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SAUNDERS'

New Aid Series of Manuals.

I'oiiiiHeH Pfow Jteoftff,

FHYSIOIiOOT, >>y Jixrth llowAHn RAVHimn. A.M.,
M.l>.,l'nitt;»<uriifVli]'«.>lii«'iiii<lliy|iU'iKaiHl l^iurvt
(in (Iyncct;l<ii;y lu llic l.i>ii|t labuid lx>llr|;i! lliKpilal. clc

8UBOBBY, liriivntl H
'■■(■iiSTA. M. " ■■■■
.llnl full

«'. tlM a
DOSE-BOOK AND H&HUAI. OF FBB8CBIP-

TION-WBITINO, liy E. (i. Tiic.iii.Ti.ii, M. D., Hera-

(iiiMrninr of Tl].-ni]K.'ii[{.'>. ivgtn*ia Mvdical U.lk-g«,

I'tiUuili'lpliio. I'rlr.', II.;^. ui't.
MEDICAIj JUBISPBUDBNCE. Iiy IIknhv C. Chai^

KIN, M. D., Pn.foMc.r uf lii.-niiiieii Of Mi>dldne and

Vjg^^m

oirt

Dr. Orunt Self ridge

« *

PRACTICAL

POINTS IN NURSING

Nurses in Private Practice
appendix

CONTAINING RULES FOR FEEDING THE SICK; KECIPES FOR
INVALID FOOIW AND BEVERAGES; WEIGHTS AND MEAS-
U«ES; DOSE LIST; AND A FULL GUSSARY OF MEDI-
CAL TERMS AND NURSING TREATMENT

EMILY A. M. pONEY

. ThAINIHC ScHODL FUK NvCsia. LlWHIHCR,

r>BD«NT or Ti.*ii.ii«; ScMoeii, fob Nuihd,
HosFtTAL. South Boston, Muucku»its

PHILADELPHIA

W. B. SAUNDERS

915 Walnut Strkbt

1896.

"^ B SAUNDERS.

ft •
>• • •

♦ • •• •

• • • •
•• •••

••

• •

• • •

• • ••

• • • •

• ••

PREFACE.

In preparing the subject-matter of this volume, whose
I titk-page cleariy indicates its design, the author has

attempted to explain, in popular language and in the

shortest pofisiblc form, the entire range oK private nurs-
I ing as distinguished from hospital nursing, and to instruct

the nurse how bt;st to meet the various emergencies of
I medical and surgical cases when distant from medical or

surgical aid, or whon thrown on her own resources, stu-
I diously refraining, however, from advising the nurse to
I act upon her own responsibility or to assume ]jersonal
I treatment of the patient except under circumstances of
I great urgency. There is simply placed before the nurse
I what the different diseases are, their characters and chief
[ points of distinction and the attention required, their
I possible compSications, and the treatment likely to be
I adopted in a given case by the family physician, so that
I suitable preparations may be made by the nurse.

An especially valuable feature of the work will be
I found in the directions to the nurse how to imprm'ise

everything ordinarily needed in the illness of her patient.

In the sick-room the embarrassment of the nurse, through
I want of proper appliances due to unexpected conditions
1 or to her environments, is frequently extreme ; the diffi-
I culty may frequently be overcome by the simplest means
I when one possesses a knowledge of how to apply them.
There has also been attempted a logical division of
I the text, which includes the following sections :

16912

1 3 FREFACE

1 MicNiirM ; hor responsibilities, qualifications,equip- I

tncrit, lU'.
II. i'liu Sick -mum ; its selection, preparation, and man-
Ill. TliL- I'aii, III ; t urse in medical. surgi-
cal, iih-siL-tiLC )gic ca.ses.
nergencies.
^scs.

d Sick Children,
\jiatomy.

1 briefly, will be ample

'he Appendix contains

,.,..r. that will be of valm-.

IV. Niirsi„^i„ Ac(
\-. Niirsiti^r in Si«
\\ Nursing,' of the
VII. I'iiysir.lotjyam
'Ihu latter -^(jcti.Mi,
for the pur[iiisL'> nf

much inform, itinn in . ,„.

and the full Iiuhx prc■s^■nt^

cunsultinji any dc^irud to]>i.

The numerous illu-.tr,iti<

c-ady uu-dium

iikk-d will I>c
<.l c.rl;
>rk of t

■e.ihlc

treatment fallin^r s])ecific[illy to the

rinully. this di.scus.sion. being based on a -eri,- .M
lectures delivered before the Carney TraininL;-.ebo,,l toi
Nurses, will serve as a te.\t-booh for student mir.-e> and
a useful teach in!,'-b(K>lv for those uccupyiuL; positions a'-
tochers in trainin'j-.schools ; and it ma)' prove intere^lin;^
to the ■■ home " nurse who wi-hes to comprehend some-
thin- of tlie pur])o^es of Ihe dilferenl methods adopted
in nursiiiLi-treatment.

The Author's sincere thanks aic due t- l)i. |ohn K.
Shittery for his technical revisinn of the «oik and tor
other kind asMstanee. and to all who have IrIikiI by
friendly su-;^'estions,

i.MiLv A. M. s■l■(>^^:^,

CONTENTS.

I. THE NURSE 17

Rrapomibililies of the Nurse, 17 — Qualifications of ihc Nurae,
■9 — Duties of ihe Nuise, 20— Hospital Etiqueile-, thc^ Nurac'»
Duties lo her Su])eriiir*, 13 — Etiquette when out lYivnle
Nurui^, 24 — D^eI^s and Peisonal Habits oF [he Nurse, 35 —
Equipment of the Nurse's. Baj;, 15— Keeping the Recoids, 25.

U. THE SICKROOM 19

Selection and Preparation of the Sick-room, 29— rrepanition of
the Bed, ig — Changing the Bed-clnthmg, 30 — Dcii-making for
Difletent Cases, ja— Appliances (or the Relief of Bed-palientB,
34 — Care of the Sick-room, 36 — Hygiene of the Sick.ioom, 36.

III. THE PATIENT 39

I, NtiKstNC IN Mf.dicalCasks 39

I Grm/rai OtsfrvatiBHi in Af^/fiia/ Cam .Tiie Pfi\ie, 3g~Eody.

leiuperatuic, 41 — Respiration, 44 — Observation of Symptoms,

AS-
1. Bodily Cart of Ihe Palieni : Changing the Clothing, 53 —

Toilet of the Patient, 53— Baths, 55— Feeding of the Patient,

56 — M'jving of the Patient, 57. "

3. /Celiff of FunttioHai DisturbaHia : Enemata, 59— Rectal
Feeding, 64— Douches, 65— Catheleriiation, 68— Washing out
the Bladder, fig — Wnshing out the Stomach, 70.

4. A^minisltatioK 0/ Midirinrs ! Rapiditj of Absorption of
Medicines, 70 — Action of Meilicin«, 71 — Precautions to be
Observe'] in Handling and AdminiMering Medicines. -]Z. ( I )
Uedicincs by the Mouth, 74. (2) Medicines AdminiEiered per
Rectum, 76. (]) Subcutaneous Administration of Medicine \
Hypodermatic Injection. 7G. (4) Inunctions. 7)^. (;) Inhala-

14 CONTENTS.

PAGB

5. General and Local External Applications : Baths, 81 — Symp-
toms of Inflammation, 91 — Treatment of Inflammation, 91 —
Bleeding, 92 — Fomentations, 94 — Poultices, 95 — Dry Heat,
loi — Application of Cold, loi — Counter-irritants, 104 —
Blisters, 106 — Massage, 108 — Liniments, 1 10 — Lotions, 1 10 —
Gargles, Sprays, etc., no — Eye>drops, 112.

II. Nursing IN Obstetric Cases 115

Pregnancy, 115 — Signs and Symptoms, 115 — Duration of Preg-
nancy, 116— Conception and Date of Confinement, 116 — The
Fetus, 117 — Fetal Movements, 118 — Disorders of Pregnancy,
119 — Termination of Pregnancy, and Nurse's Preparations for

the Confinement, 120 — Labor, 122 — Stages of Normal Labor,
123. — Duration of Labor, 126 — Conduct of Normal Labor, 126
— Management of the Puerperium, 129 — Pathology of the Puer-
penum, 133 — Extra-uterine Pregnancy, 136 — Cesarean Section,
136.

III. Nursing in Gynecologic Cases 137

Preparation for Gynecologic Examination, 137 — Positions for

Examination, 137 — Preparation for Operation, 140— After-care
of Patient, 143.

IV. Duties of the Nurse in General Surgical Cases ... 144
Preparation of the Operating-room, 144 — Preparations for the

Operation, 146— Preparation of the Patient, 149 — Duties of
the Nurse in Emergency Cases, 151 — Nurse's Duties in
Operating-room, 156 — Arranging the Patient for Operation,
158 — After-care of the Patient, 159 — Sequelae of Operation,
159 — After-treatment of Patient, 163 — Surgical Disinfection
and Materials, 167.

IV. ACCIDENTS AND EMERGENCIES 172

1. Surgical Accidents: Fractures, 172 — Dislocations, 176 —
Sprains, 176 — Surgical Dressings, 176 — Bandages, 178 —
Splints, 186 — Extension, 187 — Wounds, 188 — Gangrene, 191
— Abscess, 192 — Boil, 192 — Carbuncle, 192 — Ulcer, 192 —
Fistula, 192 — Sinus, 192.

2. Common Emergencies: Hemorrhages, 193 — Burns and
Scalds, 197 — Sunstroke, 200 — Heat-exhaustion, 200 — Light-
ning-stroke, 20 i-r Fainting, 201 — Drowning, 201 — Accidents
from Fire, 203 — Retention of Urine, 203 — Head-accidents,
203 — Cuts and Bruises, 204 — Foreign Bodies, 204 — Insect

Bites and Slings, 205 — Dysmencirrhea, 205 — Vomiting, Joj —
Kkluktice, zod^Toollmclie, zo6 — Itisonuiia, 206— SunUirn,
106 — Fitut-liilc, Z07— Chilblains, 207.
3. Accidental I'oisiJNiNC: I'oiscm Defined, 208— ClaHificnlioii
uhI Action of Poiwna, 208~Whu to do in Ca^c of I'oisoii-
ing, J08 — Irrilam roisons, 109— Narcoue Puisons, 211 — Diics
of Rabid Animuls, 212.

I V. NURSING IN SPECIAL MEDICAL CASES. . .
I. InficHi'ui aiiJ Om/agiims Diiiosei : Infectious Disc:

= '3

— Contagious Diseases, 214 — Tyjilioid Kever, 215 — Scarlet
Fever, 222 — Typhus Fevct, 225— Small -lox, 226— MeaslcR,
228 — DifiliLlicria, 229 — Fumigation of Sick-ronm after Con-
tagious Dbeases, 234 — Phthi»s, 236 — Simple Croup, 237 —
Membranous Cniup, 238 — Whoopnc Cough, 238.
3. FuHelional and Idiopathic Diitain : InfluedM, 239 — Croupous
PDeuinonli, 241 — Bruncljitis, 242 — Asthma. 243 — Ileurfsy,
243 — Empyema, 143 — Angina Pectoris. 244 — Gastritis, 244 —
Perilunilis, 245 — Appendicitis. 246 — Dysentery, 248 — Cholera
Morbus, 149 — Acufe Diarrhea, 250 — Uremia, 250 — Ceretiro-
spina] Meningitis, 251 — Cerebral Apoplexy, 251 — I'aralysis,
254 — Epilepsy, 254— Hysieria, 356 — Neurasthenia, 257—
Dropsy, 257— Diabetes, 258 — Rheumatism, 258 — Diseases of
the Skin ; Eczema, 259 — Scalnes, 259 — Ringworm, 260 —
Herpes Zoster, 260 — Caring for the Dead, 261,

|VI. NURSING <»K SICK CHILDREIT 262

lire of the Newborn, 262 — Cnre of IVemalurc Infants, 269 —
DUc3«cs of Infancy, 270 — Diseases of Childhood. 37S — Sur-
gical Diseases of Children, 3S0 — Nurse's Managemeot of
Children, 2S1.

iPHVSIOLOGV AND DESCRIPTIVE ANATOMY 285

1. Physiefagy : Blood -circulation, 285— Respiration . 2S9 — Diges>
tion, 290 — Secretions, 292 — Excretions, 293~Urinary Urgajis.

S93.

2. Dtitriftkt Anatomy : The Skin, 2q6— The Hones of the Body,

296— The Muscles of the BmIv. lot)— Heart, Blood-vessels,
and Lymphatics. 300— llmin. Coi.t. Nerves, and Organs of the
Senses, 301 — Rcspiralnrv, Digestive, and Urinary Organs. 305
— Inlcmal Female Clq;ans of Generation, 309,

- V

v.|>cs l()r Invalid Foods and Hcvcragi
Simple I'aiinaccous l'\>otls, 317 — Ik
\\<) -Urol hs. 321 —Oysters, 322 — V\
324 — Miscellaneous Dishes, 325 — V
Toasts, 328 — Desserts, 329 — Bevei
Waters. 337.

II. Wkiciits and Measures

III. Tahlk for Computing Date of Labor

IV. Abbreviations

V. Dose List

VI. Glossary

Index

Practical Points in Nursing

FOR NURSES IN

PRIVATE PRACTICE.

I. THE NURSE.

BssponBibilities of the Nurse. — In these page^
writer will ciicieavor to tcli the nurse what she can do
when private nursing, especially among the poor, who
have not the proper things to do with ; what she can use
in place of the things used in the hospital; also what
she can do in an emergency when at a distance from
medical aid, and when she must use her own knowledge
and Judgment It is for this reason that the writer de-
sires the nurse fully to understand, and to have an intcl-
Ib'gent idea about, the different cases which are most
likely to come under her care. These instructions are
not intended for hospital use; indeed, there would be no
possible excuse for the nurse to act on her own respon-
sibility in the hospital, as there is always a doctor within
calling distance, while in private practice she is left alone
with the patient, and is expected by the doctor or the
surgeon to know what to observe and to do in emer-
gencies until he arrives.
The profession of nursing is one in which there is
no limit to the good that can be done ; it is also one in

]$ PK.tr : h-AL rOMTS IN NURSISG.

which L'vriy \v( mi. id embracing it must " walk worthy of
thu voc.itinii wli, r.'ivith she is called." " A nurse should
havL- sTuh tact, a-, well as skill, that she will do what is
best for the i!,iii,iits, even against their will, knowing
how to niana^L- lli" "™^t— =t infl most irritable, and
doin^ all that i-, nu-c without their km

iiif; it." " She must y clean and neat in

her own person, csp ard to the arrange-

ment of her hair, wh nooth and well kept.

ThL' office of nurse i.s < holy for any woman

called to it to HJ-h to ne to the adornment

of her person. 1 !er gards herself, should .

be to be clean, simpl sweet-tempered, arid 1

to know how to mind her own bu.sincss " — to keep her
health unimpaired by securing' sufficient rest, sleep, fond,
and exercise, without wiiich tiie best will bre:ik iIiumi
and suffer in health.

A nurse should imjirove her mind by readins; the be.-^l
books at her command, by j;<iin^ out and visiting fiiend.--,
and by attcndin!^' the theatre twice a month : ihi-. will keep
her in touch with outside affairs, and >he will be able to
converse intelligently with her patients. Her manner
toward her pjitients and toward all with whom she comes
in contact should be kind, pleasant, courteous, and cheer-
ful— repressinj; all attempts at familiarity. It should he
remembered that while we cannot dictate the maimer of
other people toward us, yet we can to a certain e.vlent
have il wh.it we would like it to be; and we can ,d\\,iys
control our bearing- toward them. The nurse .sh-uld
culli\ate a c"nteiited mind and a cheerfiil face, ,noid
affectation an<l all temptation to air her knowIedL;e— a
niist:d.:e that m:iiiy nurses are prone to make — Lind kain
to control her emotions. The patients should be made

THE NURSE. 1 9

TO feel that tlicy arc her first thought, and they will learn
I to have faith aiid trust in her.

Unlike physicians, nurses are not called upon to attend
L charity calls. Very few nurses during their first year of
I private practice are worth tlie large fees they ask and
I receive. This mercenary spirit is steadily increasing.
I instead of decreasing. It would be well for all nurses to
I remember the words of the late Dr Agnew : " It is a
■ great and a good thing to feel that you are not always
Bworking for mere money." This feeling a nurse will not
Kitave if she enters into the work for the love of the good
Kthat can be done in lessening the weariness of pain and
Riinisery with which she comes in contact.

No nurse should take up the work unless she feels

that to serve the poor is her vocation. She must try

how much she can do for each patient, remembering

that, so far as the nature of the work admits of it. every

Lpoor person should be as well and as tenderly nursed as

T he were the highest in the land. The very essence of

Bnursing in the homes of the poor is management, tact,

md thinking for the patient. Applications of poultices

; not the only duties of a nurse, although they are in

themselves of vast importance.

The writer wishes particularly to impress upon the

Slurse the responsibilities of night duty. It is in the

fnight-time that a very large majority of patients require

[he most careful watching and nursing. It requires a

PVery competent nurse to do night duty — one who is

gentle, kind, charitable, and patient; a large stock of

patience is always necessary because of the large de-

I niands that are made upon it during the night.

^^^^ QiialiflcatioiiB of the Nurse. — The questions asked

^^^Bby physicians and surgeons before employing a nurse

20 PRACTICAL POINTS IN NURSING.

are : Is she neat and clean, and does she understand all
the recent antiseptic methods ? Is she competent to meet
an emergency ? Does she know what to look out for in
the cases under her care, and when to send for the physi-
cian ? Is she modest in assuming responsibility ? faith-
ful to the physician's orders ? patient, and fitted for the
cares of a severe and critical illness ? All these ques-
tions are asked, together with others, and it is a nurse
possessing just these qualifications that each one should
wish to be.

Duties of the Nurse. — On first going to the house
the duty of the nurse is to find out where everything
that will be needed is kept, then to wait on herself quietly
and without intruding.

The time of the nurse belongs to the family em-
ploying her, but she has full control of the patient and
the sick-room. There is no place where the presence
of mind and powers of observation of a nurse show
so plainly as in the operating-room ; so do the gentle-
ness, modesty, refinement, and cheerfulness of a nurse
shine clearly in the sick-room.

A nurse should be as little trouble to the family as
possible, and improi^ise all she can, remembering that
they are under very great expense. The same caution
should be observed in dealing with the servants : she
should be kind to them, and add as little as possible
to their work in the kitchen or the laundry. She should
wash and put away all glasses and dishes used for the
patient, as is done in the hospital ; they must not be left
in the kitchen for some member of the family or the ser-
vants to wash ; the nurse must do it herself

The patient should closely be observed, and all that
can be done to make her comfortable should be antici-

THE NURSE. 21

patcd, not waiting to be asked for anything. Tiie nurse
should wear noiseless shoes, and move about the room
quietly; she should look where she is going, and not
knock against tlie bed or the furniture, avoiding every-
thing which may annoy the patient.

The nurse should begin early in the evening to pre-
pare for the night — to get everything that will be needed,
and when moving around in the night should make no
noise, so that the patient and the family will not be dis-
turbed.

Sleep must be taken when it is most convenient for
some member of the family to relieve her; the same
with the meals, which should be taken alone, unless the
family really wish her presence at their table. At such
times, when she is away from the patient, written orders
for the substitute must be left, and she should make
sure that the one who takes charge understands thor-
oughly how everything is to be done.

The answer to the question. Should a nurse refuse to
take her meals in the kitchen? deixrnds on the circum-
stances of the family. It does not at all lessen the dig-
nity of the nurse to cat in the kitchen, a gentlewoman
being always treated as one wherever she is. It is not
.-degrading to assist in the kitchen when emergencies
it shows the true spirit of a nurse, and the kind-
5 not lost

A nurse mu.st not talk of her hospital days; she will
find a number of patients very curious to hear of the
different cases and operations that she has seen, but
they must not be talked of; it has a depressing effect
on the patient. A nui-se must be cheerful and talk of
cheerful things. Nor must she tell of her experiences
in other families : ail that she hears or sees in the &mily

rKAVnCAL POINTS L\' NUfiSINC.

for whom -^Iil- i-; working must be kept secret and re-
vtjalcd to iin mic; she has no right to speak of one
patient to ^nnthcr in private or hospital practice, or to
criticise or discuss her patient's peculiarities outside her
report to tJiu physi

The directions ol
out, and in tJie ab
think what licwoul
a mistake, it should
the physici.m will
mistakes are kfl fi
lose confidence in

If any trouble )
getting fresh air, or anytiiin;
worry the patient about it. but speak tn tJie
who will always be found a warm friend.

i\ nurse will often work for doctors wiio
cases entiiely different from the way she has
to seeins; theni treated. The doctor makes t
sis and i^'ives his orders as to the treatment (
and. no matter what the nurse may think, it
interfere with her accurate aiul faithful executi.
orders. She should never be guilty c,f maki
tions to the dtjctor: she is there to carry out
to observe every little lliinj; about the patient,
port to him in a clear, simple way ; her judi^i
never be allowed t.i prevent lier from doin- 1
the ph;

ust faithfully be carried
ions the nurse should
lone. When she makes
it the first opportunity ;
md very kind; but if
I out, he wilt naturally

egardin^ meals, sleep,

he diagno-
.r the case.

Some families
about the atttni
c.uvrul how sli.'
-ihie confidence
worked for him 1

JslH

I the

I'll

SIk'

THE NURSE.

tion the doctor about the nurse ; the battle 1.1 half won
when the family has confidence in both physician and
nurse.

Hospital Etiquette ; the Nurse's Duties to her Su-
periors.— The diffcrciici; between hospital nursing and
private nursing is very great. The regularity of hospital
life and tho strict discipline which prevails arc of great
benefit to a nurse in as.sisting her to become punctual,
trustworthy, patient, obedient, and courteous. Evefy-
thing needed in the care of the sick is at hand in the
hospital, and a si.ster-nurse and a doctor within calling
distance. She has a number of patients under her care,
whereas in private nursing she has to do with a single
patient, and her success depends mainly upon making
the relation one of satisfaction and esteem, and upon her
ability to meet the sudden emergencies which may arise,
having no longer the sister or doctor to call upon. There
I are also anxious friends and relatives to meet, and who
\ in their own opinion know how everything ought to be
' done.

The presence of a senior or a junior member of the

hospital staff, the superintendent of the hospital, the

superintendent of nurses, or strangers visiting the hos-

■ pital is a severe test of the professional manners of a

[ nurse. A nurse must always receive any hospital officials

I standing, and remain standing like a sentinel on duty

until they have left the ward or room. It is a courtesy

1 due to the position which they hold. During the visit

I of a physician the nurses must be ready to accompany

I him, and answer any questions he may ask, If the

% bead-nurse is in the ward, she will accompany the doc-

■tor on his rounds and answer all questions. A nurse

Imust never answer a question or give the doctor any

XTytl,
.rcvail while tliL- c
Etiquette when

Ihu (.■ti<iiiultu wIrii I
ruius to bu oliJ-i.Tvi
luirsc to ri.su when
to rcniLiin .staiuiinj
^illoukl hand him h
»|uictly Ic'uvu tlic r<
private practi

iiiforniatioii ahuLii a patient or patients when tlie head-
i present, unless the question is put directly to

her. 'HiL' heaii-imrse is responsible for everything that
occurs on the Unor of which she has charge, and it is
the duty of tlii; nurses to kt:cp her fully informed of

I'erfect quiet must

c stethoscope.
irsing . — R ega rdi n g
lorc .ire no definite
of respect for the
ters the room, and
o be seated ; she
all questions, then > ]
....1 n .1 period plan rn both
.pilal ]irivalc paliriil-^, for in
the physidan is the faniiiy frioid, and there
may be many tliinL;.s about which the ]iatient would
like to ,s|K'ak witli llie doctor, and not care to have the
nurse hear. If the lu-se ol,ser\es lliis course fr.an the
bej;iniiin!;. it will >,i\-e her the iirnbable eitibarrasMneiit
of bdn- asked to ka^e the mom. Then, .i-ain. -he
will have an n|.|,orliuiity ..f --peakini; t. the doctor uf
.unthini; reLitiiv.,' to tlie ca>e of \ihich the i>,itient
sh^uklnot kn.nv.

.She should al-. leave the room « hen a vi-itor cmes,
so th.at p.atient and frien.l cm eniov thrir talk alone: if
the vi-it is limited, the \i-itor .-liouM be told u lien llle
time ha- expired.

A nur-e -hnidd n.>t «hi-per in the McL-n.om: it
makes the |ialient think she i-^ bein- t.ilked abotil : it
should be remembered th.a the lie.nitiL; of;, ],.itient who

.|ipa

o„e-.t wh),pe

the

THE NURSE.

f case should not be discussed nor any but the kindest

I things be said before a patient.

Drees and Personal Habits. — The dress of a nurse

\ should be of cotton goods. She should always wear her

I cap; it is her" badge of authority." Her appearance must
at all times be as though she had just been lifted out of
a bandbox. At night she should wear a flannel wrapper
and soft shoes and look as neat as in the daytime. She

■ should shun curl-papers; under no consideration must
she be seen with them or even be seen using curling-
irons, or she will lose the respect of the patient, the
family, and the physician.

Equipment of the Nurse's Bag. — Some of the things
which everj' nurse should carry in her bag arc — a clin-

Iical thermometer ; a pair of surgical scissors and forceps ;
small bottles of brandy; tincture of digitalis; strychnia
tablets, grain ^^th ; morphia tablets, grain ^th ; normal
Uquid ergot ; a hypodermic syringe ; a fountain syringe ;
two glass catheters ; a flexible catheter ; small bottles of
corrosive tablets ; carbolic acid, I : 20 ; permanganate-of-
potash crystals ; oxalic -acid cry.stals and washing soda;
rubber tubing ; a razor ; large and small safety-pins ;
needles and white thread ; one-ounce graduate minim-
glass; a medicine-dropper; temperature and nouri.sh-
ment charts ; gauze sponges of various sizes ; a small
I ice-pick ; matches.

A fountain syringe will be found very handy in pri-
fvate practice. It can be used for a number of things — to
iwa.sh out the stomach and bladder, for douches, as an
lirrigator, and the rubber-tubing attachment can be de-
I tachcd and be used as a tourniquet.

Keeping the Records. — It is a good plan to write out
|.the phyaidan's orders on paper, for instance :

PRACTICAL POINTS IN NURSING.

Mnk,6 ounces. «{J°.^'|*j;j;^

Ordered medicine, i teaspoonful, at < m'J^l,

Whi.Vy. i ounce, at { f.^o. -.30 x. m. ^ ^

Flaxseed poultices to chest, at| ^» c'7^*p**i

The hours must be checked off as they are filled. If
the orders keep about the same, the paper will last two
days by checking the opposite way on the second day.

The day or night Report will run somewhat as follows :

Day Report.
Mrs.

Extra-uterine.

Milk, 2 ounces, 8, 9, 10, 1 1, 12 a. m; I, 2, 3, 4, 5, 6, 7 p. M. Total,
24 ounces.

Whisky, 2 drachms, 8*, 9**, 10**, ii* 12* a. m. ; i*®, 2*, 3'", 4*, 5*,
6», i^ p. M. Total, 3 ounces.

Strychnia, gr. ^y subcutaneously, 9, 11 A. M. ; 1, 3, 5, 7 p. m. Total,
^ftjths.

Milk, 4 ounces, 1

Whisky, i ounce, • "^^ ''^^*"™' '° ^- M. ; 2, 6 P. M. Retained.

Effervescent citrate of magnesia, bottle I. Given in divided doses dur-
• ing the day.

Low enema of —
Turpentine, \ ounce,
Epsom salts, 3 ounces.
Glycerin, 4 ounces.
Warm water, 12 ounces,

High enema of —
Turpentine, I ounce.
Magnesia sulphate, I ounce.
Glycerin, 4 ounces.
Warm water, 8 ounces,

Rectal tube inserted, very little gas expelled. Abdomen very much
distended.

at 9 A. M. Was not retained. Returned
soon as injected.

at 10, II A. M., I p. M. Was not re-
tained. Returned soon as injected.

THE NURSE.

Bo well did not move.

Though pBlient did nut sleep, yet she bud a comfbrtnlilF <lay.

Magnesia aul[)liate, I drachm, i
Hoi coffee. I drachm, J

Strychnia, gi. jij, subculaneously, 9, ii p. u.: 1,3,5,7 A.M. Total

Whisky. \ ouace, 8, 10, 12 P, M. ; 4, 6 A. M, Tolid, ij ounces.
Oxalate cerium, gis. 5, ai 9, 10. Total, 10 grains.
Nouriahment — \

Milk, 10 ounces, i Tdal. 15 ounces through the night.

Bccf-tca, S ounces, I

Temperalure and puUe taken every two houis and recorded on chart.
Urinated at 9 P. M.. 3 ounces, 1

" " II P. M., 3 ounces, !■ Total, 7 DODced.

Bowels moved at 9, II. 30 P. M. 1

/ery good

; veiy good.

After bowels moved al 9 o'clock distention gmduaHy disappeared ; very
I lillle diflentiun this morning. Passed considerable gas.
Slept continuously 1) hours, ■

" " Ij '• [ Total, S hours.

al inlervals i " \

Hkd ■ comforlabte night.

Another favorite way is to rule a sheet of paper, leav-
ing spaces for the hour, temperature, pulse, nourish-
t ment, stimulant, medicine, sleep, and remarks, For in-
f stance:

i :

I TlieJt; twfnty-fniir-hci'

THE SlCk'-ROOM.

II. THE SICK-ROOM.

Selection and Preparation of the Sick-room. — The
sick-room should be on tht; sunny side of the house
and capable of thorough ventilation. If there is a
stationary basin in the room, it should be covered with
paper or a board, or be kept filled with water, which
must be changed often ; this will prevent impure air
coming up through the waste-pipe should the pipe not
be properly trapped. The room should be as near the
top of tlie house as possible, for the reason that the
higher we go the purer i.s the air, and aUo that if a
room on the lower floor is used the germs of the disease
will be carried upward. If the light is too bright, the
bed should be so made that the patient will lie with the
back to the window, or a screen may be put before the
•window. If the case is disease of the brain or the eye,
llhe room must be darkened; the curtains so arranged
that there will be no flapping when the window is open,
nor flashes of light.

Preparation of the Bed. — Probably the first thing
that will need the attention of the nurse will be the bed.
In very few families will she find the mattress protected,
which should be done both for cleanliness and expense.
Many think that in the absence of a rubber sheet or an
oilcloth an old blanket or a comforter will do to protect
the mattress, but such substitutes must not be used if it
can possibly be avoided, as it is impossible to know

'here they have been or how dirty they arc ; they may
filled with germs. Newspapers can always be pro-
cured, which will absorb the discharges, and which can
be bumed when removed. They are to be placed be-

o- ,

PRACTICAL POINTS IN NURSING.

tween the under sheet and draw-sheet, which, if put on
here, will keep the under sheet clean much longer.

In making the bed the under sheet should be well
tucked in at the top and sides, even if it is a little short
at the bottom, for it is easier to pull an under sheet
down from the bottom than to pull it up from the top.
Next comes the rubber sheet, oilcloth, or newspapers.
The four corners of the rubber sheet must be pinned to
prevent wrinkling. The smooth end of the draw-sheet
must come under the patient's back. The upper cloth-
ing must be well tucked in at the foot, still not too
tightly, and the nurse should guard against a weight
of clothing lying on the patient's chest ; if the sheets
or blankets are very long, the surplus must be brought
down to the foot of the bed.

Changing the Bed-clothing. — Before beginning to
change the bed- or body-linen the nurse should get
everything ready and thoroughly aired and warmed.
The patient is moved to the other side of the bed, and
the upper and under sheets are loosened ; then the upper

Fig. I. — Changing the bed-sheet without removing patient from the bed (a, sheet

partly rolled ; b, sheet partly folded).

clothing and under sheets are pushed well over against
the patient's back, and the clean sheet, rubber, and draw-
sheet inserted, the under sheet being tucked in at the top
and sides, and rolled up close to the soiled sheet (Fig. i).

THE SJCK ROOM.

upper clothing is then spread out, and the patient

ed back to the clean side, after which the soiled sheets

removed, and the clean sheets be well stretched

tucked in at the top and sides. To change the

r sheet, the spread and one blanket are removed ;

over the soiled sheet put the clean sheet and blanket;

tiien, with one hand holding the clean sheet and blanket,

jthe soiled sheet and blanket are drawn down toward the

hi o( the bed and removed with the other hand. In

langing the bed in this way we guard against exposing

chiUing the patient.

When the patient cannot turn on the side, the bed

should be changed from the top, the soiled sheet being

first loosened at the top and sides and pushed well

down under the pillow. Another person must assi.st at

the other side of the bed in working down the two

sheets ; the shoulders, back, and upper part of the thighs

the patient must be raised with one hand, while the

cts are worked down with the other hand. In case

fractured limb, one person must support the limb

ivc and below the fracture, taking care to raise the

lb very gently.

When arranging the pillows, the head of the patient
should be lifted and supported by the nurse's arm, her
hand supporting the back ; with the other hand the pil-
low IS turned, the lower pillow being brought under the
shoulders to support the back, the upper one to support
the head without bringing it too far forward or loo far
backward. The patient must be permitted to suit herself
in arranging her pillows, as every patient has a favorite
way. A pillow should nc\'er be shaken up on the bed;
the upper pillow should be removed and shaken away
from the bed, then the second pillow taken out, replacing

32 PRACTICAL POINTS IN NURSING.

it with the fresh one, so that the patient will always have
one.

Bed-makingr for Different Caaes. — We will now con-
sider the making of beds for the different cases which
come under the nurse's care. In private practice the
supply of bed-linen may be very limited, and for this
reason it would be well first to put on the under sheet,
then the protector, which may be of rubber, ordinary
table oilcloth, or newspapers, then the draw-sheet ; by so
doing the under sheet will be kept clean much longer.

Medical and Surgical Beds. — ^A medical and a surgical
bed is made with an under sheet, a protector, a draw-
sheet, and the usual upper clothing. If the bed is to be
prepared for a patient with a broken limb, a wide board,
table-leaf, or small strips of board (slats) or an ironing-
board must be placed across the middle of the bed,
under the mattress, to make the bed firm and prevent
sagging.

Obstetric Bed. — An obstetric bed is made with an
under sheet, a protector, and a draw-sheet, then over
these a second protector and sheet ; this is called a
*' temporary " bed, which, after all is over, is easily re-
moved, and the patient lies on a clean bed ; both beds
during labor must be pinned securely to the mattress
at each comer, the protectors also being pinned at their
four corners. If the bed is a large double bed, then one
side of it should be prepared, or the lower part of one
side. After delivery the patient is lifted to the other
side, or to the upper part of the bed, whichever has been
prepared. Here the writer again warns the nurse not
to use old comforters or blankets, unless positively sure
that they are clean ; if there is any doubt about it, then
give way to the doubt by not using them.

THE SICK-ROOM. 33

Cross-bed. — A cross-bed is vtry often used for gyne-
cologic examinations and minor operations; the pillows
are arranged across the bed in the middle, which arrange-
ment brings the hips of the patient to the edge of the
bed ; across the mattress under the sheet is slipped a
table-leaf or board, which will, to a certain extent, take
ithc place of the examining table ; the patient lies upon a
■hard surface, thus preventing the body sinking into the
A sheet and a blanket are the upper coverings.
Divided Bed. — Some surgeons like the upper bed-chlh-
Wg dh'ided for abdominal cases. For this form of bed
are needed two sheets and two single blankets,
fhich are doubled, placed over the patient, and meet in
ithe centre, the sheets first, then the blankets. The upper
clothing is thus divided into two distinct halves; the
bed-spread being put on as usual. When the dressing
is to be done, the spread is thrown back and the sheets
and blankets parted, so that unnecessary exposure of
the patient is guarded against.

Water-bed and Air-bed. — Water- and air-beds are used
cases of long illness, and in cases where bed-sores are
>rmed or where there is a tendency to them, and where
lere is much moisture. The water-bed is placed on the
bed-springs, which should be covered with rubber sheet-
ing, a comforter, or paper, to prevent rusting, and the
bed filled with water {at a temperature of about 100° F.)
means of a funnel and pitcher. To empty a water-
it is laid in a slanting position until all the water has
m out i it is then rolled up and laid away. India rub-
rr, if unused for any length of time, becomes hard and
apt to break, and for this reason the bed should be
filled every six weeks or oftener, the water remaining in
it three or four hours. The air-bed is filled with air by

PRACTICAL POINTS IN NURSING,

means of a pair of bellows or an air-pump ; after filling,
it is made up in the usual way. Care must be taken
that these beds are not pricked with pins, or they will
collapse.

Appliances for the Belief of Bed-patients. — In very
few families will a nurse find a bed-cradle^ a screen, a bed-
rest , pads, and rings,

Tlu cradle (Fig. 2) can be improvised by taking one or

two chairs, placing them
backs uppermost, and
securing them by tying
their two lower legs to
the sides of the bed;
to be sure, they look
clumsy, but a chair is
always to be had in the

F.C. a.-Cradlc for protecting patient from pre.- ^bsenCC of anything clse.
sure of bed-clothes. J o

Half barrel-hoops, with
a string fastened to each end to be tied to the sides of
the bed, make a good cradle ; three halves are all that
are needed. A cradle must always be placed under the
blankets, the sheet covering the patient to prevent her
taking cold.

