Finish with a circular turn around the head ; fasten
with a safety pin in front.

The tailed bandages are often found very convenient,
especially for keeping poultices and the like in posi-
tion.

The four tailed bandage of the head is made from
a piece of muslin eight inches wide and long enough

to go over the scalp and tie under the chin. It is torn
from each extremity to within three or four inches
of the middle. The body of the bandage is placed on

FIGURE 8 OF THK HEAD

the top of the head, the two posterior tails tied under
the chin, and the two anterior ones around the back of

the neck. If it is desired to cover the front of the
head the body of the bandage is placed at this point,
the two anterior tails are fastened at the back of the
head, and the two posterior ones down under the jaw.

120

HOME CARE OP THE SICK

A four tailed bandage for the knee is made by
splitting a strip of muslin at each end, to within two
or three inches of the center. Place the body of the

FOUR-TAILED BANDAGE OF THE HEAD

bandage over the knee, carry the tails under the knee,
cross them so that the lower ones will come above the
joint, and the upper ones below ; bring
them around, and tie in front,
icoitetiu A scultetus, or many tailed, is used

on the abdomen, to obtain pressure, to
keep a surgical dressing or poultice in
place, etc. To make it take four or five
strips three inches wide and a yard and
a quarter to a yard and a half long, sew
them together in the center for a quar-
ter of a yard, each one overlapping the
other by two-thirds of its width. To
apply, pass the bandage under the pa-
tient, so that the sewed part is under
her back ; fold the strips alternately „ « „ ^ „ ^

' i. , « / ^^^' Tailed Band

.over the abdomen, from below upward, a^eof tiieKne^

BANDAGING

121

To make a sling take a square yard of muslin and
cut it across diagonally ; this makes two slings. When
the fore-arm is injured its whole extent should be
supported equally. Put it in the center of the sling;
carry its outer end around the neck on the side of the
injured arm, and the end between the arm and the

Sllnffi

SLINGS FOR LOWER AND UPPER ARMS

chest around the other side, tying them at the back.
The third end is brought around the elbow and fas-
tened in front.

If the injury is of the upper arm the sling should
support the wrist only, making no pressure on the
elbow. Turn the hand palm inward, fold the apex
of the bandage in place, the arm just above the wrist
in the center of the sling, cross the ends and tie them
around the neck.

The student should practice the various bandages
and slings described on some member of the family
or a friend. Some little experience is required before
they can be applied securely and neatly. The illustra-
tions will help to make the matter clear.

Bllngr for
Upper Arm

HOME CARE OF THE SICK

BIBLIOGRAPHY

Food and Gx>kery for the Sick and Convalescent ($1.50).

Fannie M. Farmer.
Food for the Sick ($1.00). Edward C French.
Home Nursing ($1.00). Eveleen Harrison,
Nursing ($2.00). Isabel A. Hampton.
Practical Normal Histology ($1.25). T. Mitchell Prudden.
Practical Points in Nursing ($1.75). Emily A. N. Stoney.
Text Book of Nursing ($1.75). Clara Week Shaw.

XAGAZnrES

The American Journal of Nursing.
The Trained Nurse.

Note. — For the conTCtiiencc of students the School will {wrchase and
forward any of the above books on receipt of the price given.

TEST QUESTIONS

The following questions constitute the "written reci-
tation" which the regular members of the A. S. H. E.
answer in writing and send in for the correction and
comment of the instructor. They are intended to
emphasize and fix in the memory the most important
points in the lesson.

HOME CARE OF THE SICK

PART II

Read Caf efuUy* Place your name and address ^0n the
first sheet of the test. Use a light grade of paper and write
on one side of the sheet only. Do not copy answers from
the lesson paper. Use your own words, so that your in-
structor may know that you understand the subject. Carry
out the directions given in the text^ if possible^ before
answering the questions.

1. How are infectious and contagious diseases alike?

How do they differ? Name some of each.

2. What precautionary measures should be taken

with typhoid fever? With consumption?

3. What are the rules when isolation is necessary?

4. What precautionary measures should be taken

by the attendant while nursing in a contagious
disease ?

5. How disinfect (a) the patient, (b) the room,

contagious disease?
Why are the many precautions taken in surgical

operations and in childbirth ?
What can you say of diet for the sick? Why

should special care be taken in serving?
What should the medicine closet contain in prepa-
ration for emergencies and accidents?
How would you treat a scald or burn? Frost

bite? A wound?
What is shock and how should this condition be

treated ?

HOME CARE OF THE SICK

11. Why should written directions be sent to the

doctor in accidents?

12. What would you do for a sprain? Fractures?

In case of hemorrhage from an arm or leg?

13. What should be done at once for one who has

fainted? One apparently drowned? Asphyxi-
ated ?

14. Give the rules of hygiene in pregnancy.

15. Name some of the things to be provided for child-

birth. How should the room be prepared?

16. Describe the stages of labor.

17. What should be done if the doctor does not ar-

rive in time?

18. How should the child be cared for directly after

birth?

19. How would you remove a foreign body from the

eye? Ear? Nose? Throat?

20. In case of poisoning, what objects has the treat-

ment in view ?

21. What would you do for carbolic acid poisoning?

Bichloride of mercury? Arsenic? Opium?

22. Of what material are bandages made? How

should they be applied and fastened?

23. Bandage a foot as shown in the illustration and

then describe the process.

24. Try some of the other bandages described and

report.

25. Make and adjust a sling for the forearm. When

should it be used ?

26. What questions would you like to ask in connec-

tion with these lessons ? Tell of any experience
that you may have had in nursing and of meth-
ods that were helpful.

Note. — After completing the test sign your full name.

PREVENTABLE DISEASES

CONSUMPTION

Circular op Information for Persons Suffering From

Pulmonary Disease, and for Others

Living in the Same House

Issued by the National Association for the Study and Prevention of Tuber-
culosis, IDS East Twenty-second Street, New York.

GENERAL CONSIDERATIONS

Several diseases of the lung$ are spread from person
to person by the coughing and spitting of those
affected. Among these diseases are Consumption,
Influenza or Grippe, Bronchitis, Common Colds, and
Pneumonia. Those who suffer with any of these
affections cannot help coughing and spitting, but they
can cough and spit in such a way as to avoid com-
municating their disease to others.

COUGHING

The infective agent, or "germ,'* is contained in the
material raised by coughing. Very small bits of
such material may contain large numbers of these
germs. Most persons, when coughing, instinctively
hold the hand over the mouth. That is not a very
bad habit, for you may at least know what you have
done. You have possibly infected your hand, but
have not prevented the act of coughing from scatter-

125

126 HOME eAKE ^B THE Sl&K

ing about you fine particles of saliva, which may
contain bacilli. It is better to hold a handkerclnef*
over your mouth, and, when done coughing, to put
the handkerchief at once into the pocket — into the
handkerchief pocket, into which a small paper bag
has been previously placed to prevent contamination
of the pocket, and which can be burned when con-
venient. If accidentally " you cough anything, no
matter how little, into your hand, you should clean
your hand very carefully. If one has tuberculosis
or pneumonia it is most important, indeed it is almost
vital to persons around, to avoid cantaminating the
room with materials coughed up.

Persons subject to prolonged attacks of coughing
should, if possible, retire to a convenient place until
the fit is over, and under all circumstances should be
careful that the fine spray coughed up is all caught
upon some material which can be completely and
promptly destroyed.

The material expelled by coughing is, as a rule,
small in amount, and consists of minute droplets, but
its power to infect is not to be judged by the small
amount or by the minuteness of its particles, for the
tiny germs are plants, each of them capable of rapid
growth when transferred to the lungs of another
person.

*NoTE. — The use of handkerchiefs for this purpose might well be dis-
coiiraged, for the mouth and nose secretions of healthy people often contain
disease germs. Japanese napkms, tissue paper, or pieces of cloth which can
be destroyed, are preferable on all accounts.

CONSUMPTION 127

Persons in health need have no fear whatever of
the matter exhaled by the sick in ordinary breathing
or in conversation.

SPITTING

The larger quantities of material, coughed up into
the mouth, contain enormous possibilities of infection,
but this source of danger is easily avoided by simply
knowing where to spit.

Many persons, women especially, swallow what
they cough up. This is a bad habit. It is most
.unclean and disgusting to spit into your stomach,
and if one has tuberculosis it is dangerous. Consump-
tives would oftener get well if they were not repeat-
edly reinfected, and to swallow the sputum is one
way of renewing the infection.

Those who have ordinary colds or pneumonia,
or influenza, or tuberculosis, must spit, but they must
not spit in such a way that they themselves or any
other person can come in contact with any particle
of the sputum.

In the house no one, sick or well, should ever spit
anywhere except into a vessel made for such purposes.
Those who are out of health should have their own
spittoons containing water or some disinfecting
solution, or sputum cups of paper cheap enough to be
dropped in the fire and destroyed, or a water-proof
pocket or paper bag for cloths or absorbent paper
napkins, which are burned as soon as they are soiled.
A disinfecting solution in the spittoon is not absolutely

138 HOME CARE OF THE SICK

necessary, but it is absolutely necessary that the
sputum should never be allowed to dry, and water in
the spittoon will answer every purpose to accomplish
this end. Spittoons should have perpendicular sides,
and no slanting surfaces on which the sputum can
stick and dry. It is well to place the spittoon on a
piece of paper which will show if accidentally soiled,
and can be easily destroyed. It is dried sputum,
from which particles can rise as dust in the air, that
is dangerous.

For use on the street, or away from home, similar
conveniences can be obtained, capable of being used
quite decently and without attractmg attention. If
one happens to be without such conveniences, when
it is absolutely necessary to spit, remember not to
spit where anyone is liable to step on the sputum.
It is a punishable offense to spit on the floor or plat-
form of a trolley car or railway coach or on the floor
of a railway station or public building, and in many
places the law forbids spitting on a pavement. When
you must spit, look about for a sewer opening or a
gutter.

When in company, and in a room, the tendency
of the invalid is ta swallow the sputum rather than at-
tract attention,but this should not be done,as it is both
dangerous to the patient and disgusting, and the ex-
pectoration can always be received on pieces of cheese-
cloth; or it would be better even, if necessary, to ex-
pectorate in the handkerchief and bum it afterwards.

CONSUMPTION 129

Of the diseases considered in this circular the most
important from every standpoint is tuberculosis.
This disease, when it affects the Itmgs, is commonly
called consumption. Nearly all diseases of the lungs
are communicable in some degree, and the advice given
in this circular can be followed with advantage by all
persons who have cough or expectoration.

TUBERCULOSIS OR CONSUMPTION

Tuberculosis, of the lungs, commonly called con-
sumption, is the most common form of the disease.
There is also tuberculosis of the throat, known as
consumption of the throat ; tuberculosis of the bowels,
called consumption of the bowels ; tuberculosis of the
lymph glands, known as scrofula; tuberculosis of the
various bones, as of the spine, which is the cause of
hunch back; tuberculosis of the joints, as of the hip,
which is known as hip-joint disease; and various
tuberculosis abscesses, known as white swelling.

Tuberculosis is a communicable disease.

Tuberculosis is a preventable disease.

Tuberculosis is a curable disease.

It is communicated from one person to another
through the discharges from tuberculous ulcers, the
principal source being the sputum which comes from
ulcers in the lungs of persons suffering from consump-
tion.

It is a preventable disease, because if these dis-
charges which contain bacilli were destroyed, there
would be no spread of the disease.

130 HOME CARE OF THE SICK

That it is curable is proven by the fact that more
than one-half of the people have tuberculosis some
time in their life, and yet only about one in seven
die of it.

FIRST 8TBP8 IN THB PRBVBNTION OF THB SPREAD OF CON.

SUMPTION

If the spread of consumption is to be prevented, the
disease should be discovered as early as possible, and
the patient should be told that he has the disease.
He should at the same time be told that the disease
is curable and that, in order to be cured and in order
not to give it to others, he must know that he has it.
If the disease were discovered early and the patients
thoroughly instructed and trained in being careful,
there would be little danger of scattering infection.

If you have a cough, don't say, "It's nothing but
a cold." You may be injuring yourself and others.
Go to a doctor who knows, and learn the truth.

Persons sulffenng from tuberculosis should earnestly
desire to know that they have tuberculosis, that they
mav take advantage of the modem methods of treat-
ing the disease and be restored to health. They
should know that "bronchial trouble," "throat
trouble," "stomadh cough," and such terms, are
only deceptive and mean, in many cases, consump-
tion They should also know that the spitting of
blood, unless positively from the gums, nose or throat,
is in all probability from tuberculosis in the lung.
Repeated protracted colds are often signs of tuber-

CONSUMPTION 131

culosis. A cough that hangs on for any length of
time should always excite suspicion.

DISPOSAL OP THE SPUTUM

The expectoration of persons suffering from dis-
eases of the lungs always contains infective germs,
and the expectoration of consumptives is particularly
harmful. The matter spat up by consumptives may
soil the bedding, furniture, clothing, etc., and other
persons handling these things may soil their hands
and thus infect themselves. Consumptive persons
are very likely to soil their hands through the pocket
handkerchiefs which they use. It is best for persons
suffering from any pulmonary disease not to use the
ordinary pocket handkerchief at all. The Japanese
paper napkins, tissue paper, or pieces of gauze, as
as they are used but once, are less apt to soil the hands,
and can be burned as soon as used.

The best way of destroying sputum is to bum it.
A number of disinfectants will destroy its infectious-
ness, but their action is slow, uncertain, and they are
more expensive than burning. Paper cups to receive
the sputum are often furnished by State and Local
Boards of Health, or they can be purchased at drug
stores. These cups should be burned every day or
every other day. In summer, when there is no fire
in the house, a fire should be made with waste paper
and wood for the purpose of burning the cups and
paper napkins which have been used. The cups and
napkins may be thrown into an earth closet and

132 HOME CARE OF THE SICK

covered with dry earth or Ume, as the germs soon die
tinder these conditions. In hotels, flats and apart-
ments, where there is no access to an earth closet or
a fire, the patient should .spit into a cup containing
water or a disinfecting solution, and empty it every
day into the water closet. In the earth closet and
water closet the germs are not destroyed at once as
by burning, but they cannot harm the patient or any
one else, and they soon die.

The sputum must not be thrown on the ground,
or into a surface gutter, or thrown away with ashes,
garbage, or other refuse. The cover of the sputum
cup should be kept closed to keep out flies and other
insects, which may carry the sputum on their legs and
bodies and distribute it wherever they afterwards
alight.

Sick persons who are walking about, away from
home, where they cannot carry sputum cups, should
spit into a Japanese paper napkin, tissue paper, or
cheese-cloth, and put it at once into a waterproof
pocket, or paper bags can be used for this purpose.
The waterproof pocket may be sewed or buttoned
into the left pocket of the skirt or trousers. A supply
of unused napkins should be carried in the right
pocket. The paper napkins should be used only once.
Sick patients, too weak to use the cups, should spit
into Japanese napkins, bits of tissue paper, or pieces
of gauze, which can be kept in a covered paste-
board box or tin bucket, and afterwards burned.

CONSUMPTION 133

It is well always to wipe the lips after expectorating.

If the sputum accidentally gets on the floor, cloth-
ing, or furniture, a thorough washing with laundry
soap and water should immediately be applied.

Persons whose sputum contains disease germs,
especially those of tuberculosis, should frequently
wash their hands with soap and water. Patients
who cook or prepare food should take especial care
to have clean hands.

The beard and moustache are sure to be infected,
and probably help the consumptive to reinfect him-
self by contaminating his food and drink. The beard
should be removed or trimmed quite short.

SPECIAL DIRECTIONS FOR MEMBERS OP THE HOUSEHOLD

Young children should not be allowed to play in the
sick-room of anyotie who has any disease of the lungs.
Playing on the floor of the sick-room especially should
be absolutely forbidden.

The germs of consumption are more dangerous for
children than adults.

Mothers with tuberculosis should not nurse their
infants, as nursing involves a considerable danger
to the child and a heavy drain upon the mother's
vitality. Mothers should thoroughly wash their
hands before preparing the bottles or handling the
infants' food.

Patients with pulmonary disease should not kiss
anyone on the mouth. If the mouth and lips have

134 HOME CARE OF THE SICK

been carefully cleansed, kissing perhaps is but slightly
dangerous.

Towels, pipes, clothing, handkerchiefs and other
personal articles used by a tuberculosis person should
not be used by other members of the family. When
consumptives are bedridden their clothing and bed-
ding ought not to be thrown into the common recep-
tacle for soiled clothes. Such things as can be boiled
should be boiled as soon as possible, or else soaked
for several hours in a disinfecting solution.

CARE OP THE SICK-ROOM

A person suffering from consumption should occupy,
if possible, a sunny room, and one that can be well
ventilated. If the room is not so arranged that there
can be good ventilation, so as to frequently change
the air, the patient should draw his bed near the
window, so as to get as much fresh air as possible.

If the floors and walls of the room have become
soiled by sputum the room should be disinfected by
formaldehyde gas. If possible, the room should be
disinfected, and afterwards the walls scraped, and
repapered, repainted, or rekalsomined. After that
the walls should not become infected again in many
months, provided the coughing and spitting are
properly cared for.

The floors may be washed with hot soda lye. The
floor should be bare or covered with wash cotton rugs.

Heavy curtains should be removed, and sash

CONSUMPTION 135

curtains of washable materials substituted. Roller
shades are not objectionable, unless they exclude too
much daylight.

Do not sweep or dust the room. The floor should
be wiped at least once a week with a damp cloth.
The bed, furniture, woodwork, mantels, etc., should
be wiped off in the same manner.

The patient should have his own bed, and if possible
his own room. It is injurious to the invalid and
dangerous to the well person to occupy the same bed.

The bedroom should not be used as a dining-
room or kitchen if it is possible to avoid it.

The windows should be kept open.

The cardinal principles to be observed in the sick-
room are cleanliness, sunlight, fresh air, and care of the
sputum.

THE CURE OP DISEASES OP THE LUNQS

Consumption is not a very fatal disease. The
majority of those attacked recover. More than in
any other disease the outcome of a case of tuber-
culosis is in the hands of the patient. The develop-
ment of consumption is caused by errors in our ways
of living; some of these are nature's errors, some
errors of circumstance, and some our own personal
errors. Medical experience has shown that we can
easily overcome the adverse chances of nature and
circumstance if we correct our personal errors of
hygiene.

136 HOME CARE OF THE SICK

HOW TO MAKE HEALTHY LUNQS DISEASED

1. Exposure to dust containing germs.

2. Drinking excessive amounts of alcoholic liquor.

3. Loss of sleep, worry and confinement.

4. All forms of dissipation and excess.

5. Unwholesome and improperly cooked food.

6. Meals at irregular hours.

7 Working or living in a dusty or vitiated atmos-

phere.

8 Prolonged hours of work. Severe and pro-

longed muscular or mental exertion. Work
requiring a constrained or stooping posture.
9. Exposure to extreme heat, noxious fumes,
injurious dust, dampness.

10. Certain occupations: Stone-cutting, file-grind-

ing, and dusty occupations generally.

1 1 . Contracting diseases which aggravate or predis-

pose to consumption — measles, whooping-
cough, grippe, and pneumonia.

12. Exposure in the room of a careless consumptive.

13. Drinking of milk of tuberculous cows, especially

by children.

HOW TO MAKE DISEASED LUNOS HEALTHY

I . The person suffering from tuberculosis should be
careful to destroy his sputum. He should not
soil his hands, handkerchief, clothes, bed
clothes, or anything about him with his expec-
toration. In case any of these should become
soiled, they should be cleaned and disinfected

CONSUMPTION 137

at once. He should not swallow his expecto-
ration; he should not associate with other
persons who have the disease and are careless
about their expectoration, for by carelessnes
on his own part or that of others he may be
reinfected.

2. Employ an intelligent physician. Consult him

about food, drink, work, rest, amusements,
exercise, and all the details of daily life, in-
cluding the expediency of going to a sanato-
rium, or adopting sanatorium regime in your
own home.

3. Don't spend one cent for advertised cures, for

they never cure.

4. Take the four cures:

The air cure ;
The food cure ;
The rest cure ;
The mind cure.

5. Sleep well, don't worry, keep out of doors. Be

confident that you are going to get well.

6. Don't take any liquor, except on a physician's

prescription.

7. Eat plenty of meat, milk, butter and eggs — all

you want, and want as much as you can eat.

8. Avoid the frying pan and its products.

9. Keep regular hours, good company and a clear

conscience.

138 HOME CARE OF THE SICK

10. Your most inportant duty is to get well; let all

other duties be secondary.

11. If your work involves long hours, prolonged and

severe mental or muscular exertion, stooping
position, inhalation of dust or noxious fumes,
leave it if you want to get well.

HOW TO KEEP HEALTHY LUNGS HEALTHY

1. Keep your general health in as good condition

as possible by avoiding excess, and by living
as hygienically as possible.

2. Follow the foregoing rules as faithfully as your
occupation permits.

Numerous investigations have shown that pro-
longed and repeated exposures are necessary to cause
tuberculosis in a healthy person ; accordingly there is
little danger to be feared from casual exposure to
consumptives.

Any one may safely live in the same apartments
with a consumptive, provided the simple precautions
given in this Circular of Information are observed.

Tuberculosis is not a contagious disease like
measles or small-pox. It is, however, a commtmi-
cable disease, and we know just where the danger lies
and how easy it is to avoid it. It is not the consump-
tive himself, but the consumptive's expectoration
which is dangerous to those about him. If the simple
directions given above are followed by him, the con-
consumptive ceases to be a source of danger to those
about him.

CONSUMPTION 139

AS TO CHANGE OF CLIMATE

Climate in Consumption is a will-o'-the-wisp. It
is the end of the rainbow with its pot of gold. It is
ever just a little beyond. It rests in Colorado, New
Mexico, Arizona, California. Like children in their
simple faith, chasing the rainbow's vanishing end and
delving for treasures where once it stood, our patient
pursues his phantom till, worn and wasted, weary, but
hopeful still, he falls asleep and wakes to learn that
the magic end of the bow of promise rests upon the
mystic shores of the spirit land.