Red-rest. — A straight-backed chair answers nicely for
a bed-rest ; one pillow should be carried well down in
the small of the back, another (if there are only two)
is placed above for the head and shoulders.

Bed-screen, — A clothes-horse covered with a sheet, a
blanket, or a shawl makes a very good screen ; it can be
made quite attractive by tying the corners of the covering
with ribbon and pinning on it photographs or pictures
cut from illustrated papers ; they will help to amuse the
patient, and should be renewed from time to time : if the

36 PRACTICAL POINTS IN NURSING.

vised by putting a clean blanket or a comforter in a
pillow-case.

During convalescence the Nightingale wrap will be
found useful. It is made of two yards of flannel of
ordinary width. A straight slit 6 inches deep is cut in
the middle of one side ; the points are turned back to
form the collar. The points farthest from the collar are
turned back to form cuffs. Buttons and button-holes
are added, as shown in the illustration (Fig. 5). The
wrap can be ornamented if desired.

Ccure of the Sick-room. — It should be remembered
that the sick-room is the home of the patient during the
time she is in it; hence great pains should be taken by the
nurse to keep the room clean, the air pure and fresh, and
herself bright, cheerful, quiet, and gentle, so that when the
illness of the patient is a thing of the past, she will look
back to the pleasant room, the systematic way in which
everything was done, the kindness of the physician and
nurse. Sweeping must be done slowly, the broom being
kept near the floor, lest the dust be thrown around and
back ; the sweepings must be gathered up and burned.
A damp cloth should be used to dust with ; if a feather-
duster or a dry cloth be used, the dust is thrown around
the room and settles again. If there is a fire in the room,
the coal should be wrapped in paper or placed in paper
bags before carrying it to the room; it can then be
dropped on the fire without noise.

Hygriene of the Sick-room. — Temperature. — The
temperature of the room must be kept as even as pos-
sible ; for lung troubles it should be kept about 70° F.,
but in fevers it should be lower, about 65° F. A point to
be remembered is that the temperature decreases at night,
and that between the hours of 12 and 4 a. m. the vital

THE SICKROOM.

1. powers are at their lowest ebb ; the sick patient must
carefully be watched and hot drinks be given, and extra
blankets and heaters be applied if necessary. The tem-
perature must be regulated by opening or closing the
registers, and applying extra clothing, not by closing
the windows, thus shutting off" the fresh air. Dry air,
I which is irritating, can be made moist by keeping a kettle
I of boiling water in the room, or by dropping very hot
I bricks into a pail of water, or, if there is a fire or register
I in the room, blankets or sheets wrung out of water may
I be hung up to dry.

Air. — ^The air of the room must be kept pure, whole-

l«ome, and cool. To keep a room cool in hot weather is

Inot always an easy matter, but good results have been

lobtained by keeping the windows and blinds closed dur-

king the day, thus shutting out the hot air and sun, and

fopening them in the evening when the air has become

Vcooler, because, if the hot air be let into the room during

|the day, it remains, and the room is hot for the patient

•at night; whereas, if the windows and blinds be kept

■closed during the day and opened in the evening, when

B;tbe air is cooler, the patient will be able to sleep. An-

[tther way, and one which also gives to the room a very

lol appearance, is to place near the window the branch

f a tree in a tub containing large pieces of ice.

Ventilativn. — Ventilation is pure fresh air displacing
mpure air, and it is the duty of the nurse to see that
r^ie patient is kept supplied with fresh air. In almost
every case the window can be kept open i yi inches at
the top without injury to the patient; hot air rises and
displaces the cold air, which becomes warmed as it de-
scends. If there is a fireplace in the room, a small fire
may be made, which will direct the impure air up the chim-

PKACTICAL PO/.VTS m NURSING.

ney ; a lighted lamp or candle will also direct an upward
current. A board from 4 to 6 inches wide may be placed
under the lower window-sash, and tho fresh air will enter
between the sashes (Fig. 6). thus preventing a draught.
Opening the window widely top and bottom, and cover-
ing the patient, who, if afraid of the air, may hold an open
umbrella before her or
may have a screen placed
before the bed, will air the
room thoroughly; airing
should be done for a
few minutes every morn-
ing and evening. Many
patients will object to the
window being open at
night, but the night air
is purer than that of the
day. It is said that the
air in Manchester, that
great manufacturing dis-
trict— '■ the workshop of
England," as it is called —
is pure.st after 10 p. m., as
then there is no smoke
from the immense factory chimneys, and other conditiotia
which tend to make the air impure are lacking. There
should always be removed immediately from the room
movements, urine, vomited matter, soiled linen, or dress-
ings, as all these make the air of the room impure. The
patient should have all the sun possible.

^ i|

Jl, ■;;

Window vcntLUtltn.

THE FATJENT.

III. THE PATIENT.

I. NURSING IN MEDICAL CASES.

In reporting to the doctor the nurse must remember
two things — namely, that he wants facts, not opinions,
and that he is dependent upon her for a faithful and ac-

I curate account of the patient's condition since his last
visit; he must be told things just as they are, nothing
added to or taken from the facts. Many things which
the nurse may think too simple to report may, to the
doctor, be very important, and may considerably help
him in making his diagnosis. The temperature, pulse,
and respirations must be taken and be recorded on the
chart.

I. General Observations in Medical Cases.
The Pulse. — The pulse, temperature, and respiration,
I which are called the " three vital signs," are so closely
leonnected that whatever affects one generally affects the
r others. Every time the heart contracts blood is thrown
into the arteries (see p. 287), which are distended on re-
ceiving the blood ; it is this distention, this rising up of
the wall of the artery at regular intervals, which corre-
onds with the beatings of the heart, that is called " the
lulse."

By taking the pulse we know the number of times
file heart beats per minute, its fulness, and its regular-
Position and action alter its rate ; for instance, it is
generally faster when standing than when sitting, and
faster when sitting than when lying ; it is slower in sleep
lad (aster when dying ; it is slower in old age than in mid-

PRACTICAL POINTS IN NURSING.

M die life, slower in men than in women, faster in children than

I in adults, faster, again, during excitement or exercise.

I Frequency and Varklies of Pulse. — We notice the fre-

quency of the pulse — that is, how fast or how slow it is ;
when we say a pulse is frequent, we mean that it beats
about from 105 to 1 10 times per minute; a rapid pulse
is from 120 to 140; and a rj<n«i«^ pulse is above that

A pulse is regular when the beats come at regular in-
tervals and are of the same strength; a/»// pulse is when
the beat is strong and long. In an irregular pulse the
intervals between the beats are unequal, or .some beats
are feebler than the others. A pulse is in/enni/tent when
a beat is dropped out every few beats, the pulse being
generally otherwise regular ; this pulse may occur in
health or may be due to some heart trouble or to ex-
haustion. A pulse is cptnpressible when it is easily
stopped, and incompressible when it is very hard to
stop ; of liigh tension when the artery seems to be full
of blood between the beats, and the force of the beat is
increased and is incompressible; in z. Imv-lension pulse
the beat is easily compressed. The dicrotic pulse is one
in which there seems to be two beats, the second beat
being smaller than the first. There really is only one
beat, the first one which is counted ; the second must
not be counted, as it is called "the dicrotic wave," or a
secondary wave in the blood-current, not another beat
of the heart. This fact is very important for the nurse
to remember ; the large beat is to be counted, and not
the small wave which comes directly after it. If there
be any difficulty in making the di.stinction, place one
hand over the heart, the other at the temple or the wrist,

I and the difference will at once be noticed.

E Taking the Pulse. — The way to take the pulse is to

THE PATIENT. 4I

place two or three fingers on the artery at the wrist or
the temple, and count by tenths of one minute, then mul-
tiply. The thumb must not be placed on the artery, be-
cause there is an artery in the thumb, and the nurse
would thus be taking her own pulse.

The puUe in Ihe feliis a about . . rrom 130 tu t6o per minute.

In Ihc infant at biiih ■• 110 to 150 ■'

At t monih 120 "

At I year , . . . from 120 10 130 "

Atajeara " 9010115 •■

te<
^^" or

This latter rate is the average normal pulse.

At puberty the pulse is from 80 to 85. because at this
time the nervous system is more or less excitable ; in the
prime of life, from 70 to 75 per minute ; in old age, from
60 to 65. In very old age it rises until it is almost as
high as that of an infant. The normal pulse of some
persons is rather high, while that of others is as low as
from 60 to 40.

Body-temperature, — The normal temperature of the
body is from 98.5° to gS.6° F., though it may, like the
pulse, be slightly higher or lower, and be the norma!
temperature for that person. The temperature is higher
after meals, on account of the activity of digestion ; it
increased by exercise or by emotion ; in children
or in hysterical patients it is accelerated by excitement.
Alcoholic drinks will lower the temperature, a^ will
also profuse perspiration. It is lowest between 12 and
,4 A. M., and highest between 5 and 8 p. m., because dur-
ing the night we are resting, and the temperature natu-
iy lowers, while during the day food, exercise, and

42 fKAVTlCAL POINTS IN NURSING.

ux-citcmtiit ,ill tend to increase it A temperature ]
ab'fvc ioX° 111- below 95° F. is generally fatal. The

tuiupcriitiiri,' of

A|.'

.11.11

« helm

iC F.
' to 97° F.
' to 98" F.
' to 98.6° F.
' to 101° F.
' to ia3'* F.
to 105" F.
F. and abov&

Collapsr is
SiibiiMrm.il.
Nurnial,
Siil,fLl,rilc,

M..,Iv:|-;,[cfei

lli-!| liver.
Hy|KT])yri;x

HypiT|iyi, \i,i f^'encTtniy inattBiCS approaching ctraSi

when llu; teiii|ieratiiR- lias been knnwn to rise as iii^^li
as I 10'^ F. In a case .if tetanus recently seen the ther-
mometer ju^t befuie lieutll re^istcrtil a temperature of
\<y.}' I"., o]ie hour after death 111° F,, ami two hours
after iliatli I 13" V . In siin--lrnke the ttm]>erature may
l>e 112- V. or abn\e. H\-.lerical i>atieiits have been
known to |mt the bulb of the thermometer hi a cn|i of
\w\ milk or tea. or a hot-water haji. ami to shake the
mercury up, when the attention of the lUu-se has been
called to other thinji-^, tlm-^ producint: an alariiiin<,dy
hiL;h teiH])erature-

Subnonn.-d temper.iture.s .ue ..b^Tved during; eoiua-
lescence after t\phoid fever [uui pneumonia, when the
temperature may he subnormal foi a few days. It iii.iy
also re-ult from'hemorrha-e from the Inn-, stomach, or
bowel, perforation of the bowel, and from -.hock.

The temperature of a ehild is normal .after the (lr>t
week; ,it hirlli il i-^ about .,<.{' V. The puUe Generally
liM-- from eiiihl to ten be.U-with each de^iree of tem-

Taking thf Body ■temperature. — The temperature of the
I body is taken with a clinical thermometer (Fig. 7) in the
mouth, tht axilla, the groin, the vagina, or the rectum.
The temperature of the axilla is about half a degree lower
than that of tlie mouth. The temperature of the rectum
and vagina is about half a degrct; higher than that of
the mouth, because these cavities are constantly closed.
For convenience the temperature is generally taken in

^gr^ nTT\ "T'T T'T'l" j"f |,^^^

the mouth. The thermometer is washed in cold water
and wiped dry, the mercury is shaken down to 95'*, and
tile bulb of the thermometer is placed under the tongue
and the lips kept closed for five minutes. The patient
must be told not to open the lips while the temperature
is being taken, or cold air will enter the mouth and
the instrument will register a temperature lower than it
should. Hot or cold drinks given immediately before
taking a temperature in the mouth will make the re-
corded temperature higher or lower than it really is.
The temperature of very weak patients, unable to
the mouth closed, and of unconscious and delirious
;nts, should be taken in the axilla or the rectum.

PRACTICAL POINTS IN NURSING.

The clothing is removed from under the arm, the arm-
pit is dried from perspiration, the bulb of the tliermome-
ter is placed between the folds of the skin of the armpit,
the elbow is bent, and the arm is held close to the side,
the hand touching the opposite shoulder. The ther-
mometer should remain in the axilla from seven to ten
minutes. Before taking the temperature in the rectum
the latter must be emptied if full, or the thermometer
will become imbedded in the fecal matter and will not
come in contact with the mucous membrane. The ther-
mometer is oiled and inserted for about I J inches, and is
allowed to remain five minutes. The same length of
time is allowed for taking the temperature in the va-
gina.

Fevers are said to end by lysis or by crisis. By lysis
the temperature falls gradually, as in typhoid fever, while
crisis is a sudden fall to normal, as in pneumonia. A
sudden rise or fall must always be reported promptly, as
some complication has probably set in, though with hys-
terical patients the temperature may rise to 103° F. or
above, and fall, without indicating anything serious. The
same is also true of children. Very little things will
often cause in a child a ri.se of temperature, which fells
in a short time, so that a high temperature in a child is
not so serious as that in an adult.

Bespiration. — The normal number of respirations in
an adult arc 16 to 18 per minute; we breathe once to
four beats of the heart. With man the breathing is
abdominal, and with women it is thoracic. When taking
the respirations one should notice if they are regular or
irregular, frequent, quiet, deep, shallow, thoracic, or
I abdominal. The respirations can be counted by watch-
■ ing the rise and fall of the chest after having taken the

THE PATIENT.

pulse, the fingers being still on the wrist The most
accurate way is to lay the hand lightly on the chest, but
there is the danger of the patient breathing slower or
fester when he knows they are being counted. It is
always best to count the respirations when he is asleep,
as they are then slower, but natural; excitement ajid
exertion increase them. The respirations in

lofanls ire about from 30 to jj,

At the fifth year " 20 )u 25.

" " eighth ycat ... the »imc as thoee of an udult.

The Chtync-Stokcs respiration is a very peculiar form of
breathing. The respirations gradually increase until they
reach a certain height ; then they gradually decrease until
they entirely cease for a few moments, when they begin
again in the same order. The Chcyne-Stokes respiration,

! which usually occurs in certain diseases of the heart, brain,

[ or kidneys, is a fatal symptom.

The pulse, temperature, and respirations must accu-

I rately be recorded on paper or on a chart ; when there

I is any doubt as to their correctness, a question-mark
should be made, so that the attention of the attending
physician will be drawn to the record. A patient must
not see her temperature chart or even be informed of
the run of her temperature, because if the fever con-
tinues the patient becomes depressed. If unusual symp-
toms have developetl, it is a good plan to leave a note

I downstairs for the doctor informing him.

Observation of Symptoms. — The accurate observa-
j*ion of symptoms in the cases which a nurse will have
Sinder her care is of the utmo.st importance, so that she
may know how to give the doctor a faithful and accurate
account of everything that has happened since his last

46 PRACTICAL POINTS IN NVKSING.

Position. — Notice must be taken of the position the
patient assumes when lying in bed, because he always
takes a position which gives him the most comfort. A
patient ill with peritonitis Ues on the back with the knees
drawn up, to relax the muscles of the abdomen ; one ill
with pleurisy or asthma will breathe much easier when
propped Lp. If one lung is affected, the patient wilt
generally be found lying on the affected side, so that the
sound lung can work better. Again, when a patient has
been very ill, and has been lying on the back continually,
it is a good sign when he turns over on the side,

Naitsi-a and Vomiting. — Under all circumstances nau-
sea and vomiting must be reported, and the following
symptoms of the condition be noted : Is the patient con*
tinually nauseated without vomiting, or does the vomit-
ing occur soon after taking medicine or nourishment? is
the color of the ejected matter green, as it may be in
any case where there is straining ? does it contain blood,
as in hemorrhage from the stomach ? is it fecal or dark
like coffee-grounds, such as we gel in intestinal obstruc-
tion ? or are the contents of the .stomach rejected with-
out any distress or nausea?

Footi. — A record should be kept of the exact amount
of food the patient takes: Does he like or dislike it? is
there a craving for other food than that he is taking ? is
there any difficulty in swallowing?

Tlie Mouth. — The state of the mouth should be ob-
served: Is there any pain? is the mouth hot? arc the
teeth decayed or unclean ? The condition of the gums
should also be examined : are they a normal red or very
pale, swollen, bleeding, or rather blue?
■ The Tongue. — The condition of the tongue should be

I noted : Is it coated ? if so, is the color light, the coat gray,

THE PATIENT.

dry, and brown, as seen in tj-phoid fever, or is the tongue
red like beef, or of the so-called " strawberry -tongue "
type, which is rather pecuHar, having awhile fur through
which project bright red dots or points? This form is
seen in scarlet fever. Another condition of the tongue
to be noticed is the trembling which accompanies typhoid
and other fevers.

Pain. — In reporting pain, which is a condition that can
neither be heard nor seen, the nurse can tell the doctor
only what the patient says respecting the location of the
pain and its character — throbbing, steady, or a shooting
pain, and so on.

Facial Expression. — The expression of the (ace must
carefully be watched : Is it anxious and pinched ? does
the patient seem to take an interest in what is going on ?
or is he dull and listless ? Are there hot flushes of the
face, paleness, bluene.ss (commonly called "cyanosis,"
which is caused by insufficient oxygen in the blood)?
or does the color come more in one cheek than in the
other ?

Coiigh and Expectoration. — The nature of the cough
and expectoration must be determined : Is the cough
hard and dry, without expectoration, or moist, loose,
or hacking? does it tire the patient to cough? and does
he cough more when lying upon hi-s back than upon his
side ? and upon which side ? or does the attack come on
in paroxysms or fits of coughing? The expectoration
may be frothy and watery, rusty, and adhere to the vessel ;
it may be the color of prune-juice, as is seen in gangrene
of the lung, and have an offensive odor; it may also re-
semble pus ; it may be streaked with blood, or be thick
id yellow. The expectoration should always be saved
»for the doctor's inspection and its character and quantity

^^Lond yell
^Bforthec

PRACTICAL POINTS J.V J^URS/.VC.

a sputum-cup (Fig. 64) with paper, which
can be taken out .ind burned and the cup boiled. This
should be done at least three times a day. especially in
infectious diseases, such as pneumonia and consumption, J
where the germ leaves the body through the expeol
toration.

Tfif Brtatk. — The character of the breath should bel
observed : Is its odor sweetish like chloroform ? or hasl
it a fetid odor caused by decayed teeth, dyspepsia, con*|
stipation, etc. ?

Sleep must be noted ; Is it quiet and restful ? or do«
the patient sleep all night and awake very tired, entirely
unrefreshed ? at what time did she fall asleep, and howl
long did she steep? was it in the first or the latter part of J
the night ? or would she fall a.sleep and awake at intervals,
and remain awake for a few minutes, an hour, or a few
hours, then drop off to sleep again? was she restless
when asleep? Notice whether the patient is hard toj
waken; is there twitching of the muscles during £
muttering, or any sign of delirium?

The character of the breathing: Was it quiet,
shallow, rapid, regular, irregular, or snoring (stertorous)^
with flapping out of both cheeks, or of one cheek mon
than the other ? This condition must always be report
promptly, as it generally denotes unconsciousness.

Delirium. — Note the kind of delirium : is it quiet and
busy ; muttering ; picking at the bed-clothes or i
imaginary objects ; or violent ; if so, when is it moi
violent? Patients are very often quiet during the physt->l
cian's visit; indeed, they seem to know the instant he
enters the house. They are, as a rule, very cuiming,
and must not be left alone for a single moment, no mat-
ter how mild the delirium, as they may get out of bed^

THE PATIENT.

nun

and harm themselves, or may even jump out of the win-
dow. Terrible accidents have happened through delir-
ious patients being left alone; hence the nurse should
always remain near a delirious patient until some one
can relieve her.

Chills. — In reporting a chill there should be given the
time it occurred, how long it lasted, and the temperature,
pulse, and respirations. As very many diseases and com-
plications begin with a chill, it is very necessary that
a chill should be reported at once. It may vary from a
mere chilly feeling to a violent shivering or chattering of
teeth ; even the bed may be shaken. A chill may be
divided into three stages : first, the cold, shivering
stage ; second, the hot stage, during which, if the tem-
perature be taken, one will find it elevated, often in se-
vere cases from 104° to 106° F. The second stage passes
into the third, the stage of perspiration. For the first
stage the nurse should apply heaters well covered,
extra blankets, and give hot drinks of any kind — hot
milk, tea. coffee, or cocoa; for the second she should
gradually remove the heaters and extra covering ; and
for the third the patient should be wiped dry under
the bedclothes with warm towels. If the perspiration
is very profuse, the clothing may be changed, but the
nurse must be sure that it is thoroughly aired and
warmed before changing, thus guarding against another

The Skin, etc. — The eohr of the skin must be noted,
its pallor, blueness, or yellowness; any discoloration,
hardness, or edema, which is a watery swelling caused
by a collection of serum in the cellular tissue, and
'hich pits on pressure; note if the skin is hot and
or if there are hot Hushes of the head and face, suc-

^^Btlry, ori

TACTICAL POINTS IN NURSING.

cceded by creeping chills down the spine alone or over
the whole body ; also, the condition of the nails : are they
discolored, blue, dry, and brittle? Is there any dis-
charge from the nose, the ears, or the eyes ?

Till- Bouvh. — The condition of the bowels must care-
fully be watched, noting if there is constipation or
diarrhea ; also the color of the movements. Black
movements follow the use of certain medicines, such
as bismuth, iron, charcoal, and tannin. When hemor-
rhage has taken place and the blood has been retained
in the bowels, as will sometimes occur in typhoid fever,
the movements are then of a black or tarry color, but
when the hemorrhage has occurred and the blood passes
immediately from the bowels, the color is very little if
any changed, and the movements are of a red color. It
should be noticed if the feces contain mucus or pus,
undigested food, or even pills which may pass through
the bowels without being dissolved. The patient may
have diarrhea accompanied by the so-called "packed"
feces — that is, the bowels arc packed with small, round,
hard lumps like marbles ; the movements are then fre-
quent and watery or contain these small lumps, and still
the bowels may not be emptied. This condition must
be reported, and whether the movements are attended
with pain. Pain, tenderness, and distention of the abdo-
men, also flatulence, must be reported. The passage of
gas by the rectum afier an abdominal operation is a very
good sign.

The Bladder: Urine. — The condition of the bladder

must be recorded : is the normal amount of urine passed,

or is the amount decreased or increased ? is there reten-

I tion, suppression, or a constant dribbling of urine (incon-

■ ttnence) ? is there a constant desire to urinate, and is the

THE PATIENT. 5 1

liirine passed with difficulty or pain? Anything abnor-
lal in the color, odor. etc. of the contents of either
Kbowels or bladder must always lead the nurse to save
specimen for inspection.

A specimen of the morning urine should always be
Bved for examination, because the secretion has not
fcnerally been influenced by food or medicine, and a
•better knowledge is obtained as to its specific gravity
Eond the amount of solids excreted. The urine must be
Idrawn with a glass catheter into a clean bottle or a
' tumbler, and be labelled with the name, date, quantity.
and hour that it was drawn. The bottle must be cov-
ered tightly and placed in a cool place, because warmth
increases the acidity of the urine, the color becomes
high, and the normal cloud settles to the bottom. In
hot weather the reaction may change to alkaline and
k the color become pale.

The general points to be noted about the urine are the

\ during the twenty-four hours; its odor,

»lor, and appearance ; whether perfectly clear or cloudy ;

: time the urine was passed, its reaction and specific

ravity. It must be noticed whether there is retention

r suppression of urine : is the urine passed with pain or

9 very small quantities? does it contain blood or pus?

To record the twenty-four hours' amount, the excretion

llould be taken from 6 A. M. to 6 p. M. and from 6 p. m.

> 6 A. M., and both amounts be added together. When

e bladder is very full, it must not be emptied at once,

lut one part must be drawn off, and the other later on,

S sudden empt>-ing of the bladder would bring the walls

)gether, and inflammation or cystitis might set in.

Hiccough and the periods of its occurrence must be

(^Mrted. It is a spa.smodic contraction or movement

S2 PRACTICAL POINTS I.V NUJISING.

of the diaphragm, and may come on after eating or drink-
ing, on account of nervousness, or when there is great
exhaustion following acute diseases. Sometimes hot
drinks, or holding the breath for a few seconds or as
long as possible, will relieve hiccough.

Menstruation. — Report menstruation, the amount and
regularity : does pain come before, with, or after the flow
begins? and does it last a few hours, one or two days,
or does it last all through the period? Also report the
locality and character of the pain; the character of the
flow, whether it is of a normal color and odor, or scanty,
dark, or pale, and, if clots come away with it. their number
and si^e. If there is any leucorrhea, the character and
quantity should be noted : is it profuse, thick, and stringy,
or does it resemble the white of an egg? Leucorrhea is
not a disease, but is generally a symptom of inflamma-
tion of the vagina or the lining membrane of the uterus.

3. Bodily Care of the Patient.
Changing the Clothing. — To change the nightdress
and undershirt, they are loosened at the neck and wrists,
and brought well up under the shoulders on one side of
the patient ; the arm is taken out of the soiled garments,
and the corresponding clean sleeves are put on, and both
sets of garments slipped over the head ; this slips the
soiled shirts off and the clean shirts on, The nurse
now goes to the other side of the bed, removes the
soiled clothing, and puts on the sleeves of the clean
clothing, r.iising the patient slightly and pulling the
clothing down smoothly at the back. It is generally
well to have the body-linen open all the way down
the front, and to button or tie it with tapes. Where
I one side is injured or paralyzed, the clothes should be

THE PATIENT.

taken off at the sound side first, and be put on at the
injured side first ; this will save the patient a good deal
of unnecessary pain. Should one or both arms be frac-
tured, the sleeves can be opened from wrist to neck and
tapes be stitched on either side from 4 to 6 inches
apart ; the arm is then raised, the sleeve placed under,
and the tapes tied.

Toilet of the Patient. — TTte Hair. — The hair must be
combed every day. and be braided in two braids : if it is
done up in a tight knot at the back of the head, the
patient has a hard lump to lie on. If the hair is much
matted through neglect, it must be gently combed, a little
at one time, not Jerked. The nurse will find it easier to
comb upward. She must not tire herself and the patient
by trying to comb it all at one time, but must do one part
and leave the other until later in the day. If vermin are
in the hair, tincture of larkspur, which is about the best
exterminator to use, or carbolic acid (i : 40). or kerosene
oil, should be rubbed into the hair, and the head be
wrapiJcd in a towel or cloth for two or three days.
When the hair is dry, the nits can be destroyed by
very thoroughly rubbing it with alcohol.

The Mouth. — The patient's mouth should be attended
to each day punctually. The mouth, to be kept perfectly
clean, should be washed at least three times a day, and
the teeth carefully brushed. Nothing is more refreshing
in illness than a clean mouth and well-brushed teeth. If
the pab'ent has no tooth-brush, a piece of cotton wrapped
around the end of a toothpick or a matchstick will serve
to clean the teeth with.

The nails must be cleaned and trimmed if necessarj'.
bands and face should be bathed and the teeth
just before setthng down for the night.

^^L The ban
^^ftiirushed

PRACTICAL POINTS IN iVUKSlNG.

The Body. — The nurse should be careful to Icccp the -
bed- and body-linen perfectly dry and free froin wrinkles,
and the bed free from crumbs, and should guard against
bed-sons, which are generally the result of careless
nursing in allowing continued pressure upon the promi-
nent parts of the body, except in cases such as those
of fractured spine resulting in paralysis, and where the
nerve-supply is injured, when bed-sores will form under
tiic best of care. It must not be forgotten that a bed-
sore is a disgrace to a nurse, except, of course, in these
exceptional cases, and every good nurse will do all in her
power to prevent it. She must not wail for redness to
appear before beginning to bathe the back. Alcohol in
any form, cologne, vinegar, or lemon-juice, may be used
to harden the skin ; and there may be used to powder
the back oxid of zinc, powdered laundry starch, corn-
starch, baby-powder, bismuth, or borax. In the absence
of alcohol and powder the sheets should be kept perfectly
dry and free from crumbs and wrinkles, the parts be kept
clean, and pressure be removed by pads and rings made
of oakum, muslin, sheet-wadding or compress, and wound
round with a bandage (Fig. 3). The patient's position
should frequently be changed. If there is much moisture,
the back may be rubbed with any kind of oil, sweet oil,
mutton -tallow, lard, or even melted candle, any one of
which will prevent the ninisturo from being absorbed.
There are some patients so very thin and emaciated that J
bed-sores form notwithstanding all the care that can be
taken. Should one form, the pressure must be removed
with a ring, the part painted with the white of an e^,
which will be the next best application to collodion and
will exclude the air. or be dressed with oxid-of-zinc-
ointment. If the nurse is at a distance from an apothe-

THE PATIEMT. 55

cafy store, and has oxid-of-zinc powder and pure lard,
four parts of the lard should be mixed with ont: part of
powder ; the regular ointment is prepared with benzoated
lard, but the nurse may use common lard in an emergency.

Baths. — Foot-bath. — It is only tlie work of a few min-
utes to give a foot-bath: everything should be made
ready, the upper bed-clothes then loosened at the foot
of tht.' bed. and across the lower part is spread a rubber,
newspapers, or a soiled sheet, on which the foot-tub or a
large basin is placed. The patient puts her feet in the
tub, and the nurse draws the upper clothing around the
limbs to protect them from cold. After the bath the
nurse should see that the feet are properly dried ; if they
are cold, a well-covered hot-water bottle may be put to
them.

SpoHgc-balh. — To give a sponge-bath to a patient in
bed, the nurse first gets everything ready, and sees that
the fresh clothing is thoroughly aired ; the patient is then
wrapped in a blanket, the clothing removed, and one
part bathed at a time. She begins with the patient's
■fece and neck, then the chest, abdomen, and arms, then
the back, bathing the lower extremities last of all. The
water should be changed at least three times, and the
patient have the full benefit of the water as far as possi-
ble; the arms, the legs, and the feet placed in the basin
and bathed thoroughly. Care must be taken not to
expose more than one part at a time.

It will be found that some of the patients; in private
practice will take a sponge-bath every day. while others
will take one only once a week. The nurse must go
according to the inclinations of the patient, unless, of
course, the physician should otherwise order.

Tub-bath. — When a tub-bath is ordered, and there is

^^L course,
^B Tuh-l

56 PRACTICAL POINTS IN NURSING.

no bath-tub, a wash-tub will answer, the patient bein|
seated in it and pailsfiil of water poured over the bod]

The Bed-pan. — When inserting a bed-pan the patieni
should be requested to raise herself a little; the nurse then I
puts her hand under the patient's back and inserts the*
pan : if this method is followed, the pan will rub against
the back of her hand, thus preventing the patient's bacleJ
becoming; irritated and a bed-sore forming. The nurse]
should raise the patient when removing the pan ; it mui
not be dragged out : if the patient is very heavy, som
one may be asked to assist in lifting her on and off tl
pan. which must first be warmed, to prevent chilling t
patient, either by holding the pan over a register or byl
pouring over it warm water.

Feeding of the Patdent. — Sen'ing the Meal.-
meal-limes the nurse should have the napkin and ti
cloth spotless, and the china, glcussware, and silver <
the best that the house affords ; hot food should 1
served hot, not lukewarm, and cold food and cold drink!
cold. It is better to serve too little than too much, i
there should be a variety. Plenty of time should be-1
allowed for the meal ; the patient must not be hurried^J
so that the food can be thoroughly masticated and mixed \
with the digestive juices. The liquid must not be spilled,/
nor must a tumbler or cup be held at the rim wher&l
the patient is going to drink, but it should be held at the I
bottom. The tray must be removed when the meal isJ
over, and if the patient has left anything to eat later, I
it should be put away, and on no account be left in thej
room. It is perhaps needle.ss to add that the nurse's I
hands must be washed before preparing the food, also!
the hands of the patient before each meal.

Feeding Feeble Palieiils. — Tiie principal thing to ob- J

THE PATIENT. 57

r serve in feeding a feeble patient is to feed often and a
1 little at a time. One will be astonished at the end of the
I day to find how much nourishment a patient has taken
I by giving it in small quantities every ten or fifteen minutes,
gradually increasing the amount of the food and length-
ening the intervals between the meals. Milk (which must
be fresh and pure, and to which can be added the white of
I, gruel, beef-tea. oyster-broth, raw oysters (which
are very nourishing and easily digested), and eggnog, may
all be given (see Dietary, p. 315); as the patient gains
strength the food may be gradually changed to soft solids.
When feeding an unconscious patient pass the spoon far
back into the mouth, empty it slowly, and then close the

I lips and nostrils : the patient will involuntarily swallow.
Milk and brandy dropped on the tongue will be absorbed.
When feeding an unconscious patient by rectum the
enema should be given as high up into the intestine as
possible, so that the fluid will be injected into the colon
ntther than into the rectum, because, according to some
authorities, absorption goes on very slowly from the
rectum, but very rapidly from the colon Itself Both
the colon and rectum must be free from feces before
the enema is injected.
When supplying a patient with ice to suck, a piece of
flannel or of cotton should be laid over the top of a
tumbler, and a dent made in the centre in which to put the
small pieces of ice ; then as the ice melts the water drops
into the tumbler, and the ice keeps much longer than it
would if allowed to stand in the water.

Hovine of the Patient. — The nurse should never

attempt to lift a helpltss patient alone : she should ask

^^L.some one to help, nurse and assistant standing at the same
^^^feljde of the bed. The nurse places one arm under the

58 PRACTICAL POINTS IN NURSING.

neck of the patient ; this brin^js the head resting on her
arm, her hand being passed under the arm on the other
side ; the other hand and arm are passed under the
middle of the back. The assistant passes one arm under
the lower part of the back and the other under the knees,
and both lift the patient toward the head of the bed.
a limb is injured, a second assistant will be needed t
support the limb above and below the seat of injury.!

A patient can be moved from one side of the bed ti
the other by the nurse placing one hand and arm dow
the patient's back, thus supporting the head and should
dcrs, and by passing her other hand over and slipping it '
under the upper part of the back ; the upper part of the
body can then be moved to the fresh side of the bed.
The nurse's hands are then placed, one under the lower ■
part of the back and the other under the knees, and tb<
lower part of the body is hfted over. Or the under she€
can be secured to the mattress with safety-pins, the draw-
sheet loosened, and the patient on the draw-sheet be
drawn to the fresh side of the bed ; the draw-sheet being
then replaced. The best way is to have two beds of equal I
height, one for day and one for night, each having its o
set of bedding; when changing the patient the beds atel
placed side by side, the nurse taking the sheet at th<
head, an assistant at the foot; the patient in this way tsl
lifted to the fresh bed without Jarring. If the patient e
very heavy, an assistant will be needed at each corner, ofl
if there are broken Hmbs, other assistants will be needei
to support the limbs. If alone, the nur.se .should loosen thea
under sheet, gather in her hands the side nearest to herfl
top and bottom, and draw the patient to the fresh I
When two beds cannot be obtained, a sofa or a loungl
maybe used for the daytime. If the patient is in a large fl

If
d to^H

^dto^H
lowi^H

tig it ^^
■ the
bed.
:>wer^H

I tbc^H
iheeti^H

THE PATIENT. 59

double bed, one half of it should be kept for the day, the
other half for tlie night

It needs two persons to carry a patient, and this js
[ done by each grasping the forearms of her companion
I at the patient's back and under the knees, thus forming a
I chair, the patient resting an arm on the shoulder of
I each; but a much better way is to improvise a
• stretcher by rolling two long broom-hamlles or poles
tightly in each side of the under sheet ; in this way, with
an assistant at the head and foot, the patient may be car-
ried steadily to any part of the room or the house. The
nurse must first make sure that the under sheet is good
and stout, or she may have an accident by the sheet
tearing and the patient falling.
. To carry a baby, one arm is passed downward under
I the shoulders, with the head resting on the upper
part of the arm ; the other arm is passed under the
knees, the lower part of the back resting on the hand.
A child should never be carried with one arm around
the neck, the other under the knees, thus allowing the
body to sink between the arms and the head to hang
down over the arm. One will readily see that by carry-
ing a child in this way the blood is apt to leave the brain
and go to the abdomen. The head must always be
supported.

3. Relief of Functional Dlstcr dances.
Bnemata. — An enema is a liquid preparation for in-
jection into the rectum, and is given to relieve constipa-
tion or to check diarrhea ; to give nourishment, stimu-
lants, or medicines when they cannot be retained by the
stomach; to relieve the bowels of flatulence; and for
other purposes. For all large enemata a Davidson or

PRACTICAL POINTS IN NURSING.

a fountain syringe should be used, and a hard-rubber
syringe for small enemata. After being used the syringe
must be cleansed by running hot soapsuds, and after-
ward hot water, through it, the outside wiped dry, am
the instrument hung up to drain. If a hard-rubbi
syringe leaks and is not tight enough, filling it widj
water and leaving it full will cause the washer to sw
and fit tightly; it always shrinks when not in use. i
for this reason it is always well to soak rubber syring«
every other day or so, that they may always be i
for use.