'*While certain climates may be preferred for cer-
tain consumptives, it is nevertheless the consensus
of opinion of the leading authorities of the day that
there is no climate which has a specific curative
power over consumption. Many, including Dr. S. A.
Knopf, of New York, an acknowledged expert on the
treatment of Consumption, hold that cures effected
in the home climate in which the patients will have
to live and work after their restoration to health, are
more lasting and assured than cures obtained in more
genial climes. While it is known that patients cured
in the salubrious regions of the West have been able
to return and live in Illinois and eastern states from
whence they came, it is also known that others can
never leave the climates in which they recovered, for
on their return to their own state their disease recurs.

"There are many reasons why an attempt should be
made to cure a consumptive patient at or near his

Uo HOME CARE OF THE SICK

own home, if it be in a climate not unsuitable for the
cure of Consumption; many reasons why he should
not be sent a long distance from home.

Separation from friends depresses the patient.
"Homesickness" is a malady which often baffles the
physician.

The expense of the journey is a serious drain on his
resources and is often incurred unnecessarily. As
has been aptly stated by the State Board of Health
of Maine. **many patients could be well put on the
road to recovery in their own state at a cost which
would barely defray their expenses to and from Colo-
rado and Arizona."

The fatigue of a long journey is bad for a consump-
tive.

The lack of home comforts in a distant state and
the inability often to obtain proper accommodations
unless at a prohibitive price naturally handicap the
best efforts made to cure the patient.

The expense of living in the states having "specific"
climates is great. Even if his disease be cured, the
patient may not be able to return to live in his home
state.

If the patient must work, he can find no occupa-
tion. Too many have preceded him.

It is known that in certain Western states doors
are closed to the consumptive, and legislation against
him is contemplated.

For the wealthy patient, who can be surrounded

CONSVMPTIOM Ut

by his relatives and friends wherever he goes, a change
of climate may be desirable; for the poor patient —
and Consumption is often a disease of the poor — a
change of climate frequently quickens an unfavor-
able termination of his disease.

The consumptives of Illinois should not forget that
their disease can, as a rule, be cured in Illinois, if it
can be cured anywhere. — Bulletin on Consumption ^
Illinois State Board of Health

THE GREAT WHITE PLAGUE

** It is with a very real sense of melancholy that one
contemplates the long death-roll of those of the
world *s great men and women who have succumbed
untimely to the tubercle-bacillus, which is and has
been through countless generations by far the most
potent of all death-dealing agencies. Had it not been
for this detestable parasite, Bastien Le Page might
have given us another Joan-of-Arc to feast our eyes
upon ; Rachel might for many years have" continued
to permeate the spirits of her audiences with the di-
vine fire that was in her'. Our navy did weirenough
in the 1812 war, as all the world knows; but what a
rip-roaring time there would have been if John Paul
Jones had lived to take a hand in it! We might
be reading some more of Stephen Crane's splendid
war stories ; we might have had some more of Robert
Louis Stevenson 's delicious lace-work ; Schiller might
have given us another Song of the Bells; we might

!42 HOME CARE OF THE SICK

have taken another 'Sentimental Journey' with
Laurence Sterne; Henry Cuyler Bunner might have
continued to delight us, and to touch our hearts ; John
Keats might have given us another 'Endymion.* Had
the tubercle-bacillus permitted, Nevin might have
vouchsafed us another *Rosary'; von Weber another
'Euryanthe Overture'; Chopin might have dreamed
another * First Polonaise*; and the tender flute notes
of Sidney Lanier might even now be heard. Maria
Constantinovna Bashkirtseff, Zavier Bichat, John
Godman, Rene Theophile Hyacinth Laennac, Henry
Purcell, John Sterling, Henry Timrod, Artemus Ward,
Henry Kirke White, Henry David Thoreau, Baruch
Spinoza — such names as these are but a moiety among
those of the world's nobility whose precious lives
were cut off in their prime by the 'Great White
Plague.' " — From Popular S device Monthly, by Dr.
John B. Huber.

Of the people living in the United States to-day over
8,000,000 will die of tuberculosis, at the present death rate.
All these lives might be saved.

CONSUMPTION

^g^ DIPHTHERIA AND CROUP
^H TYPHOID FEVER

■ SCARLET FEVER

■ MEASLES
I SMALLPOX

DIAGRAM OP PREVENTABLE DISEASES.

-Sarlat thli p«led thnadladla
V*w B*aip«Un, fiom all moM*,
■■•twMn a* t— ol 10 and M,
lOMB panoDif a wboa a,Mi
tPMoslMd to oonmunptlaoi or, la

DIAGRAM SHOWING PROPORTION OP DEATHS
FROM CONSUMPTION TO DEATH FROM ALL OTHER
CAUSES BETWEEN THE AGES OP TWENTY AND
THIRTY YEARS. BLACK, CONSUMPTION; WHITE,
ALL OTHER CAUSES.

144

HOME CARE OF THE SICK

/to/0

/OtOU)

sofyso

SOtOj^

90t030

SOIO6C

60 to 70

70 to SO

vrerro

DEATH RATE FROM CONSUMPTION IN NEW

HAMPSHIRE BY AGES.

/to/0

/otoxo

SJ>t030

30t0¥0

H>0i0S0

SO to 60

60t070

lOtOKO

oveno

MORTALITY FROM CONSUMPTION TO EACH 10,000
OF THE SAME AGE, IN NEW HAMPSHIRE, FOR 20
YEARS.

PNEUMONIA*

Definition. — Pneumonia is an infectious inflamma-
tion of the lungs, due to a specific micro-organism,
the micrococcus pneumonice, which produces a potent
poison, affecting the whole system and frequently-
causing death.

The Virulence of the Germ. — The virulence of the
germ of pneumonia is subject to wide variations. In
the bacteriological laboratory there are cultures one-
millionth of a cubic centimeter of which will induce
death in animals, while there are other cultures twen-
ty times the above given amount of which are neces-
sary to produce the same effect. As a rule, the viru-
lence is increased when the germ passes directly from
one person or one animal to another. This is one of
the reasons why the disinfection of the sputum of the
person suffering from pneumonia is so desirable.

Importance of Pneumonia as a Cause of Deaths. —
Averaging the mortality statistics of Michigan, col-
lected under the new law, for the six years, 1898-1903,
the latest yet compiled by the State Department, the
order of importance of the most dangerous conununi-
cable diseases, as causes of deaths, was as follows:
Pneumonia, tuberculosis, meningitis, typhoid fever,
diphtheria, whooping-cough, scarlet fever, measles,
and small-pox. The relative importance of these
diseases, in those years, is shown by the diagram,

^Leaflet of the Michigan State Board of Health.

I4S

146 HOME CARE OF THE SICK

DEATHS IN MICHIGAN 6 YEARS. l8Sa-l903.

PNEUHOMA
TUBERCULOSIS

TYPHQD FEVER

I VMOOPMC-COUGH
SCARUET FEVER

Ismipox

During the ten years ending with 1897, the statis-
tics collected under the old law showed that then the
most dangerous communicable diseases, named in the
order of their importance, were: Tuberculosis, pneu-
monia, diphtheria, typhoid fever, influenza, scarlet
fever, meningitis, measles, whooping-cough and small-
pox. It will be seen that pneumonia was then ex-
ceeded only by tuberculosis as a terrible death-dealing
scourge. Tuberculosis has continued to decrease.
Pnetunonia has been rapidly replacing tuberculosis
and is now the greatest single cause of deaths in
Michigan

The Mode of Communication. — It is by means of
sputa (all discharges from the lungs, throat, nose, and
mouth) containing micro-organisms capable of pro-
ducing pneumonia that this dangerous disease is
usually spread.

Destruction of the Sputa. — It is evident that the
most certain preventive of pneumonia is to destroy

PNEUMONIA 147

the sputum from the patient before it has an oppor-
tunity to dry and scatter the germs of disease.

How the Sputa Should be Destroyed. — During the
illness great care should be taken to prevent soiling
bed clothing, carpets, or furniture with the sputa.
The patient should cough into a moistened cloth and
the cloth should be burned before allowing it to
become dry. It is not a sufficient precaution to exer-
cise this care during the patient's brief illness,
because the germs causing pneumonia are capable of
living for a considerable time in the mouth and nose
of a person who has had the disease. Therefore, dur-
ing convalescence, so long as any sputum is raised
from the lungs, and for at least two or three weeks, all
expectoration should be into a cup or cuspidor con-
taining a disinfectant, the best disinfectant being a
five per cent solution of carbolic acid — one ounce of
carbolic acid dissolved in a pint and a half of water.
If not confined to the house, it is best that the conva-
lescent, and that all persotis who have a cough, should
carry small pieces of cloth (each just large enough to
properly receive one sputum) and paraffined paper
envelopes or wrappers in which the cloth, as soon as
once used, may be put and securely enclosed, and,
with its envelope, burned on the first opportunity.
Remember that the sputum must not be allowed to
become dry.

The Spitting Nuisance Dangerous to the Public
Health. — It is now well known that the human saliva

148 HOME CARE OF THE SICK

is the natural habitat of many species of micro-organ-
isms which gain access to the mouth in various ways,
the most common being by breathing, through the
mouth, air containing them. In a case of pneumonia,
however, the germs of the disease are coughed up
from the lungs. The sputum is, therefore, the com-
mon way by which pneumonia and some other dan-
gerous communicable diseases are spread. After dry-
ing, the germs with which the sputum is charged
mingle with the dust of rooms in homes, churches,
schools, public halls, stores, and cars. In these places
they are inhaled by human beings, with results depen-
dent largely upon physical and meteorological condi-
tions. The physical and meteorological conditions
cannot always be avoided; therefore, success in the
restriction of those diseases must lie in the direction
of the destruction of the germs which produce those
diseases. It is probable that, could the sputum al-
ways be destroyed as soon as ejected, pneumonia and
a few other important diseases would soon disappear.
We are confronted with the practical problem of how
this may be done, either wholly or in a large degree.
This problem is not an easy one to solve, for the reason
that every man regards himself as independent and
endowed with the inalienable right enjoyed by man
throughout all ages, of depositing saliva wherever he
chooses. Many municipalities are indeavoring to
enforce regulations more or less stringent to prohibit
spitting upon sidewalks and in other public places.