Ei-tKuant Enema. — A simple enema, to relieve '
bowels, is of soapsuds, made with castile or brown soi^S
the amount of warm water varies from one to thre
pints. A sheet or rubber sheet should be placed under
the patient, who should lie upon the left side with the
knees drawn up, or upon the back. Both ends of the
syringe should be put in the water, and the air expelled ;
the tube is oiled, and also the first finger of the nurse's
left hand, which is passed under the clothes to the rec-
tum, the finger acting as a guide. With the right haiw
the tube is inserted, as gently as possible, upward i
slightly backward, following the natural curve of I
rectum ; the tube is held in place with the left hai
and the injection slowly made with the right. If the*
is any difficulty' in in.serting the tube, it should be t
moved. No force is to be used ; the resistance may b
caused by the rectum being packed with fecal matb
(which can be removed with the fingers), or obstruct
by hemorrhoids (piles) or other obstacles.

Should the enema give pain to the patient, the n
should rest a few moments until the pain has passfi
away; then the injection can generally be continw

THE PATIENT.

itil all the fluid has been given. The tube is gently
femoved, and to the anus is placed a folded towel,
which will apply pressure and help the patient to retain
the enema a few minutes. The result must always be
accuratdy reported. If there is no result from one
.enenia, it is safe to repeat it in half an hour.
I High Emma. — A high enema is an injection of fluid
high up in the bowels in cases of obstinate constipation.
There are needed a rectal tube and a soft-rubber catheter,
piece of rubber tubing which is connected with the
tube of the syringe and inserted up the rectum about 8
[inches. If there is no rectal tube or rubber tubing, and
le nurse has a fountain syringe, the hard-rubber or
letal tip can be taken olT, and the soft tubing will
iswer. If the syringe is a Davidson, the patient's head
lowered, the hips raised by placing a pillow under them,
and the foot of the bed is also raised as high as possi-
ble on chairs. This position of the patient will send the
flow higher up in the bowel, as will also the knee-chest
po.sition (Fig. 34 ; see p. 140). When the tubing is used
always the possibility of its coiling up inside the
'rectum. Should the nurse suspect this, she should insert
flnger, and if a coil is found, the tubing should be
drawn out a little, then inserted again.

Purgath'c Enemata. — An enema of olive oil or castor
is to soften the feces. Six ounces of oil are warmed
id injected as high as possible, this injection being
lUowed in half an hour with an enema of i quart of
ipsuds.

For a glycerin enema from \ an ounce to 2 ounces of
lycerin are mixed with the same amount of warm soap-
In many poor families the nurse may not find
ive oil, castor oil, nor glycerin, in which case either

/'A U nCAL POINTS IN NURSING.

-liri. ItnttLT, iir lard melted and strained before inject-J

„,»)■ be u,al.

a /iirf,h!ii/i enema is ordered, i ounce of turpen-9
adtk'd t< J ; ounces of warm water, is given (irst^fl

>vv(.-d with .111 I t of soapsuds.

K,.r/iM- s.tli ,iiid

. hcalL-,1 uill n
i-^LS L-iiLiii.i being _

wliJcl-
clrnps

;)liate of magnesia) arc
ounce of the salt andl
d with I pint of warn»l

ative: from 2 to 10
soapsuds, or the 1
ough the syringe, thi
1 half an hour with a^

.■iii.it^i thai have been used with success arc —
I, (i!ycc,in,4nunccs.

Tuipciitinc, I I'liiicc,

W.ULH soapsuds, S ounces.
J. Molasses. - ounce-.

(ilycci-in, 4 ounces,

Magnesia sulpliatu, I ounce,

Turpentine, . ounce.

Warm simpsucis, S ounces,
i. Rochelle salt. 2 ounces,

Warm soapsuds, i pint,
n„'^,-,il /i>„>mi.—A slmrh-,u!,i-laud,inuu, enema is
ck diarrhea. The st.uch is pre])ai-ed as for laundry
-;cept lh.it it should be thii! tnou;^di to i»ass ihrou^'h
■rin-e; then the i|ii-ti>tily io !)e used is nieasiirfd,
is uMtally 1\ or ^ ounces, and there is added 30
of laudanum, this being the usual quantity or-

THE PATIENT. 63

dered. The enema is to stand until lukewarm before
being injected.

Bland Enemata. — Barley , flaxseed, oatmial,AnA Indian-
mia/ i-nemata are very soothing to an irritated membrane.
They are each made thin enough to pass easily through
the syringe, and must be strained before being injected.

Stimulating Euanata. — A salt enema is given for a
stimulating effect : \\ teaspoonsful of common salt are
dissolved in I quart of hot water. Other stimulating
enemata are black coffee, half a pint (to be strained be-
fore injected) ; plain hot water ; or whisky or brandy, 1
ounce added to 2 oimces of hoi water. If there is no
brandy or whisky at hand, but tliere is pure alcohol,
only one-half this amount should be given, because the
spirits are only h^lf as strong as pure alcohol, but of the
same strength as diluted alcohol, the wines, port and
sherry, being still weaker; so where the nurse is di-
fected to give 4 teaspoonsful (half an ounce) of brandy
or whisky, she should give the same amount of diluted
alcohol, or 2 teaspoonsful of pure alcohol, or i ounce of
the wines.

If the pulse becomes nearer normal, the temperature
lower, the patient quieter, and an improvement takes
place, the nurse will know that the stimulants are doing
good; but if the face becomes flushed, the pulse full and
bounding, and the restlessness increased, she will know

it they are not doing good, and must be stopped and
physician be notified,

A stimulating nutritive enema generally consists of —
Milk. 4 ounces,
Whisky, \ ounce.

Tincture digitalis. 10 or 15 minims,
the enema being injected high up in the bowel.

64 PRACTICAL POINTS IN NURSING.

Rectal Feeding. — Niitritivi; enemata must be mjectedt
as high up into the intestine as possible, because the colon J
absorbs more quickly than the rectum, and if the enema I
is not given high it is very apt to remain in the lowerf
bowel, and is incompletely absorbed when the second I
one is given ; as a result the second and part of the first I
are rejected,

A nutritive enema consists of —

Milk, 4 ounces,
Whisky, \ ounce.
White of egg.

Or, Milk, 4 ounces,

and one egg.

Beef-tea, beef-juice, liquid foods, extracts of
cream, and oyster-broth are given per rectum, Stimu-]
lants are very irritating to the mucous membrane, and -I
for this reason they should not be put into every enema, [
but only into every other one. The nurse should report; I
whether the enema is or is not retained, also as to the I
presence of food in the movements.

A nutritive enema must not be given oftencr than onceil
in every three or four hours, and must not exceed from]
4 to6 ounces each time. unless differently ordered by the j
physician. A cleansing enema of warm water must bel
given first, to clean the bowel and to prevent irritation 1
of the mucous membrane.

If the patient is very weak and docs not retain the I
enema very well, it is a good plan to plug the bowel |
with soft linen or gauze, the end inserted having first ,
been oiled. This measure will prevent the enema from
being returned.

THE PATIENT. 65

Douches. — A douche is a stream of water directed
I against a part for cleanliness, for stimulation, and to rc-
L lieve inflammation or liemorrhagc. Three of the com-
LsQonest douches arc the aural, the vaginal, and the rectal.
Vaginai Douclw. — The vaginal douche is generally for
|cleansing purposes and to relieve inflammation. The

Iiurgical antiseptic douche is for cleansing purposes,
feom I to 3 quarts of warm water being used. The
gynecological hot douche is to relieve inflammation.
The amount of water used is from 5 to 6 quarts, begin-
ning with a temperature of 110° F., and gradually in-
creasing it each day until it reaches 1 19° F. The tem-
perature must always be tested with a bath -thermometer.
The Baker douche apparatus (Fig. 8) is the best to
;, as the pail and pan each hold five quarts of water,
nd the patient can lie in the proper position for the
jfteen minutes required fur the water to run out of the

66 rHACTICAI. POINTS I.V NUKSING.

When taking a douche the patient should he on her
back, with the hips raised by means of a pillow and the
knees drawn up. In this position tite water conii
contact with the whole vagina, for it is for the womb and .
ovaries that a douche is given, and if taken sitting over j
a vessel the water runs down by tho side of the tube a
fast as it runs in, the water reaching only as high as the I
nozzle.

The fountain syringe, when used, must be hung high ]
enough over the bed for it to take fifteen or twenty min-
utes for the water to run out of the syringe. Air must I
be expelled, the tube oiled, and the water must run warm I
before the tube is inserted into the vagina.

The vagina being a curved and not a .straight canal, ]
the tube must be inserted slightly downward, then uj>-
ward. Again, the injection does not flow into the womb, (
as many think : if one will study a vaginal tube with the '
three small holes pierced in its sides, it will be seen that
the injection is not intended to enter the womb, but is for
the surrounding parts ; if a few drops of water should
accidentally enter the uterus, there would follow a severe -
attack of uterine colic. A hard-rubber tube is the best, I
as glass or metal will burn the parts, though a glass I
nozzle can be rendered aseptic more thoroughly than [
one of any other material.

AH have noticed how red and swollen the hands be- ]
come on putting them into hot water, caused by the j
blood-vessels dilating and bringing more blood to the ]
parts; then after a while the vessels contract and the J
blood is driven away, and the hands have a wrinkled |
appearance, commonly called "washerwoman's bands." 1
A vaginal douche given to relieve inflammation has ex- J
actly the same effect. The hot water dilates the blood* I

THE PATIENT. 67

!sseLs and brings more blood to the parts ; then, on
xintinuation of the hot water, the vessels contract, the
blood is driven away from the parts, and the inflamma-
tion is subdued. The nurse wilt therefore see why she
must be faithful in keeping up the douches as ordered,
giving them at the proper time and temperature and
length of time. A patient should lie quietly for half an
hour after taking a douche; if she is taking only one a
day. it is best to give it at night, because then the womb
! is most congested and needs the hot water most, and
the temporary weak feeling which follows a douche will
be gone before morning. However, the nurse should go
according to the orders given by the physician.

Many patients object to taking douches, and will
LaKglect them on account of the inconvenience, especially
Bf they live in apartments and there are children in the
' femily ; but this can be overcome by taking them in the
bath-tub. Halfway across the bottom of the tub there
is made to fit a piece of board, on which the patient can
J be. Douches are easily taken in this way, which obvi-
kntes a great deal of annoyance.

Antisfftic Douchfs. — Corrosive sublimate, carbolic acid,
R'creolin, and boric acid are used for antiseptic douches.
CCorrosivc sublimate and carbolic acid are very poisonous,
reolin is irritating, and to prevent ab.sorption and irrita-
a a plain water douche is often ordered to follow any
r these antiseptics when a strong solution has been
led.

Rectal Douche. — Rectal douches are for cleanliness

tnd to relieve inflammation. Hot rectal injections to

pvelieve inflammation are given with a fountain syringe

and a recta! tube. The patient lies on her back with the

knees drawn up, and a small pillow is placed under the

68 PRACTICAL POINTS IN NURSING.

hips to direct the flow upward. The physician will g
directions as to the amount of water to be used, its tei
perature, etc,

Douches to the external genitab, to the perineum, i
to the anus for the relief of inflammation or hemorrhoitl
may be given with the patient in the sitting position i
witii an ordinary rectal tube. The force of the strea
and tlic temperature of the water are decided by I
physician.

Ccitheterization. — Before catheteriziiig a patient gre
care niu.st be taken in cleansing the hands, the cathete
and the parts, as there is danger of infecting the b!add<
and thus causing septic poisoning by passing a dirt;
catheter or in neglecting to wash the hands and part
Germs are in this way introduced into the bladder, and
produce septic poisoning. The catheter should be of
glass or of silver, and be boiled five minutes before being
used ; then be put in a solution of carbolic acid (i : zo).

If a gum-elastic or a rubber catheter is to be used, it
should be soaked in i : lOOO corrosive sublimate for half
an hour, then put it into very hot water until needed
Glass catheters are the best; they are easily rend«
aseptic, and show whether they are or are not perfec
clean. Besides the catheter, which is taken to the h
side in a basin of very hot water, there are needed a t
of corrosive-sublimate solution (i : lOOo), sterilized gaiu
orcotton, a vessel to receive the urine, and a lubricant a
sterilized oil to render the entrance of the catheter as e
as possible. Gynecologists prefer that no lubricant should
be used, and when one is necessary it should be a mixtan
of carbolic-acid solution (i 140) and glycerin.

The Operation. — The patient lies on her back with ti
knees drawn up and separated, the upper clothing 1

ffividai over exii KBoe to gBJM -^c^
The lafaia «c aqw^d vilk
fore fa^erof (Mc haBd,aMl tlK paib vaded viA t
comoaive solubOB. IW *'-'*fc**"' is Mwrted Mia tfe
aretlua, the opoa^ jart jiwwe the n^m (Ft. 9^ tf
there is anj- iS&nd^. the othetcr Aorid he »idMhjmB
a littlf, and ^/stof pcHNed a HIk oosMBnl or ^Monl^
to the (^fat or to the kA: If the lav Aa«U osne
before cdck^ ■fine fan beoi dram, the fjihihi b
withdrawn a Stile or is inerted a Bile faiAer ihM be-
fore Before idnoving the c^hdcr a fiagET ihoald be
|Jaced over its end to prevent any <haps of «
the bed. After Ac opcralioa the parts are ac
and the catheter bailed aw) pboed in a bottle c
a solution of carbolic add (i : 2o)l oriess the cMhthj a
of rubber ; carfaobc add rutns lufahei.

A bladder very fuU of urine nnwt be "— flL^* grad-
ually, or the waib wfll be broa^bt mddenly together.
rcHiItit^ in cystilBu Cjrtiitis is dae to many camcs, ooc
being the introduetion of genns into tfae bladder by
mcans of a dirty catbeter, and the narse who passes the
catheter is alwa>-s Uamed.

Tl^adunff oat the BUddM-.— To wash out the blad-
der there are needed a fa^^io ^rif^e. which must
ha\x boiling water and a dnnfectant mn throc^ to
ckaosc it. and a glass catheter, which is cleansed in the
same way as for tatheterinag ; the parts arc abo batlicd.
The patient is first catbetcrizcd ; the catbeter is then
rinsed with boiling water and attached to the rubber
tubmg (rf the syringe which contains the ordered solu-
tion, its temperatme being about 100° F. The solution
must run warm before the catheter is inserted. When
the bladder is distended or the patient complains of pain.

PRACTICAL POINTS IN NURSING.

the flow must be stopped, and after a few moments the
tubing removed from the catheter, the fluid will then
come away. This operation is generally refjeated until
the fluid returns perfectly clear. A flexible rubber c
eter with a funnel attached can be used in the absence
a fountain syringe.

WaBhing out the Stomach. — A fountain syringe \
also used in the absence of a stomach-pump to wash c
the stomach. The hard-rubber nozzle is removed, I
syringe is cleansed and filled with lukewarm water, t
tubing is oiled and passed far back in the mouth,
the p.itient is told to swallow. The syringe is raJsi
and the fluid poured into the stomach ; when the tatter \
filled there will be retching ; the bag is then detached, a
the tubing placed over a basin or pail, and the contents o
the stomach removed. This washing is continued i
the fluid returns clear, after which the tube must 1
removed quickly to avoid retching. Liquid food is ge|
erally given directly afterward. Should there not be |
fountain syringe at hand, a piece of rubber tubing and J
small funnel may be used, or the patient may drink L
quantities of lukewann water until the water is return
clear (lavage).

4. Administration of Medicines.

The five ways of introducing medicine into the syst«(
arc by the stomach, the rectum, the cellular tissue (sun
cutaneously), the skin (inunction), and the lungs (inhi
tions).

Bapidity of AbaorptioD of Medicines. — The rapidly
of absorption depends upon the parts to which the med-
icine is applied, the state of the circulation, the solubility
of the medicine, and the power it has of passing rapidly _
through a living membrane. Absorption takes ;

THE PATIENT.

[ more rapidly when the medicine is given subcutaneously.
[ it taking only about five minutes for the drug to act,
I because it enters directly into the circulation ; it is more
slowly absorbed by the vessels of the mucous mem-
I brane of the stomach, and slower still by the intestines.
* Absorption through the lungs is rapid on account of
I their large blood-supply.

It takes about twenty minutes for a drug to act when
' given by the stomach, and about three-quarters of an
hour when given by the rectum. It is absorbed more
quickly if given on an empty stomach and if given
in solution, because it then comes in contact with all
parts of the mucous membrane of the stomach, and is
not diluted with food. Pills and powders are absorbed
more slowly; they require to be first dissolved. There
are some medicines — for instance, iron and arsenic — which
must be given after meals, so as to be diluted with the
I food, to avoid irritating the stomach.

Action of MedicineB. — The action of medicines must
L always be reported, as sometimes it is the reverse of
r what is expected : this is called an " idiosyncrasy." which
I means an individual peculiarity in regard to the action
I of certain drugs. Some drugs have what is called a
"cumulative " action ; that is, the excretion of the drug
is so very slow that one dose is not excreted from the
I body when the next one is given, the drug thus accumu-
I Jates in the body, and after a while symptoms of poison-
t ing may develop through cumulative action.

When patients have been taking a drug for some time
they become accustomed to it, and can take a large
quantity without injury, a habit being formed. It there-
Lfore takes a larger quantity to produce the result, and a
wiger time for the drug to take eflfect. It is in this way

^HLlbre takes ;
^^Hfenger time

PRACTICAL POINTS IN NURSING.

that the opium, morphin, chloral, and cocain habits
originate.

Some medicines act as Ionics, some as stimulants
and sedatives — heart and nerve stimulants, heart and
nerve sedatives ; others as narcotics, hypnotics, astrin-
gents, etc.

Tonics. — A tonic is a medicine which increases the
strength and vigor, and gives tone to the whole body.
There arc many kinds of tonics, all of which act upon
and improve the tone of the organs upon which they
have a special effect.

Stimulants arc to prevent some depressing effect, as in
shock, collapse, or in typhoid fever, when the heart's
action is depressed. To do good, they should strengthen
and slow the pulse and respirations, lower the tempera-
ture, moisten the tongue, cool the skin, lessen delirium,
and induce sleep. An opposite effect would show that
the stimulants were doing harm instead of good, and
that they must be stopped and reported.

Sedatives lessen the force and frequency of the heart's
action ; they have a soothing influence on the system,
and lessen pain to a certain extent.

Cerebral stimulants increase the activity of the brain,
and cerebral sedatives lower its activity. Vascular stim-
ulants dilate the superficial blood-vessels and increase
the circulation through them. Vascular sedath<cs con-
tract the vessels, lessening the flow of blood through
them.

Hypnotics produce sleep, and narcotics produce pro-
found sleep characterized by stupor.

PrecautioDS to be Observed in Handliner and Ad-
ministerin? Medicines. — Medicines must be kept out <rfjfl
the reach of patients. cs[x:cially children and «

kept out (Sj^^H
d delirutd^H

4inucdmnsta)«afsbeA^paarda£ 'ncMBScAairf

at the bbdtfeiyA

measoring it, a

US sbdf ; tfais rule ■

of so maojrsad i

be sure that Ac c«g»ha m to lose ih^y vCha |

while she is i

MeAdne-elasses (Fie- K^ ami
iz) mast be tborooeMr vas^ed aAcr
being ttseo, uk wmc ansg^ ^gy-
rate ones fcr stmog-andbie bkA-
citics and for oih. When tKdaed
before meals, bk&sks showJd be
given half an boar l^urr, aad ibose
to be given aiter meals sbodld be
given about half an hoar^bT,

.(F»

olhemiise onleted An i

the metBdne dropped &r back on tbe tongue, and it will

be absorbed, if not swallowed. Powders must not be
given an unconscious patient by the mouth, as with a
patient in thi« condition they- may cause suffocation.

1. Mediclnea by the Mouth. — The nurse should
always give minim doses when iiiinims are ordered, and|
drops if drops are ordered, because of the tincture
two drops are equal to one minim, but of fluid extract
the minims and drops are equal.

Drops may be given upon a piece of lump sugar or il
a little water.

Poivdcrs may be given dry upon the tongue and I
swallowed by drinking water, or may be dissolved i

water or hot milk. Powders that are unpleasant to taki
such as quinin, are now enclosed in wafers (Fig. 13)

ak«^^

THE PATIENT.

in gelatin capsules (Fig. 14). The wafers, which arc
made of rice paper, may be obtained from most chemists,

Fkj. 14— Kmp'y I""! capsules

and are from I ^ to 1 1 inches in diameter. One is moist-
ened, and the powder is laid in its centre, another wafer is
laid over the powder, and the two secured together by firm
pressure. The wafer is then laid on the patient's tongue,
and swallowed by drinkinj; water. Or a spoon containing
UdL the wafer may be filled with water and the ma.ss swallowed.
^H I^ls should be placed at the back of the tongue and
^H be swallowed with water. For children, who find it
^H very hard to swallow a pill, the pill may be finely
^^r 'Crushed and given with a little preserve, molasses,
^^H honey, or sugar. Powders may also be administered in
^^1 this form.

^^^[ ^rii/f, which injure the teeth, should be taken through
^^^b glass tube and the mouth thoroughly rinsed afterward.
^^H Oils may be taken in coffee, hot beef-tea, milk, ale, or
^^pbrandy, or in lemon- or orange-juice. Oily medicines
are sometimes given in gelatin capsules.

Purgatives must be given early in the day. so that the
patient will not be disturbed at night, but laxatives ^-\o\AA

»be given late in the evening; a result is then had the
next morning.
Many medicines of unpleasant flavor are given in
wafers and capsules.

Should a patient x-omil directly after, or in fiiv or tin

76 PRACTICAL PO/NTS IN NURSING.

minutes after, taking a vudicine by the mouth, or if the
medicine is returned witen given by reetnm, it is safe to
repeat the dose tn from fifteen to tiventy minutes.

2. Medicines Administered per Heotum. — Medi-
cints given by tlic rectum art; id the form of supposi-
tories or of enemata, which latter should be given higt
up in the bowel (see p. 59).

Suppositories. — Suppositories are drugs incorpora

with cacao-butter and then made up into conical shapes
(Fig, r5)for their convenient introduction into the rec-
tum, the vagina, or the urethra. The finger is first oiled ;
then the suppository is inserted, and pushed well up in
the rectum until it cannot be felt by the finger, a cloth
being applied and pressed against the part. The patient
is in the same position as that for giving a

3. Hypodermatio Injection. — A hypodermatic

dermatic o^^H

THE PATIENT-

mbciitaiuoiis injection means the injecting of a medicine
P under the skin for a more rapid and certain effect than
Iwc would get if given by stomach or the ri;ctum. The
imost convenient places for the injection are the outside

mti the arms, the forearms, the thighs, the chest, and the
rabdomen, the injection being made into the fleshy part,
^avoiding the large blood-vessels, nerves, and bone. The
t^ringe (Fig. 16) is cleansed by drawing through it sev-
Icral times a 1 : 30 solution of carbolic acid, followed by
Ivery hot water. The needle is boiled in a large spoonful

Jof water over a gas-flame. The synnge is loaded with

■tbe ordered solution, the needle is screwed on tightly.

taking sure that it does not leak at the junction, and

s expelled.

After cleansing the part a fold of skin is pinched up
ween the thumb and finger (Fig. 17), the needle
uickly and slantingly inserted, then withdrawn slightly,
lod the fluid is slowly injected. A gentle friction over the

78 PRACTICAL POINTS IN NURSING.

part will distribute the fluid and aid the absorption. The
needle is quickly removed, and the friction is kept up for
a few moments. If a large quantity, half a drachm or
more, i.s to be injected, it is better to inject deep in
muscle, to avoid irritation.

The syringe mu.st afterward be thoroughly washed,
drawing through it the carbolic-acid solution and hot
water, and the thin wire kept constantly in the needle to
keep it clear. If not often used, the syringe should be
soaked every few days in hot water to prevent the pack-
ing from shrinking. Abscesses following hypodermatic
injections are generally caused by the .syringe and needle
not being thoroughly clean and the solution not fresh or
pure. If the syringe is in constant use, it should be kept
in a solution (i : 20} of carbolic acid. Hypodermic
inges hold from 20 to 30 minims.

Intravenous injection, which is the injection of solutii
into a vein, is only practised in cases of emergency,
for instance, the injection of blood or of salt-solutii
when there has been an excessive hemorrhage.

4. InunctionB, — Inunction is the rubbing of an oil
or an ointment into the akin for medicinal purposes, as
in the application of mercury.

Mercurial Inunction. — When applying mercurial oint-
ment, it must be rubbed on some part where the skin is
thin, such as the inner sides of the thighs; absorption
will then take place much quicker. The order of appli-
cation differs somewhat. One way is for the patient to
take a full bath the first evening, and put on fresh under-
clothing. The second evening a piece of ointment, about
the size of a small nut, is with the hand rubbed in on the
inner side of the right thigh. The third evening the left
thigh is taken, then on successive evenings the left

kept

THE PATIENT.

pit and the right are taken. In this way one part is taken
each evening, and irritation on account of excessive fric-
^ tion on the same part is avoided. The rubbing should
: about fifteen minutes, the ointment being thor-
lUghly rubbed in. The application is to be omitted on
ftie sixth evening, and on the seventh the patient takes
1 bath, changes the underclothing, and resumes
»tment. Dr. W. H. Devine in his lectures on medi-
ines gives the following order;
First evening, the buttocks ;
Second " the thighs ;

Third " the side of the chest, but not the armpit ;

Fourth " the internal surface of the arms and

forearms ;
Fifth " the back and abdomen ;

Sixth " omit treatment ;

Seventh" bathe, change underclothing, and re-

sume treatment.

This method of applying mercury to the skin is
csortcd to wlien the stomach will not bear aiiy mer-
rurial, and also to obtain the general action of mercury,
"he mercury passes through the skin without producing
iny irritation, and is absorbed into the general circula-
ion, where the general effects of the drug are produced.
The symptoms of mercurial poisoning are an increased
mount of saliva, a fetid breath, swollen and spongy
[tims, with a bluish line along their margins, and a
allic taste in the mouth ; any one of these symptoms
must promptly be reported.

Children are not easily salivated, but when the breath

Cctid the mercury must be stopped at once,
ilied to children, it is a good plan to put the

PRAfTtCAL POINTS IN NURSING.

ointment on a piece of flannel and fasten the flannel
to the part with a bandage. There is then no danger
of the child getting the ointment over other parts of the
body. Fresh ointment is put on the flannel every day,
even if the latter does look soiled. The nurse should
wash her hands thoroughly after each application, or
absorption may take place through the skin of the hands.

5. Inhalations. — Inhalation is the administration of a
drug in the form of a vapor, whose action is on the air-
passages.

Mitist Inhalation. — In the absence of a steam-
the vaporized substances may be inhaled from a tea-
cofiee-pot standing over an oil or a spirit lamp by the
bedside, the spout being directed toward the patient; or
the solution may be put into a pitcher or a tin pan, cov-
ered with paper, which is perforated, and through which
the patient can inhale the vapor. The patient mu.st breathe
quite naturally, taking in the vapor through the mouth,
then closing the mouth, and letting it escape through the
nose, breathing five or six times in succession before
withdrawing the face for a few moments; then the pa-
tient begins again, and continues in the same way for
the length of time ordered. If the patient is not in
bed, he should inhale the vapor before going to bed ; if
done in the daytime, he should not go out for about an
hour after. The inhalation of moist air may be obtained
by means of kettles of boiling water in the room or by
placing small pieces of unslaked lime in pans of water.

Dry inhalations may be taken from a heated shovel or
a plate. The drug is placed on the shovel, and a paper
cone is made ; one end of the cone is put over the drug,
which is lighted, the vapors being inhaled from the nar-
row end of the cone and taken into the lungs.

e air-
-or^^H

the patient. 8 1

5. General and Local External Applications.
Baths. — Temperature. — The temperature of baths

I varies, and the water must be tested with a bath-thcr-
■nometor (Fig. 18).
A hot bath varies from 98° to 1 10'^ F.
A warm " " 85° to 98° '"

A tepid " '■ 70° to 85° "

A bath must never be given earlier than two hours
jAer eating, for the reason that after eating the digestive
Organs, as a rule, are congested, owing to the
activity with which they are obliged to do their
work in the process of digestion.

Action of Baths. — A hot bath stimulates
Hhe nervous system through its action on
; cutaneous nerves, which are connected,
1 a manner too varied and difficult for us to
race out, with the main nerves of the heart
md with the respiratory and digestive sys-
The nerves being already in a state of
increased activity, a bath would lead to over-
stimulation and might lead to shock, fainting,
vomiting, etc. In simpler words, food increases
the circulation, and a bath stimulates and ex-
cites the nervous system, hence one might get
a shock through over-stimulation if a bath
was given directly after a meal. A patient
should never be left alone while in the bath-
tub, as faintness may come on, the patient
may lose consciousness, shp under the water, '^^^'^
and be drowned.

Vapor-baths also act as stimulants to the nervous
d induce perspiration. A wamt bath acts as a seda-

^^H yapor-oai
^^Bpmandind

82 PRACTICAL POINTS IN NURSING.

live ; it relieves inflammation, stupor, and delirium. Th(
vessels of the surface of the body are dilated, but not s
much as by tlie hot and vapor-baths ; the blood is draw
from the brain, its activity is lessened, and the patiei
falls asleep. The warm and the hot sits-fiath. also the ho|
foot-bath, increase the circulation in the pelvic orgar
They relieve retarded menstruation by dilating the i
teries, so that the supply of blood is increased in I
pelvic organs. Mustard, being a powerful stimulai
increases the effect of the hot bath. The amount use^
is i^ tea.spoonsfu! to i gallon of water.

Tepid and cold baths reduce inflammation and feva
and act as tonics and sedatives. The first eflect of %\
cold bath is chilliness, through contraction of the blood-'3
vessels; but later they relax, and the warm blood comet
to the surface, and if the patient be rubbed, the circulatiw
will be increased. To reduce the temperature the patie
must have the full benefit of the bath. If in bed, each
part must be bathed separately; each limb must be put
into the water and well bathed by pouring the water
over it, using a sponge or a wash-cloth ; the other part
of the body must be well bathed with a very wet clo
then mopped with towels, and allowed to dry.
above stated, cold water contracts the small blood-vc!
sels ; therefore, in sea-bathing or cold baths we apply
cold water to the head to prevent a rush of blood to tlu
brain, because, as the lower limbs are the first to 1
placed in the cold water, the blood-vessels of the lej
arc the first to contract, sending the blood upward.

It will be found that cold and tepid bathing will reliei
thirst. When one is thirsty, it is a sign that the s
is in need of water, though one feels the thirst only fi
the mouth and throat ; but if the body is bathed, I

THE PATIENT. 83

I will absorb the water, and the system will get

hough water to satisfy its demands. Water when in-

cted will also relieve thirst. After an abdominal opc-

ition. when nothing is given by the mouth for several

lOurs, the bathing of the hands and face greatly relieves

^c extreme thirst. Hunger, which is felt in the stomach.

lay also be relieved otherwise than by the mouth. If

[Ourishment be given by rectum, it will be absorbed by

: intestines, and the hunger be alleviated to the same

tent as though nourishment had been taken by mouth.

Cold Tub-bath. — Should a patient be ordered a cold

bub-bath, the water at first should be about 70° F. ; the

Btient, wrapped in a sheet or blanket, is put into the

* bath, and the temijerature is gradually lowered either by

ice or cold water. When taken out of the bath the wet

blanket should be replaced by a dry one, and the patient

I be carried to bed and wiped dry. The nurse should

atch for chilliness and shock. The pulse and tcm-

lerature must be taken before and after the bath. The

mgth of time to keep the patient in the bath varies from

1 to twenty minutes.

Hot Baths. — Hot baths and vapor-\a\h.s are given to

iduce perspiration. When the kidneys are not work-

j properly and the waste material is not carried away

n the body, hot baths and vapor-baths dilate the supcr-

ial blood-vessels (tllose near the surface of the body),

iausing the patient to pterspire profusely and a large

mount of the waste material to be thus thrown off. If

a tub-bath is ordered, the tub may partly be filled with

warm water, the patient be lifted in, and then the tcm-

lerature gradually increased by adding very hot water.

fit the end of fifteen minutes the patient b taken out,

[ to bed, and wrapped in blankets, which are tucked

I
I

84 PRACTICAL POINTS I.V NUKSiNG.

in very securely about the neck and body so that n<
can enter. Cold clotlis are applied to the head,
water is given to drink, because when there is a 1;
quantity of water in the body the perspiration becoi
much more profuse, and consequently the impuril
thrown off are larger in amount. After tlie bath is c
pleted the blankets are gradually removed, and
patient sponged with warm water or with alcohol
water.

Hot Foot-batlis. — When giving liot foot-baths the nui
must remember to keep the temperature of the wal
even by adding hot water. The bed-clothes at the ft
of the bed are loosened, newspapers or a rubber cl
is spread across to prevent the bed from getting '
the patient's knees are drawn up. the feet are placed in
the tub, and the clothing is drawn around the limbs to
prevent chilling. When taken out the feet are to be
wiped dry, and care be taken that they are comfoi
warm by either wrapping them in a blanket or appl;
heaters.

Hot-air Bath. — To give a hot-air bath, a rubber cloth
or an oilcloth and blanket are put on the bed (the pa-
tient being turned on one side, as is done in changing
the bed); the patient's clothing is removed, and he is
then wrapped snugly in the blanket, the upper cloth-
ing being supported by means of a cradle. The
clothing should be well tucked in about the patient's
neck and the sides of the bed, under the mattress, to pre-
vent the escape of air, and another oilcloth put over all
will make the covering much more air-tight Under the
clothing, at the foot of the bed, is inserted the spout of
a kettle of boiling water, which can stand over a gas-
or an oil-stove or a spirit-lamp placed on a chair or a

irtab^^^H
plyilj^H

THE PATIENT

ptable, the whole being covered with a blanket to
1 the steam under the blankets (Fig. 19), If the bed

direct ^^H
ha.s ^^H

a high footboard, the steam can be directed from one
side of the foot of the bed. The nurse should guard
against fire. The doctor will give orders as to the
length of time the patient is to remain in the bath. He
may order a thermometer to be placed in the bed, and
the steam continued until the thermometer registers r20°
F. or above, when the steam is stopped and the patient is
treated as after the hot bath. As the water in the kettle
boils down it must be replaced with boiling water, not
with hot or cold water, or the steam will stop until the
water boils again. Carefid watch must be kept over the
patient's pulse, which can be taken at the temples.

In the absence of an nil-stove or a spirit-lamp, ver>'
hot bricks, smoothing-irons, or plates may be wrapped
in wet flannel or cloths; the hot bricks in contact with
the wet cloths will make steam. The cloths must be
placed about the patient on plates or in dishes to prevent
wetting the bed, and care be taken not to burn the patient.

86 PRACTICAL POINTS IN NURSING.

If able to sit up, the patient can be seated on a cane-bottom
chair, the clothing being removed, and snrrounded will:
blankets or comfortables, which must be fastened from tlu
neck down (Fig. 20). A kettle
of boiling water over a spil
lamp or an oil-stove, or a
or pail of boiling water.
placed under the chair. T
feet may be put into a pail
hot water to increase the cffe
because the blood-vessels
the surface of the body
dilated, and remain so while
heat or vapor is continued;
I this way the activity of the ski
s increased, the pores of the skjln
inginngahoi-airbiiihiopjiiLciiiiii ^jq Opened, and perspiration

.iuinu p«ilii.n. (Thorn™). , . t-l 1. u

produced. Ihe nurse should
sure that the blankets or coverings are fa.stened close^j
around the patient's neck and about the chair to prev<
the steam escaping. Cold is applied to the head,
water is given to drink, for the same reason as that given
in describing the hot baths, and the after-treatment is thft:
same.

Aciti Suam-bath. — An acid steam-bath, which is &<
valuable application in rheumatism, is given by prepar-
ing the patient in the usual manner, and placing around
her very hot bricks wrapped in flannel which has been
steeped in vinegar. The bath is continued for fifteen

inutes, after which the body is wiped over with a tow<
wrung out of cold water, then thoroughly dried.

Shozvcr-halh. — A shower-bath is given by directii
the water from an ordinary watering-can, a pitcher, or

or a ^^H

THE PATIENT. 8/

pail elevated a few feet above the patient. To douche the
head the patient generally lies upon her stomach, her
^^ head hanging over the side of the bed, or the bath may
^^L be given her lying in bed. The patient lies on her side
^^B'Dr back; the pillows are removed, the clothing loosened
^^^.^id pushed well down under the shoulders to prevent
^R-lvctting; a pad is made with rubber cloth, oilcloth.
^^■.Or newspapers, by rolling the cloth at each side and
^^■^t one end ; the pad is put under the shoulders of the
^^Lpatient, her head resting on it, and the unrolled end
^^P bangs in a pail. The pad will prevent the water from
running down the patient's back and the sides of the
pad. and will also keep the bed dry. The water is poured
upon the patient's head from
I ,a pitcher elevated a little dis-
Ltance above. After the
ftdouche the patient's head
I. and shoulders are raised
land wiped, the pad is slipped
I into the pail, and the
clothing and pillows are re-
placed.