PNEUMONIA 149

These efforts are largely due to the knowledge now
becoming so common that the germs of tuberculosis
are spread by the air containing the germs of this dis-
ease which have been ejected in the sputum of the
victims of the disease. When it becomes generally
understood that sputum may contain not only germs
of tuberculosis, but also the germs of pneumonia and
of other dangerous communicable diseases, the efforts
that are now being put forth to prohibit this public
and dangerous nuisance should be largely increased.
Legal measures can be used only against the per-
son spitting in public places. The person who con-
taminates the air of his home with his saliva is largely
beyond the reach of such measures. Public opinioti
is necessary to sustain the enforcement of any law.
It is especially necsssary where it is sought to enforce
a law depriving citizens of a privilege they have long
enjoyed and can see no reason why they should not
continue to possess. Education of the people con-
cerning the importance of destroying or disinfecting
all sputum must, therefore, precede forcible measures.
This education should be such as to induce every in-
telligent person to destroy or disinfect the sputum or
saliva he or she ejects, and to insist that the careless
and the ignorant be compelled to do likewise. It is
to be hoped that such education will result in the
formation of public opinion, so that it will demand that
the law shall not only reach the public spitter, but
that it will also apply to the person who contaminates

150 HOME CARE OF THE SICK

his own home, thus not only endangering his own
family, but also endangering the lives of all who may
enter such a home. The press, the teachers in our
public shcools, the preachers in our pulpits, and all
others who in any degree mould public opinion should
urge this most important sanitary reform.

Isolation of the Patient. — It is believed that if care
is taken with all the discharges from the nose and
mouth, isolation of the patient may not always be
necessary, although it is undoubtedly wise for all who
can do so, and especially all children, to keep away
from the patient. And, pneumonia being an acute
disease, of short duration, isolation may properly be
practiced.

Ventilation of Buildings. — Through better systems
of ventilation, much may be done for lessening the
number of micro-organisms inhaled with the dust of
floors, carpets, etc., especially by having the foul air
exits at the floor level, so that the general motion of
the foul air shall be downwards, and not upwards into
the nostrils of the inmates of the room. This is
especially important with reference to all public build-
ings, as, also, that they shall constantly have a liberal
supply of fresh air.

Personal Precaution. — Any person dusting ob-
jects in a room, cleansing the floors, walls or ceiling
of the living or sleeping room of a person suffering
with pneumonia might well use a respirator. Sev-
eral folds of gauze moistened and tied loosely over the

PNEUMONIA 151

nose and mouth might be used. The sweeping and
dusting of a room which has recently been occupied
by a person sick with pneumonia should be deferred
until after the room and contents have been subjected
to the fumes of burning sulphur, or of formaldehyde.

No one should sleep in the same room with a pa-
tient, nor in a room which has been recently occupied
by a person sick with pneumonia, unless the room
(with all its contents) has been previously thoroughly
disinfected.

It is best not to stand near a person who is cough-
ing, because in coughing finely divided droplets of
saliva are thrown from the mouth and may be carried
for a distance of three feet. These droplets may con-
tain large numbers of germs. They are also sometimes
thrown out in forcible speaking. The ordinary breath
does not contain them.

Much may be done to lessen the liability to con-
tract pneumonia, by having the sanitary surrotmd-
ings as nearly perfect as possible, and by keepmg the
lungs strong and healthy. These facts emphasize the
importance of pure food, pure air, and healthful exer-
cise.

Exposure to Cold Wind should be Avoided. — Statis-
tics of sickness and of deaths, collated with meteoro-
logical statistics, prove that the colder months of the
year and those following are the months during which
pneumonia prevails most extensively, and during
which it sometimes assumes an epidemic form. At

152 HOME CARE OF THE SICK

such times every person should avoid exposure to cold
wind and to chill from a change from heavy to light
clothing.

Disinfection. — Disinfection of rooms and contents
can be complete only in the absence of living persons,
as fumes strong enough for the purpose are destruc-
tive of human life. Curtains, draperies, carpets,
clothing and all movable articles should be exposed -to
sunlight in the open air. The unwashed clothing of
a person sick with pneumonia should not be mingled
with the unwashed clothing of another person; care
should be taken that the handkerchiefs be boiled, and
other articles likely to harbor the germs be disinfected
before sending them to the laundry.

After a death or recovery from pneumonia, the room
in which there has been a case of this disease, and the
furniture and other contents, should be thoroughly
exposed for several hours to formaldehyde gas, or to
fumes of burning sulphur, and then exposed for
several hours to currents of fresh air. Hang up and
spread out as much as possible all blankets and other
articles to be disinfected ; turn pockets inside out, and
otherwise facilitate the access of the disinfecting
fumes to all infected places. For a room ten feet
square, at least eight ounces of a forty per cent solu-
tion of formaldehyde, or at least two ounces of solidi-
fied formaldehyde should be rapidly distilled into the
room, or at least three pounds of sulphur should be
rapidly burned ; and for larger rooms proportionately

DIPHTHERIA 15^

increased quantities should be used, at the rate of at
least eight ounces of a forty per cent solution of for-
maldehyde, or at least two ounces of solidified formalde-
hyde, or three pounds of sulphur per each one thous-
and cubic feet of air-space. After fumigation, the
walls may be whitewashed, albastined, painted,
repapered, or rubbed with bread-crumbs, which should
then be burned ; the woodwork, including the floor,
may be painted or thoroughly washed. If any sputum
is deposited thereon, it should be washed with a five
per cent solution of carbolic acid.

DIPHTHERIA*

Diphtheria is a dangerous communicable disease,
caused by a specific contagium, the germ of which
is propagated in the human body or its excretions,
and spread from person to person ^ directly and indirect-
ly. Until recent years, the supposition has prevailed
that cases of diphtheria might arise de novo from a
filthy condition of premises, backyards, privy vaults,
cesspools, etc.; but later researches have made it
plain that this notion is not a correct one. Filthy
conditions may serve to harbor the germs, but they do
not produce the germ. Rather, it seems to have been
proved from statistics compiled in this department
that at least four-fifths of the cases of diphtheria in
Michigan come almost directly from a preceding case.

The bacillus which causes diphtheria does not gen-

*Btilletin of the Michigan State Board of Health.

154 HOME CARE OF THE SICK

erally enter the blood. The poison generated by the

bacillus is absorbed into the body, and causes degen-
erations of muscular tissue, heart failure, paralysis,
etc.; but the germ generally remains in its locality,
usually in the throat. Therefore the spread of this
disease is mainly from the throat and mouth. Every-
thing touched by the mouth, or by the discharges
from the mouth, throat or nose, may be infected.

^K ^^ ^^ T^ ^^

HOW TO AVOID AND PREVENT DIPTHERIA

Avoid the Special Contagium of the Disease. — This
is especially important to be observed by children.
Children under ten years of age are in much greater
danger of death from diphtheria than are adults ; but
adult persons often get and spread the disease, and
sometimes die from it. Mild cases in adults may
cause fatal cases among children. Because of these
facts it is frequently dangerous for children to go
where adult persons go with almost perfect safety to
themselves.

Do Not Let a Child Go Near a Case of Diphtheria. —
Do not permit any person or thing, or a dog, cat, or
other animal to come from a case of diphtheria to a
child. No cat or dog should be permitted to enter
the sick-room. Unless your services are needed, keep
away from the disease yourself. If you do visit a case,
bathe yourself and change and disinfect your clothing,
hair, beard, if any, and hands, before you go where
there is a child.

DIPHTHERIA iJJ

The contagium of diphtheria sometimes retains its
virulence for a long time, and may be carried a long
distance in articles in which it has found lodgment.
Do not permit a child to enter a privy or water closet,
or to breathe the air from a privy, water closet, cess-
pool or sewer into which undisinfected discharges
from persons sick with diphtheria have entered, nor
to drink water or milk which has been exposed to
such air.

Do not permit a child to ride in any closed carriage
in which has been a person sick with diphtheria,
except the carriage has since been thoroughly disin-
fected with fumes of burning sulphur.

Abrasions of the skin or mucous membrane favor
the contraction of diphtheria. The disease spreads
most at such seasons of the year as sore throats prevail.
All influences which cause sore throats, such as expo-
sure to wind and to breathing cold, dry air, probably
tend to promote the taking and spreading of this
disease.

Do not permit a child to wear or handle clothing
worn by a person during sickness or convalescence
from diphtheria.

Beware of any person who has a sore throat. Do
not kiss or come near to such a person. Do not drink
from the same cup, blow the same whistle, or put his
pencil or pen in your mouth.

Beware of crowded assemblies in unventilated
rooms.

IS6 HOME CARE OF THE SICK

Individual drinking cups should be used. A com-
mon drinking cup should not be used, especially in
school-rooms and places where there is liability of in-
fection. Diphtheria bacilli have been found on cups
in actual common use in schools. A fountain cup
would be less liable to spread disease, because the
water continually overflows the sides and tends to
wash away any infection which might otherwise col-
lect on the edges of the cup.

Children believed to be uninfected may be sent
away from the house in which there is diphtheria, to
families in which there are no persons liable to the
disease, or to previously disinfected convalescent
wards in hospitals ; but in either case they should be
isolated from the public until the expiration of the
period of incubation, that is, the interval of time be-
tween exposure to the contagium of diphtheria and
the first sign of the disease in the person so exposed.
This time may vary. In many cases it may appear
in seven days, in some cases twelve days or more ; the
average period is about seven or eight days, but for
full protection to the public isolation should be
observed for two weeks, at least.

Exposed persons should be isolated until this time
has elapsed.

The administration of antitoxic serum, by physi-
cians, has been found to be safe and quite effective
as a preventive measure, especially in children; and
when circumstances are such that they must remain

DIPHTHERIA 157

in the same house with a person sick with diphtheria,
the antoxin is so very important that it cannot prop-
erly be neglected. But even where the antitoxin is
administered, isolation of a person exposed to diph-
theria is advised, to prevent the spread of the disease.

Where Diphtheria Is Present in a Community. —
When a child or a young person has a sore throat,
bad odor to its breath, especially if it has fever, it
should immediately be kept separated from all other
persons, except necessary attendants, until it be
ascertained whether or not it has diphtheria or some
other communicable disease.

Persons who are attending upon children or other
persons suffering from diphtheria, and also the mem-
bers of the patient's family, should not mingle with
other people nor permit the entrance of children into
their house.

SANITARY CARE OF INPEQTED AND SICK PERSONS AND

ROOMS

Membranous Croup. — Modem researches point to a
probable common origin of diphtheria and membran-
ous or inflammatory croup, differing only in location
from true diphtheria; therefore, membranous or in-
flammatory croup should be recognized as a commu-
nicable disease dangerous to the public health, and
should be reported, and isolation and disinfection
should be enforced the same as in other cases of
diphtheria.

In all cases of sore throat, precaution should be

158 HOME CARE OF THE SICK

taken. It is often difficult to distinguish mild cases
of diphtheria from a simple tonsillitis, pharyngitis, or
lar5mgitis, and such mild cases of diphtheria often
commtmicate a dangerous and fatal form of diphtheria ;
therefore, it is the duty of physicians and householders
in reporting diseases dangerous to the public health,
and of local health authorities in their efforts to restrict
such diseases, in every case, to give to the public
safety the benefit of the doubt, and in localities where
diphtheria exists to regard cases of acute sore throat
as suspected cases of diphtheria.

Bacteriological Tests.— No health officer should fail
to act for the restriction of diphtheria in any case of
sore throat in which there is doubt, certainly not until
bacteriological tests have indicated the absence of
Loffler bacillus (now known to be the specific cause of
true diptheria). Such tests will be made at cost by
the "State Laboratory of Hygiene, Ann Arbor, Michi-
gan." Disease germs cannot lawfully be sent by
mail, except in special mailing cases.

Every person known to be sick with diphtheria
should be promptly and thoroughly isolated from the
public.

In ordering the isolation of infected or exposed per-
sons, the health officer means that their communica-
tion with well persons, and the removal of any article
from the infected room or premises, shall be abso-
lutely cut off, unless such communication is carried
on only under his supervision. Except it be disin-

DIPHTHERIA 159

fected, no letter or paper should be sent through the
mail from an infected place.

That this is of more importance than in the case of
small-pox is indicated by the fact of the much greater
number of cases of sickness and of deaths from
diphtheria.

The room in which one sick with this disease is to
be placed should previously be cleared of all needless
clothing, drapery, and other materials likely to harbor
the germs of the disease; and, except after thorough
disinfection, nothing already exposed to the conta-
gium of the disease should be moved from the room.
The sick-room should have only such articles as are
indispensable to the well-being of the patient, and
should have no carpet, or only pieces which can after-
wards be destroyed. Provision should be made for
the introduction of a liberal supply of fresh air and
the continual change of the air in the room without
sensible currents or drafts.

Handkerchiefs, that need to be saved, should not be
used by the patient ; small pieces of rag should be sub-
stituted therefor, and after being once used should be
immediately burned.

Soiled clothing, towels, bed-linen, etc., on removal
from the patient, should not be carried about while
dry, but should be placed in a pail or tub and covered
with a two per cent solution of carbolic acid Soiled
clothing should, in all cases, be disinfected before
sending away to a laundry, either by boiling for at

i6o HOME CARE OF THE SICK

least half an hour, or by soaking in a two per cent
solution of carbolic acid.

The discharges from the throat, mouth, and from
the kidneys and bowels of the patient should be
received into vessels containing an equal volume of a
five per cent solution of carbolic acid, and in cities
where sewers are used, thrown into the water closet;
elsewhere the same should be buried at least loo feet
distant from any well, and should not by any means
be thrown into a running stream, nor into a cesspool
or privy, except after having been thoroughly disin-
fected. Discharges from the nose, bladder, and bowels
may be received on old cloths, which should be imme-
diately burned. All vessels should be kept scrupu-
lously clean and disinfected.

All cups, glasses, spoons, etc., used in the sick-room
should at once on removal from the room be washed
in the disinfecting solution mentioned above, and
afterwards in hot water, before being used by any
other person.

Food and drink that have been in a sick-room,
or otherwise infected with diptheria, should be
destroyed or burned. They should not be put in the
swill barrel.

Perfect cleanliness of nurses and attendants should
be enjoined and secured. As the hands of nurses of
necessity become frequently contaminated by the
contagium of the disease, a good supply of towels and
basins, — one containing a two per cent solution of car-

DIPHTHERIA i6i

bolic acid, and another for plain soap and water, —
should alw^s be at hand and freely used.

All persons recovering, or very recently recovered,
from diphtheria should be considered dangerous ; there-
fore, such a person shotdd not be permitted to asso-
ciate with others, or to attend school, church, or any
public assembly until the throat and any sores which
may have been on the lips or nose are healed, nor until,
in the judgment of a careful and intelligent health
officer, he can do so without endangering others. The
bacillus which is the specific cause of diphtheria has
been found in the throat weeks after apparent com-
plete recovery from the disease.

In a house infected with diphtheria, a temporary dis-
infection after apparent recovery may be made, so
as to release from isolation the members of the house-
hold who have not had the disease, but those released
should be kept under surveillance by the health officer
for seven or eight days. After the period of infec-
tiousness has passed, a final disinfection of the room
occupied by the convalescent should be made.

Disinfection is Necessary — Diphtheria bacilli in a
comparatively dry state remain capable of renewed
activity for at least four or five months. Therefore
dust derived from the discharges from the throat,
mouth, or nose may cause the disease months after
the bacilli have left the throat in which they were
propagated. This is the reason why disinfection is
necessary.

i62 HOME CARE OF THE SICK

PINAL PRECAUTIONS

After a death or recovery from diphtheria, the law
requires that thorough disinfection of the infected
person and premises be made before releasing the per-
son from isolation, and that the local board provide
for a temporary shelter during disinfection. Disin-
fection of a room always necessitates vacating it, and
sometimes makes it impossible to remain in adjoin-
ing rooms; therefore, in some cases it seems essential
to have hospital, tent, or temporary shelter for the
inmates of infected houses, where bathing, disinfection
and washing can be done while such houses are being
disinfected and put in order.

Disinfection of the person, after recovery, consists
of a thorough washing with soap and water of the per-
son, hair, and beard, if any. Under the direction of
a physician an antiseptic bath may be employed ; but
antiseptics are, as a rule, poisons to be carefully used
as directed by a physician. A common antiseptic is
bichloride of mercury (corrosive sublimate), one part
to one thousand parts of water.

All infected articles, including the clothing worn by
the patient during recovery, should immediately be
destroyed or disinfected in a way so careful and com-
plete that the contagium have no opportunity to
spread the disease in the process. Articles of small
value, or which cannot be properly disinfected, should
be burned by a quick, strong fire.

Thorough disinfection should be made of the sick-

DIPHTHERIA 163

room, its contents, and all articles handled by the
convalescing patient. Germs have been known to
remain for a long time in the clothing, especially if
woolen, and packed away in drawers or trunks; and
books and furs that have been used or handled by
those convalescing from this disease are particularly
liable to convey the poison to children who have never
had the disease. Therefore, great care should be
taken to spread out as much as possible all clothing,
turning the pockets inside out; to expose as great a
surface as possible of the bedding to the disinfectant.
Cotton, linen, flannels, blankets, etc., should be treat-
ed with the boiling-hot water, introducing them piece
by piece, securing thorough wetting and boiling for at
least half an hour. Heavy woolen clothing, silks, furs,
stuffed bed covers, beds and other articles which can-
not be boiled, should be hung in the room during fumi-
gation, pockets being turned inside out and the whole
garment being thoroughly exposed. Afterward, they
should be hung in the open air, beaten and shaken.
Carpets are best fumigated on the floor, but should
afterward be removed to the open air and thoroughly
beaten. Pillows, beds, stuffed mattresses, uphol-
stered furniture, etc., after being disinfected on the
outside, may be cut open and their contents again
exposed to fumes of burning sulphur. In no cases
should the thorough disinfection of clothing, bedding,
etc., be omitted. Infected clothing and bedding have
b^en known to communicate diphtheria months after

..T

164 HOME CARE OF THE SICK

their infection . As diphtheria germs have been known
to find lodgment in wall-paper and remain active for
months, all paper should be removed from the walls
of a room occupied by a diphtheria case, before disin-
fecting said room. After disinfection the woodwork
should be washed with a i-iooo solution of corrosive
sublimate, or a two per cent solution of carbolic acid;
or better still, painted over with a coat of paint.

Rooms should be disinfected either with sulphur or
formaldehyde. For each thousand cubic feet of air
space to be disinfected, three pounds of sulphur should
be burned. Thus for a room about ten feet square,
three potmds of sulphur should be used. The best
results are obtained by using roll brimstone broken
up, or flowers of sulphur, burning the sulphur in shal-
low pans of sufficient number and size to rapidly fill
the room with the fumes, and having quantities suffi-
cient to last for several hours. Experience of the
health officers in Michigan seems to have demonstra-
ted that, in the ordinary homes of the people, in the
manner above mentioned, and without the presence of
the vapor of water, the specific cause of diphtheria is
rendered incapable of causing diphtheria. This is a
very important fact, because it enables us to disin-
fect rooms without the destruction of much property
which would be entirely ruined if the vapor of water
were present. The combustion of sulphur should be
rapid, and continue a considerable time. Care should
be taken to secure the complete burning of as much

TYPHOID FEVER 165

of the sulphur as possible. To avoid danger of fire
the iron pot or pan in which the sulphur is to be
burned should be free from leaks, and should be
placed over water in a tub or pan.

If formaldehyde is used, at least eight ounces of a
forty per cent solution, or not less than two ounces of
the solidified formaldehyde should be used and vapor-
ized, for each thousand cubic feet of air-space to be
disinfected. After disinfection, the room and con-
tents should be exposed for several hours, or days, if
practicable, to currents of fresh air and sunshine.

TYPHOID FEVER*

Typhoid fever is a communicable disease of pro-
tracted duration and found in all countries and under
all conditions of climate. It is one of the preventable
diseases, and sanitarians and physicians very generally
agree that there is no cause for its existence in any
community. This opinion is based upon a thorough
knowledge of the nature and character of the disease,
the well understood methods of infection and the
further fact that it is often directly and positively
controlled by modem measures. Notwithstanding
this, there are between 350,000 and 400,000 cases of
this disease with 35,000 deaths every year in the
United States. Its widespread prevalence is due
largely to public ignorance or indifference to the
measures which can and should be taken to prevent it.

*Sanitary Bulletin, October, 1906, New Hampshire State Board of Health.

i66 HOME CARE OF THE SICK

While no age is exempt from the disease, the most
susceptible period is between the ages of 20 and 30.
After 30 years of age, there is a decrease of liability
of infection up to 70 years of age, when it again
increases to the extreme limit of life.

Typhoid fever, although it exists at all seasons of
the year, is more prevalent in the autumn months.
Its greatest fatality is in September and October.
The reason why typhoid fever should be more fatal
in autumn than in any other period of the year is not
well understood. Many theories have been advanced
and some of the older ones abandoned. It is generally
thought that the summer heat and dryness are in some
way responsible to a greater or less degree for the
increased prevalence of this disease in autumn. It is
probable that the cold weather following has a
restrictive effect, so that upon its advent the disease
rapidly diminishes.

THE CAUSE OF TYPHOID FEVER.

Typhoid fever is a germ disease — that is, it is
produced hy a micro-organism, known as the typhoid
bacillus. The growth and development of this germ
take place within the body of the typhoid patient.
It is always found in great abundance in the dis-
charges of a person having typhoid fever, from the
time of infection to weeks after convalescence is
established.

This germ always maintains its specific character,

TYPHOID FEVER I67

and when it finds its way into the body of a person
who is susceptible, the disease is developed in some
form between that of a so-called walking case, slightly
indisposed, to the most malignant, fatal type.

Formerly it was believed that typhoid fever was
developed from general bad sanitary conditions, but
this view is no longer entertained, the fact being that
the seed must be sown, or, in other words, the par-
ticular germ of the disease must be taken into the
system before a true case of typhoid fever can be
established, and this germ comes from some prior
case. A further consideration of the subject will
show the various ways in which this may happen.

HOW TYPHOID FEVER IS SPREAD.