Skfet-iatk {Drip-sheet).~
The sheet-bath, or drip-sheet,
which is frequently applied in
lervous diseases, is generally
given in the following way:

patient, with clothing

removed, stands in a tub

prhich contains enough warm

^ater to cover the feet to the

ikles to prevent chilling (Fig. :

mid water is thrown over the

I ). A sheet wrung out of
patient from behind, and

88 PRACTICAL POINTS IN NURSING.

covers the head and entire body. The patient is then
gently rubbed (over the sheet) with both hands to pro-
duce friction and bring the blood to the surface. As the
sheet becomes warm it can be re-wet by pouring water
on it from a cup or a bowl. The doctor will always give
directions as to the length of time the patient should be
in the sheet. After being dried some phy,sicians like the
patient to be put to bed for a certain length of time, while
others will leave orders for the patient to dress and go,
out for a short walk or to sit by an open window.

Cold Douche. — The cold douche, or afTusion, is gii
by wrapping the patient in a sheet, placing him in tlie'
bath-tub, and pouring pailsfiil of water over the body.
The first pailful should be tepid, and be poured rather
slowly, to prevent shock. Exhaustion must be watched
for, and after the affusion the patient should be put to
bed and wrapped in blankets. Another way, one often
employed in nervous diseases, is to stand the patient in
the bath-tub, and direct the water to the spine or to the
part to be treated by a piece of hose-pipe attached to the
faucet.

Cold Pack. — The cold pack is ordered for reducing
the temperature in many acute diseases. A rubber, an
oilcloth, or a newspaper is first put on the bed, and
over this one or two blankets ; then a sheet or a table-
cloth which has been dipped in tepid water and wrung
out is placed on the blankets. The patient is laid upQ*i
the sheet (the patient's clothing having first been
moved), and every surface of the body is covered
pressing the folds of the sheet down between the a)
body, and lower extremities. The sheet is tucked
in at the neck and feet ; the binnkets are then folded
and tucked evenly under the patient on both sides.

THE PATIENT.

t are lifted up and the comer cuds of the sheets and
lankets are tucked under them (Figs. 22 and 23). A
^ wet towel or compress is applied to the head. The
patient should be kept in the pack ten or fifteen i
utes. It will be found that, besides lowering the tem-
I perature, the cold pack will relieve nervou.snesa and
iducc sound sleep.

' Pack. — The hot pack is given in the same way as

; cold pack, with ihe exception that the blanket, the

ts, or tablecloth is wrung out of boiling water by

T the blanket in a sheet, and pouring the boiling

r over them ; two persons, each taking an end of the

, wring in oppo-sitc directions. More coverings are

the patient than in the cold pack. Should

the nurse not have anything with which to prevent the
mattress from getting wet, a table may be arranged with
blanket and sheets ; in the absence of a table the floor
near the bed may be prepared. Towels, tablecloths.

PRACTICAL POINTS IN NUKSING.

and old linen may be used where there are but few
sheets. After the pack the sheets and blankets are
removed, the patient is wiped dry with soft towels, the
cIothin[f is put on. heat is .ipphed if necessary, and tlie

pulse and temperature are taken. Partial packs are
compresses applied to different parts of the body, and
covered with a flannel or a cotton bandage to prevent
the patient's clothing becoming damp.

Infiammation. — Blood is made up of three parts: a
watery, almost colorless fluid, called "plasma," and
red and white corpuscles, which give to the blood its
rich red color ; there are more red corpuscles in the
blood than white. The plasma contains a substance
called '■ fibrin," which is an albuminoid, and which is the
nourishing part of the blood. Hlood in its normal con-
dition is perfectly fluid, but when drawn from the body
into a basin the fibrin causes the blood to coagulate oi
clot; the corpuscles, which are heavier than the p1a.sma,
sink to the bottom of the basin and are bound togethi
by the fibrin, the whole forming a red semi-solid mass,
covered with a clear yellowish liquid called " serum.

THE PATIENT.

The c£ttf is the corpuscles, together with the fibrin, which
has now left the plasma, and the scntm is the plasma
without the fibrin. It is thus seen that when the blood
is fluid tlierc are two parts — the plasma and corpuscles ;
when it is clotted or coagulated there are two jiarts —

■the serum and clot, the clot being made up of the cor-
Busclcs and fibrin, the serum consisting of the plasma
pith out the Abrin.
I Bs'^nptome of Inflammation. — The four symptoms
If inflammation are heat, redness, swelling, and pain —
Wiaf, due to the abnormal conditions of the blood in the
Inflamed area ; ndntss, due to increased hematin in the
blood of the part; swdling, due to increased blood-
supply; pain, due to pressure on the end-organs of the
sensory nerves. We can feel heat when the inflam-
mation is on the surfece, as in the case of an inflamed
finger, but where the inflammation is hidden, as in the
lungs, the brain, or the bowels, or in any of the internal
organs, we ascertain it by taking the temperature with
the clinical thermometer.

Trsatment of Inflammatioii. — If heat or cold is
applied at the beginning of inflammation, the latter may
subside; but should it continue, it generally terminates
9 an abscess. The poultice or fomentation which is gen-
slly ordered softens and relaxes the skin and tissues,
fates tile blood-vessels, quickens the circulation in the
0 that the fresh, pure blood can pass through, and
B tight, painful feehng caused by the blood-pressure to
S part is relieved. Ice contracts the capillaries, and
s lessens the amount of blood flowing to the part, and
B-formation maybe prevented. When pus has formed
Hilticcs are again ordered to bring it up to the'surface,
inging it lo a head, as it is termed.

PRACTICAL POINTS IN NURSING.

Bleedin?. — Leeching. — Leeches are used in inflamma-
tion when it is necessary to remove a small quantity of
blood. The part must be washed very clean, shaved if
necessaty, and be wiped dry ; the leech is taken be-
tween the folds of a towel and applied. If it does not
bite, a drop of blood extracted from a pricked finger
will generally cause the leech immediately to bite.
Another very successful way is to put the leech in a
very small wineglass or cup filled with water, in which it
should remain for a few minutes; the edge of the wine-
glass is then held to the part we wish the leech to bite,
and it will come up out of the water and generally take
hold ; should it move around, it can be guided to the right
spot. As a leech is always hot and uncomfortable after
being shut up in a box, it should be put into water (the
glass or cup having a perforated paper cover) until we
are ready to use it; being then in its natural element, it
becomes cool and good-natured.

After the leech has taken hold a piece of cotton should
be slipped between it and the skin, because the move-
ments of the leech give a very unpleasant sensation to
the patient, and tend to make .some patients nervous, A
leech generally holds from i to 2 teaspoonsful of blood,
and when full it will drop off If necessary to remove
leeches after being on a certain length of time, a little
salt sprinkled on their he.ids will make them drop off;
they must not be pulled off, or they may leave their
teeth in the wound and cause inflammation. The bleed-
ing can further be encouraged by the application of hot
poultices or fomentations. To stop the bleeding pres-
sure is the be.st — a pad of graduated com press- cloth ; or
cold may be used — a small lump of ice. The patient mii^..
not be left for the night until the bleeding has s

as stoppedt^HM

THE PAT! EAT.

E'Lecches should not be applied o^-er an arter^', a s€ax,
r over loose cellular tissue where pressure cannot be
ipliied, but, if possible, o\'er a bony surface. It should
also be known that the odor of tobacco, \-tnegar, or dts-
infectants in the room will often prevent a leech from
biting. All cavities must be filled with cotton if leeches
are to be applied near; should a leech get into one, it
can be removed u-ith an injection of salt and water.
Leeches must always be disposed of after being used by
putting them into a ver^' strong solution of salt and water
or into dry salt, and co\'ering the vessel tightly. The
nurse must be sure they are dead before throwing them
away. The American leeches are best for children ; they
draw less blood In case the patient is a child, the leech
should be well covered, so that the child will not be
frightened.

Cupping. — Cupping is to relieve pain and congestion,
and to prevent absorption. Dry cupping draws the
blood to the sur&ce of, and wet cupping draws blood
from, the body.

ViiT dry cupping there will be needed two of three
tumblers, or wine-glasses, or medidrK-glasses ; akobol ;
a candle, a lamp, or a sjurit-lamp ; matches ; towels.
The part is washed with warm water, the glasses rinsed
with hot water, and thoroughly dried. A few drops of
alcohol are poured into a glass and shaken around ; the
edge of the glass is wet with the finger or b oiled, which
prevents the fire reaching the patient's skin ; the alcohol
is then lighted with a match, and the glass turned over
on the part, which must be an even surfiice. All this is
done very quickly. The skin is seen to rise almost im-

Etely in the interior of the glass, and the blood is
I toward the surface. To remove the glass the
.

94 PRACTICAL POINTS IN NURSING.

skin is pressed down with the thumb or finger. The
air will then enter the glass, which can be taken off.
Care must be taken to avoid getting too much alco-
liol in the glass or getting the edges of the glass too
hat.

Wet cupping is done with a scarificator. In addition
to the thing.s needed for the dry cupping, the nurse
should prepare for the wetting operation some disinfec-
tant and a dry dressing of gauze or compress. The
part is wa.shed with soap and water and a disinfectant;
incisions are then made with the scarificator, and a dry
cup is applied, which draws the blood. After the re-
quired amount has been drawn the cup i,s removed and
the dressing is applied. Sometimes poultices are ordered
to increase the effect. The nurse must have everything
prepared for the physician, and stand ready to hand what-
ever he needs.

Fomentations. — Moist heat is applied to the body in
the form of warm or hot baths, poultices, and fomenta-
tions (stuijes). For a hot-water fomentation coarse flan-
nel or two or three thicknesses of old blanket is the
best. White flannel is preferable, as the dyes of colored
flannels arc apt to be poisonous. The flannel is placed
in the middle of a towel, and both dipped in a basin of
boiling water for a few moments, the ends of the towel
being twisted in opposite directions until all the water is
wrung out ; the fomentation is then carried to the bedside,
the towel untwisted, and the flannel shaken out, before
applying, to let in the air ; it will then retain the heal
much longer. The fomentation is covered with dry flan-
nel or towels and a piece of rubber cloth (both flannel
and rubber being larger than the fomentation), and a
bandage is applied to keep it in position. This proce-

THE PATIENT.

dure will retain the heat of the fomentation longer and
aUo keep the patient dry. When renewing the fomenta-
tion the fresh stupe must always be ready before the
cool one is removed.

Laudanum and turpentine stupes are prepared in the
same way as the preceding: when the flannel has been
wrung out of the water, from 15 to 20 drops of laudanum
are sprinkled over it. For the turpentine stupe about
30 drops of turpentine are sprinkled over the flannel, or
to I pint of boiling water there are added 3 teaspoonsful
of turpentine ; this solution is well mixed and the flannel
put in, stirring all the time. The flannel is then taken
out. wrung, and applied, the turpentine being then more
evenly distributed over the flannel.

Mustarii fomentation consists of flannel wrung out
of very hot water (not boiling), about 1 pint, to which
has been added i tablespoonful of mustard. It is pref-
erable to make a paste of the mustard before adding it
to the hot water; there will thus be less danger of it
forming lump.s. Mustard must not be added to boiling
water, or the action of the volatile oil which the mus-
tard contains, and to which it owes its value, will be de-
stroyed.

Fomentations to the eyes and neck are changed every
few minutes. Flannel, old cotton handkerchiefs, or
sponges may be used, all of which can be put in boiling
water and be pressed out with a lemon-squeezer, which
is very handy for these small stupes.

When stupes are discontinued the part must be dried
and covered with absorbent cotton, flannel, or a towel
for a while, and afterward be bathed with alcohol, which
llill be a preventive against cold.

—A Jlaxseed-meal poultice is made by rap-

96 PK.iCTlCAL POINTS IN NURSING.

idly Stirring the meal little by little into boiling water.
When the mixture is of the consistency of mush, stiff
enough to drop away from the spoon, it is well beaten
with the spoon to remove the lumps. This flaxseed
paste is spread smoothly and evenly half an inch thick
on a piece of old cotton, cheese-cloth, mosquito-netting,
or even on paper, of the desired size, leaving a margin
to turn in of about 1^ inches all around the poultice.
Another l.iyer of muslin is put over the face of the poul-
tice; the edges are turned well under to prevent the flax-
seed escaping. The poultice should be rolled in a towel
and carried on a plate to the patient. When applying
the poultice the nurse places her hand under it, the back
of her hand resting on the part to which the poultice is
to be applied, and slowly removes her hand; this will
get the patient used to the heat, and is far better than
suddenly putting a hot poultice on an already tender
and sen.sitive skin, as repeated applications make the
part very tender. This fact applies also to children:
if once a child is frightened by too hot a poultice, the
nurse will probably never be able to put on another.
The poultice should be covered with Rannel and rub-
ber cloth or with newspapers, and be fastened with a
bandage; the heat will thus be retained and the patient
kept dry.

Large poultices should be changed every four hours,
or if well covered they will last five or six hours; the
smaller ones must be changed every one or two hours.
A poultice must never be removed until a fresh one is
made and ready to be applied ; then the old poultice is
removed and the part wiped dry with a piece of soft cot-
ton, for the reason that the air acts as an irritant to a
moist surdce and causes an itching sensation. A poul-

THE PATIENT.

tice once used must never be reheated: it is valueless:
hence poultices must be freshly made each time they
are needed. If, for some reason, the nurse has to wait
before applying a poultice, it can be kept hoi by placing
it between two plates over a pan of boiling water ; if it
is put in an oven, it will bake.

When applied for the removal of a slough, the poul-
tices must be discontinued as soon as the slough is rc-
_^oved, as further poulticing will prevent tlie heahng of
part by making the skin too moist and flabby.

Jacket-pvultkcs. — A jacket-poultice, which is a poultice
to encirck tht; whole chest, is readily made by taking
four large pieces of muslin, old linen, etc., that will reach
from the neck to the waist-lme, and sloped out to fit
under the arms ; the poultice is then made in the usual
way, one poultice being applied to the back and one to
the chest, and fastened together over the shoulders and
down the sides with safety-pins to keep them in posi-
tion ; then the usual coverings and bandages are applied.
The jacket-poultice must not be renewed until the fresh
poultice is ready to be applied; then the bandage is
unpinned, the patient turned on his side, the cold
poultice removed, the back wiped dry, and the fresh
poultice and coverings applied; then the patient is
turned on his back and the fresh poultice applied to the
chest and fastened with safety-pins. It is an e.\pert act
to remove a poultice or a fomentation without awaken-
ing a sleeping patient : it can be done on almost any
of the body excepting the back, and even here it

Ly be accomplished if the nurse has the confidence of
patient, who will wake up just enough to turn over

id have the poultice renewed, and then drop off to
sleep again.

A bran-jacket is made by placing bran between two
pieces of muslin, which are cut the same as for the
jacket-poultice, and stitching them all round and in dif-
ferent places after the manner of quilting, to keep the
bran in place. The bran-jacket may bi; applied dry after
heating it in an oven, or it may be placed in boiling
water for a few minutes, then wrung out, laid on the
part, and covered with rubber cloth or flannel and fast-
ened with a bandage. When cold it is again wrung out
of boiling water and reapplied. There should be two
jackets made.

Bread Poultice. — Bread poultices are applied to very
tender parts, and are milder than flaxseed, but they do
not retain the heat as long. The poultice is made by
stirring stale bread-crumbs into boiling water, and beat-
ing the mixture well to remove the lumps ; then the
water is drained o(T and fresh boiling water is added,
which will remove the alum found in some bread; the
second water is drained off, the poultice being then
spread and applied.

Mustard Poultice. — A mustard poultice is made by
adding to very hot water two parts of mustard (all
the lumps being thoroughly dissolved) to four parts
of flaxseed meal, and the poultice is spread and ap-
plied in the usual way. If the mustard be sprinkled
over the flaxseed poultice, there is danger of burning
the patient in patches ; we avoid this by first dissolving
the mustard in the water.

Charcoal Poultice. — A charcoal poultice, which is a
very dirty poultice to prepare, is generally made with
one part of charcoal and two parts of flaxseed meal,
mi?ced and made in the usual way, a little additional^
charcoal being sprinkled over the surface of the

'the pod^H

THE PATIENT.

poult

^H su

Hce before applying. This poultice, which is ordtrtxi
Tor wuunds which have an ofTensive discharge, acts as
a deodorant by absorbing the odor and promoting a
healthy condition. Another method of making this
poultice is to add \ an ounce of charcoal to 4 ounces

r flaxseed meal and bread-crumbs, mixing all together
I making the ^plication in the ordinary way.

1 Starch Poultice. — A starch poultice is made by taking
■ordinary laundry starch, mixing it with cold water, and
then adding boiling water to make it into a thick paste.
A starch poultice is used in skin diseases to relieve irri-
tation. Very otlen belladonna or laudanum is sprinkled
over the surface of both starch and flaxseed poultices to
act on the nerves of the part and allay the pain. The
s of the drug must be watched for ; this is very im-

IDrtant, especially in the case of children.

Spke Poultice. — A spice poultice is made by placing
in a bag equal parts of cloves, cayenne pepper, ginger,
and cinnamon. The bag is sewed up and submerged in
hot alcohol or in vinegar for a few moments, when it is

IMrrung out and applied. Another way is to mix the
tpices with about 1 ounce of flour and enough hot alco-
■dI to make a paste, and to spread this between two
pycrs of muslin or linen. If the skin is tender, the
proportions of cloves and pepper should be decreased.
!n the absence of the spices flannel may be wrung out
of hot whisky or pure alcohol and applied to the part.
The action of a spice poultice is that of a mild counter-
ritant.
Yeast Poultice. — To make a yeast poultice, which is
stimulant to slow-healing wounds, take 3
tiunces of fluid yeast and hot water, and stir in a quarter
of a pound of either flour, oatmeal, flaxseed, or Indian

^^^nitan

lOO PRACTICAL POINTS IN NURSING.

meal. This mixture is heated, stirring it all the time
until it is hot; or it is set by the fire until it rises;
it is then spread on muslin the same as a flaxseed-
meal poultice is prepared, and is applied while fer-
menting.

Slippery-elm Poultice. — A slippery-elm poultice is mai
by mixing slippery elm with very hot water ; they shoul
be mixed slowly or the poultice will become lumpy,
be well beaten before spreading it on the linen.

Hop Poultice. — A hop poultice may be made in
same manner as a bread poultice, or by filling a
about half full with hops and wringing it out of
ing water when needed.

Antiseptic Poultices. — Corrosive sublimate is used
antiseptic poultices, the strength varying from I : 5000
I : 10,000. A towel, absorbent cotton, or gauze is wrui
out of a hot solution, applied to the part, and covei
with a dry towel, oil-silk, or paper, and a bandage. Ci
bolie acid is used for poultices in strengths varying fr<
1 : 60 to I : icx>. Both carbolic acid and corrosive sul
limate are very easily absorbed, and the general effects
of the drugs must be watched for, Crcolin, which is
not so poisonous as the preceding, is used in strengths
of from 2 to 5 per cent. For boric-aeid poultices
per cent, solution is generally used.

Green-soap Poultice. — A green-soap poultice is a thi
layer of green soap spread over a pad of gauze,
sorbent cotton, or a towel, and covered with a dry toi
and a bandage.

Ice Poultice. — An ice poultice is to relieve hemoi**!
rhage. or pain due to neuralgia or inflammation,
is made of crushed ice, mixed with salt and sawdust
flaxseed, bran, or oatmeal, and sewed up tightly in

h is
gths

andfll

lust ■'«

THE PATIENT.

lOI

mbber cloth, a coarse towel, or in paper, so as not
wet the patient and the bed.

It is not at all difficult to apply poultices or fomenta-
tions in a railway car; aU one needs is a pint tin-cup,
flaxseed meal, a spoon, paper, and a spirit lamp. In
cases of sudden illness of an adult or a child attacked
with croup, where fomentations will give great relief,
hot water can generally be had, and handkerchiefs be

» wrung out of it and .ipplied.
Dry Heat. — Dry heat is applied with hot bottles,
bricks, plates, or smoothing-irons, well covered to pre-
vent burning the patient. Hot flannel and bags filled
with salt or bran or sand are used in aural surgery to
relieve pain in the ear: the bags are made of old mus-
Un or gauze, cut half-moon shape, and applied around
the car, never over it, as there would be danger of the

Ibeat causing the walls of the aural canal to swell \ tiiis
would bring the walls together, and if the Eustachian
iube were closed and there was an abscess in the mid-
l^e ear, the nurse would have a sad state of affairs.
(Two bags will be needed — one being in the oven or
in a farina-boiler heating, the other being on the pa-
tient When using a hot-water bag the contained air
must be expelled before putting in the stopper; the
bag will then lie flat.

Applioatjon of Cold. — loiter Coil. — Cold is applied
to a part to relieve pain, to relieve inflammation, to ar-
rest hemorrhage, and as a local anesthetic to freeze
the tissues and allow slight operations to be performed
painlessly; also as a stimulant, as when cold water is
dashed on the face of a fainting person. It relieves
1 by reducing the feeling of sensation, acting as an
it relieves inflammation by contracting the

102

PliACTICAL POINTS Iff ffUftSING.

blood-vessels, so that the amount of blood flowing to
the inflamed part is considerably lessened and pus-
formation is prevented.

The Leitcr coil (Figs. 24, 25), which is used to apply
continued cold to a part, is made
of coils of pliable metal through
which ice-water runs continually.
Coils are made to fit the head,
the ear, the abdomen, and difler-
ent parts of tlie body. Two long
pieces of rubber tubing are at-
tached to the coil; the end of
one tube being put in a vessel
containing ice-water; the water
Fm M-i-iier coil .ppiiod .0 runs to the coil, and after cir-
culating through it the water
passes out of the second tube into a pail on the floor
to receive it (Fig. 25). The ice-water pail, which should
be a few feet above the patient's head, may stand on a
hassock or a small chair placed on a table, or it may
hang from the knob of one of the bedposts ; the reser-
voir must not be too high or the water will run through
the coil too rapidly. If the tubing is large, the second
tube which conveys the water to the pail may be made
smaller by tying it a little tightly at different parts
along its length, thus preventing the water running out
too rapidly. The supply-pail must be kept filled with
water and ice. Should there be any difficulty in get-
ting the water to run, or should the water stop run-
ning, by putting the end of the lower tube in the mouth
and making slight suction the water will generally begin
to circulate. These coils are fastened to the part by
tapes passed through slits at each end and tied around

THE PATIENT

103

; part. Should the patient complain of the intense
»Id, a piece of compress first put between the part and
I "the coil will make it more bearable ; this applies also to
ice-bags.

Ice-bags. — Ice-bags must carefully be watched : if the
I nurse has only one ice-bag, ice-cold compresses must be
p applied to the part while the

bag is being refilled. Ice
melts rapidly, and if the bag
remains on after the ice has
melted, the water will rise to
the temperature of the part
to which it is applied and do

Buch harm. When applying an ice-bag to the back or
p any part of the body that will lie upon the bag, two
Bings must be remembered : first, that there is air in the
J. and second, that the heat of the part to which it is
ipliedvery rapidly melts the ice in the upper portion of
the bag, the water becomes warm, and the ice lying at

104 PRACTICAL POINTS IN NUHSING.

the bottom of the bag does no good. To remove the
water and air, one end of a piece of small rubber tube
is placed in the mouth of the bag, the other end in a pail
on the floor. In this way the water will be drained off as
the ice melts, and continuous cold will be applied.

To fill an ice-bag the tee is wrapped in a coarse cloth
or a towel and crushed with a hammer, or the ice ra^
be broken into small pieces with a strong pin or a darn
ing needle. Fill the bag half full, and press out the a
before sealing it.

When cold is applied to the head and spine
the head alone, heat is generally applied to the fefl
and other parts of the body to avoid any deprc
effect on the circulation.

Counter-irritants. — Counter-i rritati on rel ie
seated inflammation by irritating the ends of the senson
nerves and dilating the blood-vessels of the part s
the circulation of the blood through them is incr
the blood is brought to the surface, thus relieving t
inflamed part beneath. There are three classes 1
counter-irritants. Counter-irritants of the first class
are rubcfackuts, which redden the skiti by distending
the small blood-vessels. Friction will also do tliis, as
it tends to send the blood nut of the small blood-vesse
through the veins; the circulation of the part istncrea
and the swelling is removed; other counter-irritants (
this class arc mustard poultices and turpentine )
mustard fomentations (.stupes).

Counter-irritants of the second class act more strongljl
they, too, are rubefacients, but of a stronger kind ; i
example, a mu.stard plaster, which is stronger than I
mustard poultice. The blood-vessels are dilated,
circulation is greatly- increased, and a certain amount 0

THE PATfEXr.

105

: blood is brought to the surlace; the blood in the
iflamed part is lessened and the pain is relieved.

L counter-irritant of the third class is 2'csitralion, or
ilistering, which produces true inflammation by drawing
e blood from the inflamed part directly to the surface,
and there is an outpouring of the serum (the water of
the blood) between the cuticle and the true skin.
Counter-irritants are generally applied a little distance

I from the inflamed parts, for the reason that if the vessels
of these parts are dilated more blood is brought to them.
For instance, in cases of meningitis, severe headaches,
Knd other affections of the head a blister is sometimes
^)plied to the nape of the neck ; the blood-vessels here
being dilated, more blood is brouglit to them, and the head
is relieved. It is the same when a hot-water or a mustard
foot-bath is given to relieve headache : it causes greater
_ dilatation of the blood-vessels in the limbs, so that more
blood is drawn to them, thus relieving the head. If the
plister was applied directly over or too near the inflamed
lart. there would be danger of the accumulation of blood,
: the "congestion," increasing and doing more harm
lan good.

The reader may have had an inflamed finger, and have

iticed that when the hand was hanging down by the

ide the throbbing and pain were increased ; this was due

» the blood rushing down to the hand, thus putting

pnore pressure upon the finger; but on raising the

ind the pain was relieved, because the pressure of blood

Tiecame less. It is for this reason that rest is ordered

for inflammation. The part is kept quiet and elevated;

the arterial blood is thus prevented from rushing to the

, and the venous blood can better return to the

^K|»rt, and

PRACTICAL POINTS IN NURSING.

Mustard f^aster. — A mustard plaster is made of mus-
tard and flour, equal parts, or of all mustard, mixed into
a paste with warm water and spread between two layers
of muslin or soft linen rag. When mixed with flour
the action of the mustard is slower and it is not so liable
to blister. The plaster is covered and left on from ten
to twenty minutes. When it is removed a little vaselin
is rubbed over the part, which is covered with a soft
cloth. While the plEister remains on the patient a comer
should be raised from time to time, to see that it is not
blistering ; especially is this necessary with unconscious
and paralyzed patients. For children four parts of flour
are mixed with one part of mustard ; when the skin is
red the plaster is removed and a flaxseed-meal poultice
applied. The action is slower, but blistering is prevented.
White of egg and mustard make also a non -blistering
plaster.

Tincture of Jodin. — Tincture of iodin is a counter-
irritant; it is painted over the part with a swab or a
camel's hair brush, a little of the tincture being poured
into a cup or a saucer. Two coatings will be sufficient.
The iodin stains the skin a dark yellowish-brown color,
and may cause a painful, smarting sensation, which can
be relieved with alcohol or ammonia, though some pa-
tients prefer olive oil. The swab or brush must never
be put into the bottle afl:cr being used on the patient.
There should be a separate brush for each patient

Croton Oil. — Croton oil is a powerful counter-irritant ;
3 or 4 drops are sprinkled on a small piece of flannel
and rubbed into the skin; this gives rise to a vesicular
eruption.

BliaterB. — Cantharidism. — A blister is raised with either
cantharidal plaster (Spanish-fly), cantharidat cerate (blis-

THE PATIENT.

lo;

termg cerate), or cantharidal collodion. The part must
be washed, and shaved if necessary, and be wiped per-
fectly dry ; the plaster is cut the desired size and shape
[Fig. 26) and applied. If the cerate is used, it siiould be

spread on a piece of cotton and be kept in place with a

bandage. If adhesive plaster is used to keep either of

these plasters in place, tliere will be no room for tlie

blister to rise, and it will cause a dragging pain. Before

applying the cantharidal collodion the parts to be blis-

rcd must be outlined with vaselin or with oil, which will

revent spreading of the blistering solution. The collo-

Bion, which is painted on with a swab or a brush, causes

1 itching sensation when first applied : patients must be

(old of this to guard against scratching.

The action of the cantharis must be watched for It
B a powerful irritant and affects the kidncy.s, and some-
auses painful urination or suppression of urine.

I
J

PRACTICAL POINTS IN NURSING.

For children and very weak persons the plaster should
be kept on just long enough to start the blister, then a
poultice be applied to make the blister rise, otherwise a
slough may be formed. It generally takes from four to J
eight hours for a blister to rise (collodion acts more-l
quickly). If at the end of that time the blister has notj
risen, the application of a flaxseed poultice will hasten
this result.

Should the physician leave to the nurse the time of fl
applying the irritant, she should apply it during the early I
part of the day. so that the blister will rise before even-f
ing. If applied in the evening, the patient is kept awake 1
through the night with the pain caused by the rising of f
the blister. When the blister has risen, the lower parti
should be snipped with a pair of scissors, and the fluid
discharged on a towel or a piece of cotton to prevent
irritation of the skin, and then be dressed with vasclin.
It must be remembered that the cuticle, or skin, of the J
blister must not be removed without orders; the skin is J
only removed when the blister is to be kept open. In this j
case it is called a "perpetual" blister, and is dressed with
some irritating ointment. If the physician wishes the
fluid to be reabsorbed, care must be taken that the
skin is not broken.

Chloroform Blistering. — A ready way to produce S.I
blister is to pour a few drops of chloroform or of stronj
ammonia into a watch-crystal, which is then placed c
the part; the bhster will rapidly rise.

A blister mu.st not be produced over a bony part, I
cause here the circulation is less active, and a slough.l
may be the result.

Massaffe. — Massage consists of a series of movemei
which give to the muscles and the whole system s

THE PATIENT.

109

and vigor, and in a certain sense takes the place of active
exercise, but it is entirely different from rubbing. The
work is done by the ball of the thumb, the fingers, and
the palm of the hand. Some of the movements are
stroking with the finger-tips, followed by deep stroking ;
kneading, which is grasping a muscle or group of mus-
cles between both hands or between the thumb and fin-
ger, and pressing, rolling, and squeezing it, beginning at
the extremity of a limb and working upward. Then
there is the deeper kneading, as in treating an arm or
limb, followed by rolling or fulling, which is a to-and-
fro movement with the limb between the palms of the
inds, the limb being rolled back and forth ; deep pres-
^SUre with the knuckles, used when a part is either hard
or flabby and we want to reach a deep-seated nerve ;
ttvisting of the muscles, followed by vibration, which
stimulates the capillary circulation ; percussion, which is
striking or beating the surface with the palm of the hand
(clapping) or the side of the hand with the fingers held
very loosely (whipping), and with the fingers held stiffly,
'hich is true percussion. AH this is followed with light
ition. On the abdomen the kneading is begun at the
lending colon, then is continued on the transverse and
[descending colon. The tissues are rolled, not rubbed ;
firm grasp of the muscles should be taken, and a con-
'siderable amount of force be used, but not too much.

Repose of touch should be cultivated, and work be

done from the wrists, or the movements will be jerky

itead of being even. Tender parts should be gone

lightly over at first : later on more force may be used.

It will be found, if done skilfully (and skill can only

acquired by constant practice), that massage is a

re sedative, relieves neuralgia and also some chronic

no PRACTICAL POINTS IN NURSING.

affections. In order that the student may have a pei
knowledge of massage and its application, it is absolute!
necessary that she should first take a complete course a
anatomy, and familiarize herself with the bones, muscU
and organs of the body, their form and location.

Liniments, — Liniments are for external use, to relieve
pain or to produce local stimulation. They must be
applied to the skin with friction until the part is en-
tirely dry. A cloth must not be used, or the effect will
not be so good.

Lotions, — A lotion is a medicinal application, and
be evaporating or non-evaporating; it is used external
for cooling purposes and for the relief of pain. Wh«
ciaporating lotions, such as alcohol, vinegar, or camphi
are u.sed, one single thickness of cotton, saturated wi(
the selected lotion, is applied and left uncovered. Lotioi
must be changed often, and not be allowed to becoi
warm or dry, Non-roaporating lotions are applied wil
two or three thicknesses of compress wrung out of
ordered solution and covered with rubber tissue or ch
and a bandage to keep it in position.

Oargles, Sprays, etc. — To gargle the throat the sol
tion is taken into the mouth, the head being thrown
and moved from side to side. The fluid in this way is
brought in contact with the back part and sides of the
throat, and is more beneficial than by causing the fluid to
bubble up in the throat. If the gargle is an add, the
mouth must afterward be rinsed with water, so that the
teeth will not be injured. Sprays are much better than
gargles when the throat is ulcerated ; a patient can seldom
gargle thoroughly. A spray will reach all the parts.
When spraying or painting the throat the nurse should
stand a little to one side, so that the patient will

/ill naC;^H

THE PATISNT.

Ill

High in her face. When paintinp, the rule is to paint
am down w/, because the patient wi!l always gay; by
beginning to paint at the bottom of the throat one can
paint upward, bringing with one sweep the brush or
cotton-stick out ot the mouth. A roll of paper answers
nicely for blowing powder into the throat ; the paper roll
is placed back in the throat with the powder inside, and
is blown in by the nurse or is inspired by the patient.

All instruments used in the throat must be very clean
and warm, also be free from odor, so as not to nauseate
-. patient. The back part of the throat is connected
yith the Eustachian tube, which is about i^ inches long,
land passes from the ear to the back of the throat, and
which in order to hear perfectly should be kept open ;
but when one has a (old in the throat the mucous niem-
, branc which lines the back of the throat and this little
swollen, and a temporary deafness results.
irgling the tliroat with very hot water is very bene-
ra'al when the soreness is first felt, and will very often
prevent its extension. The nose also calls for special
attention; its passages must be kept open and clean.

Pireathe through the nose, and by so doing the cold
xromes warmed in passing through the n;isal cavities
; lungs, and dry air is moistened; but if we breathe
igh the mouth, as when the nostrils are inflamed,
old air goes directly to the lungs, the mouth and
I become dry. and the throat becomes sore. Certain
diseases of the nose call for special treatment and special
directions. When spraying the nose it should be sprayed
down on a level with the roof of the mouth, and not up
if the nose ; this mistake is often made.
lust be instructed to close the mouth and
into the throat, then to cough it out ; if

and <

IP
and

whici

but V

^_ branc

■tabe

K>rgli

l!2 PRACTICAL POINTS /A' NURSING.

tht.s is not done, the fluid will run out the nose as the
spray is applied.

Eye-drops. — To put a drop in tlie eye the patient
should look up, the lower lid be drawn down, and the
drop be put in with a dropper or a quill on the centre of
\\Mi lower lid : it will then flow over the surlace of the
eye to the duct next the nose. A mi.stake often made is
tliat of putting drops in the eye in the inner comer, next
the nose.

The interior of the eyelids and front of the eyeball are
covered with a mucous membrane called the "con-
junctiva," and in the orbit on the outer side of the eye-
ball is a gland called the "lachrymal gland," which
secretes the tears and keeps the eye moist. The tears
pass over the surface of the eyeball, and those not u.sed
are carried off into the nose by a small canal called tlie
" lachrymal duct," which passes down from the orbit into
the nose. This secretion of tears is going on day and night,
but we do not notice it until either the conjunctiva is irri-
tated by a foreig[i body in the eye or by strong vapors, or
when we are affected by strong emotional feelings of sor-
row or of happiness, when the secretion of tears by tJie
lachrymal gland exceeds the drainage-power of the duct
and they overflow on the face. When we try not to cry
the tears pass down through the duct to the nose, and
pass out through the no.se ; then we get the " blowing of
the nose," commonly thus called when people try not to
cry. So we see that the gland which secretes the tears
is at the outer part of the eye. and the duct which re-
moves them from the eye is in the inner comer. It
must now be clear why a drop should be put in the cen-
tre of the lower lid, so that the solution will pass over
the surface of the eye to the duct next the nose.

THE PATIENT.

Ointment should also be applied in the centre of the

or lid, either with a small spatula used for the pur-

ise. with the handle of a small teaspoon, or with any-

ling that has a smooth, flat, narrow surface.

A medictne-dropptr may be used to syringi: the eye,

'hich must be done from the inner to the outer comer.

Syringing the ear must not be done with too much

rce or the drum-membrane may be ruptured. A foun-

syringe (Fig. 27) is the

to use, as with it we get

continuous flow, and injec-

in of air into the ear is

fiFCvented ; stili, an ordinary

Davidson syringe will answer

if the nur.se has not a fountain

or a hard-rubber syringe.