The most frequent medium for the spread of
typhoid fever is a polluted water supply, and it is to
this source that substantially all of the great epidemics
of typhoid fever have been traced. From a like
source, also, spring a great number of individual
cases, frequently classed as "sporadic," the water
being contaminated from sewers, house drains,
privy vaults, and other sources through which the
typhoid fever germ may be transmitted. A water
supply, whether well, stream,, reservoir, or pond,
that is polluted with human excreta, solid or fluid,
is a dangerous supply, because of the liability of
typhoid infection at any moment. It is therefore
highly essential that all water supplies, both private

"- • • " '

i68 HOME CARE OF THE SICK

and public, should be guarded against pollution of
this kind.

Another source of typhoid fever is an infected milk
supply. Outbreaks of the disease have occasionally
appeared from this cause. Milk infection may take
place through the addition of polluted water, or by
washing the cans and other utensils with such water,
or by the carelessness of milkers or others who handle
the milk, whose hands or clothing may be infected.

No milk should be distributed from a farm or dairy
where there is a case of typhoid fever.

Personal contact has been shown, by the commission
appointed to investigate the spread of typhoid fever
in the military camps during the Spanish War, to be
a factor in the spread of this disease heretofore only
partially recognized. In other words, the evidence
shows that the disease was transmitted by persons not
having the disease, infected bedding, clothing, eating
and other utensils, and this to an extent that suggests
the importance of most thorough disinfection of
persons and things having any relation to a typhoid
fever patient.

Flies are also carriers of contagion. Food may be
infected through their agency. Oysters and other
shell-fish that came from sewage-polluted waters and
were eaten uncooked have transmitted this disease in
numerous instances. Typhoid infection has un-
doubtedly been occasionally spread through vege-
tables grown upon infected soil and eaten raw.
Infection from such a source is possible.

TYPHOID FEVER 169

HOW TYPHOID GERMS ARE SCATTERED

The media through which typhoid germs leave
the body are the fecal xiischarges and the urine.
The expectorations in some cases of pneumonia
(typhoid-pneumonia, so called) also contain them.
In all cases where complete and constant disinfection
is not practised the organisms of this disease are
often so disposed of as to endanger the water and milk
supplies, and other food products.

The so-called sporadic cases (individual cases,
that cannot be directly connected with a prior case,)
may readily be accounted for when the various ways
in which the infection is distributed are understood.

An interval of 10 or 12 days takes place between the
inception of the germ and the development of the
characteristic symptoms, during which time the
patient is daily excreting the germs of the disease in
countless thousands. During this period of incu-
bation the patient is unknowingly scattering the
infection, wherever he may be.

There are also mild cases in which the patient is
under no restraint, and travel^ about as usual. Such
a case continues often for weeks, and, with no pre-
cautions taken, may cause a wide distribution of the
germs of the disease.

A third way in which the poison of typhoid is
extensively distributed is by patients who have
so far recovered from the disease as to be able to
travel about, or to assume their ordinary vocation.

I70 HOME CARE OF THE SICK

it having been demonstrated that the germ in many-
cases is present in the urine for weeks, and in some
cases for months, after convalescence is established.
It will, therefore, be seen that the typhoid fever germ
is doubtless very widely scattered, and when this
fact is understood, it does not require a great stretch
of the imagination to account for individual, or so-
called sporadic, cases.

These facts, thoroughly established by scientific
investigations, emphasize the great importance of
enforcing disinfection in the sick-room constantly
and to the minutest details and, further, of educating
the patient that unless intelligent and effective
precautions are taken he may be a source of danger
to the community for some time after recovery.

The typhoid germ is nearly always taken into the
system with food or drink, especially with water, and
multiplies enormously in the intestinal canal. It is
cast out of the body in the stools and in the urine, and
probably by no other channel. This is of the utmost
importance in considering measures to prevent the
disease. As stated above, this germ, or plant organ-
ism, can live for some time after it leaves the body,
just how long we do not know. In polluted soil,
that is, earth containing much vegetable and animal
matter undergoing decomposition, it may remain
alive for several months, and possibly longer. Many-
soils possess excellent filtering properties, and remove
practically all germs from water passing through

TYPHOID FEVER 171

them. Other soils fail to filter out these germs. A well
with a privy in close proximity is always moi-e or less
dangerous, and many outbreaks of typhoid fever
have been traced to this condition. The germs of
typhoid fever may get into the well at its top. In a
hilly or rolling country it is not uncommon to find the
privy on higher ground than the well. The privy
often has no vault, the stools and urine being
deposited on the surface of the ground. If the stools
or urine of a typhoid patient are thrown into the
privy, the first rain-storm may wash the germs of
the disease into the well. The roots of trees growing
into a well may serve as conductors for contaminat-
ing substances. A leaky drain near the well may
pollute it.

It is only since a few years that we have known
that the germs of typhoid fever are often present in
the urine of a person suffering from that disease.
Formerly they were thought to be in stools, so that
while the stools were carefully disinfected, and
possibly buried at a distance from the well, no atten-
tion was paid to the urine. The night vessel con-
taining nothing but urine was often emptied near the
well, where it was washed. We must now consider
that the urine^ from its liquid character, is even more
dangerous than the stools,

CARE OF A CASE

A typhoid fever patient should be placed in a large,

172 HOME CARE OF THE SICK

airy room without a carpet or unnecessary furnish-
ings. If there is diarrhoea, it is well to protect the
bed with a rubber sheet, placed under the linen sheet.
The most scrupulous care should be taken of the
discharges from the bowels and bladder. The stools
or urine should be received in a vessel containing
milk of lime, prepared by freshly slaking lime, using
one part of the resulting powder or creamy liquid to
four parts of water. Use a liberal quantity, and mix
thoroughly by stirring with a stick. Fresh chloride
of lime (it should smell strongly of chlorine), eight
ounces to the gallon, may be used instead, or carbolic
acid, seven ounces to the gallon. The contents of the
vessel may then be thrown into the water closet or
buried far from any well or spring.

If the body linen or bed clothing should be soiled
with the patient's discharges, they should be at once
removed and placed in the carbolic acid solution ; or,
if the odor is objected to, in a solution of corrosive
sublimate, a drachm to a gallon of water. After
soaking an hour or more, they may be laundered, as
usual. There is no disinfectant for clothing better
than boiling water, and if soiled clothing can be
promptly boiled this is the best treatment.

The nurse should be exceeding careful about dis-
infecting her hands immediately after handling the
patient. The carbolic acid or corrosive sublimate
solution will be suitable for this purpose, or Labar-
raque's solution, one pint to a gallon of water, is

TYPHOID FEVER 173

efficient and pleasant. She should never eat or drink
in the sick-room. As spoons, dishes, etc., used in the
sick-room may become infected, it is well to disinfect
these by boiling them in water for half an hour before
they are used again.

The disinfection of stools, clothing, etc., should be
kept up until the patient has fully recovered. While
it is not necessary to strictly isolate the patient, no
needless visits to the sick-room should be allowed.

In all outbreaks of typhoid fever of any considerable
extent, there are, as a rule, many doubtful cases;
persons who have fever for some days, and possibly
bowel symptoms, but who are not confined to the
house. These cases should be dealt with as typhoid
fever and taken care of, to secure efficient disinfection.

Allow no flies to have access to sputum or discharges
from the bowels and bladder, infected with typhoid
fever. The disease is liable to be spread by flies,
which go from infected excreta to bread, cake, and
other food to be eaten uncooked.

QUARANTINE UNNECESSARY

It is entirely unnecessary to quarantine a case of
typhoid fever, or the premises in which it exists,
provided proper care is given to all the details of the
sick-room, as recommended.

The use of placards has been largely discontinued
in this disease, and is not now required in this state.

If disinfection is practiced as strictly as it should

174 HOME CARE OF THE SICK

be, there is no danger of the disease's being communi-
cated to others from a given case ; but constant cleanli-
ness and disinfection are absolutely necessary to
secure such result.

DISINFECTANTS

For daily use in connection with a case of typhoid
fever there are no better disinfectants than chloride
of lime, and the milk of lime, formulas for which
are given below. The milk of lime has the decided
advantage of not having an objectionable odor.

At the proper time, general disinfection of the sick-
room should be carried out by the local board of
health, using the formaldehyde process already
recommended for this purpose.

CHLORIDB OP LIME SOLUTION

Chloride of lime (bleaching powder), one. pound;
water, three gallons. Mix. Cost, about three cents
per gallon.

Care should be taken to obtain fresh chloride of lime.

This solution is so cheap that it can be used with
great freedom, and it is one of the best disinfectants
known. A quart or more per day may be used in an
offensive vault, and such quantities as may be neces-
sary in other places. It may be used in a sprinkler
in stables and elsewhere. In the sick-room it may
be used in vessels, cuspidors, etc. Sheets and other
clothing used by the patient may be immersed in a

TYPHOID FEVER 175

pail or tub of this solution, diluted (one gallon of
solution to ten of water), for two hours, or till ready
for the wash-room or laundry. This solution is non-
poisonous and does not injure white clothing.

It may also be used for washing the hands or other
parts of the body which may have been exposed to
infection from excreta, etc.

For a free and general use in privy vaults, sewers,
sink-drains, refuse heaps, stables, and wherever else
the odor of the disinfectant is not objectionable, this
is one of the cheapest and most effective disinfectants
and germicides available for general use. It should
be used so freely as to wet everything required to be
disinfected. Its odor does not disinfect — only covers
up other odors.

MILK OF LIME (qUICKLIME)

Slake a quart of freshly burnt lime (in small pieces)
with three fourths of a quart of water — or, to be
exact, 60 parts of water by weight with 100 of lime.
A dry powder of slaked lime (hydrate of lime) results.
Make milk of lime not long before it is to be used by
mixing one part of this dry hydrate of lime with eight
parts (by weight) of water.

Air-slaked lime is worthless. The dry hydrate
may be preserved some time if it is enclosed in an
air-tight container. Milk of lime should be freshly
prepared, but may be kept a few days if it is closely
sk)ppered.

176 HOME CARE OF THE SICK

Quicklime is one of the cheapest of disinfectants.
This solution can take the place of chloride of lime,
if desired. It should be used freely, in quantity equal
in amount to the material to be disinfected. It can
be used to whitewash exposed surfaces, to disinfect
excreta in the sick-room or on the surface of the
ground, in sinks, drains, stagnant pools, etc.

Much of the so-called disinfection practiced in
families is wholly inefficient and useless. The burn-
ing of coffee, tar, sulphur, or other substance in the
sick-room or in any other part of the house or prem-
ises in the presence of the patient or other persons,
operates, at most, only as a deodorizer, and does not
destroy the germs of the disease.

It should also be known that many of the prepara-
tions offered for sale as disinfectants, germ killers,
etc., are worthless, or nearly so, and should never be
relied upon.

Reliable formulas are given by which a family may
make disinfectant solutions possessing the required
strength and efficiency, and at a much less cost
than is asked for proprietary preparations.

"In olden days, no crime was so atrocious as that
of poisoning wells, and even in times of war, the
moral sense of those heathen nations was sufficient
to prevent such a convenient way of destroying a
nation's enemies. But in these days, one city
poisons another's water supply without the. least

TYPHOID FEVER

177

hesitation and with Uttle or no protest except from
the State Department of Health." — Monthly Bulletin,
New York State Board of Health.

**The time is not far distant when an epidenic
of typhoid fever in any commonwealth will be
just grievance for damage against the municipality
allowing its existence. The water and milk supply
are the great sources of infection, and by adopting
proper sanitary and hygienic measures along these
lines typhoid fever can be wiped out.'* — Wisconsin
State Board of Health Bulletin.

FORMALDEHYDE DISINFECTION — A NEW

PROCESS*

A long series of experiments in the Laboratory of
Hygiene have developed the fact that formaldehyde
may successfully and very conveniently be used in
the disinfection of the rooms with the use of no lamps,
generators, or other special apparatus whatever.
In the process which has been employed in this work,
formaldehyde gas is liberated by pouring formalde-
hyde upon permanganate of potassium. At ordi-
nary room temperatures a chemical reaction results
whereby a high degree of heat is evolved. This
heat causes an effervescence or boiling, and formalde-
hyde gas is given off very rapidly.

The advantages of this method are, that the dis-
infecter need not transport apparatus from place to
place ; that there is no generator or lamp which might
originate a fire; that almost the whole quantity of
formaldehyde available for disinfection is liberated
in a few moments, thus giving the maximum concen-
tration of the gas before there has been time for
leakage of the part first evolved ; that, through the
action of the heat liberated by the chemical reaction,
a sufficient quantity of steam goes off wih the formal-
dehyde to insure efficient disinfection.

In carrying out this process of disinfection the

'Circular No. 75, State Board of Health of Maine.

178

FORMALDEHYDE DISINFECTION 179

requisites are simply the ordinary so-called 40 per
cent formaldehyde solution, commercial perman-
ganate of potassium, and a vessel to mix them in.

The required quantity of permanganate for each
pint of formaldehyde is 7>^ ounces. The perman-
ganate is first put into the dish and the formaldehyde
is then poured upon it. The permanganate must go in
first. Before the mixture, is made everything must
be in readiness, because a rapid flight from the room
must be made. Leave the room closed up tightly four
hours.

The vessel in which the permanganate and formal-
dehyde are to be mixed should be of considerable
size, else the vigorous foaming will throw a part of
the mixture upon the floor. A flaring ten-quart
tin pail is a suitable and large enough vessel unless
more than three pints of formaldehyde are to be used,
and even then until the disinfecter is well acquainted
with this process, it would be a safe precaution to
set the pail inside of a large pan. In this, as in all
methods of chemical disinfection, the disinfectsmt
action is more efficient the warmer the room.

As it is necessary to adjust carefully the relative
quantities of permanganate and formaldehyde, and
as it is much more convenient to measure the per-
manganate than to weigh it, arrangements have
been made with some of the druggists to keep in
stock a small tin measure holding 3^ ounces of
permanganate, **strick" measure, not shaken down.

i8q home care of THE SICK

The rule is, in ordinary disinfection: for each looo
cubic feet of room space to be disinfected, two
measurefuls of permanganate and one pint measureful
of formaldehyde.

A large quantity of formaldehyde and a shortened
time of exposure are more efficient and generally
more economical than a smaller quantity of formal-
dehyde and a lengthened period of exposure. It is
a saving to families that have to submit to disinfection
to have the time shortened, and is much more satis-
factory to them. With the time at four hours,
formaldehyde fumigation may be completed in the
forenoon and the rooms may have a lengthened
airing in the aftemooon so the family may occupy
their rooms the same evening The state board
of health now makes the following recommendations:

I. In ordinary disinfection, when the infection to
be destroyed is that of typhoid fever, diphtheria,
scarlet fever, small-pox, measles, grippe, whooping-
cough, dysentery or cholera, use one pint of formal-
dehyde for each looo cubic feet of space to be disin-
fected. Though a considerably smaller quantity
was found efficient in the experimental work, allow-
ance must be made for unusual leakage from rooms,
for low temperature, for insufficient moisture, for
inaccessibility of parts of the infection, etc. It is
necessary to have quite a wide margin for safety, but
the quantities herein advised provide for that margin
if the work is intelligently done.

FORMALDEHYDE DISINFECTION i8i

2. When the infection to be destroyed is the more
resistant micro-organisms of tuberculosis, or of
specticemia, a pint and a half of formaldehyde
(formalin) per looo cubic feet of space should be
used. The same quantity at least should be used in
the disinfection of books, clothing, and in all cases in
which the infection is not entirely open and accessible
to the gas, that is, when some degree of penetration
must be secured.

The experiments have shown that, used as is herein
reconmiended, formaldehyde gas has some consider-
able power of penetration; nevertheless, the state
board of health does not yet deem it safe to advise
any marked departure from the general method of
disinfection given in its circulars on the infectious
diseases — scrubbing up of floors, boiling the
cotton and linen clothing of the patient and of his bed
and such other badly infected articles as can thus be
treated, or soaking them in a disinfecting solution.

4 I v. a A

SUPPLEMENTAL PROGRAM ARRANGED FOR CLASS

STUDY ON

HOME CARE FOR THE SICK

MEETING I

(Study pages 1-13)
Symptoms of Disease

See Car^ of Children, pages 153-159, for children's dis-
eases. (Vol. XI of the Library of Home Economics.)
The Sick-Room.

See Household Hygiene, Ventilation and Heating,
Home Nursing, Harrison, pages 1-13. ($1.00, post-
age IOC.)

MEETING II

(Study pages 13-34)
Care of the Patient

Make bed with draw-sheet, as described in the text.
Change the bed as described.
Lift patient to sitting position.
Make back rest and foot brace.

Change patient from one bed to another, tv/o methods.
Change mattress with patient in bed.
Make a wadding ring to relieve pressure.
If possible, get a trained nurse to show how these things
are done.
Convalescence

Lift patient into a chair.

Topic — Amusing the convalescent and sick children.

MEETING III

(Study pages 34-62.)
Baths and Bathing

Make up pitcher of water, cool, tepid, warm, etc., of
the various degrees of temperature given on page 41.

183

HOME CARE OF THE SICK

Test with a bath or other thermometer and with the
hand. Note how unreliable the hand may be; after
the hand has been in the cold water, the tepid water
feels warm, and after having been in the hot water,
the tepid water feels cold.

Home Nursing, Harrison, . pages 63-73. ($1.00, post-
age IOC.

Practical Points in Nursing, Emily Stoney, pages 83-93
($1.75, postage 20c.)
Temperature, Pulse, Giving Medicine, etc.

Obtain a clinical thermometer and take temperature a
number of times, having all read the thermometer
to I- 1 oof a degree, and write the reading on slips of
paper. Compare results. If there is any difficulty
in shaking down the mercury, get a physician or
nurse to show how it is done. A clinical thermometei
may be purchased through the School for $1.25,
or will be loaned for loc.

Count the pulse in quarters for a second, as described,
and compare results as in the taking of temperature.

Count the respiration, as directed.

Have an exhibit of medicine glasses, feeding cups,
syringes, ice-caps.

Make poultices, sinapisms, flannel for fomentations,
compresses.

(Select answers to the Test Questions on Part I and send
to the School. Report on Meetings I, II, and III.)

MEETING IV

(Study pages 63-73)
Contagious Diseases: Disinfection

See article in the supplement, also send for and read
some of the following Bulletins issued by State
Boards of Health:

PROGRAM 185

Lansing, Michigan, '* Dangerous Communicable Dis-

eases. ' ^

Concord, New Hampshire, "Consumption."
Springfield, Illinois, "Consumption" also "Practical

Disinfection. ' '
Augusta, Maine, "Contagious Diseases."
Trenton, New Jersey, "Restriction of the Spread of

Infectious Diseases."
These Bulletins are sent free, or for a 2c stamp. Send

to your own State Board of Health, if not included

in the above; to your capital city, for any Bulletins.

MEETING V

(Study pages 73-105)
Surgical Work: Obstetrics

Practical Points in Nursing, Stoney, ($1.75, postage 20c.)
Food for the Sick

Food and Cookery for the Sick and Convalescent.
($1.50, postage 1 8c.)

Food for the Sick, French, ($1.00, postage loc.)

Hand Book of Invalid Cookery, Boland, ($2.00, post-
age 1 6c.

Collect appropriate recipes in addition to those given
in the text.

Show dainty and suitable serving for the sick.

MEETING VI

(Study pages 1 05-1 21)
Emergencies

Practice artificial respiration, as described.
Make a tourniquet.
Bandaging and Bandages

Practice all the bandages described. If possible, get

a trained nurse to show methods.
(Select answers to the Test Questions on Part II and
report on Meetings IV, V, and VI.)

INDEX

Air cushion, rubber, 29
Airing the sick room, 1 2
Amusing patient, 3 1
Antidotes for poisons, 113
Artificial respifation, 108

skin, 27
Ashes, removing, 13
Asphyxiation, 109

Baby, care of, 91
Back rests, 22
Bandages, 114

capeline, 117

foot, 115

forehead, 117

four tailed, n8

leg, 116

materials for, 114

of the hand, 118
Bandaging, 114

kinds of, 115
Bath thermometer, 37
Baths, 34

cleansing, 34

foot, 35

hot, 37

salt, 40

temperature for, 41

to reduce temperature, 36
Bed, the, 9*

changing, 16

height of, 9

making, 15

size of, 9
Bed sores, 25

care of, 28
Bibliography, 122
Bichloride of mercury, 64
Blood poisoning, 109

Brand treatment, 36
Bums, 106

Carbolic acid, 64
Care of nurse, 13

of patient, 13

of sick-room, 9
Catheterization, 57
Changing mattress with pa-
tient in bed, 25

patient from one bed to
another, 23

position of patient, 22
Chickenpox, 3
Choice of sick-room, 9
Cholera infantum, 5
Climate in consumption, 139
Colic, 4

treatment for, 4
Collodion, 27
Compresses, 62
Consumption, 65, 127
Contagion, 63
Contagious diseases, 2, 67
Convalescence, 29

diet in, 29
Convulsions, 5
Coughing, 125
Croup, 6

false, 6

membranous, 6
Cure of bed sores, 25

Diet in convalescence, 29

special, 95
Diphtheria, 4. ^53

cause of, 153

187

1 88

HOME CARE OF THE SICK

Diphtheria, precautions in, 155

prevention of, 154
Diseases, children's, 4

contagious, 2

not contagious, 4

preventable, 125
Disinfectant solutions, 64
Disinfectants, 63
Disinfection, 63, 65, 152, 161

at termination of disease, 70

formaldehyde, 177

of clothes, 68

of dishes, 68

of patient, 70

of room, 71

personal, 72

special rules for, 69
Dislocations, 11 1
Doctor, province of, i
Douches, 56
Draw sheet, 15

changing, 16, 19.
Drowning, 107
Dusting, II

Ear, foreign bodies in, 112
Emergencies, 105
Enema, cleansing, 54

soap, 55
Enemata, nutritive, 52
Epilepsy, 107
Epistaxis, no
Eyes, care of, 73

foreign bodies in, 112

Fainting, 106
Fever, scarlet, 4

typhoid, 5, 165
First aid to injured, 105
Floor of sick-room, 1 1
Flowers in sick-room, 9
Fomentations, 61
Food for sick, 93