■ The necessary things for syringing the ear are a foun-
iun or a hard-rubber syringe, a bowl for the water to be
Used (unless the nurse uses a fountain syringe), a bowl for
the return flow, a towel for the patient's shoulders, and
one for the assistant. The syringe is filled, the air cx-
;lied, and the tip of the ear is pulled backward and
iward to straighten the canal, which is then syringed
tty. The patient may hold the small bowl beneath
the ear, but if not able an assistant will be necessary.
Warm water is used for ordinary syringing.

For an ear-doucltc to relieve inflammation the tcmptira-
ire of the water is about 100" F. The douche is continued
6fleen or twenty minutes, unless the patient should
iplain of dizziness, which is often due to the water
ig directed to one spot or to too much force being
;d. When syringing for the removal of discharge, the
;Ie of the syringe should be moved around, directing

114

PRACTICAL POINTS IN NUKSING.

the stream against the sides of the auditory canal and
not in the centra! axis. This procedure is also necessary
when syringing to remove a hard collection of wax. By
syringing thus the water will pass between the sides of
the canal and the plug of wax, and, reaching the space
behind, will bring out the wax with the return current.

Many persons syringe their own ears, which operation
is easily done if one has a fountain syringe. The head
is held over a bowl ; one hand is passed over the back
of the head to hold the auricle and straighten out the
canal, while the other hand directs the stream of water
into the car.

An car-bath, which may be of plain water or of watef
to which is added a small quantity of .sodium bicarbonate
is used to soften an accumulation of wax that cannot be
removed by syringing. The head is laid on the unaf-
fected side, the tip of the ear is pulled slightly backward
and upward to straighten the auditory canal, and th<
ordered solution is poured into, and remains in, the
about fifteen minutes, when the mass will be softent
sufficiently to be removed by syringing. A piece
cotton should be worn in the ear for a while after
operation to prevent chilling.

No liquids should be dropped into the ear without'J
direct orders from a specialist. Laudanum, oil. glycerin,'
lard, and other applications that we hear of as ear-drops
are all injurious, though they may alleviate the pain fori
the instant. Pain should be relieved by heat until
aural specialist can be consulted. The nurse is justified
in putting oil into the ear only when it is invaded by
insect; then the oil must be warmed and poured in, and
the insect will float to the top ajid fall out. Jf no oil is
at hand, warm water will do — the insect will thus

lo oil IS ^ ^1
:hus be^HM

TVE PATtRNT.

drowned. Beans and other things likely to s«ell with
water must not be interfered with, but a surgeon should
at once be consulted. The ears must not be picked with
pins; the drum -membrane is often perforated through
this habit. Before washing the patient's head it is always
well to put cotton in the ears, the ends of the pledgets
having first been dipped in oil or \\\ vaselin. If cotton
alone is used, the water will soak through ; but as water
and oil do not mix, the water cannot get beyond the oil
into the ears.

II. NURSING IN OBSTETRIC CASES.
Pregnancy: Bigne and Symptoms. — The probable
signs of pregnancy are — stoppage of menstruation, morn-
ing sickness (though with some women this is entirely
absent or may come on regularly every evening), en-
largement of the abdomen at the end of the tliird month,
a sense of weight and fulness in the breasts, and darken-
ing of the skin around the nipples. Still, these symp-
toms are uncertain. Nurses having experience in gyne-
cologic wards know that the abdomen may be en-
larged by a tumor, and that the blue color of the vagina
may be due to dilatation of the veins, thus impeding the
circulation, caused also by the presence of a tumor.
Menstruation may cease from cold and from anemia ; or
a change of climate and nf living will many times stop
lenstrual flow for a few months, as will also an
k of any of the acute fevers, until the nervous sys-
regains its normal condition. In some womb dis-
the breasts have increa.sed in size and contained
milk, and the nausea and vomiting may be cau.sed by
some disease of the stomach. None of these symptoms,
teken singly, is a positive sign of pregnancy.

tDe n

116

PRACTICAL POINTS IN NUFSING,

The positkie signs of pregnancy are the fetal puis
which can be heard about the fifth month, and the feta
movements, which are feh between the fourth and fi(U|-f
months. There are other signs, but they belong to tl
obstetrician.

Duration of Pregnancy. — The average length ef
pregnancy is two hundred and eighty days — nine cal-
endar months, or ten lunar months.

Conception and Date of Confinement. — Conception
may take place ju.st before or very soon after a menstru-
ation. VVe begin to count the probable date of confine-
ment from the last menstruation. The way to date is to
find out on what day the last menstruation began, count
forward nine months or three months backward, and add
five days, which is the probable duration of the men-
struation ; when the date of the last menstruation a I
uncertain, add four and a half months to the date <rf I
quickening, which will give the probable date of confinfr* I
ment. There is always a possibility of a mistake, because
conception may take place j ust before or soon after a men-f
strual period; that is, if conception did not occur
after a menstruation, it probably took place just befori
the date of the next occurring period. (See Appendix.)"

As pregnancy advances the abdomen becomes larger
(Fig. 28). About the fourth month the abdomen begins
to enlarge, and the top of the womb can be felt at the ,
brim of the pelvis ; at the fifth month it is halfway to thi
navel ; at the end of the sixth month it is on a level «
the navel ; at the seventh month it is between the nave
and the point of the breast-bone ; at the eighth month 1
is a little higher; and at the ninth month it graduallyi
sinks into the abdomen, the pressure upon the orgi
within the chest is removed, and the woman breath

eier, though pressure at the same time is now put
the lower organs, and it is difficult for her to

walk. At the end of nine months the child is fully
developed and labor takes place.

The Fetua. — The fetus receives its nourishment from
the mother through the blood-vessels of the placenta,
Irhich, when fully formed, ^consists of two portions, a
I and maternal. These two portions are connected

I l8 PXJCT/CAL POINTS IN NURSING.

SO closely that waste material from the child is carried
to the mother, and nourishment from the mother is car-
ried to the child very easily without there being any
direct blood-communication between the mother and ■
fetus ; the blood is carried from the placenta to the fetusi]
by the umbilical vein, and the two umbilical arteries cany I
the waste substance from the fetus to the mother. Thi
unibUUal cord is connected with the navel of the fctutfA
and the placenta. When fully developed the cord is]
about 20 inches long, and is covered with a gelatinous!
substance called " Wharton's jelly," which acts as a pro-']
tective. The cord contains two arteries and one veiot^
The arteries twist around the vein, which cai
blood from the placenta to the fetus, and it is returnee
by the arteries. After a while the fetus is enclosed in a '
membrane which gradually fills with what is called the
" amniotic fluid," which is water containing albumin and
other salts. In this bag of waters the child floats,
being thus preserved from all injury. The bag of watet
at the beginning of labor acts also as a wedge to dih
the mouth of the womb, and when it is fully dilated t
membranes give way and the waters escape.

Fetal Movementa. — The movements of the fetus a
felt between the fourth and the fifth month, and they g
erally occur two weeks later in a woman who has t
pregnant before. The supposition that the child—
"fetus," as it is called while in the womb — has no Ii$
until between the fourth and the fifth month, when i
movements are felt by the mother, is entirely wroogd
The child is living from the moment of conception, bu|
its movements are not felt because, up to the first fool
and a half months, the womb, which is not sensitive, b
not large enough to come in contact with the inner sur-^

THE PATIENT.

119

of the abdominal wall, which is fully endowed with

isibility.

Disorders of Pregnancy, — Some of the disorders
'hich may arise during pregnancy are — nausea, vomit-
nstipation, diarrhea, leucorrhea, retention or in-

mtinence of urine, salivation, swelMng of the veins of
liie legs and thighs, swelling of the external parts, heart-
burn, neuralgia, etc. The constipation is due to the
pressure of the enlarged uterus on the intestines. The
diarrhea is caused by the constipation, as there is then
the packed feces. Pressure on the bladder is the cause
of the constant desire to urinate, as the pressure inter-
feres with the distention of Uie bladder and there is little
room for the urine to accumulate. The pressure of the
enlarged womb on the nerves of the pelvis, wliich supply
the stomach, causes the nausea and vomiting. This dis-
order disappears about the fourth month, when the womb
rises out of the pelvis into the abdomen, but may appear
again during the la.st month, as then there is direct pres-
sure on the stomach. The swelling of the limbs and
external parts is due to the amount of pressure put upon
some of the blood-vessels, thus causing distention of
other blood-vessels.

CommUions during pregnancy may be hysterical or
'Kpileptic, though they are generally uremic, caused by a

lease of the kidneys, owing to the wa.ste material of
body, which is disposed of by them, being retained
In the body. The urine should be watched carefully;
the increase or decrease in its amount, and its paleness or
deepness of color, etc., must be reported. The premon-

iry symptoms which announce the convulsions in the

ijority of cases are — edema of the face, feet, and

ikles, dull headache, dimness of vision, bright flashes

t20

PRACTICAL PO/.VTS IN NURSING.

before the eyes, ringing in the ears, a confused conditiol
of the mind, and the presence of albumin in the urine.
The convulsions of pregnancy are treated in the same
manner as uremic convulsions.

Hemorrhage. — Should there be hemorrhage from the
womb litiring pregnancy, the patient .should be put to
bed; the foot of the bed should be elevated and the
head of the patient be lowered. The physician must
then be sent for. The clots should be saved for the
physician's examination. Ergot should be given, and
cold applied to the abdomen and the genitals.

Termination of Pregnancy and Nurse's PreparationB
for the Oonflnement. — We will now suppose that a nurse
has been called to a confinement case. What is the first
thing to be done? She should find out if the patient is
really in labor — if the pains are true pains or false pains.
\{ false, the pains will be irregular and short; if inte.
they will be regular, first felt in the lower part of the
back, and gradually increase to a certain intensity, then
gradually subside. If the pains are the true labor-pains,
the nurse should ask the patient at what time they
began ; if the membranes have ruptured, the physician
should be notified.

Preparation of the Patient. — The patient's bowels should
be emptied with soap-and- water enema, which will both
clear the bowels and make labor easier by removing
the fecal obstruction. If this is not done, the pressure
put uix>n the rectum during the second stage will cause
the bowels to empty of themselves, to the great annoy-
ance of all in the room.

A full bath is to be given if possible; if there is not
time for the bath, the p;irts should be washed thor-
oughly, and a corrosive-sublimate douche (about

it t^^k

T»B PATIENT. 121

i) should be given. The hair of the patient should
braided in two braids. During the first stage she may
be allowed to walk about ; but if it is night-time, she may
lie down and try to get a little sleep between the pains.

Preparation of thi Bed. — The nurse should prepare the
bed as follows : A large rubber sheet should be tightly
pinned over the mattress, and covered with a sheet and
a draw-sheet tightly tucked under the mattress; over
these should be placed another rubber sheet and a draw-
sheet, which must be tightly pinned at the four comers,
so as not to be pulled out of place. If rubber sheets are
not at hand, one may use newspapers, which can be
iiimcd afterward. The patient's napkins should be
ikcd in a solution (i : looo) of corrosive sublimate,
hen dry folded in a towel and so kept until needed.
Accessory Preparation. — Antiseptic pads can be made
cheese-cloth and common cotton -wool. The
le-cloth is to be washed with soap and water,
iled, dried, and then cut it into as many pieces as the
uircd number of pads (the number should be about
irty), each piece being about i6 inches square; into
each piece is folded the cotton-wool, which should first
be cut about 8 inches .square; the cotton-wool is then
doubled, which will make it 4 inches wide and 8 inches
ig, so that when the pad is made it will be 4 inches
le and 16 inches long. These pads are soaked thor-
;hly in corrosive sublimate (1 : 1000), then dried, and
Iccpt in an antiseptic towel. When the pads are applied
they should be pinned to the abdominal bandage back
and front; when removed they must be burned. Prepa-
rations should also be made for sterilizing the doctor's
aprons and instruments. Plenty of hot water should be
at hand.

122 PRACTICAL POI.VTS IN NURSING.

Other things that will be needed are — a pail, a fountain
or Davidson syringe, safety-pins, scissors, a glass cath-
eter, vaselin, stimulants, a fan, ergot (fluid extract), cor-
rosive tablets, carbolic acid (i : 30); a binder of stout
cotton about ij yards long and from 1 6 to i8 inches
wide ; a basket for the baby if there is no crib (a clothes-
basket, even a foot-tub, has been brought into use, lined
with a blanket or comforter and provided with a pillow) ;
a blanket or a receiver for the baby ; clothing for the
baby; boiled vinegar, ice, cold water, a minim-glass, an
ounce graduate, a spoon, a feeder; a basin for the after-
birth, basins for solutions for the hands ; a bed-pan, soap,
towels, a nail-brush, a hypodermic syringe, some old soft
linen (old handkerchiefs answer nicely), and very strong
thread or fine string for tying the cord. The string
should be cut into twelve lengths, each 12 inches long;
these pieces are divided into threes, which will give three
four-strand pieces, each four to be knotted together at
both ends. This gives three separate lengths, which,
with the scissors, must be put into carbolic solution, and
placed ready for the physician when he needs them. A
word of caution to the nurse before proceeding: she
should be scrupulously clean — she cannot be too clean.
Septic material is carried by unclean hands and dirty fin-
ger-nails, by clothing, instruments, or anything that is
used about the patient that is not jierfectly clean and
sterilized. Hands must be washed in antiseptic solution
each time anything is done for the patient before and
after delivery. After birth the womb is like one large
wound ; even the most minute portion of septic material
will be absorbed, and may cost the patient her life.

Labor. — In a normal labor the head is born first-
" head presentation," as it is called — but there are

oth^^H

presentations, such as breech, brow, face. etc. For this
reason the nurse must never attemjit to take the respon-
sibility of the case alone. She is not justified in so
doing, because in large cities and country places a phy-
sician can always be called in time. She does not know
what complications may exist, and by undertaking the
case alone she might lose the lives of both mother and
child. Neither is she justified in making an examination
to ascertain the presentation without orders from the at-
tending physician.

Under no consideration should a nurse take a case if
: has been near a contagious case (medical or surgi-
al), typhoid fever included, to say nothing of having
ttended one.

Stogee of Normal Labor. — Labor is divided into
liree stages : first stage, from the beginning of the pains
> the dilatation of the mouth of the womb ; sfcond stage.
"om the complete dilatation of the mouth oi the womb
I the birth of the child; third stage, from the birth of
the child to the birth of the placenta.

/■'irst Stage: — The pains, wliich are caused by the con-
Faction of the muscles of the womb, are very severe,
lod they increase in intensity and duration as labor ad-
irces. The first sign of labor is pain in the lower part
r the back, which pain gradually comes forward to the
»nt of the abdomen, extends down the thighs, and is
f a bearing-down character. The pain at first is slight,
t it increases until it reaches its height, then gradu-
Rlly disappears. When the pain is at its height the
louth of the womb is stretched, and as the pain passes
r it closes and the membranes recede. These pains at
regularly, about every twenty minutes or half
lur, and this regularity helps to distinguish true labor-

PRACTICAL POINTS IN NURSING.

pains from colic-pains, which are irregular. During the
dilatation the mouth of the womb may be very slightly
torn and the discharge of mucus be slightly tinged with
blood; this is called the "show." When the dilatation
has reached a certain extent the bag of waters breaks.
and the physician must be notified. In this, the first
stage, the patient may sit down or walk about, but she
must be instructed not to bear down.

Second Stage. — At the beginning of the second stage
the nurse must put the patient to bed, roll up under
the arms the night-dress and under-vest. fasten them
with safety-pins, and pin a sheet around the waist, leav-
ing it open at the right side. This arrangement will
guard against exposure and keep the night-dress and
under-vest clean. The nurse should remind the patient
from time to time to urinate. Stimulants must not be
given without the physician's orders. When the pains
come a roller-towel or a sheet may be tied around the
foot of the bed, and the ends be given to the patient to
pull upon.

The stage of expulsion now begins: the pains change;
they are stronger, are more frequent, and force the child
out of the womb through the vagina. At the end of
each pain the head of the child goes back, or " retreats."
and the patient may think that something is wrong; but
finally the head reaches a point where it does not retreat,
and at last slips out. There is then a little rest, during
which time the nurse can wipe the eyes of the child with
a cloth wet with a weak solution of corrosive sublimate
and cleanse its mouth. Another severe pain now comes,
and the shoulders and the rest of the body arc bom, ac-
companied with a rush of amniotic fluid and of blood
from the placenta. This discharge may cause faintncss

due to the blood leaving the brain, for, the pressure upon
the abdominal organs being removed, the blood-^TCssels
are dilated, and the blood rushes to them; there may
also be a chill, owing to a certain amount of beat being
taken away. The womb now contracts on the placenta
and closes up its vessels, thus shutting ofT the supply of
oxygen to the child. This causes the child to gasp, and
respiration is started.

Ether is sometimes given during the second stage to
lessen or dull the pain. The cone, sprinkled with a small
quantity of ether, is held over the mouth and nose when
the pain begins, and taken off as the pain subsides^

Third Stage.— hSiQi the birth of the child there is

nsualiy a rest of about fifteen or twenty minutes, when

Lthe pains begin again, and the after-birth and membranes

ire expelled. This is the third stage. When the child

I bom the womb contracts, and it can be felt like a

§round hard ball. The physician may ask the nurse to

^old the womb ; this is best done with the left hand.

iThe abdomen is depressed so as to allow the womb to

■rest in the palm of the operator's hand, the fingers being

Ithen behind and the thumb in front of the womb; in

Ijthis way the womb is firmly grasped. After the phy-

Fsician has tied and cut the cord he generally holds the

womb until the placenta comes away ; after the bed has

been cleaned, he holds it again for about an hour. If

the baby is all right, it is wrapped in the receiving blanket

^snd put away and the nurse attends to the mother.
After all is over the womb gradually decreases in size
and returns to its normal condition, called involution,
which usually takes from six to twelve weeks ; but when
involution docs not take place, when the womb remains
large and docs not return to its normal shape, this

136 PRACTICAL POINTS IN NURSING.

condition is called sitbinvoUilion, which may result
inflammation of the lining membrane of the womb.
Duration of Labor. — The duration of an ordinal
normal labor is from seventeen to twenty-four hours ft
a first child, but is less long for a second. The pains,
a rule, begin in the evening, the larger number of bi;
taking place during the small hours of the morning.

Conduct of Normal Labor. — Now, one may ni
always get a favorable state of affairs. The baby mi
be born before the physician comes, which accident
not uncommon with women who have borne childi
before.

The patient should be put to bed on her left side]
the perineum should be supported to prevent the h«
emerging too suddenly, which support will relieve
strain upon the perineum and lessen the danger of
being torn. This regulation of the expulsion is doi
by the nurse standing behind the patient at the left side
of the bed and laying her right hand on the external
genitals, which will bring the fingers on the left, the
thumb on the right side, and the palm of the hand
pressed against the perineum (Fig. 29). The head is to
be pushed rather upward, so that
the chin of the child will
against its chest and relieve
strain on the perineum. When"
_ the head is born the nurse should

•<on or the h»d wiih ihe fii>- scc if the cord is wound around
^"p^[ ™ '""'' "'""" *" ^^ child's neck ; if so, it should.,

be slipped over the head
behind ; if this is not done quickly, the circulation
blood in the cord will stop and the child will
ir there is a membrane over the child's face, it must

that

sn uuiai^^^_
d fi-o^^l
tion oi^^^l
die. ^^H
nustb^^^l

TttR PATIENT.

torn immediately or the child will suffocate. This

skno'

as being born with a veil i

lul," which is due to the

child being bom without rupture of the membranes.

The eyes, nose, and mouth of the child must be cleared

^Ejflf mucus. The perineum must again be supported when

^^Hk shoulders are being bom, because it is stretched

^^■Bore than when the head passes through, and there is

^^■lore danger of its being torn. Moreover, if it was

^^Wghtly torn when the head was born, tile tear may be

^K^nade considerably larger. If the child does not cry

and its mouth and nose are perfectly clear, it may be

patted on the back with the hand or some stimulant may

^be rubbed on its back; if this does not make it er>',

I the cord may be tied tightly in two places — the

rst hgature being \\ inches from the child, and the scc-

\\ inches from the first — and cut between the two

ptures. The child should then be put first into hot

Bid then into cold water, or artificial respiration may be

lactiscd by placing the child upon the bed with its back

Pightly arched by means of a folded towel or sheet.

nurse grasps a forearm in each hand, presses the

i lightly against the lower part of the chest to effect

expiration, the arms are then slowly lifted above the

head, which movement causes inspiration by raising the

Kand expanding the chest. These movements should
repeated ten times a minute. This is Sylvester's
hod.
Schultze's method is also very good. The child is
held by the upper arms and shoulders, with its back to
the nurse. It is then swung upward with the head
downward above the nurse's head ; the child is held in
this position while the nurse counts five, when the first
jsition is resumed. The first movement tends to ele-

128 PRACTICAL POINTS IN NURSING.

vate the ribs, while in the second they are depressed""
When the baby begins to breathe it must be wrapped in
a warm blanket and be put in a warm place.

We will now suppose that the birth has been perfectly
normal and that the nurse is still alone. As soon as the
baby is born the nurse should grasp the womb firmly
with the left hand and keep it contracted. When the
pulsation in the cord ceases she must tie and cut the
cord. She should then wrap the child in the receiver,
lay it away, and attend to the mother, Iiaving first wiped
the hands of the child to prevent any substance on them
being carried to the eyes.

When the after-birth (placenta) is being expelled, the
nurse can assist by pressing the womb evenly on all
sides ; as the placenta passes out, the nurse should tuni
it around so as to make a twist of the membranes, which
procedure will prevent them from tearing and will bring
them all away together. The placenta should be put in
a basin and kept for the physician's inspection, after which
it can be burned or buried. The patient may be given a
teaspoonful of the fluid extract of ergot, which will con-
tract the blood-vessels of the womb and keep up the
contraction, thereby preventing hemorrhage. When the
womb is hard and firm the patient may hold it while the
genitals arc bathed with an antiseptic solution. The pa-
tient is then turned on her side and her back bathed.

The soiled sheet and rubber cloth arc removed by
folding one side as closely as possible up to the back
of the patient; the binder is arranged on the bed, the
farther end being rolled up and placed next the patient,
so that when she is turned over on the other side she
rests on the clean i>ermanent bod and the binder. The
soiled sheet and rubber are removed and the binder

THE PATIENT.

129

lightened out. The nurse should keep up the con-
tractions of the womb for about an hour longer, when
it will be safe to pin the binder tightly about the hips,
beginning at the bottom and working upward. The pin-
ning should be done evunly, the pijis being about 1^
inches apart. The binder may be fitted to the waist by
taking in darts at the sides, and perineal straps may be
ilied to prevent it slipping up. The binder should
L-nd from the hips to the waist-liTie. An antiseptic
la^kin should be laid over the genitals. The patient
may be given a drink of milk or a cup of weak tea,
which is generally preferred; when everything is quiet
the patient will probably go to sleep. The nurse should
move about the room quietly, keep out visitors, and,
lastly, watch for hemorrhage.
Mana^ment of the Puerperium. — The room should
kept bright and cheerful, the air fresh and pure. The
irse should keep a record of the temperature, pulse,
ipirations, sleep, amount of diet the patient takes, and

condition of the bladder, bowels, and lochia.

The length of time that the patient remains in bed

:nds upon the amount of progress made and whether

not there Is any blood in the lochia. The sitting up

bed will be gradual. Some physicians have the

'patient propped up in bed on the third day, though as a

rule she does not leave her bed until the second week.

The return to the customary mode of living is gradual.

le period of lying-in is usually about four weeks. The

lent must not be allowed to sit up in bed without the

ician's orders, because sitting up or excitement of

any kind may bring on a hemorrhage.

Catheterization. — The nurse should see that the patient
latcs six hours after labor ; she should not wait for

the patient to express a desire to do so, but should
remind her. There may at lirst be a little difficulty in
urinating, but before passing the catheter the nurse
should try any of the means usually resorted to in in-
ducing the urine to flow — hot water in the bed- pan, the
sound of running water from a faucet or a pitcher, or
allowed to run down over the parts (cold water succeeds
with some women), or hot cloths placed over the lower
part of the abdomtn ; or the patient may turn over on ,
her hands and knees : if these means fail, the nurse mua
then resort to the catheter.

Lochia. — The lochia is the discharge which follows '
childbirth : for the first few days it is a bright red. which
gradually becomes paler and paler until it is almost
transparent, and finally ceases. The lochia may last two
weeks or longer, the length of time differing with each
patient Any odor or departure from the normal must
promptly be reported.

Napkins. — The napkins must be changed during the
first few days every three hours, taking care that they
have previously been soaked in some antiseptic solution.
If is very easy at this time, if strict antiseptic precautions
are not used, for germs to enter the uterine cavity or
peritoneum, the result being puerperal septicemia. The
parts must be kept clean and must be washed with anti-
septic solution three times a day.

Douches must not be given without direct orders from
the attending physician.

Diet. — The diet should be liquid for the first twenty-
four hours; after that there may be given soft, light,
easily-digested food. The howds must be moved by
the third day.

Temperature and /V/ji.— The temperature may rise

THE PATIENT.

■3"

ightly during the first bventy-four hour.'; after child-
birth ; then it should descend to normal, and so remain.
A rise of temperature after childbirth may be due to
constipation, exhaustion after labor, nervousness, or
threatened abscess of the breasts ; or it may indicate
sepsis. Should sepsis be indicated, other symptoms,
such as decrease of the lochia, offensive odor from the
discharges, and distention of the abdomen, will be pres-
ent The pulse may, on the contrary, be found very
low, sometimes as low as 50 beats. A low pulse is not
At all serious, but must be noted.

\ Aflfr-paitis are cau.sed by the womb contracting, and
■they generally last four or five days. Nursing will often
produce severe pains, because of the sympathetic rela-
tion between the breast and uterus, and by putting the
■child to the breast involution is hastened.
I Lactation. — The child must be put to the breast six
sBr eight hours after birth, after the mother has rested.
The milk does not generally appear until the third day
after delivery, but the breast contains a secretion called

colostrum," which acts as a laxative and clears the
boweU of the child ; putting the child to the breast early
10 teaches him to nurse and assists in forming the nip-
The breasts must be nursed alternately regularly
every two hours during the day, and the nipples must be
washed before and after each nursing with water to which
a little bof^x has been added. If the nipples are soft
and tender, they may be hardened by bathing them with
equal parts of alcohol and water.

Care of the Breasts. — If the breasts are sore and pain-
ful, this condition must be reported to the physician : in
the incaii time the nurse may rub the breast with warm
i apply gentle ma-ssage, massaging from the

132

PRACTICAL FOrf/TS Iff NUMSfyc.

base toward the nipple. Tile pulse and temperature
should be taken. A cracked nipple must promptly be
attended to, the child nursing from the other breast ; the
nipple must be kept perfectly clean; the milk must be
drawn from the sore-nipple breast with a breast-pump,
and the breast massaged gently to reheve the tight feel-
ing. The nipple usually heals after a rest of one or two
days. The bowels must be kept open. If the milk-
secretion is scanty, the mother's diet should be a mixed
one, milk entering very largely into its composition. Al-
cohol, such as beer or porter, does not make milk, as is
commonly supposed, but tends only to fatten the mother.
Breast-bandage. — The breast-bandage most commonly
used is made with three toilet napkins or with two pieces
of muslin. The two napkins are pinned together to form
a V, and are fastened to the middle of one end of the
third napkin (Fig. 30) after the manner of the Y-bandage.
The single napkin is passed across the back, which
brings the V-shaped napkins directly to the side of the
breast ; these two napkins are carried
across the chest, one below the breasts,
^ the other above, and pinned to the free
end of the napkin crossing the back.
This b.indage holds up the brea.sts. The
muslin compress is arranged in exactly
the same way, though only two pieces
are needed {each folded and about 6
inches wide), one small piece to pass
under the back, the second piece large enough to go
twice across the chest in the shape of a double V ( o ),
and pinned to the ends of the small piece. If the baby is
nursing, this bandage is left open ; if not, a pad of cotton
is placed between the breasts, and the edges are pinned

THE PATIENT.

'' together with small safety-pins. Straps of muslin passed
I over the shoulders and pinned back and front will keep
I the bandage in position.

Pathology of the Puerperium. — Some of the coni-
L plications which may arise after cliildbirth are hemor-
I rhage, puerperal insanity, eclampsia, and phlegmasia
[. dolens.

Hemorrhages. — Hemorrhage after childbirth is called
\ "post-partum hemorrhage," and is due to the womb re-
\ taxing. The symptoms of post-partiim hemorrhage are
\ restlessness or tossing of the patient in bed, faintness,
pallor, a demand for air, a sense of dizziness, shortness
I of breath, and a weak, rapid pulse. The restlessness
L alone should put the nurse on her guard and lead her
[ b) investigate. The nurse should put one hand on the
abdomen and feel for the womb by pressing on the ab-
domen ; if the womb is found, gra.sp and squeeze it hard,
squeezing out the clots ; the womb may not be found,
owing to its relaxed condition, or it may be found large
r and firm, owing to the formation of a blood-clot which pre-
l vents the womb contracting and keeps the blood-vessels
Lopen. The nurse should call for assistance and send
[ some one for the family physician, If he lives at a dis-
Itance, the nurse is justified in sending for tlie nearest
^physician. The assistant .-ihould be directed to elevate
the foot of the bed (to send the blood back to the heart
ind brain) and to bring the basin of antiseptic solution,
mcgar, gauze, or a clean handkerchief The nurse
[should wash her free hand in the antiseptic solution and
l^elean out the clots from the womb ; then the gauze or
handkerchief should be soaked in the vinegar, be carried
well up into the uterine cavity, and squeezed. The vin-
egar will flow back over the walls of the womb and the

134 PRACTICAL POINTS W NURSING.

vagina and cause the blood-vessels to contract. Thft
treatment should bo continued until the bleeding stops.
Ergot may be given hypodermatically, injected either
into the upper part of the thigh or the abdomen. A hot
douche of water and vinegar, equal parts, its temperature
being about Ii8° F. or 120° F., will also contract the
blood-vessels. The nurse should see that the bladder
is empty; she should also watch for collapse and give
stimulants. Morphia (^ grain) may be given to secure
rest. Kneading of the womb must be kept up all the
time with one hand. The application of ice is not ad-
visable, because ice is not clean, and it may be the means
of introducing septic material into the cavity of the
womb. Vinegar is the best ; it is an astringent, it can
always be had, it is readily applied, and its action is
generally very prompt.

When the bleeding has stopped the kneading must
still be continued until the womb is firm and small.
The foot of the bed and the hips should be kept elevated,
and the patient should not be left alone for a moment.
This is one of the cases where prompt action, a calm
and collected mind, and a steady hand are absolutely
necessary. It is always a safe plan to have clo.se at hand
vinegar, very hot water, a syringe, and gauze or clean
soft rags which have previously been sterilized in the
oven for a number of hours after delivery, in case this
accident should happen. The nurse is then prepared for
prompt action, for it does not take long for a patient to
bleed to death.

Septicemia. — Puerperal septicemia is caused by neglect
of antiseptic cleanliness on the part of the attendant (see
p. 165). It begins with a chill or a continued chilly feel-
ing, followed by a rise of temperature and accelerated

THE PATIENT.

'35

lulse. a bad odor from, and probably suppression of. the
Kihia, cold, clammy sweat, anxious expression, and dis-
ntion of the abdomen. The smallest rise of temper-
Mre should make the nurse watchful ; she should notify
fee physician, move the patient's bowels, give a vaginal
(ouche of r : 5000 corrosive sublimate, and apply tur-
rntine fomentations to the abdomen. The patient
ould be stimulated if necessary.
Insanity. — The treatment of puerperal insanity or mel-
ncholia lies in keeping the patient perfectly quiet and
^v■enti^g her from harming herself. The air of the
■room must be kept fresh and pure ; the patient's strength
[vsupported with nourishing food ; baths may be given
to promote activity of the skin; the bowels must be
kept open ; and any article or any person that tends to
excite the patient must be removed from her sight. The
baby is taken from the breast when the symptoms first
appear, and must be taken from the room. Bod-sores
must be guarded against, and a strict watch must be
kept over the patient; if allowed to be up and around,
she must not be permitted to go out of the nurse's sight.
With a little tact the nurse can manage this surveillance
without letting the patient think that she is being
watched. The causes of puerperal Insanity are many,
and a good recovery depends chiefly upon the nursing.
Eclampsia {Convulsions). — In event of convulsions the
nurse must send at once for the attending physician, and
put something in the mouth of the patient to prevent
her biting her tongue. A hot pack or a vapor-bath may
be ^ven, and ice be applied to the head. Morphia (J
grain) will stimulate the heart's action, induce perspira-
tion, and quiet the patient.

Phlegmasia Dolens. — Phlegmasia dolens, or milk-leg, is

136

due to a blood-clot forming i;
of the affected limb and pain, and its surface is white and
drawn. The disease may be ushered in with a chill or a
chilly feeling and a rise of temperature and pulse. The
patient must be kept on her back, and the limb be ele-
vated and kept warm by wrapping it in cotton-wool.
Recovery takes place with the ab.sorption of the clot.

Thrombosis. — Thrombosis is a clot of blood in a vein
obstructing the circulation. It is g^encrally caused by
the patient walking, or even standing, too soon after an
illness. Clotting may also take place after childbirth.
There is swelling of the part, which swelling goes down
as the clot is absorbed. But if ab-sorption does not take
place, if the clot is swept onward in the circulation of
the blood to the right side of the heart, sudden death
results from the obstruction of the pulmonary artery.
This clotting \% called (inholism.

Extra-uterine Pregnancy. — Extra-uterine pregnancy
is development of the ovum outside the womb, either in
the Fallopian tube, the ovary, or the abdominal cavity,
but generally in the Fallopian tube. As the ovum grows
the walls of the tube become very weak and thin, until
at last, about the fifth, eighth, or twelflh week, they rup-
ture. There is then sudden pain in the affected side,
together with all the symptoms of internal hemorrhage
and collapse.

Cesarean Section. — Cesarean section is the removal
of the child from the womb by abdominal incision. This
operation is performed to save the life of the child should
it be living after the death of the mother, or in case
there is some pelvic deformity or tumors complicating
natural delivery.

THE PATIENT.

III. NURSING IN GYNECOLOGIC CASES,

Preparation for G-jniecologic Examination. — To pre-

■ a patii-nt for examination the genital parts should

; cleansed and the bladder and bowels be emptied.

lie womb lies between the bladder and the rectum, and

r distention of either of these organs will alter the

tsition of the womb. A douche must itoi be given

examination, because the surgeon will want

D see the character of the discharge. All bands around

e waist and the corset must be loosened ; a single tight

aid around the waist will crowd down the contents

f Uie abdomen and displace the uterus. Around the

atient is thrown a sheet, beneath which she can raise

Icr clothing above the waist, and then step upon a chair

bd thence to the edge of the operating-table without

icre being the slightest exposure.

For the examination there is needed a small table cov-

hed witli a shawl, a rug, and a comfortable or blanket ;

«r these a sheet is .spread and a pillow is placed for

e patient's head. There should be at hand a sheet to

(ver the patient ; a chair by the table for her to step

ion : a table, covered with a towel, on which are placed

two bowls, one containing corrosive-sublimate .solution

( I : looo), and the other containing warm water ; a piece

of soap (castile) or vasclin ; and towels.

Positions for Examination. — The four positions for
examinations, and also for operations, are the dorsal, the
Sims, the knee-chest, and the upright.
f^ Dorsal Position. — The patient lies upon her back with
E knees drawn up and separated ; the hips are brought
1 near the edge of the table, leaving sufficient room

138 PRACTICAL POINTS IN NL'JiSl.VG.

for the heels to rest together comfortably, 8 or 10 inches
apart, without slipping from the table. The clothing is
pushed above tlie knees and the sheet hangs in front,

completely covering the patient's legs and avoiding all
exposure (Fig. 31).

Sims Position. — In the Sims position (I'igs. 32, 33) the
patient lies on the left side of her chest, with her head
and left cheek resting on a low pillow, and the left arm
is drawn behind the body or hangs over the edge of the
table. The hips are brought down to the left-hand cor-
ner of the table, so that her body lies diagonally across
it. the head and shoulders being at the right-hand side,
with the right hand and arm hanging over the table
edge. The thighs are flexed upon the body, the right,
knee being so bent that it lies just above the left,

.andtlM^H

ij^^^H

feet rest upon a board extentliiig from the

right-

^^1

comer of ihe table (Fig. 32)

. The patient is c

lovered

a sheet, and the buttocks

are covered with

two towels, ^^^1

one to cover each side, their

^^H

upper ends being tucked

tfeMriMMiS^gli

^^1

under the clothing, the

|HH|P[^

lower ends being tucked

i^^HSipB

_^^

between and under the legs.

^H^^^^E

^^H

thus simply exposing tlie

^■aH^^iv

entrance to the vagina (Fig.

P*2sL ^L,

^^^^^^H

33). This position is one

hH^^^^^b

1 .

^^^^^^H

in which a practical illus-

H^^^^P^

^^^^^^H

tration is needed before one

W ''^

^^^^^^1

can fully understand how

jP^ :

^^^^^B

to place the patient, and

^^^^ii^^C

^^1

also how to arrange the

^■HMl^^

-/-J

^^1

towels. The Sims position

\^ ^^1

causes the vagina to be

Ir V

ft ^H

filled with air and places

9i ^H

the mouth of the womb

within easy reach, so that it

Fic, 31,-5™.'. p<...lio,. !
curetting Ditk

fo. t^impor

ling nod

can more clearly be seen.

Knce-cktsl Position. — In the knee-chest position (Fig.

34) tlie patient first kneels on the edge of the table,

then

bends forward and rests her chest on a low

' pilIo«

U her

head IjHng just beyond, so

that her back s

lopes I

down

evenly, her arras clasping

the sides of the table.

The

clothing is drawn above the waist, and th.

e patient is ^H

covered with a sheet. In

this position thi

• abdominal ^H

organs are thrown down

toward the diaphragm

the ^H

air enters the vagina and balloons it out, s

0 to s

peak, ■

so that there is an unobstructed view of the canal and ^^|

the cervix.

■

140 PRACTICAL POINTS l.V NUKSING-

Uprighl Position. — In the upright position the clothing
of the patient is drawn up, and around the waist is pinned

a sheet extend f, to the fl or Tl c pat e t stands with
limbs separated, one foot resting on a stuol or the rung
of a chair.

Preparation for Operation. — For gynecologic opera-
tions the nurse makes hur preparations in the same

the same i

terilized towel or sheet for the instrument-tray, bowls,
t and cold water, a fountain syringe filled with cor-
rosive-sublimate solution (i : 3000) and a wide board
or an ironing-board for insertion fjetwccn the mat-
sheet (thus making a hard surface for

142

PRACTICAL POINTS IN NURSING.

patient to He upon), a chair for the surgeon, soap, and
a nail-brush.

A piece of rubber cloth, or oilcloth, or newspapers
will serve for the pad. The material used is folded at
the top and sides, covered with a towel, and the unfolded
end draped into a pail or a wash-tub. When the patient
is etherized the bed is turned toward the window to
afford the surgeon a good light — the northern light if
possible. A bay window must be avoided, because it
gives cross lights

The limbs are flexed, the hips are brought down to
the edge of the bed, and the pad is placed under them,
so that the water used in bathing the external parts i.s
conducted by the cloth into the pail or the tub. When
holding the patient's limbs the nurse should let the heel
of one foot rest in the palm of her hand ; the knee of

the patient will then rest against the chest of the nurse,
whose free hand is passed over and holds the other
limb in position at the knee. If the patient is in the
Sims position and the nurse is asked to hold the specu-

THE PAT/Effr,

'43

sho
Artier

should be held with her right hand in the exact
position in which the surgeon has placed it (Fig. 36),
her left hand, being passed over the patient's thigh,
should raise the right buttock.

After-care. — The aftcr-carf of gynecologic cases lies
ly in procuring absolute rest and quiet. The pa-
^nt musl see no visitors without permission from the
surgeon. The limbs are generally tied together for
the first few days, especially after an operation on
the perineum or the womb, to prevent the perineal
sdtches (sutures) being broken in case the patient should
toss about

The genital parts must be kept perfectly clean, and
ict antisepsis must be observed, as septic material
idily finds access. After passing the catheter the nurse
should be careful that when removing it the urine does
not drop on the stitches; the parts are afterward .sprayed
with the ordered solution and dried. When giving
douches the nurse must insert the tube carefully and
away from the stitches, and after the douche is over
she should softly wipe the vulva dry with sterilized
gauze or cotton. The same care must be used when
giving enemas, so that the rectal and vaginal stitches
are not broken by the tube. The patient must be
instructed not to strain when the bowels are being moved,
or the stitches may break, If the uterus is packed with
gauze, the pulse and temperature are taken every two
hours; should the temperature rise to 101° F.,the pack-
ing is removed.

Difl, — The diet is liquid until after the third day,
when the bowels will have been moved; then, if all is
well, the amount of food is increased.

Vnginal Tampons. — A vaginal tampon is made of

'44

PRACTICAL fOI.VTS IN NURSING-

absorbert cotton, lamb's wool or gauze, and is about
7 inches long. \\ inches wide, and \ inch thick, folded
and tied in the middle with strong white thread or fine
twine, leaving long ends with which to remove the tam-
pon. The kitf-tail tampon is made by fastening several
of these pieces of cotton to a piece of thread about 2
inches apart. When the tampon is made the pledgets
of cotton are soaked thoroughly in water, then in gly-
cerin, after which they are put away; or they may be
sterilized and the tampon put away in an aseptic glass
jar.

Vaginal Dressings. — Vaginal dressings are made of
strips of absorbent cotton, Iambs' wool, or gauze (three
thicknesses), i^ inches in length and width. They are
prepared for use in the same way as the tampons.

Each surgeon has his favorite dressings, and after see-
ing a dressing done once the nurse should know what to
prepare for him the next time.

IV.

DUTIES OV THE NURSE IN GENERAL
SURGICAL CASES.

Wc will now consider the preparations for an opera-
tion, and the care of the patient before, during, and after
operation.

Prepamtion of the Operating-room. — The directions
for the preparation for an operation will be given by the
surgeon in charge. In some houses the nurse may
have a separate room, or even the kitchen, for the
operating-room, while in others she will have to pre-
pare part of the patient's bed-room. In the latter case
the brightest end of the room should be prepared for
the operation, to afford the surgeons plenty of light. A
screen must be put up before the bed, so that the patient

ill not see the preparations ; some patients, however,
rill take a great interest in all that is going on, whilt'
others will be exceedingly nervous. The nurse should
remove from the room all movable furniture; lay oil-
cloth, or newspapers covered with a sheet, over and pin
securely to the carpet, and across the window fasten a
curtain or newspapers, so that the operation cannot be
viewed from the opposite side of the street. The re-
maining furniture and window-frames should be washed
with carbolic-acid solution {i : 20), and on the morning
of the operation should be dusted with a cloth wrung
out of the solution. The things necessary for the opera-
tion can be placed on the operating-table, covered with a
sheet, and be left outside the room until the patient is
partly etherized, when they may be carried in.

If a separate room may be had, one with a northern
light is to be preferred, and, if possible, it should be far
away from the bath-room for aseptic reasons. All un-
necessary furniture being removed, the hangings must be
taken down, the room thoroughly swept, and the walls
and remaining furniture washed with carbolic-acid solu-
tion ( 1 : 20) and exposed to the action of the sun and air
for about twelve hours, when the windows are to be
closed, the room thoroughly dusted witli a damp cloth,
and not again disturbed. The kitchen makes the best
oper.iting-room ; it is warm, hot and cold water is close
at hand, and one is not afraid of soiling carpets or
hangings.

Operating'tablf. — The operating-table should not be
wider than 25 inches, nor higher than 37 inches, because
if low and wide the surgeons will have to stoop and
bend forward. A kitchen tabic or a dining-room table
with the leaves let down, and a small table at one end

146 PRACTICAL POINTS IN NURSING,

for the patient's head, will make a good narrow ope-
rating-table; or three chairs, with two planks, a leaf
from an extension table, or an ironing-board laid across
them, may suffice.

The table may be covered with rubber cloth, oilcloth,
or even with newspapers, two sheets, and a blanket. A
word of caution here: the nurse should not use any
old blanket or comfortable to cover the operating-table ;
it may be filled with germs, which must be avoided.

Two wooden chairs should be at hand in case the
Trendelenburg position is necessary, and two wooden
boxes for the surgeons to stand upon when using this
position.

Prepajutions for the Operation. — The evening be-
fore the operation the nurse should boil a wash-boiler
full of water and set it in covered pitchers to cool, the
wash-boiler and pitchers having first been made thor-
oughly aseptic.

On the morning of the operation the nurse should
sterilize in the boiler or in an oven six sheets, two
blankets, twelve towels, and twelve sponges. She
should not take the best towels in the house, because
they are spoiled by the solutions and the blood. There
will be needed six bowls, which may be of agate-ware
or be the ordinary bed-room china bowls — one for per-
manganate of potash, one for oxalic acid, one for steril-
ized hot water, one for corrosive sublimate, one for the
surgeons' hands, and one for the vomit If there are no
pails for the sponges, the hot and cold water may be
carried in the bed-room toilet pitchers. After the hands
have been made aseptic and the part washed the perman-
ganate and oxalic acid can be disposed of and the bowls
be used for the sponges. Two tables will be needed —

THE PATIENT. 147

e for the instruments, the othLT for the assistant — which
1 be improx'ised in the same way as was done for the
operating-table (p. 1 46), and covered with sheets or towels.
There will also be needed a pail or a wash-tub for the
soiled water, a tin dish or a flat bake-pan for the instru-
ments, brandy, a hypodermic syringe (which must be
placed in a bowl containing carbolic-acid 1 : 30 solution),
and the syringe be filled with the solution, strychnia tab-
lets (jij grain), a small tumbler, a Davidson or a fountain
syringe, common table-salt for salt-solution, sheet-wad-
ding, absorbent cotton, bandages, sterilized gauze, safety-
pins, rubber tubing for a tourniquet, two new nail-brushes,
castilc soap, green soap, a razor, hot-water bottles, two
blankets, alcohol, matches, and twelve gauze sponges
of various sizes — three 2 inches square, three 4 inches

quare, three 6 inches square, and three 8 inches square.

I SterUisatwn. — Sterilization may either be dry or moist;

lioist heat is preferable, because it is more thorough and

Wore penetrating than dry heat. For dry sterilization
the clothing and dressings are placed in covered tin
pans in the oven, the temperature ranging from 160° to

1212^ F. For moist or steam sterilization an ordinary
brash-boiler is used. Water is poured in to the depth
pf about 6 inches ; sticks or bricks, placed crosswise, are
[luilt up above the level of the water, and upon them rest
^le clothing and dressings.
For both these methods the heat must be continued
for fully onL- hour before the operation. The instru-
ments are wrapped in a towel and allowed to boil for

ten minutes in a tin pail or a kettle of boiling water to

Hrbich has been added 2 teaspoonsful of washing-soda
I each pint of water, to prevent them from rusting.
lere must be left hanging out of the kettle one end

^^fnor

145 PRACTICAL POINTS IN NURSING.

of the towel, by which to lift out the instruments. The
water must boil some time before the instruments are
placed in it.

Operath'C Position. — The most popular position for ab-

dominal operations is the Trendelenburg (Fig. 37). This
position is one in which the knees of the patient are con-
siderably higher than the head, the body slanting upward _
from the shoulders ; the intestines are thus thrown d

TBB PATIENT.

149

fard tlie dtapbragm, giving the surgeon a clear view

the pelvic organs. In the absence of a Trendelenburg

table the position can readily be obtained by raising the

lower end of the operating-table and placing chairs or

;boxcs under its feet; or a wooden chair or a high box

be secured to the operating-table and covered with

rilized sheets.

I^par&tdon of Patient. — If the nurse has from
Iwenty-four to thirty-six hours in which to prepare the
lintient for operation, she should give the patient, the day
Fore the operation, a full bath and a cathartic of either
tor oil, citrate of magnesia, salts, or compound lico-
■rice powder. The diet must be nourishing and light.
Milk should not be given before an abdominal operation,
because the stomach does not digest it thoroughly, and
its curds may remain in the intestines and act as an irri-
tant. Gruel is best given; it is nourishing and easily
digested.

The part to be operated on must be shaved (if the

patient is very nervous it is generally well to leave this

operation until she is partly etherized). After the shaving,

the part is thoroughly cleansed with soap and water and

a nail-brush, then with ether, which removes all oily and

laity substances, then with warm corrosive-sublimate so-

ition (l : looo), after which cleansing a pad of sterilized

u;!e. absorbent cotton, or a towel is wrung out of the

ution, applied over the part, and held in place with a

sterilized bandage and perineal straps. This pad is not

removed until the surgeon is ready to operate. The

patient must be instructed not to put her fingers under-

ath the dressing or to disturb it in any way.

I definite rules can be laiil down for the surgical
as surgeons differ in their method of preparing

I so PRACTICAL POINTS IN NUKSINC.

patients for operation, The bath may be given in the
manner just described, while some surgeous will direct
the application of a poiUtice of green soap, which is re-
moved early on the morning of the operation, the part
being scrubbed with hot water and a brush to remove
the soap, and a warm corrosive-sublimate poultice (i :
looo) appli(!d.

On the morning of the operation the patient should
be given a simple enema to clear the bowels, and a
sponge-bath ; the nurse should then put on the patient
a clean uiider-vest, night-gown, and stockings, and braid
the hair in two braids ; she should also remove from the
patient all rings and ear-rings; also false teeth, whether
a whole or a partial set. as there is danger of their being
swallowed, and put them away in a tumbler of cold
water. Two hours before the operation the patient
should be given a stimulating enema of whisky (i ounce)
and warm water {2 ounces). This enema is to be fol-
lowed in one hour with atropia (y^ of a grain), which
acts as a sedative and lessens the irritability of the stom-
ach caused by the ether ; it also lessens the secretions of
the mouth and throat and prevents the throat filling up
with phlegm. Both these stimulants should be given by
enema, because if given by the mouth they might stay in
the stomach unabsorbed, and the patient would vomit
them when under ether. No food must be given after
midnight, unless the operation is to be performed late in
the day — about noon-time or in the afternoon — in which
case the patient may have, six hours before, beef-tea,
gruel, or coffee. Milk- should not be given, as it is very
apt to curdle and stay in the stomach, and, should the
patient vomit while under ether, the curds may get into
the larynx and trachea and choking result. The

THE PATIENT.

151

^H' eter should be passed before etherization if the operation
^Bts abdominal, even iT the patient has urinated a few niin-
^H utes before, and the nurse should be sure that the blad-
^H der is empty.

^H Special operations, abdominal and gynecologic, call
^H for special directions, which will be given by the surgeon
^H in charge.

^H Duties of the Nurse in Emergency Cases, — We will
^H consider the preparation for an emergency operation in a
^V very poor family, where there are no conveniences. We
will presume the case to be one of appendicitis, and that
the nurse has been called in the night. While the sur-
geon is making his examination of the patient the nurse
I should start a fire and put on the wash-boiler, to make
sure of plenty of boiling water; she should then get six
sheets and twelve towels, if possible. There may be no
clean towels, and the nurse will have to wash some dirty
ones. After being washed clean they can be placed in a
tin pan. boiling water poured over, and allowed to re-
main in the water a few minutes, when they are wrung
out and placed in corrosive-sublimate solution (r : 1000)
until the surgeon is ready to use them.

The kitchen should be rendered as clean as possible.
The kitchen table should be prepared for the operating-
table, and there should be procured two small tables for
the instrument-tray and the sponges. If small tables
cannot be had, chairs covered with a corrosive sheet or
^^m towels will do. If there is no gas-light, the nurse
^^Kshould get as many lamps as she can, and arrange them
^^Bnear the surgeon, but not too near the ether, be-
cause ether is inflammable. The instruments are to
be wrapped in a towel and boiled for ten minutes in a
kettle of boiling water to which has been added two tea-

152

PRACTICAL POINTS IN NURSING.

Spoonsful of washing-soda to the pint of wati
rusting, There must be left hanging out of t
end of the towel, by which to Uft out the in

After the surgeon has made the examination the part
must be shaved, washed, and a corrosive towel applied;
an enema should be givi;n to clear the bowels, also a
stimulating enema, and the urine should be drawn.
While the patient is being etherized the nurse may
arrange the tables and wash a fiat bake- or meat-pan
for the instruments. If sponges have been forgotten, a
clean sheet can be torn up and folded into flat sponges.
China basins can be used for the antiseptics, the sponges.
and the surgeon's hands ; china pitchers for hot and cold
water; awash-tub for the soiled water; and hot bricks
or beer-bottles for heaters. No matter how poor the
family, the kitchen can be cleaned and prepared as an
ope rating- room in a few minutes. Boiling water kills
germs on contact, and where there are no means of
sterilizing the sheets and towels, they can be soaked
first in boiling water and afterward in corrosive-subli-
mate solution (i : looo).

Anesthesia. — Ether. — A few words about the giving
of ether, which duty may sometimes fall to the nurse,
especially in emergency cases. Unless unavoidable, ether
or chloroform must be never given on a full stomach,
because the patient may vomit, and particles of food may
lodge in the larynx and trachea and result in strangula-
tion. The bladder and bowels must always be emptied.
or they may act involuntarily. An ether cone is made
by folding a newspaper, or a straw cuff may be shaped
to fit over the nose and mouth, a stiff towel being folded
around and secured with safety-pins, and a clean hand-,
kerchief or piece of cotton placed inside.

THE PATTSNT.

Absolute silence must be maintained while- the ether
is being administered, as any conversation may be heard
by the patient. Whatever is said by the patient when
going under ether or coming out must be kept abso-
lutely secret. Care must also be taken when the patient
is coming out of ether that the operation is not dis-
cussed. Many patients have been made miserable
through carelessness on this point ; for, while they could
hear eveT>-thing that was said by the nurses, they were
totally unable to make any sign by which the nurses
uld know that they couid hear. Death from ether is

iw — by paralysis of the respiration — the signs of dan-
ger being a blue and livid color of the skin, the respira-
tions being low, shallow, and gasping. Ether affects
people differently, and no definite rules can be laid
down. Ether should be given slowly ; in other words,

ic cone should not be filled with ether and put over

ic face, entirely smothering the patient. The nurse
should show the patient how to inhale it, slowly and
deeply, and also instruct the patient to close the eyes,
because ether is an irritant to the eyes. About 2 tea-
spoonsful of ether are poured into the cone, which the
Inirse should hold a little distance from the patient's face,
and as she becomes accustomed to the ether and under
its influence the cone may be brought nearer; the stran-
gling sensation of which so many patients complain is
then in a measure avoided. Ether generally first pro-
fhices choking and coughing, followed by excitement;
this Ls followed by the mu.scles becoming rigid, the face
IC, and the breathing stertorous or snoring; this stage
iscs away, the muscles become relaxed, and the patient
a state of insensibility.

lower jaw must be kept forward by placing the

154

PRACTICAL POINTS IN NURSING.

thumbs behind the angles of the jaw. Pushing the jaw
forward and upward, which brings the upper behind the
under teeth, prevents the tongue slipping back and ob-
structing the larynx, and gives free access of air to the
lungs (Fig. 38), Should
the tongue shp back, it
may be pulled forward
with the fingers or with
a pair of forceps. Fre-
quent inspirations of
fresh air should be
given. When com-
pletely etherized only
a small quantity of the
drug is needed to keep
the patient under its influence. The mucus should be
wiped from the patient's mouth. The pupils should re-
main contracted all through etherization, and dilate when
the patient is coming out of ether. If the pupils are
dilated during etherization, the patient is over-etherized,
and they remain dilated until the muscles of the eyes
regain their tone, when they contract. The sudden di-
latation of the pupils is generally a sign of imminent
death. It is very important for the nurse to watch
carefully the respirations, because ether kills by suffoca-
tion, the heart usually beating long afier the respirations
have ceased. The nurse should speak out if the pulse is
growing rapid, feeble, irregular, or intermittent ; if the
respirations are becoming low, rapid, or gasping; if the
fece is beconung pale or blue, or the pupils arc gi
ually dilating.

If the patient seems inclined to vomit, the ether
be pushed, which will generally ward it off; should

THE PATIENT.

155

|iK)mit. her head should be turned to one side, to allow
z matter more easily to escape from the mouth. One
Vwill see from the above that the giving; of ether requires
Fthe undivided attention of the etherizer ; no one can ether-
ize and see the operation at the same time. Nausea and
vomiting after ether may continue for two or three hours
or longer. Should it persist until the following day, it
lj.iiiay be due to shock or to some cause other than ether.
Very hot water will often check vomiting, or crushed
X. black coffee, small doses of brandy, champagne and
:e, or aromatic spirits of ammonia. Cocain, \ grain
ivery two hours for five doses, has been successful in
: cases; also a mustard plaster over the stomach
|:and the washing out of the stomach. Patients who take
I chloroform do not suffer from nausea so much as do
3iose who take ether.

In etherizing young children it is best to put them on
flie back and at once place the ether-cone over the mouth
Old nose without temporizing. If their pleadings to have
tbe cone taken away are listened to — and they are hard
I resist — their agony will only be prolonged and the
' operation delayed. Children are quickly etherized, and
very rapidly recover from the influence of the ether.

Chloroform is similar in its action to that of ether ; it is
pleasanter to take, and the patient is under its influence
quicker, though it is more depressing on the heart than
ether, and for this reason the patient is not allowed to
rise until all effects have passed off. To give chloro-
form, a few drops may be sprinkled on a handkerchief,
a towel, or a small wire framework covered with fian-
drops may be sprinkled on a piece of absorb-
^cnt cotton placed in a tumbler, which is held a little dis-
uice from the patient's face. The same symptoms are

IS6 PRACTICAL FO/NTS IN NVRSIK/G.

to be watched for as those in ether. Death from chl
roform is almost always sudden, from paralysis of
heart : the pupils become dilated, the face becomes pal^
and the pulse becomes flickering.

Nurse's Duties in OpBrating-rooni. — The duties of
the nurse in the operating- room arc the same for all
operations. Her dress must be of cotton goods, the
sleeves being made to roll up above the elbows. Both
dress and apron must be fresh for the operation.

On first going to the operating-room the hands and
forearms of the nurse are to be washed and scrubbed
thoroughly for ten minutes, and the finger-nails thor-
oughly cleaned, thus removing the germs from the
hands. The hands are then rendered absolutely sterile
by putting them first into a saturated solution of per-
manganate of potash until they are of a deep-brown
color from the tips of the fingers to the elbow, then
into a hot saturated solution of oxalic acid until all the
permanganate stain has been removed : they are then
washed in .sterilized hot water, and finally are soaked for
three minutes in a solution of corrosive sublimate (:
500). which reaches the corners and crevices in the
ger-nails that cannot be reached by the brush.

Some surgeons prefer ether and alcohol to cleanse the
skin. After the hands have thoroughly been scrubbed
in hot soap-suds and the finger-nails cleaned, the hands
are washed in ether, which removes from the skin all
oily and fatty substances; they are next washed in pure
alcohol for one minute, and finally soaked for three min-
utes in a solution of corrosive sublimate {1 : 1000). The
patient's skin is cleansed in the .same manner with ether,
alcohol, and the sublimate solution.

The nurse next puts on a sterilized gown. If

THE PATIBNT.

arc no gowns — as in an emergency case, for instance —
three sterilized sheets (see p. is[) will answer for gowns
for sui^oon, assistant, and nurse. The nurse now puts
her hands again through the different solutions, and
stands ready to get anything that may be called for.

After making her hands aseptic the nurse should not
touch her hair, her face, a door-knob, or anything that
has not been made aseptic. If any article falls to the
floor, it mu.st not be picked up unless it is an instrument
that the .'surgeon will need ; then it must be boiled in a
small pan which should be in the room in case this acci-
dent happens. If a sponge falls, the nurse should move
it with her foot to a position where it can be seen. The
assistant will always tell a nurse when he wants fresh
water for sponges ; on no account must she take the pail
without his knowledge. If she is asked to do anything
that she does not understand, she should so inform the
surgeon, who will always be perfectly willing to make
the duty clear.

The pails, bowls, and pitchers, and the tray for instru-
ments must be washed inside and out, and filled with
sterilized hot water, which is conveyed from the boiler to
Ihe pail by means of a perfectly clean pitcher or a tin
ladle. The pads and rubbers to be used, also the ope-
rating-table (the patient is generally etherized in bed),
must be thoroughly washed with the corrosive-sublimate
solution 1.1 : looo).

If the nurse is to wash the sponges, she should first
make her hands aseptic, then count the sponges as she
puts them into the pail of water, the surgeon counting
them at the same time. She must be on the alert in
case a fre-sh sponge or a sponge of a certain size is sud-
denly called for ; she should then take the soiled sponge

PRACTICAL POINTS IN NURSING.

158

from the surjjeon with her left hand and give him t
fresh sponge with her right. She should r
ing to hand a fresh sponge, rest her hands or forearms >
the pail ; and if she has to stop to get something for the
surgeon or to get fresh water, her hands must again be
washed in the antiseptics before touching the sponges.
If she is to sponge the wound, she should wipe swiftly
and firmly. She should count the sponges before the
surgeon begins to sew up the wound, and should be
very sure that she has the exact number employed in J
the operation, 4

ArrangrinET the Patient for Operation. — When the
patient is brought into the operating-room and placed on
the table, the clothes must be removed from the part to
be operated upon, to prevent their getting soiled. If the
part to be operated upon is the head or the chest, the
night-gown must be pushed well down under the shoul-
ders ; if it is a breast, an arm, or a leg, tlie gown should
be opened down the front and be pushed to the opposite I
side; if it is the abdomen, the gown and under-vealf
must be brought well up under the shoulders and t
under-vest be turned up so as to hold the arms in pos
tion across the chest.

Sterilized blankets are tucked about the chest and thi
feet, the bandage and pad are removed from the pai^
and the latter is again thoroughly cleansed with soi
and water and disinfectants. Sterilized sheets and tow
are then arranged about the part. A table for the iw
strument-tray is placed at the surgeon's right side, als
a chair or table on which is placed a pail or bowl *
water for his hands. A table for the pails or bowls E
sponges is placed at the opposite side of the table, at thl
assistant's right hand, and the operation is begut

THE PATIENT.

Ait«r-care of Patient. — Just before the wound is
closed the soiled towels are removed and replaced by
fresh ones. After the dressing has been applied the
patient is raised, wiped perfectly dry, a bandage put on,
and is then carried to the bed. which has previously been
prepared and heated with healers well covered to pre-
vent burning the patient. A towel should be placed
under the chin of the patient in case she should vomit,
and a small basin should be at hand, but not where she
can see it on first returning to consciousnes.s. The pa-
tient should not be left until she is well out of the ether.
If there is a member of the family not afraid of the sight
of blood, the nurse may ask her to assist in cleaning up
the mom.

Sequels of Operation. — Shock. — After an operation
the nurse must watch for two things — shock and hemor-
rhage. Shock is great depression of the vital organs of
the body produced through the nervous system, brought
on b>' injury or surgical operation. The greater the in-
j ury and the longer the anesthesia, the greater the shock.
The nearer the operation is to the trunk, the greater the
shock. An operation on the abdomen or the amputation
of a thigh is more severe and the shock is greater than
operations on remote parts — a finger or a toe, for in-
stance— because they are farther away from the heart
and the nerve-centres.

Mental shocks, such as sudden joy, grief, or fright,
may be as severe as those of the body. Age modifies
shock. In old people shock is usually more severe and
prolonged, especially if there is any organic disease.
Children recover readily from shock if there has been
very little loss of blood. Invalids and individuals used

suffering stand shock better than those whose nervous

l6o

PRACTICAL POINTS JN NURSING.

\ modi-

system is in a hifjh degree of activity. Shock i
fied by mental conditions ; it is aggravated by fear, de-
spondency, or depressed mental conditions of any kind,
while it is diminished by cheerfulness, hope, joy, etc.

Two very important points to be remembered in case
of shock and of hemorrhage are the temperature and
the condition of the patient's mind. In shock the tem-
perature at first is normal or very little below normal,
and the senses are dull in proportion to the degree of
shock present; in hemorrhage the temperature is sub-
normal and the mind is bright, keen, alert, and there is
an anxious expression on the face, anticipating danger.

The symptoms of shock are a weak, rapid, and irregu-
lar pulse; sighing; rapid, irregular, shallow respiration;
temperature normal or very little below; pale face with
a pinched look ; cold, clammy skin ; the mind dull.
There may be involuntary movements of the bowels and
urine through loss of muscular power; nausea and
vomiting.

The treatment of shock consists in lowering the patient's
head and elevating the foot of the bed, to send the blood
to the heart and brain ; in applying heat to all parts of
the body — the sides, between the legs, and to the feet,
and a mustard plaster over the heart; in administering
stimulants of whisky, brandy, or pure alcohol hypoder-
matically; in giving hot colTee or salt-solution by the
rectum and very high up. An enema of \ ounce off
pentine. a raw egg well beaten up, and 3 ounces of n
water is a powerful stimulant.

It must be remembered that in severe shock the func-
tion of absorption of the stomach and intestines is almost
wholly sus()ended. and anything given by the rectui
must be given very high up. When the respiration 4

oftUI^^H

le func-
almost
le rectiua^^^
}iration ofi^^|

THE PATIENT.

the patient is fast failing, everything depends on main-
taining the hearts action. To this end artificial respira-
tion must be persistently practised. When the depres-
sion is deepened by hemorrhage, transfusion must be
resorted to. External heat is the most powerful of all
heart-stimulants, and often when the heart's action
threatens to fail it may often be restored by heat over
the heart and by hot fluids taken into the stomach.

Strychnia is a powerful heart-stimulant, and, if at hand,
jiy grain should be given every half hour for four doses.
Tincture of digitalis in 15-minim doses may be given
every half hour for four doses. Ether alone, or mixed
with an equal part of alcohol, has a more rapid stimulant

ion than alcohol. Recovery may be rapid or very
;fllow ; then we get what is called " reaction " — the pulse
becomes more full, slow, and regular, the temperature
rises, the body becomes warm, and a general improve-
ment takes place.

Co/lapse is an extreme degree of shock, and almost
invariably ends in death.

Htmorrhage may be caused by the slipping of a liga-
ture or the displacement of clots, due either to restless-
ness or to reaction of the circulation, and it generally
occurs within the first twenty-four hours after the
operation.

Thf symptoms of internal hemorrhage are restlessness,
thirst, faintness, an anxious expression, pale face, cold
skin, frequent and irregular respiration, subnormal tem-
perature, and a weak, rapid pulse (120-140), though
there have been cases of internal hemorrhage in which
the pulse has not gone above 94 beats to the minute, all
the other symptoms being very marked.

Treattnent of Hemorrhage. — The two things to be

l62

PRACTICAL POINTS IX NURSING.

remembered in the treatment of hemorrhage are position
and pressure. The part from which the blood is coming
should be elevated, because blood flows upward with
difficulty; elevation also favors venous return. If the
liemorrhage is from the abdomen, the foot of the bed
should be elevated and the patient's head lowered, thus
sending the blood back to the heart and the brain. If
the nurse can apply pressure by putting her fingei
the artery, she should do so, or she may plug the wound
tightly with sterilized gauze or a compress, and hold i
there until the arrival of the surgeon, who must imm
diately be summoned. The patient is to be kept per-
fectly quiet on her back ; morphia (J grain) should be
given to secure rest and quiet. Heat is to be applied to
all parts of the body by warm blankets and hot-water
bottles Stimulants are to be given only if the pulst
falling When the hemorrhage has been excessive^
transfusion is often resorted to, the fluid that the bo<
has lost being thus replaced.

Transfusion is the injecting of blood from the vein t
one person into that of another or the injecting of a
sahne liquid, for the purpose of replacing the blood lost
by hemorrhage. The most common normal saline solu-
tion used is salt -solution, which consists of i^ teaspoons-
ful of common salt to i quart of boiled water. The
amount of .solution injected varies from 8 ounces to a
pint. The parts used for injection are the chest, the^
abdomen, the thigh, or the arm. For transfusion thertfif
will be needed an irrigator which has been thoroughljTj
sterilized with boiling water and corrosive subhm
(i : looo), followed by the boilinf* water, or a ruW
tube and a glass funnel. The needle used resembles fl
hypodermatic needle, but is much larger. It must bef

ound ^^^

: per-^^^^
Id be
led to

water ■

ilse io^^H
ssive^^H
body^H

rin d^^^H

THB PATIENT.

163
md fastened to the end of the

Fboilcd for several minutes, ;
rubber tube connected with the irrigator. The tempera-
ture of the solution should be about lOO" F., and the
solution must be strained through gauze or cotton when
being poured into the irrigator. The part is washed with
carbolic-acid solution ( 1 : 20) before the needle is inserted.
After-treatment of Patient.— ^«/. — The after-treat-
ment of evcrj' surgical operation consists in perfect rest
of the patient on the back for a certain length of time, to
prcx-ent the ligatures giving way and to prevent irritation
L of the stomach and vomiting.

I The diet following operations is liquid until after the

\ third day and the bowels have moved; then a light diet

is given, such as cream toast, a soft-boiled egg, custard,

buttered bread with the crust removed, cocoa, etc. ; solid

diet is aftenvard gradually resumed.

Aftcr-lrcatment in Amputations. — After the amputation

of a thigh the stump must slightly be elevated on a pil-

f low and a cradle be used to keep off the weight of the

I bed-clothes. A careful watch should be kept for hemor-

PThagc. When a breast has been amputated, the arm is

confined to tlie side by a bandage. The arm will become

very tired; this tired feeling can be relieved by putting

under the arm a small pillow, upon which it can rest.

^ After-treatment in Abdominal Operations. — After ab-
dominal operations the patient cannot have anything by
mouth for a certain number of hours. The extreme
thirst can greatly be relieved by frequent bathing of the
hands and face with alcohol and tepid water or with
water alone. After operations on the abdomen it is well
to place a roll under rtie knees. This roll will relax the
abdominal muscles, and also remove the strain the patient
would have to make to keep up the knees,

164. PRACTICAL POINTS IN NURSING.

The external genitals are to be kept perfectly clean,
the body is to be bathed, the bed and body-linen are to
be kept sweet and clean, the teeth arc to be brushed, and
the hair is to be combed after the third day. Every
want of the patient should be anticipated, and she should
be made as comfortable and happy as possible. No
visitors are to be admitted without the surgeon's consent.
The mind of the patient is to be kept perfectly free from
worry and excitement, and the whole atmosphere of the
room should be bright, pleasant, and cheerful, no matter
what trouble is going on outside. The nurse must not
allow the patient to sit up until two weeks after the ope-
ration, as there is danger of a clot (thrombus) forming in
a vein and being carried by the circulation to the pul-
monary artery, causing sudden death.

Bladder and Bozviis. — The catheter should be passed
every six or eight hours if necessary, according to direc-
tions. The passage of gas by the rectum is a ver>' good
sign, as it shows that the bowels have regained their
normal tone and that there is no obstruction.

Drainagc-lubc. — If a drainage-tube is in the abdomett
and the care of it is left to the nurse, she must each tii
before draining thoroughly scrub and sterilize her hands^
The syringe must be washed first with boiling water, the
water being passed through it several times, then with
corrosivc-snblimate solution (1 : 1000), followed with boil-
ing water; the syringe is then to be laid in the corrosive
solution until the nurse has washed her hands a second
time and unpinned the dre.ssing covering the tube. The
rubber tube attached to the syringe is passed dowit'
the centre of the drainage-tube to the bottom, then
drawn a little, so that only the fluid will be drawn u^^
and not the tissues of the pelvis. The syringe piston ii

THE PATIENT.

IBs

to be slowly and steadily drawn up. When removing
the syringe the nurse should be careful that the blood
does not drop on the dressing. The mouth of the tube
is to be covered while the syringe is being emptied, and
the corrosive and hot water are to be passed through the
syringe before again putting it down the tube.

Some surgeons prefer^dtf jc drainage, a piece of twisted
gaute being put into the tube, that sucks up the fluid.
This gau7.e is changed at stated intervals, and the tube-
is cleaned with a small piece of sterilized cotton or gauze
fastened on the end of a pair of long fine forceps ; then a
fresh twist of gauze is inserted. With both these meth-
ods the amount of fluid drawn and its character must be
reported. When the drainage-tube is to be removed,
the nurse should observe the same precautions as she
would for a dressing.

Hystcrrctomy. — The after-care of a hysterectomy, which
is the complete removal of the womb and ovaries, either
through the vagina (vaginal hysterectomy) or through
the abdomen (abdominal hysterectomy), is the same as
after any abdominal operation. Regarding the question
of the mild form of insanity which may follow a hyster-
ectomy or the removal of a lar^e fibroid tumor, one
must know that a large amount of blood is taken from
the body, and that the cutting and tying of the large
I blood-vessels alters the circulation; the operation is also
more or less a shock to the nervous system, and may
aflect the brain. Insanity is not a complication of this
operation, the recovery from which is usually rapid; but
when insanity does set in, this is commonly the cause,
and the patient generally recovers.

iV//ft-cw/a.— Septicemia is blood-poisoning caused by
■ the entrance of germs into the body through the agency

i66

PRACTICAL POINTS IN NURSING.

of unclean hands (especially dirty finger-nails), ins!
ments, sponges, towels, dressings, or the passing of
dirty catheter into the bladder, or in not washing the
parts before catheterization. When septicemia occurs, it
is generally the surgeon or attendants who must be
blamed. In a very large majority of surgical cases the
patient is in a healthy condition, and by a conscientious
preparation of the patient for the operation, be it ever so
simple, and of the room and of everything that will be
used, the patient should and does make a good recov(
Should a healthy patient die of sepsis, then some one
always to blame; the germ was introduced by some one.
Death may be due to some cause such as heart-disease,
over which the surgeon has no control, the patient being
willing to take the risk when consenting to the operation.