Food, highly seasoned, 30
Foot brace, '22

Formaldehy dedisinfection, 177
Foreign bodies, 112

in ear, 112

in eye, 112

in nose, 112

in windpipe, 112
Fractures, in
Frost bites, 106
Fuel in sick-room, 13
Furnishings of sick-room, 9

German measles, 3
Gowns, short, 20

Hair, care of, 32

washing. 33
Hemorrhage, 90, no

from hmgs, no

signs of, 79
High temperature, 43
Hot pack, 37
Hypodermic injections, 53

Ice caps, 61

Incubation, period of, 2
Infectious diseases, 64
Inhalations, 53

steam, 6
Injections, 50

hj'podermic, 53
Intestinal obstruction, 5
Isolation, 67

time of, 3

Lifting patient, 20, 23, 32
Lighting of sick-room, 10
Lung diseases, 135

Mattresses, 9
changing, 25
protecting, 16

INDEX

189

Meals, serving, 29
Measles, 3

German, 3
Measuring glasses, 49
Medicines, giving of, 48
Membranous croup, 157
Meningitis, 6
Mother, province of, i
Mouth, care of, 33

washes, 34
Mumps, 2
Mustard plasters, 60

Night gown, changing, 18
Night, nursing at, 14
Nose bleed, no
Nose, foreign bodies in, 112
Nurse, care of, 13

clothing of, 14

duties of, I

night, 14
Nursing the baby, 92

Obstetrics, 80
Operating room, 75

table. 75
Operations, 73

precautions when over, 78

preparation for, 74

Patient, amusing, 31

care of, 13

lifting, 20, 32
Pillows, 28
Pills, 50
Pneumonia, 5, 145

precautions in, 147

spread of, 146

symptoms of, 5
Poisoning, blood, 109
Poisons, 113
Poultices, 59

applying, 59

Poultices, linseed, 59

starch, 60
Powders, giving, 50
Pressure, relieving, 28
Preventable diseases, 125
Prevention of bed sores, 25
Program for supplemental

study, i8i
Pulse, 44

counting the, 45

Quarantine, 70

Recipes, 97
Records, keeping, 46
Relapse, cause of, 29
Respiration, 46

artificial, 108

chart, 46
Rubber air cushion, 29

sheet, 16

Scalds, 106
Scarlet fever, 4
Scultelus bandages, 1 20
Serving, dainty, 29, 96
Sheet, changing, 18

draw, 15

rubber, 16
Shock, 107
Sick-room, 9

airing, 12

care of, 9, 134

choice of, 9

don'ts, 14

dusting, II

floor of, 1 1

furnishing of, 9

lighting of, 10

methods, 41

sweeping, 11

temperature of, 13

ventilation of, 12
Sinapisms, 60

igo

HOME CARE OF THE SICK

Skin, artificial, 27

care of, 27
Slings, T2I
Smallpox, 3
Spitting, 127, 147
Sprains, iii
Sterilized water, 77
Sterilizing dressings, 76

the hands, 78
Suppositories, 52
Surgical operations, 73
Sweeping, 11
S)miptoms, first, 2
Syncope, io6

Table, 10

bedside, 11

of contagious diseases,
Teeth, care of, 33
Temperature, 43

high, 43

normal, 43

Temperature of sick-room, 13

records, 44

sub-normal, 43
Temperature, taking the, 42
Thermometer, bath, 37

clinical, 41
Tourniquet, no
Tuberculosis, 65, 129
Turning patient,- 19
Typhoid fever, 5, 165

care of patient in, 171

cause ot, 165

spread of, 167

Ventilation, 12
window, 12

Wadding ring, 28

White plague, the great, 141

Windpipe, foreign bodies in,

112
Woimds, 109

UNIV. OF MICHIGAN,

DEC 9 1912

' \i.

"^vixpoBt at tt|( (UnnvBt

nrK) make housekeeinng an inspiring profession, instead
of deadening dnidgeiy.

nrK) make the daily work in the home of fascinating in-
terest instead of monotonous labor.

nrO make housekeeping easier and simpler by utilizing
modem science in the home.

nrO make the household money go further, that the
higher things of life may be included.

^L t *

n^O preserve and increase health, and thereby promote
happiness and prosperity.

'TX) develop the children — mentally, morally and physi-
cally — ^to theif finest possibilities.

npO effect the conservation and improvement of the
American home.

JO ». a«U o, A»«K.n WMli^.

— American School of Home Economics*

NOTE— The 100-pas6 booklet, "The Profession of Home-Maklngr." erlves
details of the home-stady domestic science courses. It^s free. Bulletins
"The Up-to-Date Home.** **Free Hand Oooklng** and "Food Values.** lOo
each. Address— A. S. S. B., 606 W. 69th St., ehloago, UL

THE LIBRARY OF

PARTIAL SYNOPSIS

Vol L THE HOUSE: ITS PLAN, DECORATION AND CARE, by
Prof. Isabel B'evier, University of llliDois.

Treats of the development of the modem
home and the American house, the planning of
convenient houses, construction, floors; the
problems of decoration and furnishing; gives
suggestions for changes, repairs, household con-
veniences, "The Cost of Building," etc.

VoL II. HOUSEHOLD BACTERIOLOGY, by
S. Maria Elliott, Simmons College,
Boston.

An interesting account of the microscopic forms of life and their
relation for good and evil to the household; what dust is and how to
make "dust gardens'* ; disease germs and how to avoid them; the protect-
io gagencies of the body and how to keep them active; sanitation, etc.

Vol. IIL HOUSEHOLD HYGIENE, by S. Maria Elliott, Simmons
College.

The healthful home; the best situation for the
house; importance of the cellar; all about drainagei
heating, lighting, disposal of wastes, plumbing
tests, the water supply; practical suggestions for
sanitary furnishings ana care; hygenic house-
keeping, etc.

VoL IV. CHEMISTRY OF THE HOUSEHOLD, by Margaret E.
Dodd, S. B., Mass. Institute of Technology.

*'A Day's Chemistry" — a fascinating account of the unseen forces
in the common things met in a day's work — ^r*^

water, air, fire, fuel; chemistry of food, of ^^^^^^ \w

digestion, of cookery, of baking powder, of . 2^^ \^ ^

cleaning, of laundry, of stains, of lighting;
home tests; home-made baking powder, soap,
etc., etc.

Vol. V. PRINCIPLES OF COOKERY, by Anna Barrows, Columbia
University and Chautauqua School of Cookery.

*'A key to the cook books" — analyzing and explaining the principles
on which success rests; all approved methods of cookery explained
particular attention being paid to economy of time and materials; full con-
sideration of menus, making a fireless cook-stove, "Directions for
Waitresses," etc.

VoL VL FOOD AND DIETETICS, by Prof. Alice P. Norton, Univer-
sity of Chicago.

Tells of the composition, nutritive value and
digestibility of foods; how the body makes use of
food; food economy; the balanced ration; healthful
diet for the sedentary, the aged, the children, and
so on; food adulterations, etc.

HOME ECONOMICS

Vol. VII. HOUSEHOLD MANAGEMENT, by Prot- Bertha M. Terrill

of Hartford School of Pedagogy.
Full treatise on economy in spending: the proper division of in*
come ; systems of househola ■ccounting ; syitem in housework ; the
servant problem; help by the hoar; buying supplies and fumishingst
how to market economically; cuts of meat; season of vegetables; ex-
periences of students; "Co-operative Housekeeping," etc

The wonderful human machine; running the
machine: care of the machine — sufficient physiol-
ogy given to show the reasons for the directions
for maintaining health; emphasis placed on do
rather than don't; articles on "Ethics of Health,"
"Use and Abuse of Drugs," etc.

E. Pope, Presbyter
City.

Includes the essentials of trained nursing; specific
directions for handling and caring for the patient;
nursing in contagious diseases; obstetrics; food for
(he sick; emergencies; poisons and their antidotes;
bandaging; articles on communicable diseases, etc

and fabrics; plain and ornamental stitches and
iheir applications; machine sewing; cutting and
fitting oi waists and skirts, color and ornament;
children's clothes; repairs, etc.

Vol. XL STUDY OF CHILD UFE, by Marion Foster Washburne,

editor "Mothers Magazina"
Thoroughly sensible and practical directions for the treatment of
children; faults and tlieir remedies; character building; home occupa-
tions; play; associates; studies and accomplishments; religious training;
the sex question, answers to questions, etc.

V<d. Xll CARE OF CHILDREN, by Dr. A. C. Cotton, Prof Chil-
dren's Diseases, Rush Medical College, University of Chicago.
The care of the baby before birth and of the .j
new baby; healthful clothing; development and 'I

frowtb of the child; authoritative and specific
irections for feeding; food disorders; food for
older children: treatment of children's ailments,
hydene of the child through the pubescence
peBod, etc

Bach volume has a program for supplemental Btudr, arranged
sipecially (or clubs, giving references, exhibits, experiments., etc

COMMENDATION ON THE COURSE IN BOOK FORM:

THE OUTLOOK

*It it true that the manajsement of the home and the care of the family may now
lightly be caUed both a butmen and a profession. Looking at the subject in this
h^t. the vohimes of this library may be regarded as the tools and formulae for
canying on the work in a systematizea and intelligent manner. * * * A wife
disaimmation has been exercised in the choice of the authors of the lessons, for these
wrften are recognized authorities and special students in the various fields with which
they deal. In all cases, simplicity of statement and clarity * * * brevity with-
out sacrificing completeness, are qualities carefully sought for.'

THE INDEPENDENT

"Each of these series of lessons is written by an expert — one possessing special
knowledge on the subject concemina which he or she writes. • • * 'Yh^
volumes are handy and are well illustrated and contain an immense amount of in-
formation. Things that it must take an old housekeeper years of experience to learn,
the young ho usek eeper may have here under her hand at the very beginning of her
regime.'

GOOD HOUSEKEEPING

'Practically all the material needed by the home-maker who wants to know
about the inside and the outside of her house and the health of those within it is to
be found in these twelve volumes. The books are easy to read and scientific with-
out being technicaL'

BOSTON COOKING SCHOOL MAGAZINE

"This is the first time that an attempt has been made to gather together the
whole broad subject of home economics into one correlated series of volumes. They
give an epitome of the kind and scope of instructions given on this subject at the
present time.'

THE CRAFTSMAN

'Altogether the course seems to be widely useful in its scope, and very straight-
forward and practical in its work.'

BOSTON TRANSCiyPT

'These well printed and Hberallv illustrated volumes present a course of reading
and study that shows to what extent the profession of home-making and art of living
make for self-culture and the practical ends of our daily existence.'

CHICAGO TRIBUNE

'Each volume is prepared by practical instructors, speaking with authority in
their particular lines. Iney are well illustrated and are calculated to diffuse a great
body of necessary information to those interested in household advancement.'

IOWA STATE BOARD OF HEALTH BULLETIN

'We most heartily commend these courses to all persons interested in healthy
homes and the development of a vigorous people-^ mentally, physically and, as a
consequence, morally.'

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