Septicemia, or septic peritonitis, may occur any time,
from a few hours to six days after the operation. The
temperature is about lOO" F., and the pulse rises rapidly
to 115, 120, or 130 beats per minute, and is weak and
thready ; then the temperature rises to 103° F. or above,
or it may range between 100° and 101° F. until just
before death, when it has been known to rise to 108° F.
The abdomen is distended with gas; vomiting occurs
(the ejected matter having a dark-brown color resem-
bling coffee-grounds and a characteristic fecal odor); a
cold perspiration appears ; the patient has a very anxious
expression and is restless and talkative ; the eyes are 1
usually bright.

Trcatnuttt of Septicemia. — The nurse should send
once for the surgeon, and in the mean time try to mi
the patient's bowels with high enemata of turpentii
glycerin, oil, salts, melted vaselin, butter, lard,
la.sses, or soap and water if there is nothing else at h;

eiy^^gfl

leii^^H
one. ^^B

THE PATIENT. 167

The enemata should be given every two hours until
the bowels are thoroughly moved or large quantities of
gas are passed, because it is only by putting the bowels
into an active state that one can overcome threatened
paralysis of the intestines, and enable them to take up
from the peritoneal cavity whatever blood-serum may be
there. Stimulating enemata of whisky i ounce and warm
water 2 ounces should be given every hour and a half.
Brandy should not be used, because it is constipating.
Strychnia, being a powerful heart-stimulant, is given in
doses of grain ^ every hour until its physiological effects
are produced. It must be stopped at the first appearance
of twitching of the muscles of the face or of the limbs, and
stiffness of the neck. Vomiting may be relieved by wash-
ing out the stomach or by the application of a mustard
plaster over the stomach. If after repeated efforts the
bowels are not moved by the third day, the resuH is
usually (atal. All the symptoms deepen. The surface of
the body is cold and clammy; the face is pinched and
sunken and has a dusky hue; the restlessness increases,
also the thirst, which is very great, and to the last the
I»atient calls for water, which is vomited immediately after
being taken, but which it is cruel to withhold, The mind
is usually clear to the end.

StiTffical Dieinfectioii and Materials. — Antisepsis and
Asepsis. — Antiseptics prevent the growth of germs and
putrefaction ; a disinfictant destroys germs ; and a de-
odorant destroys bad odors. Although an antiseptic
may be a disinfectant and probably a deodorant, it does
not follow that because a deodorant will destroy bad
odors it will also kill germs. The best deodorant is
pure, fresh air and sunlight; next, carbolic acid (which
is both a disinfectant and a deodorant), charcoal, or lime.

i68

PJiACriCAL POINTS IN NURSING.

Asepsis, or sterility, means freedom from septic germa^
For instance, before an operation the hands and fore- I
arms are scrubbed with nail-brush, soap, and hot water I
to cleanse them and remove the germs ; then the handsij
are entirely freed from germs by putting them in tbeW
different antiseptic solutions ordert;d by the surgeon,
thus reaching the comers and crevices in the Knger-naiUr I
and skin that the brush could not reach; in this wajrw
the hands and forearms are rendered thoroughly asep- \
tic. The sheets, blankets, towels, gowns, instruments,
sponges, and dressings are subjected to dry or moist
heat, according to the orders of the surgeon, for a cer-
tain length of time. Everything to be used at '
operation is made as thoroughly aseptic as possible, ;
only that which has been rendered aseptic must bcl
touched by those assisting at the operation.

Antiseptics. — Some of the commonest antiseptics in
use are corrosive sublimate, carbolic acid, permang;
of potash, creolin, thymol, boric acid, lysol, alcohol
peroxid of hydrogen, iodoform, and dcrmatol.

Corrosii'c sublimate and carbolic acid are the best c
infectants and antiseptics, but the corrosive cannot bcJ
used for the instruments or the clothing, on account of 1
its discoloring properties ; it is used in solutions of froilli|
I : soo to I : (O.OOO.

Carbolic luiil does not discolor clothing or instru-
ments, it having this advantage over corrosive sublimate,
but it irritates and benumbs the hands. The strengths
of the solutions used are from i ; 20 to i : 80. The acid
is bought in the liquid form, having a .strength of 95,™
per cent. To make a .solution of 1 ; 20, 1 : 40. i : 60. org
I ; 80, I ounce of the 95 per cent solution is added t
20, 40, 60, or 80 ounces of water.

^B Both

THM PATIENT.

Both corrosive sublimate and carbolic acid are very-
poisonous ; for this reason many surgeons have the parts
washed with plain water after using these antiseptics, to
prevent absorption. Symptoms of poisoning have been
produced by the absorption of these drugs from surgical
dressings.

The first evidences of carbolic-acid poisoning are a
very dark coloration of the urine, giddiness, ringing or
singing in the ears, lieadache, and lassitude.

The first symptoms of mercurial poisoning (corrosive
sublimate) are fetid breath, excessive salivation, a metal-
lic taste in the mouth, swollen and spongy gums, with a
dark line at their upper margin, loosened teeth, and
swollen tongue. If the use of these drugs is persisted
in, all these symptoms deepen. On the appearance of
any of these symptoms the dressing should be removed.

Crfolin is not so poisonous as the two above-named
drugs, but it cannot be used for instruments, because
of its yellow color, which prevents their being seen at
the bottom of the tray. For cleansing the hands or
other parts a 5 per cent, .solution is used. To make a
2 per cent solution 2\ teaspoonsful of crcolin are added
to I pint of water.

B&TK acid is irritating and poisonous; a 4 per cent,
solution is generally used.

Lysol as an antiseptic is much objected to by some
surgeons on account of its soapy properties. When
used for instruments it makes them slippery. The
strongest solution used is 2 per cent.

Pfrmanganate of potash is an antiseptic used to
cleanse the hands and other parts before operation, fol-
lowed by a solution of oxalic acid to remove the stain.
The permanganate stains everything with which it comes

170 FRACT/C.4L POINTS IN NUXSINC.

in contact; it also causes pain and burns if used in very
strong solutions. The strength of the sohition gen-
erally used is from 20 to 60 grains of the crystals to the
pint of warm water.

Oxalic acid will remove permanganate stain from the
skin. This method is very irritating to the skin, but the
irritation can in a measure be avoided by immersing the
hands and forearms afterward in lime-water. Oxalic
acid also removes permanganate stain from white goods,
and hydrate of ammonia will remove the stain from
black goods.

Candy's fluid, which contains 16 grains of perman-
ganate-of-potash crystals to I ounce of water, is both a
disinfectant and a deodorant.

Iddoform is an antiseptic that may be absorbed into
the system if applied to raw surfaces and cause iodoform
poisoning. The symptoms of absorption are headache
and loss of appetite, followed by rise of temperature,
rapid and feeble pulse, and restlessness; a bright-red
eruption appears on the face and limbs, and there may
be retention of urine.

Peroxid of hydrogen, which is the most expensive anti-
septic now in use, destroys the germs of pus. When
poured into a wound an effervescence takes place which
ceases only when the wound is rendered sterile, and
which carries off any shreds of tissue in the wound that
cannot easily be reached. It is also applied to the throat
in diphtheria to destroy and remove the false membrane.
Pcroxid readily decomposes by coming in contact with
metals. If used as a spray, a glass atomizer must be
employed ; the bottle must not be kept in a bright light.
nor should the mouth of the bottle remain unstoppered-
any longer than necessarj'.

13 iwppt 1 'ni^^^^

TRE PATIENT.

Abiolittt alcohol is an antiseptic used for cleansing the
> skin \ it is also used for sterilizing silk, catgut, and silk-
, worm-gut sutures and ligatures.

The best disinTectant is heat — either dry heat (baking)
or moist heat (steam). Water of a temperature of 212° F.
will kill germs on contact.

Suturing. — Sutures, which are used to bring the edges
of a wound together, are of silver wire, silk, catgut, or

silkworm gut. The interrupted
suture {P\g. 39) is made by pass-
ing catgut or silk through the
jgl^^^ ;^^rMu skin from one side of the wound
■^^ JJ to the other; then both ends are

drawn together and tied in a
double knot. The continuous
SMture (Fig. 40) is the ordinary over-and-over .stitch from
one end of the wound to the other. The dutton suture
(Fig. 41) is made by passing wire across the bottom of
the wound, bringing out the ends about 1 inch from the
edge of the wound, and securing each end with a button.
UgaiioH. — Ligatures, which arc used for tying large
blood-vessels, arc of heavy twisted silk, silver wire, silk-
worm gut, or catgut.

Sf^ilinnng Sutures. — To prepare sutures and ligatures
for an operation the hands and finger-nails are first thor-
oughly cleansed with soap, hot water, and a nail-brush,

172 PRACTICAL POINTS IN NUPSING,

then with corrosive-sublimate solution (i : looo). The
pan in which the sutures are to be boiled and the jars
into which they are to be placed are treated in the same
way. The sutures and ligatures are boiled for two
hours, after which they are taken out with a pair of ster-
ilized forceps and placed in separate jars, care being
taken not to touch the sides of the jars, which have
previously been half filled with a solution of alcohol and
corrosive sublimate (i : 6000).

Gauze Sponges. — Gauze sponges are sterilized by boil-
ing them for two hours, and then placing them in a
glass jar containing corrosive-sublimate solution (i :
1000) until needed.

In these days of antiseptic surgery the surgeon gen-
erally attends to the preparation of the sutures, ligatures,
and sponges : when this duty is left to the nurse it is a
clear proof that the surgeon has great confidence in her,
for septic material may as readily be conveyed into the
wound by dirty sponges, sutures, and ligatures as by
the hands, instruments, and dressings.

IV. ACCIDENTS AND EMERGENCIES.

I. Surgical Accidents.

Fractures. — A fracture is the breaking of a bone into
two or more pieces. A shtiple fracture is a single break
without injury to the flesh. A compound fracture is a
single break with injury to the flesh. A fracture is said
to be comminuted when the bone is broken into several
pieces. An impacted fracture is one in which one frag-
ment is driven and fixed into another. A green-stick
fracture is often seen in young children ; the bone is
bent, not broken, owing to its being soft.

CTli

ACCW&.NTS AND EMERGENCIES.

A fracture is said to be complicaUd when there is
other injuiy, such as a lung punctured from a broken
rib. or a nerve or a blood-vessel is injured, or when other
bones or joints are injured. Fractures are also trans-
verse, longitudinal, or oblique.

Signs of a Fracture. — The signs of a fracture are
loss of power, pain, swelling, crepitus (which is the
grating made by the rubbing of the ends of the broken
bone together, and which is both heard and felt), dis-
tortion, and deformity.

Bone-repair. — The repair of a broken bone is very
interesting. At first blood is poured out around the
ends of the broken bone and surrounding tissues. This
blood gradually becomes infiltrated with lime and thick-
ens to the consistency of jelly, which is then called " cal-
lus." The callus cements and unites the broken ends
the bone, and by the deposit of new bone-forming

:11s gradually hardens and eventually becomes bone.

'he union takes about six weeks, though it is about

nths before being thoroughly complete.

Alanagement of Fractures. — The management of a
broken bone until the arrival of a surgeon consi.sts in
securing perfect rest. If a leg be broken, the patient
should be laid on a stretcher, a door, or a shutter; a
Splint may be improvised with an umbrella, a walking-
lick, a thin board, books, newspapers, or a coat rolled
iqj and tied to the side of the leg with handkerchiefs
above and below the seat of fracture. If none of these
articles are at hand, then both legs may be tied together.
The patient's clothes must be removed from the sound
side first. The clothes should not be torn, but should
be opened at the seams, which can easily be sewed up
To remove the boots, one hand should be

--^ l» Ab^ Ike iMbi. a
btxit m^ he wtmani. It tbc foot is
-re B mmdk pmrn, Ife job cf the boot

= = -■ :--^

GamnwHl

-"- _- _ -J

i^fairii^Kil ■ front and

:i- V -Ji

!MN«d Woric slMMild

r.;? 2 col

rhncTT of caoverting a
fc tfao^h tike broken
tk ftsh. If there is

r.vi: 1* to

I', i ;^ to 1

1 **'^"'""" gn-en.
iiTinl v^. witfa a board

..:> -he a

mat it snloBg ia the
occn afOBod the bmb

-s. i-ii 2 sand-ba^ should be
'.■.:r.b :■:■ keep i: xn pi'sition.

rrt ;o prevent the sind from
■.y -h..'j:d be loni: enouj^h to
->: to above the kntx'. und be
t- ^,ind must be thoroui;hly

,ib.v.,; three parts full. The

fi'-f..rt the

t he-

arrival i-.f the
i the patient
ruadv ci .tton c

cle;

■n the nurse must get
as possible. She

r gauze bandages of different
ui-hh- (frojji ^ f- f< inches); sheei-wadding bandages
fal,..iit .( iii.ln.-. «id(.|, which, if a plaster-of- Paris baiid-
aj;i; i^ applied, will be put on first to protect the skin;
^huel wadiling ; plenty of warm water; towels; corro-
sivi.-snbliinate sokition ([ : tooo) or carbolic-acid solu-
Iron d : 30) ; ^htcts to cover the surgeon and to protect
tin; bed and the floor. If sheets cannot be had, news-

ACCIDENTS AND MMERCMNCIES.

175

pspers may be used for the bed and floor and a large
1 for tlie surgeon.

A patient with a broken leg is generally in bed from
four to six weeks, and one with a broken thigh from
eight to ten weeks. Bed-sores must not be allowed to
form, and will not form if proper care be taken, unless
the spine is broken or the nerve-supply is injured, in
which case they will form even with the best of care.

A broken arm after being dressed (Fig. 42) should be
put in a wide sling (Fig. 43) made with a large handker-

chief folded diagonally, the ends tied around the neck,
the point turned up above the elbow and fastened with

^-pins.

[ For a broken jaw the mouth should be closed firmly
^nd bandaged with a folded handkerchief or a four-tailed
bandage (Fig. 44).

When the collar-bone is broken a pad of cotton should
be put under the arm and the arm be bound across the
chest

D-BJoraaceg. — A*

:-2r» i's the paijea
Sprains. — A spi

I be put to
ee4>Ml *oc applied to

r. wlidi is somctuncs
Ip be overcome by the

SMftefdricf and placing
he liMvr hkck Icetfa uid
tke bone «iil generally

■dtaBgoT the figaraents

-jrc-r-c ■-"■!' ;htf fibres and
i iw :?!jced nr>t in mod-

ir. btdr. the limb rom.iin-
:-.n h-',;r: or hot foTin.-iUa-
!:mb he alaccd in a com-

Surz-.cal Dres^Lnss. — ^■J:^-

» i. I"

■ sinij> are divided
•.-JT is commonly called a
checje-cloth (prepared by
n water to which has been
lt which the cloth is wrun';
r ti remove the soda, and
plain water, then Liken out
I, or the ordinar)- cotloii-
[iros. iodoform gauze, and
-ed as drcs.*intj-i. though in
■n nr cotton, cut to the de-
ovcii.make verj- good ster-

ACCIDENTS AND EMEKGENCTES.

177

For a wajer-drfssing several thicknesses of gauze are
wrung out of the ordered hot solution, applied over the
part, and covered with two layers of sheet-cotton and a
single piece of oil-silk or oil-paper, the whole being kept
in place by a gauze bandage.

A dry dressing consists in covering the wound with
several thicknesses of sterilized gauze, over which is
placed two or three layers of sheet-coHon, both dress-
ings being secured by a bandage. Many surgeons first
powder the wound with iodoform or a preparation of
boric ;icid and iodoform or dermatol powder, to prevent
irritation and chafing and to absorb the moisture.

Ttnts are small strips of rolled gauze and are used to
keep wounds open for the escape of pus.

Management of Surgical Dressings. — Before beginning
to do a surgical dressing the nurse should see that every-
tiiing is ready. She should try to remember the favorite
dressings for the different surgeons: this is sometimes
rather difficult ; still, after seeing a dressing done once
she should, if quick and intelligent, know what will be
needed the next time. Besides the dressings there will
be needed a basin of warm corrosive-sublimate solution
(i : tooo) for the hands, a basin of carboHc-acid solution
(i : 20) for the instruments, towels, and a pail or a basin
for the soiled dressings and discharges. If asked to pre-
pare a wound for the surgeon's inspection, the nurse
must wash her hands with soap and water and corrosive-
sublimate solution, having first covered any cut or scratch.
She should then remove the bandage and dressing, which,
if it adheres to the wound, may be wet with corrosive-
sublimate or carbolic-acid .solution, after which it will
easily come off The nurse should wash ttnvard. not
away from, the wound, and cover it with a cloth wet in

17S PRACTICAL POINTS IN NURSING.

carbolic-acid solution until the surgeon is ready
inspect it. To remove a plaster begin at each end at
work toward the wound. Putting one hand on the sk
and pressing firmly down will prevent the peculiar tear-
ing feeling of which a patient will complain. The marks
of the plaster can be removed with alcohol, ether, tur-
pentine, or soap and water, care being taken that
solution used does not enter the wound.

Bandages. — Bandages are to retain dressings
splints in position, and also to apply pressure. Almosts]
any kind of household muslin or gauze may be used foi
a bandage. Gauze is the best, on account of its el
city; it can be applied to any irregular surface, and
is not necessary to reverse a gauze bandage, Stiaki
flannel cut on the bias is used where greater strength
required and to make firm pressure.

Rubber Bandage. — Rubber or elastic bandages arc
prevent hemorrhage and to prevent or reduce swelling.
The rubber bandage is put on from below upward, with-
out reverses. It must not be drawn too tight nor be
left on too long, or paralysis from pressure on the nerves
of the part may result, or the circulation will be interfered
with or entirely cut ofT Rubber bandages should be
rolled up qaite loosely and be kept in a dark, moist
place, or they become brittle and break into pieces. J

Rolkr-bandages. — Roller-bandages are from J inch to
6 inches wide and from 2 tn 8 yards long. The selvage
must always be removed, the bandage rolled very tightly
and evenly by hand or on a regular bandage- roller, and,
the loose threads of the edges trimmed off.

In applying a bandage the nurse should hold

one hand, and, taking the loose end in

other hand, should so apply it to the part to be bandaj

that the outer surface may be against the likin, and that
the bandage will he close to the limb (Fig, 46). All band-
ages must lie smoothly and thdrpressurc be unirorm. A

bandage should always begin from the inner side of a
hmb, and thus bring the turns to its outer side (Fig. 45).
A bandage must not be put on loo tightly, as there is
\ considerable danger of inflammation or of gangrene
I through the circulation being interfered with or being
I entirely cut off. It should fit snugly to the part, and an
I equal amount of pressure should be maintained. Inflam-
I mation and gangrene (death of a part) are often caused
by tight bandaging. The fingers or the toes must be
left exposed, so that one can sec if the circulation is car-
ried on all right. They should feel warm to the touch,
and tJie color should disappear upon pressure and reap-
pear when the pressure is removed. If they are cold,
numb, swollen, or have a livid appearance, the bandage
should be loosened. If in compound fracture the patient
ha.s pain, the pulse and temperature should be taken and
the surgeon be notified. The bandage or dressing must

Boot be removed unless the splints are pressing unevenly
or displacement has occurred, or the fingers and toes are

l8o PRACTICAL POINTS IN NURSING.

When taking off a bandage it should be rolled
loosely in the hand as it is unwound, thereby keeping it!]
all together.

The simplest forms of bandaging are the spiral and'J
the figure-of-8 bandage.

The spiral bandage consists in covering a Hmb by a
series of spiral turns, each turn overlapping the one
below for about one-third its width. In most limbs the
enlargement at the upper part prevents the applicatii
of a spiral bandage without making a reversed turn
it. Without this turn only one edge of the bam
would come in contact with the part, the other would
stand freely away from it. The reverses are made by
placing a finger on Ihe lower edge of the bandage to
hold it firmly in position, and folding the bandage down-
ward upon itself {Fig. 46). The turns should not
made over the prominence of a bone, and where possibl)
should be made on the outer side of a limb. At the
moment of making the turn the bandage should be held
quite loose, and after the turn has been made it can be

pulled as tight as necessary. In making the turn
hand should be held a little above the limb, and care
taken not to unroll more bandage than is necessary.

ACCWBKTS AND EMEKGENCtES.

Thf^ figure-of-8 bandage (Fig. 47) is the one most fre-
quently used ; it is easier to apply and it fits better. It is
applied alternately above and below, each succeeding
turn overlapping its neighbor by one-third its width.
The figure-of-8 bandage needs very few reverses ; still,
they must be employed should occasion require them.

The Desauit bandage (Fig. 49) is applied in the treat-
ment of fracture of the clavicle.

Divided Bandages.— 'Wic four-taiied bandage (Fig.
50) is useful for dress-
ings about the face (Fig.
44), the scalp (Fig. 58).
and the knee. A many-
taiUd bandagi; (Fig. 51)
is applied to a limb
which requires frequent
dressing, and consists of
a piece of linen or muslin
the length of the limb
and wide enough to go
one and a half times

around. The muslin is torn from each side, in strips
about 2 inches wide, to within about 3 inches of the

l82

PRACTiCAI. POINTS IN NVKS/NG.

middle. The central part of this bandage is placed under
the limb, and the tails are drawn to the front over the
dressing and tied ; beginning at the lowest pair, the ends
are brought up and the next pair tied over them.

The Sculteha bandage (Fig. 52) is used for bandagii^. 1
the abdomen, and is made by taking two pieces of flai
nel or of cotton, each i yard long and 4 inches wid«
the two pieces being placed 4 inches apart ; across thei
are sewed five other pieces of the same length and widtb
each piece being overlapped by the one above it by one-
half its breadth. This bandage is placed under the p
tient's back, the cress strips are folded over the abdoma
from below upward, and the lower ends of the \

pni

-The Scutliliu bondace.

strips are brought up between the thighs and pinned t
the front of the bandage. This keeps the bandage fi
wrinkling and retains it in position.

1-bandage. — The T-bandage (Fig. 53), which is 1
secure dressings on the anus or the perineum, is ma(
of two strips of bandage, each about 5 inches wide. Td(
the middle of one strip, which is to go around the ^
the end of the other strip is sewed, and is passed I

r. 183

' tween the thighs and fastened in front to the waist band-
age with safety-pins.

Handkerchuf Batidagcs. — Handkerchief bandages
(Figs. S4~5^)- which are very useful in emergencies,

consist of large handkerchiefs or of pieces of linen or
mushn, each about 32 inches square. The Iriattgi

f made by cutting the square diagonally, so that two
threc-comercd pieces is the result. A crm-at is made by
folding in the sharp corner toward the base of the tri-
angle until a bandage about 3 inches wide is formed.

Plates 1 and 2 give a very good idea as 1
various applications of roller-bandages.

Plaster-of-Paris 5rt«(/fl^f.— Plaster-of-Paris \
which are intended to prevent all motion i
made by sprinkling gauze or cotton bandages with
dentists' plaster of Paris ; these bandages are loosely
rolled and kept in a covered jar or a tin box to <
cludL- the air

When needed the rolled bandages are placed in Wfl
water to which has been added a little salt, to help i.
plaster to set more rapidly ; they remain in the water
until the water-bubbles cease, when they are wrung out
by holding the bandage at each end, thus preventing tl
plaster coming out at the sides, which happens if I
bandage is taken in the hand and squeezed in the midd]
A little plaster cream should be prepared, to be applied
over the bandage afler its application to fill up any crevices.
The cream ntust constantly be stirred or it wUl gradually
thicken and become hard. The limb is first enveloped
in a thick layer of sheet wadding, then the prepared
bandages, after having been thoroughly wet, arc applied
in the usual manner. After the bandage has been ap-

■osely I

Iptke I

Lvater

I out I

BANDAGING.

r AffH EMERGENCIES.

185

lied the dressed limb is exposed to the air until tlie
,baiidage is dry and hard ; after this the limb is placed
between sand-bags, covered with the upper bed-sheet,

id the weight of the blankets is supported by a cradle.

Another method of making the plaster bandage is to

lake the plaster into cold water until the mixture is of
tte consistency of cream : the plain mushn or gauze
bandage is unrolled in a basin of water, re-rolled in the
basin containing die plaster cream, and then applied ; but
this method is only resorted to when the powdered band-
are not prepared. The cream must constantly be
'Btirred or it will gradually thicken and become hard.

If the bandage is applied to the upper part of the
thigh, where it is likely (especially with children) to get
wet with urine or soiled with fecal discharge, it may be
kept clean by giving it a coat of varnish.

SUicatc-of-ioda Bandage. — A silicate-of-soda dres.sing
isists in protecting the limb as in the case of a pbster-
of-Paris bandage, after which bandages saturated with
silicate of soda are applied. Another way is to bandage
the limb with muslin bandages and paint each layer with
the silicate. From three to five layers of bandage are
generally applied. The disadvantage of this dressing is
that it takes too long for it to dry thoroughly; it is
readily removed with water.

Starch Bandage. — A starch bandage is made by mix-
ing starch in the way it is ordinarily prepared for laundry
purposes, applying a bandage over the limb, and painting
the starch over the bandage; strips of pasteboard arc
soaked in the starch, laid along the limb for support, and
another starch bandage is applied over the pasteboard.

Citalk-and-gum Bandage. — A chalk-and-gum bandage
is applied in the same way as the starch bandage. The

tnis

■atirr

r If

thig

kep!
■^of-P

iS6

PRACTICAL POINTS IN NVRSING.

mixture is prepared by taking equal parts of gum-arabic
and precipitated chalk, and adding boiling water until
the admixture becomes of the consistency of thick
cream. This mixture dries more quickly than starch,
which takes two or three days to dry. and the bandage
is also stouter. The plaster-of- Paris bandage has the
advantage over all other bandages in being more durable
and in the rapidity with which it can be applied and with
which it sets.

Splints. — Splints are used to keep a broken bone in
its proper position. A splint should fit above and below
the seat of fracture, care being taken that it does not
press upon any prominent part. There are a large
variety of splints which are adapted for every part of the
body, but perhaps the commonest are the coaptation
splint, which can be adj usted to any part, and the plaster-
of-Paris splint.

Splints may be improvised with cardboard, gutta-
percha, leathtr, felt, tin, wood, an old hat, a coat rolled
up, an umbrella, a walking-stick, or newspapers. The
cardboard, leather, or gutta-percha is first soaked in hot
water, after which it will easily mould to the part; such
splints are perforated to allow the escape of perspiration.
They should be covered with a compress or with sheet
wadding of three or four thicknesses, brought smoothly
over the edges and stitched firmly or held in place with
strips of adhesive plaster.

Plaster-of- Paris Spiint. — A pi aster-of- Paris sphnt is
made by taking flannel, linen, or muslin (folded to three
or four thicknesses) to envelop the limb, and stitching
through the middle of the folds after the manner of
stitching the leaves of a book. The folded material is
soaked in the plaster-of- Paris cream, laid on a board,

ACCIDENTS AND EHESGENCIES.

187

opened out, and applied over the limb, which is first cov-
ered with sheet wadding. Plaster of Paris must be kept
covered, as It absorbs moisture from the air; if it is
moist, it can be dried in the oven.

This bandage is readily removed by making a line
with a knife and dropping water along the line from a
median c-dropper or a spoon to soften the plaster, after
which the bandage can be cut with scissors and removed.

Bztenmon. — Extension (Fig. 59) is used to prevent
the shortening of a Hmb. To prevent the extension-
apparatus gradually pulling the patient's body to the

foot of the bed, the foot of the bed must be raised on
two blocks of wood (8 or 10 inches high), thus obtaining
counter-extension by the weight of the patient's body,
everything being taken away from under the patient's
head except a small pillow. The materials required for
extension are two strips of adhesive plaster %, inches wide
and long enough to reach from above the knee to below
the foot, leaving a loop. A piece of wood (4 inches long
and I inch thick), having a hole pierced through its cen-
tre, is inserted in the loop beneath the foot and fastened
. place. The adhesive-plaster strips are placed along

l88 PRACTICAL POINTS IN NURSING-

the sides of the Ic'K to above the knee, and further se-
cured by a bandage. One end of a stout cord is passed
through the hole in the wood and knotted. The cord is
carried over a pulley attached to the foot of the bed and
fastened to a weight. Smoothing-irons, bricks, or sand-
bags may be used as weights ; these must first be
weighed, so that the surgeon will know the number of
pounds he is putting on.

Wounds. — A wound is defined as a solution of con-
tinuity of the tissues — a separation of the continuous
parts by violence. There are different kinds of wounds
— incised, contused, lacerated, punctured, gunshot, or
poisoned. An incised wound is a cut made with a sharp
instrument. Contused and lacerated wounds are made
with a blunt instrument, the tissues being torn and
bruised. A punctured wound is made with a pointed
instrument, such as scissors, a nail, etc. Gunshot wounds
are caused by firearms. A poisoned wound is caused by
an agent which carries with it into the wound a poison.
Wounds may also be aseptic or septic. An aseptic
wound is one which is free from and is preserved from
all poisonous bacterial products. A septic wound is one
in which the bacteria are present, they having gained
access either through injury and exposure before treat-
ment or during the treatment.

Healing of Wounds. — Wounds heal by first intention
or by second intention. Wounds heal by first intention.
or primary- union, when the edges are brought together
and rapidly heal without granulation or suppuration.
Wounds heal by second intention, or granulation, when
the edges are separated and the wound is large and
deep, and the granulations, which are soft, bright-red
elevations, fill up the wound from the bottom and sides.

ACCWE/fTS AND BMERGMNCIES.

xasionally the granulations grow too rapidly and pro-
face of the skin. This condition is
commonly called " proud flesh," which is removed either
with nitrate of silver or with the knife. Granulations are
Ijometimes pale and flabby and have to be stimulated.
kcasionally a wound healing by granulation will heal
fom the top instead of from the bottom and sides.
yhen this process of repair occurs the wound is kept
>cn with gauze packing, a little of which is removed
|ach day as the wound heals up from the bottom. Only
g incised wound heals by first intention ; other wounds
al by granulation. Healing undtr a blood-clot, of
Firhich we so often hear, occurs whi:n an aseptic blood-
clot remains in a sterile wound. The blood-clot grad-
ually becomes organized and serves as a scaffolding for
the new tissue which is thrown out from the surround-
ing parts. When the wound heals the surface clot breaks
up, is brought away with the dressings, and a firm scar
is seen. If the wound has become infected, the clot may
be swept away with the pus, and the wound then heals
by granulation. Suppuration, which is the end of infect-

tiire inflammation, consists in the formation of pus, which,
V absorbed into the system, will result in erysipelas or
^^mia. Both these terms mean blood-poisoning; the
former is septicemia without abscesses, the latter, septi-
cemia witli abscesses, and is the severer disease.

Erysipelas. — Erysipelas is due to the entrance of germs
into a wound either during or after an operation, and is
generally caused by the instruments, the sponges, the
dressings, or the hands not being properly sterilized.
The symptoms are a chill, a rise of temperature, and
.swelling and pain : the skin around the wound is of a
bright-red color, which disappears upon pressure.

;her with m^^

rJCACTJCAL POIATS IN NUkSING.

Pyemia. — Pyemia is blood-poisoning togethi
formation of abscesses. The symptoms are severe chill,
followed by profuse perspiration, rise of temperature and
pulse, nausea, vomiting, and diarrhea, and pain at the
point where the abscess is forming.

The treatment for both these diseases consists in iso-
lating the patient, in sustaining the patient's strength
with nourishing food and stimulants, and in observing
thorough asepsis. Each surgeon has his own method
of treatment, and his directions must faithfully be carried
out.

Tetanus. — Tetanus is an infective disease which almost
always originates from wounds, particularly those of the
extremities. The infecting germ may enter a wound,
large or small, at or a few days after the time of injury.
The earliest symptom is stiffness of the neck, afler which
the muscles of the face and jaw are so affected that the
patient cannot open his mouth. This condition is com-
monly called " lockjaw." Gradually the other muscles
are affected by spasms, which are very severe, and the
face has a peculiar grinning expression. If the body is
rigid but straight, the condition is called "tetanus;" if
the head is stretched backward and the spine arched, it
is called " opisthotonos."

The treatment of tetanus consists in keeping the pa-
tient perfectly quiet in a darkened room, care being taken
to disturb him as little as possible. Nourishment, stimu-
lants, and medicine may be given by the rectum if nec-
essary. Morphia may be given subcutaneously. The
bowels must be kept open, and retention of urine may
be relieved by catheterization. The number of spasms
must be counted and the degree of their severity be
noted. The pulse is rapid and weak, and the temper-

ACCIDBNT^ AND i

VERGESCmS.

191

ire IS slightly elevated. The exhaustion is extreme,
doe to loss of food and sleep. An acute attack may
result in death from asphyxia or exhaustion in frnm
three to five days, the mind, as a rule, being clear to
the end.

Oangrene is the mortification or death of a part, pro-
duced by the stoppage of the circulation in that part by
cold or frost-bites; a severe form of inflammation in a
weak part may also lead to gangrene. The germs de-
stroy the vitality of the part, and spread until they meet
Jirith parts strong enough to resist their action ; then a
■rc of demarcation is formed. There are two forms of
.gingrene, moist and dry.

Maisl gangrcttf may be produced by an accident when
the injury is extensive and the supply of arterial blood
cut off", or it may be caused by an obstruction to the
:um of venous blood. The symptoms are first pain and
ise burning in the part; red skin-coloration which
iges to a purple or a greenish -black ; there is a fetid
■ ; the part is swollen and soft ; the skin is raised in
;ers ; there is a watery discharge ; and the line of
larcation marks the living from the dead part.
Dry gangrene, or " senile gangrene." as it is called, is
impaired condition of the circulation in parts
at a distance from the heart, such as the toes, where the
circulation is not very vigorous, or to a diseased condi-
tion of the arteries.

Tfu symptoms are numbness and tingling in the part;
color of the skin gradually changes to a dark red,
to purple, and finally the part destroyed becomes
black, dry, wrinkled, and resembles in appearance the
limb of a mummy. When the progres.s of the disease
is arrested a line of demarcation is formed. The de-

-1

H The

^H Sinu

^H ending

PRACTICAL POINTS IN NURSIN

pressed and lowered condition of the patient must be
met with stimulants and nourishing food, and thorough
antisepsis be observed.

Abecess. — An abscess is a collection of pus occurring
in any of the tissues or organs of the body, and is one
of the terminations of inflammation. It may be acute or
chronic (cold), circumscribed or diffused.

Boil. — A boil (furuncle) is a localized inflammation of
the skin and subcutaneous tissues, frequently about a
sebaceous gland, forming a small painful swelling with
pus-formation and ending in the expulsion of a necrosed
centre or " core." A blind boil \?, a non-suppurating swell-
ing that gradually subsides, the contents being absorbed.

Carbuncle. — A suppuration of the subcutaneous tis-
sue, most generally situated under the thick skin at the
back of the neck, is a carbuncle. It is distinguished
from a boil by being larger and of longer duration, in
having no central core, in having several points of sup-
puration, in being less defined and prominent, but more
extensive in its sloughing.

The treatment is surgical, antiseptic dressing, and
good nourishing food.

Ulcer. — An ulcer is an open sore, attended by dis-
charge, generally due to certain diflficulties obstructing
the healing process.

Fistula. — A fistula is an abnormal opening between
an internal part and the surface of the body, or between
two organs of the body, such as the bladder and vagina

the vagina and rectum.

The treatment is surgical : fresh air, good food, and
Ionics arc essential.

SinuB. — An opening upon the surface of the skin,
ending in the cavity of an abscess, is a sinus. It is gen-

ACCIDENTS AND EMERGENCIES.

^^HiaUy caused by the failure of the abscess to heal, by the
presence of a piece of dead bone, by inability of the walls
of the cavity to come together, or by a diseased condi-
tion of the walls of the cavity.

*2. Common Emergencies.
Under this head will be considered the emergencies
apt to be met with in every-day life.

Hemorrhages. — It is impossible to be too thoroughly
prepared to meet the emergency of hemorrhage, as the
care and responsibility of the patient rest entirely upon
the nurse until the arrival of the surgeon.

Hemorrhage may be external or inUrnaL The bleed-
ing may come from the arteries, the veins, or the capil-
laries. Arterial blood is bright red, and bursts out in
spurts with each beat of the heart. Vcnoits blood is
dark ; the stream is steady, flowing to the heart. Cap-
illary blood is of an intermediate shade, and oozes.
Capillary hemorrhage is dangerous only when a num-
ber of capillaries give way at one time.

Hemorrhage is also primary, recurrent (intermediate),
or secondary. Primary hemorrhage is that which takes
place when an incision is made. Recurrent or ititcrmaii-
ate hemorrhage is that which takes place during the first
twenty-four or forty-eight hours after an operation, and
which is due to the force of the circulation of the blood
after reaction has set in. to the di.spiacement of clots
through restlessness, or to the slipping of a ligature.
Secondary hemorrhage takes place between the first day
and the complete healing of the wound, about the time
the ligatures or sloughs separate. It is generally caused
}sy diseases of the walls of the arteries, by a ligature not
being strong enough or being tied too loosely, or by the

T94 PRACTICAL POIXTS IN NURSING.

too rapid absorption of a catgut ligature, or by sqisis,
the germs eating their way through the walls of the
blood-vessels, which become so thin that lliey cannot
stand the force of the blood pumping through them, and
finally burst. Children do not stand the loss of blood
well, but they rapidly recover as a rule. Adults in
health stand the loss of blood well ; old people do not,
neither do they quickly recover.

Symptoms. — The symptoms of hemorrhage are rest-
lessness, faintness, demand for air, weak and rapid pulse,
subnormal temperature (96° or 97° F.), anxious expres-
sion, pale face, cold extremities, feeble, sighing respira-
tions, sometimes a mist over the eyes, and a roaring in
the ears.

Treatment. — The treatment of hemorrhage consists of
position and pressure. The bleeding part should be ele-
vated to send the blood to the heart, because blood flows
up-hill with difficulty; pressure may be applied with the
finger on the artery, or the wound may be plugged with
sterilized gauze or with a handkerchief; morphia (gr. |)
may be given to secure rest and quiet, stimulate the
heart, and contract the blood- vessels. The patient is to
be kept perfectly quiet, to allow the blood to coagulate
in the vessels, and plenty of fresh air lihould be given.
Alcoholic stimulants must be given very cautiously, as
they excite the heart's action and increase the hemor-
rhage; hence they must not be given without orders
from the surgeon, unless the pulse is very weak and in-
dicates heart-failure. If hemorrhage should occur from
the stump of a limb after the amputation, the nurse should
elevate the part and make firm pressure with her finger
on the artery until the surgeon arrives.

Flexion, or the bending of a limb, is another way to

ACCIDENTS AND EMERGENCIES.

19s

hemorrhage. A pad of cotton is put in the joint —
the hollow of the elbow, under the knee, or in the groin ;
against this pad pressure will be made when the limb is
bent. Ice and very hot water are also used in hemor-
;e. heat being the belter, as it stimulates the blood-
isels and causes the blood to coagulate, while ice par-
alyzes the vessels, stopping the hemorrhage for a while;
but when the ice is removed and reaction from the cold
sets in, and the circulation is restored, the blood-vessels
dilate wider than before and the bleeding begins again.
■. with the application of ice, which is seldom
11, thctx; is the danger, if it be put on a raw surface.
«f introducing germs into the system. Fainting has a
lendency to check hemorrhage, as it permits the blood
to coagulate.

Venous hemorrhage is checked on the side of the
wound that is away from the heart. The limb should
be elevated shghtly and pressure applied.
A tourniquet made of a piece of compress or a knotted
idkerchief tied and twisted with a stick, the knot or
le round smooth object being over the artery (Fig.

^Hfean, the
^Kof introdt

60, K and b) will stop the circulation to a part, but it
cannot remain on longer than half an hour or the part
may die. Position, pressure, and morphia are the best

196 PRACTICAL POINTS IN NURSING.

remedies for hemorrhage. The first two can always be
had, and morphia sustains the heart's action, secures rest
and quiet, and contracts the blood-vessels.

The other methods of stopping hemorrhage — tor-
sion, ligation, cauterization, acupressure — belong to the
surgeon.

When much blood has been lost the patient suffers
greatly with thirst, which is often extreme on account of
the amount of fluid that has been taken from the body.
For this reason there may be given to drink, in small
quantities, cold water, which will relieve the thirst and
also make up for the amount lost by resorption. The
patient should be fed well and often and in small quan-
tities,

Bleeding from the palm of the hand may be controlled
by clasping a clean handkercliief and holding the hand
high above the head.

Hemoptysis. — In hemorrhage from the /m«^j (hemopty-
sis) the blood is bright red, and frothy from its admixture
with air. In treating hemoptysis the head and shoulders
are elevated and an ice-bag or an ice poultice is applied
to the chest; crushed ice may be given the patient to
swallow. Equal parts of vinegar or lemon-juice and
water, given in teaspoonful doses, or a quarter of a tea-
spoonful of dry salt, will contract the blood-vessels.
Rest and quiet will be obtained by the administration of
morphia (gr. ^), chloral (gr, x), or bromid of potassium
(gr. xx).

Hcmatemcsk. — Bleeding from the stomach (hemateme-
sis) is treated in the same way as that from the lungs.
The blood in this case is vomited, is of a dark-red color,
and contains particles of food. The feces are of a very
dark color, through the blood having passed into the

ACCIDSNTS AND EMERGENaES.

197

btestines. It is always well to examine the nose and
throat, because the bleeding may not come from the
stomach, but from the nose, the blood having passed
down the throat into the stomach.

Epistaxis. — For nosebkfd (epistaxis) thi; head and arms

should be elevated, and pressure with the fingers should

be made on the nostril from which the blood is coming,

or a small piece of lemon or a small piece of cotton

wrung out of vinegar and inserted will contract the

blood-vessels. The patient should not blow the nose,

as it will disturb the formation of clots. Ice may be

applied to the back of the neck and to the forehead.

Bums and Scalds. — Bums and scalds are the same in

effect. A burn is caused by dry heat — fire or heated

metals ; a scald is caused by moi.st heat — heated fluids

^^ or steam — and is apt to be extensive, because the fluid

^^■tspreads over a larger surface than a burn ; a bum, how-

^^■'Cver, is deeper. Burns are of three degrees :

^^^k I. Inflammation without blisters, or destruction of the

^^npidertnis without penetrating the true skin.

^^B 2. Inflammation of the skin resulting in thi! formation

^^Bof blisters, the latter caused by an outpouring of the

^^Hwater of the blood, that lids the outer skin from the

^^Ptrue skin.

3. Partial or complete destruction of the nerves and
blood-vessels of the part. Their vitality is destroyed.
A burn of i!as first degree may result in death if two-
thirds of the body is burned, because, although there is
only a mere reddening of the skin, the action of the skin
is lost, consequently the power of perspiration or excre-
tion is lost; extra work is thus thrown upon the kid-
neys, wltich become inflamed, and death may occur from
nephritis, which is inflammation of the kidneys.

■ ^^1

PRACTICAL POINTS I.V NURSING.

of the second degree may end fetally if exten-
sive, because the superficial blood-vessels are destroyed ;
consequently, more blood is driven to the internal or-
gans of the body, which become very much congested,
and acute inflammation sets in, which may result in death.
Death from bums of the second degree may occur from
shock, exhaustion after long-continued suppuration, which
follows the separation of the sloughs, also septicemia or
tetanus (lockjaw).

The result of a bum of the third degree is nearly
always fatal in the old or the young, and is determined
by the part affected and by the age and health of the
patient. Burns of the abdomen, the head, and the chest
are more severe than those of the extremities, because
they are nearer the vital organs.

Shock is always present in burns of the first degree,
though not so great as in those of the second and third
degree, and the reaction after shock may result in in-
flammation of any of the vital organs.

Pain is severe in slight bums, because the nerve-end-
ings are exposed ; it is less severe in deep bums in which
there is total destruction of the part.

Edema of the Glottis. — Edema, or dropsy of the glottis.
is caused by the inhalation of steam or the drinking of
scalding liquids. Edema is a pouring out of the water>'
part of the blood into the tissues, and the effusion may
increase with great rapidity. Death by suffocation may
occur within a very short time. The symptoms of edema
are gradual loss of voice, difiiculty in breathing, and
blueness of the surface of the body (cyanosis) from in-
sufficient oxidation of the blood, gasping respirations,
and a flickering pulse. Tracheotomy or intubation is
generally performed. There may be inflammation with-

ACCIDENTS AND EMERGENCIES.

Hit edema, and this may develop into bronchitis and
' jmeumonia.

Tht treatmatt of bums and scalds consists in first at-
tending to the shock by the application of heat to the
body, or. if possible, in giving a hot bath (temperature
100° F.), the administration of stimulants (alcohol or
black coffee), and the application of a mustard plaster

»Over the heart. The clothing is to be removed gently,
being cut if necessary. If the bum is slight and no blis-
ters have formed, the part is to be dressed with a satu-
lated solution of ordinary baking-soda or dusted with
ether baking-soda, flour, or starch, and the air excluded,
because air is an irritant. If blisters have formed, they
should be opened, the fluid being allowed to run on to a
piece of cotton, and then dressed with either carbolic-
acid solution (I :4o). sodium -bicarbonate water, sweet
Loil, vaselin, zinc ointment, or Carron oil (equal parts of
^linseed oil and lime-water), and the air excluded.

A raw surface should not be dusted with flour, starch,

r any other powder, because these substances harden

md form crusts, which are painful to remove. The

Msing should be removed only when really necessary.

Q account of the extreme pain, and only one part at a

me should be exposed and dressed. If the dressing

adheres to the part, it should not be pulled off, but

should be wet, so that it will come off without causing

the patient much pain. The bed should be made up

with old sheets and old pillow-cases. The patient's

strength should be maintained with a nutritious diet

and stimulants, and the thirst relieved with crushed

The bowels should be kept open, and the nurse

jbould watch for retention of urine.

I Complications <if Burns and Scalds. — Some of the

200 PRACTICAL POINTS IN NURSING.

complications are delirium, meningitis, ulceration of tfie
duodenum (the first part of the small intestine near the
stomach), which may result in perforation of the intes-
tine and cause peritonitis, inflammation of the lungs and
kidneys or intestines, and retention or suppression of
urine. Great distortion or deformity is often caused by
contraction of the healing skin. The scars are densely
white. To prevent deformity, the parts are put in splints
in the best possible position ; skin-grafting is often re-
sorted to, and in some cases amputation is performed.

Sunstroke. — The symptoms of sunstroke are a tem-
perature of from 105 to 112° F., sometimes higher, a
flushed face, stertorous breathing, and unconsciousness.
The patient should be put into a cold bath and rubbed
with ice. If at the seaside, he may be carried to the
beach and put in the water ; the head may be kept cold
by bathing it, or by the application of handkerchiefs
wrung out of the water. If a cold bath is impossible,
the patient may be douched with cold water from a
hose-pipe or from pails, and cold cloths be kept on the
head. Enemata of ice-water are very good. The cold-
water treatment must be continued until the temperature
has fallen, after which the patient should be put to bed.
and, if there is depression, be given stimulants moder-
ately. Should the temperature begin to rise, the above
treatment should be renewed.

Heat-ezhauBtion. — Heat-exhaustion is caused by too
long exposure to a very high temperature; the blood
leaves the brain and the surface of the body, and goes
to the large blood-vessels of the abdomen. The symp-
toms are those of shock. The treatment is the same as
that for shock : hot bath if possible, or heat applied to all
parts of the body ; stimulants of alcohol or strong colTee.

ACCIDENTS AtfD EMERGENCIES. 201

Lightning-Btroke. — For a lightning- stroke the treat-
ment is the same as that for shock.

Faintiiis. — The head of a person in a faint shouM be
lowered and the feet raised, the blood being thus sent
back to the brain. Plenty of air, the clothing loosened
about the neck and chest, and a little cold water dashed
over the fece, are usually sufficient to restore conscious-
ness. A method often practised is to place the patient
on a chair, and to push the head down between the
knees, the hands hanging down by tbe side. The pa-
tient is kept in that position until the face becomes red,
being then able to rise and walk about This position
restricts the abdomen and shuts off the blood-supply to
the lower extremities, the blood going to the brain.
Strong ammonia should not be held to the nostrils of
an unconscious patient, as it is very irritating. The
pulse should be watched, and if consciousness does
not soon return, heat should be applied and a physician
be sent for. Little can be done for loss of conscious-
ness from heart-failure, beyond stimulating a flagging
pulse, until the arrival of medical assistance.

Dpowninfif. — In asphyxia from drowning, if the person
when taken from the water is breathing, he should be
removed, if po.ssible. to a near-by house, and put into a
hot bath, which will act as a stimulant ; or heat may be
applied directly over the heart and other vital organs,
tbe head and shoulders be raised, stimulants given, and
Ac body briskly rubbed. This can be done until the ar-

ia\ of a physician. In all cases o^ suffocation the throat
Enust be cleared, so that fresh air can reach the lungs.

Artificiai nspiration is the imitation, as nearly as possi-
ble, of natural breathing. We breathe from sixteen to
ightcen times a minute ; this number of chest move-

•^

202 PKACT2CAL POINTS IN NUXSING.

ments must not be exceeded, or the lungs cannot ex-
pand to fiil thoroughly with air nor contract to expel
the air.

To produce artificial respiration in case of drowning or
or suffocation, the patient's clothing is first removed and

G- 6i.^Arti£cul

the body is quickly dried, The mouth, the throat, and
the nose should be cleared and the tongue be pulled
forward to facilitate access of air to the windpipe ; a roll,

a pillow, a roUed-up coat, or a piece of wood should be
placed under the shoulders. The arms near the elbows
should now be grasped and be swept around horiEon-
tally. away from the body, until the hands meet over the
head (Fig, 6i); this movement raises the ribs and ex-
pands the chest as in inspiration ; the arms should then
be brought down to the sides, the elbows meeting almost

ACaUM/fTS AND EMERGENaES. 203

i over the pit of the stomach (Fig. 62) ; pressure is then
made against the chest-wall, producing contraction of
the chest ; the arms are to be held in the latter position
a few seconds, and then the movements are repeated.
Twelve or fifteen respirations will be sufficient. The
mouth must be kept open and the tongue be held
forward.

Accidents from Fire. — If clothing catches fire, the
person should be thrown down and rolled in a rug,
shawl, blanket, or coat. Any one may at some time be
compelled to pass through sulphur fumes or smoke, and
it can be done by holding a wet towel, a large wet hand-
kerchief, or a wet cloth over the nose and mouth. Some
.persons who have been through this experience never
■retire without first placing at their bedside a large hand-
kerchief or a towel and a bowl of water, in case this
emergency should arise.

Retention of Urine. — Retention of urine is due to the
patient's inability to pass urine, owing to shock, paralysis,
ifaysteria {commonly known as hyslcrkal retention'), or
lother causes, which, if not relieved, may result in rupture
of the bladder or uremic poisoning through resorption.
The patient should be put into a hot balh if possible,
which will act as a stimulant, relieve the pain, contract
the muscular coats of the bladder, and also produce per-
spiration. If the bath is impossible, a hot poultice or
fomentation should be applied over the bladder, or cath-
eterization may be practised and a simple enema be
given.

Head-accidents. — For all accidents to the head, the
part is to be bathed with warm water and firm pressure
with a clean compress be made until the arrival of a
>hysician.

204

PRACTICAL POINTS IN NURSING.

Concussion of the brain is the sudden interruption of
the functions of the brain brought on by severe blows
on, or by other injury to, the head. In the simple form
of concussion the patient is partly insensible ; the pupils
are contracted, and the face is pale. In a few moments
he may regain consciousness ; there is nausea and vom-
iting and headache. In a severe case of brain-concus-
sion death may very soon occur.

Compression of the brain is due to tumors, to depres-
sion of the skull from fracture, and other causes. The
symptoms closely resemble those of apoplexy. In both
these injuries, until the arrival of a physician, who should
be sent for at once, the patient should be placed in bed
with the head slightly raised; the room should be dark-
ened and cold applied to the head. If there is shock, heat
is to be applied, but stimulants are not to be given with-
out orders from the doctor.

Guts and Bruises. — For a cut or a bruised finger, the
part is to be washed thoroughly with an antiseptic solu-
tion or with boiled sterilized water, then with dilute alco-
hol or with hamamelis (witch-hazel), and the part bound
up with clean cotton and a bandage.

Poreign Bodies. — A foreign body in the ear should
be removed at once. If the obstruction be an insect,
the patient should lie on the side with the affected ear
upward, the aural canal being straightened by pulling
the auricle upward and slightly backward; the ear is
then filled with warm water or with olive oil. The insect
will then float to the top and fall out. No other liquid
should be put into the ear without the consent of an ear
specialist. The ear is a very delicate organ, and will be
injured by unskilful treatment. If the foreign body is a
bean or any object likely to swell, the ear must not be

ACCIDENTS AND EMERGENCIES.

20S

Tinged. If the obstruction i;
I syringe i

ani
bo

pott

button, a stone, t
ton, one may t
should be attempted, or the obstruction may be pushed
farther in. A foreign body in the nosf. if it can be seen,
may be removed with a bent hair-pin or with forceps.

An obstruction in the throat may be removed by the
drinking of water, the swallowing of a piece of bread,
or by a hard blow between the shoulders ; if these
measures fail, an emetic of mustard and water or of salt
and water may be given.

A foreign body in the eye may be removed by having
le patient look down; a pencil or some similar thin
'bcxiy is then placed across the upper lid, and the lashes
are seized and the lid turned over ; the e.vposcd particle
is then wiped off!

Inaeot Bites and Stings. — Insect or mosquito bites
are treated by bathing the part with dilute or pure vin-
egar or with a solution of carbolic acid (i :40).

Dysmenorrhea. — Dysmenorrhea, or painful menstrua-
tion, very often calls for prompt treatment, vi'hich consists

hot mustard foot-baths, rest in bed, the application of
hot flaxseed poultices, or turpentine or mustard fomcnta-
to the lower part of the abdomen, and a hot-water
tie to the back and one to the feet. Drinks of hot
ginger-tea or of gin will increase the circulation. It may
be mentioned that painful menstruation is often the re-
sult of tight lacing: the abdominal organs are crowded
down upon the womb, the bladder, and the rectum, and
the womb is forced down out of its normal position, the
free escape of the blood thus being prevented. Expo-
sure to cold during menstruation is another cause. A
normal menstruation should be painless.

Vomitinflr. — To relieve vomiting a mustard plaster or

206 PRACTICAL POINTS IN NURSING.

an ice poultice over the stomach is very good, if the
vomiting is caused by constipation, a Sddlitz or a Ro-
chelle powder will generally stop iL

Flatulence. — Flatulence is relieved by 10 drops of
the oil of peppermint or 5 drops of the oil of turpentine
on sugar every three hours, or by drinking very hot
water.

Toothache. — Toothache may be relieved by oil of
cloves, oil of peppermint, or creasote applied on cotton
and inserted in the cavity of the tooth.

Ineonmia. — Insomnia, or sleeplessness, considered as
an emergency, may be relieved by the application of
heat to the abdomen, and to the feet if they are cold.
Should the patient sleep the first few hours of the night,
then awake, and remain so during the early morning
hours, a light meal, such as a cup of hot cocoa and a
cracker, or even a glass of hot milk, will induce sleep
by drawing the blood-supply from the brain to the stom-
ach, and at the same time the blood will be replenished
by substances formed in the process of digestion, that
have a soothing effect Wakefulness is increased if there
is a light in the room, because the brain cannot rest un-
less there is darkness ; to procure this the room should
be darkened as much as possible and a handkerchief
folded over the patient's eyes.

Sunburn, — Sunburn is painful, and may be relieved
by any kind of oil or by a wash made of sodium bicar-
bonate, and by excluding the air.

Burns by Acids and Alkalies. — A bum by an anV
should be treated by pouring over the bum a solution
of sodium bicarbonate and water or plain water to dilute
the acid ; the part is then dressed as for an ordinary
bum. For a burn by an alkali, for instance, quicklime.

ACCIDENTS AND EMERGENCIES.

207

an acid is applied, such as lemon-juice or vinegar. For
burns of the eye with an acid or an alkali the eye should
be washed immediately with warm water to dilute the
substance and to prevent its being absorbed; vaselin or
any of the oils then should be applied.

Prost-bite. — Frost-bite is due to extreme cold. The
vitality of the part is lowered and the circulation in it
ceases. Exposure to intense cold may cause death,
owing to the action of the skin and the superficial blood-
vessels being cut off; as a consequence, the internal
organs are very much congested, which condition is
followed by congestion of the brain, causing drowsiness,
stupor, and coma, and ending in death.

The trtatmeiit of frost-bite consists in rubbing the part
with snow or with ice-water, which will gradually dilate
the contracted blood-vessels and start up the circulation
in the part. The patient must be kept in a cold room.
As the temperature of the part and of the body rises, the
patient should be rubbed gently with equal parts of alco-
hol (or vinegar) and water, and the temperature of the
room be slowly increased ; or the patient may gradually
be removed to a warmer room. The part should be
exposed to the air for a while and then covered. Hot
drinks and stimulants are to be given if necessary.

The return (o heat must be gradual, as the sudden
rtion of the circulation in the part may result in
Intense inflammation and gangrene. Should inflamma-
tion set in, cloths wet in equal parts of alcohol (or vine-
gar) and water may be applied.
_ ObilblainB. — Chilblains are caused by exposure to
followed by a sudden return to heat. The treat-
is the same as that for frost-bite. Patients after

e attack should wear woollen stockings and gloves.

z08 practical points in nursjng.

3. Accidental Poisoning,

Poiaon Defined. — A poison is a substance which, when
taken into the body, produces cither disease or death.
Any substance causing death when taken into the stom-
ach is a poison. Poisons may also enter the circulation
through the broken .skin,

Cloesiflcation and Action of Poisons. — Poisons are
divided into two classes — irritants and narcotics. The
irritant poisons act on the stomach and bowels, and the
symptoms of all such poisons are generally the same.
Coming Jn contact with the lips, mouth, throat, and
stomach, they produce a burning sensation and give rise
to vomiting and pain in the stomach and abdomen, the
pain being increased upon pressure, and by purging.
The effects of the poisons are chiefly upon these oi^ans,
which they irritate and influence. After all irritant poi-
sons, demulcent drinks, such as flaxseed tea. white of
eggs, glycerin, sweet oil. starch-water, or warm milk,
should be given to soothe the inflamed mucous mem-
brane. Neurotic poisons act upon one or more parts of
the nervous system, producing headache, giddiness,
numbness, stupor, and paralysis, and often convulsions
and death. They have not the burning taste of irritants,
and rarely give rise to vomiting and purging.

"What to Do in Case of Poisoning. — The first thing
to do in all cases of poisoning is to ascertain what kind
of poison has been taken, cither from the symptoms pro-
duced or from the vomited matter. If this detection is
impossible, the stomach is to be emptied — that is, if the
drug has been taken by mouth — to prevent the poison
being absorbed ; the antidote (a remedy to counteract
the effect of the poison) is then to be given. If the

ACCIDSffTS AND EMERGENCIES. 2O9

poison has been absorbed, medicines are given to coun-
teract its effect on the temperature, the respiration, or
I the circulation. Vomiting may be induced by giving
mustard and warm water, salt and warm water, tepid oil
and water (a tablespoonful to a cup of water), warm
water, or by running the finger down the throat, or by
tickhng the throat with a feather. Vomiting is gener-
ally easier if the stomach is full of food or of fluid.
Should the stomach be empty, a quantity of fluid should
be given before the emetic.

When emetics are administered, they should be given

I quickly and not more than half a pint at a time, or the

I walls of the stomach may become paralyzed through

I over-distention. After vomiting, the patient should drink

I plenty of milk or water, and the bowels should be

§deared, in case the poison has entered the intestines.

A few of the most common poisons and their anti-

iotcs are the following :

Irritant Poisona. — Carbolic Add. — Milk and lime-

I water, equal parts; stimulants; no oil, as it will help

(absorption ; flaxseed tea, hot applications to the extrem-

l^es, and counter-irritation upon the abdomen.

Carbonic-acid Gas. — Removal of patient from the
^room; artificial respiration; bathing with alcohol and
■ water; application of heat to the feet; cold douching,
|£iction, and stimulants.

Oxalic, Acetic, and Tartaric Acids. — Chalk or plaster
scraped from the wall and dissolved in water or in milk
(in an emergency); soapsuds; emetics; stimulants, and
heat externally.

I^vssic Acid {Hydrocyanic Acid, Cyantd of Potassium).
—Apply sraeHing-saits to the nose; an emetic; black
^Coffee. Action should be prompt ; often there is little

2IO rHACTICAL POISTS IX NUJfSJNG.

time for anything but hot and cold affusions to the head
and artificial respiration.

Sttlf^huhr. Phosphtmc, Nitric, and Hydrochloric Acids.
— Magnesia, whiting, chalk, sodium bicarbonate, milk,
white of egg. or plaster scraped from the wall ; external
heat.

AtHmonium. — Vinegar, lemon-juice or orange-juice,
milk. oil.

AmmoHia, Caustic Lime, Potash, and Soda, and the
Carbonates of Sodium and Potassium, arc alkalies, and are
treated with acids, such as vinegar and lemon-juice, and
milk, and olive or any bland oil to soothe the mucous
membrane.

Arsenic and Paris Green. — Emetics ; oil and lime-
water ; milk ; raw eggs ; flaxseed tea ; powdered charcoal
in water (half an ounce to a cup of water); heat over
the abdomen.

Corrosri-e Sublintatc. — White of egg, which, being an
albumin, will render the corrosive insoluble, or milk or
flour and water will answer ; then an emetic is given to
remove the poison. Poisoning by copper or lead ^^
treated in the same way. ^H

Ergot. — Stimulants; strong tea. ^1

lodin. — Emetic ; flour or starch and water ; white of
egg in milk ; sodium bicarbonate.

Phosphorus. — Emetics and purgatives; no oil, as it
aids absorption ; poultices to stomach.

Poison ivy when brought in contact with the skin is
capable of exciting inflammation of its tissues. It is an
acid, and is treated with an alkaline. Plain cold water,
baking-soda (saleratus) and water made into a thick
wash, lime-water, or soapsuds will help to relieve the
inflammation. The amplications should be continued

ACCIDENTS AND EMERGENCIES

^f fiuthfully for twenty-four hours. The parts should after-
ward be dusted with powdered starch.

Narcotic Poisons. — AconiU. — Emetics ; purgatives ;
stinmlanLs of alcohol, digitalis, or atropin to restore the
heart's action ; heat to the body,

Atropin and Bdladonna. — Emetics; black coffee and

I stimulants ; hot and cold water alternately to the head ;
lemon- or orange-juice and water. The patient should
be aroused from stupor.
Ckleral. — Emetics; heat is to be applied and strong
cofiei; giveii ; hot mustard foot-baths ; artificial respira-
tion should be practised if necessary. The patient
should be aroused as in opium -poisoning.
Digitaiis. — Ivmctics ; strong tea and perfect quiet in
bed ; also cathartics.
Opium and Morphia. — Emetics (the stomach may be
washed out with warm water) ; black coffee by the mouth
or the rectum; vinegar and water; lemon- or orange-
juice and water. The patient should be aroused from
stupor and kept awake by being walked about the room
aiid flicked with a wet towel ; a hot- and a cold-water
douche may be given. Mustard plasters may be applied
to diHerent parts of the body. Blistering should be
guarded against ; the patient should be kept warm all
through tlic treatment.

Nux Vomica and Strychnia. — The stomach should be
emptied before the convulsions begin. If an emetic is
impossible, inhalations of ether or of chloroform should
be given, and the_stomach be washed out; chloral or
bromtd of potassium be given subcutaneously to quiet
the convulsions ; also a hot bath. Heat and friction
are to be applied and artificial respiration is to be
practised.

XitraU ef AmfL — Arbfiml ics^anCiDa : bot and cold

C^':rT7 — K--nBbCT; pnrgatives; 9boug tea or coAec;
r.-f. ~\- _ > . aitifidal tEaynatiMi.

JA. . .- itiwes ; poutbces to abdo-

men ft:n!u.ant

?c4<«mng b} W 6A or b>- mushrooms

i~ treated with t {itivc$. Heat and stbn-

-!ant= should b mc is shock.

Bites of Bat toisoned bites by a mad

dog or by so] ■ treated by having the

poison sucked und (imkss there is an

abta^-^ion on the nurst? uyi. and the wound afterward
wa-hed with plain wami water. The patient must be
taken at once m a physician, who will cauterize the
wf.und. The patient must be given stimulants in mod-
erate quantities tn sustain the system. The state of the
pulse must be taken as a guide to indicate when the
proper amount <•( stimulation has been reached.

In all emergen cies the nurse must keep perfectly calm ;
she should think what has happened and what should
be (lone, and then do it quietly. If she gets excited and
losts her presence of mind, the life of the patient may
be lost. When notifying the physician or surgeon
she shoulil send a U'lirUfi. not a verbal message, and
should state clearly what has ha]>pened. so that he will
fully understand nnd conic prepared : he should also be
informed of what is being done by the nurse.

V. NURSING IN SPECIAL MEDICAL
DISEASES.

I. Infectious and Contagious Diseases.
InfocidouB Diseases. — Infectious diseases are caused
by the introduction into the body of a living poison.
which has the power of producing a disease if it can
find therein conditions suitable for its development.
Every infectious or contagious disease is caused by a
specific germ — a germ which produces that disease and
no other. Exposure to an infectious disease does not
produce that disease in a healthy person, because its
germs cannot find conditions suitable for their develop-
ment, so that tlie mere presence of the active cause in
itself is insufficient to produce the disease. In diphtheria
it will usually be found that the attack of the disease has
- been preceded by a local inflammation of the throat,
thus making a suitable place for the specific action of
the diphtheria germs. In tj-phoid fever the germs re-
quire a suitable condition of the bowels before they can
produce the disease. Healthy lungs arc not a suitable
location for the development and activity of the germs
which produce consumption. On finding these conditions
I it takes the germs some days to develop and produce the
i disease ; this explains what is meant by the period of in-
I cvbation. All germs — or bacteria, as they are called —
J have their favorite seat in the body, and they leave the
\ body through the lungs, the skin, the kidneys, or the
t bowels. The germs of diphtheria leave the body through
1 the breath and the discharges from the nose and throat ;
I those of pneumonia and of consumption (which is tuber-
> culosis of the lungs) leave the body through the expec-

214

PRACTICAL POINTS IN NURSING.

torations. which are charged with ihem; those ofscarK
fever and of measles, through the breath, skin, and dis-
charges from the nose and throat; those of whooping
cough, in the same manner as those of diphtheria ; those
of small-pox, through all the discharges; and those of
typhoid fever, through the bowels.

ContagiouB Diseaaes. — Contagious diseases spread by
contact with a patient or with the coqtse of one dead of
a contagious disease, articles of clothing, etc. Some-
times the disease will be communicated by a single ap-
proach to a patient, though persons who have once had
a contagious disease rarely ever have it a second time :
this is wliat is meant by imimmity. A child that never
had scarlet fever if placed in the same room with one
who has the disease will take it because of this ex-
posure. The " acute exanthemata " are the eruptive
diseases — scarlet fever, measles, small-pox, and chicken-
pox.

Another term very often heard is miasmatic disease.
Intermittent fever and malarial fever come under the
head of miasmatic diseases, the poison of which is found
in the low, marshy districts. These diseases are infec-
tious, but not contagious ; one cannot take them by
contact with the patient, but must get them from ex-
posure to the continual dampness of the soU and from
the atmosphere.

We guard again.it the spread of contagious diseases
by isolating the patient in a room at the top of tlie
house, because the air there is purer, and because if the
patient be on any of the lower floors the poison might
spread upward through the house ; by the utmost clean-
liness, by keeping the air pure, by the faithful use of dis-,
infectants, and by hanging a sheet wet with some

to.

;di9i^H

JVUXSIJ^G IN SPECIAL MEDICAL DISEASES. 21 5

I fectaiit. or even with plain water, before the door of the
room, so that when the door is opened the germs in the
air coming from the room will come in contact with the
wet sheet and cling to it; by having separate dishes
and utensils for the room and the patient, and separate
bed- and body-linen, and by thoroughly disinfecting the
movements and expectorations before disposing of them.
The very best way to treat the latter is to mix them with
sawdust and then burn them.

Typhoid Fever. — Typhoid fever is an acute infectious
disease due to the entrance into the body of a special poi-
son by drinking impure water or milk, through bad air or
drainage, or from a previous case of typhoid fever where
no precautions were taken again-st the spread of the dis-
ease. It is also called enteric fever, slow fever, low fever,
and nervous fever, and is characterized by inflammation,
and in some localities by ulceration, of the bowels. In
mild cases the stage of ulceration may not be reached.
The period of incubation is from two to three weeks.

SytHptoms. — Some of the symptoms are headache,
aching pains in the back and the limbs, loss of appetite,
increasing weakness, nausea, sleeplessness, depression,
a chilly feeling, nose-bleed, slight diarrhea, gradual rise
of temperature and increase of pulse, coaled tongue,
stupor, and delirium. There may be coma xngU, the
patient lying perfectly quiet with his eyes open, but
paying no attention to what is going on around him.

The ttmpcraturf gradually rises morning and evening
until it reaches 104°, sometimes 105° F., with a corre-
sponding increase in the pulse-rate. During the second
week the temperature is high and varies very little; it
begins to descend gradually during the third week, the
morning temperature being one or two degrees lower

3l6

PRACTICAL POINTS !.\' NVRSmC.

^L or a soluti

than that of the evening. During the fourth week 1
temperature is almost normal in the morning, and rather
irregular. A sudden drop would indicate hemorrhage
or perforation of the bowels. The pulse is generally
rapid, and in severe cases may be dicrotic.

About the second week rose-colored spots appear on
the chest, the back, and the abdomen. These spots are
slightly elevated and disapi)ear upon pressure. Each
spot lasts about three days, a few fresh ones appearing
every day or two until the third week, when they dis-
appear. The eruption may be absent in the old and the
very young. The third week is an anxious week, as then
very often the symptoms arc at their worst. The patient
may have a relapse, which is another course of the fever;
but generally the duration of the disease following a
relapse is not so long as the first attack. It is, however,
a very serious time, the patient's strength being very low.

The uiirsing consists in keeping the patient quietly in
bed. the bed- and body-linen sweet and clean, the air of
the room fresh and pure, and the temperature 65° F. The
typhoid germ is eliminated from the body through the
discharge from the bowels, and the smallest portion of
fecal matter can produce the disease in another person.
There may be diarrhea, the movements being loose and
yellowish in color, with an offensive odor, or there may
be constipation. After a recent hemorrhage the move-
ments are dark red, containing blood; but if not passed
for some time after the hemorrhage has taken place,
they will be black, resembling tar.

The excreta must be thoroughly disinfected with
chlorid of lime (i pound to 4 gallons of water, i quart
being well stirred in each dejection), or with whitewash
a solution of carbolic acid {1 : 30). Corrosive subli-

NURSING t/f SFECIAl MEDICAL DISEASES. 21/

ite is not so good, as it hardens the albuminous mate-
Tial which covers the outside of all fecal masses, and
thus protects the inside from its action. In the absence
of all disinfectants boiling water may be used, or the
movements may be 'mixed with sawdust and burned.
The feces must not be emptied near a well nor any place
vhere the water-supply would become contaminated. A

infectant should be poured into the bed-pan before it

carried to the patient, and on its removal it should be

vercd with a cloth wet in carbolic-acid solution. Bed-
and body-linen soiled with fecal matter must be thor-
oughly boiled.

Sometimes there is a constant dribbling of urine
through over-di.stention of the bladder. This trouble is
easily remedied if the catheter be passed. There may
be retention or suppression of urine. Retention exists
wht;n the bladder is full of urine, the patient being
incapable of urinating; in suppression the bladder is
empty, no urine having been secreted by the kidneys.

The nurse should report any cough, the character of
the expectoration, and nose-bleed ; also delirium, which
very often occurs, and which may be mild, active, or
violent. She should be very kind and gentle, but firm;
she should not leave the patient alone for a single mo-
ment, but should wait until .some member of the family
can relieve her or bring what she needs. She should
report any symptoms of pain in the ear. discharge from
the ear, or deafness, which is not uncommon. The
mouth of the patient must be kept perfectly clean ; it
should be washed at least three times daily to prevent
the collection of sordcs. a dark-brown accumulation on
the teeth, gums, lips, and tongue.

The diet will be liquid food, which is easily digested ;

2l8

PRACTICAL POINTS IN NURSING.

a more solid diet would irritate the intestines and cause
perforation. Milk will probably be ordered. For an
adult two quarts should be given in small quantities
every one or two hours during the twenty-four hours;
the milk may be flavored with tea, coffee, cocoa, vanilla.
or any flavor for which the patient has a fondness.
Should the milk not digest, a.s will readily be deter-
mined by the presence of milk-curds in the dejections,
this fact should be reported to the doctor.

A few words may be said here about the drinking of
milk. Many patients will drink half a glass, and often a
whole glass, of milk at one time, and soon afterward wiil
complain of a feeling of indigestion and want very hot
water to drink. Milk curdles as it is swallowed, and if a
large quantity is drunk at once, it forms in the stomach
a large hard mass, and the juices of the stomach can
act only on the outside of it; whereas if the milk is
drunk in little sips, it forms a loose mass of small lumps,
and the juices of the stomach can work around and
among them, and thus dissolve the whole in a very
little time. The milk diet should be alternated with
beef-tea, chicken-broth, oyster-broth, coffee, or cocoa.
Oysters contain an amount of albumin, are very nour-
ishing, are easily digested, and are often retained when
all else fails. One oyster, fresh from the shell, may be
given every hour or half hour, It should be remem-
bered that the patient's mouth and lips are very often
parched and dry; therefore they should be moistened
before feeding. The patient should always be awakened
for treatment in the daytime, but the doctor should be
asked if he is to be awakened during the night.

Thirst may be relieved with crushed ice. lemonade,
or orangeade. The patient should also be supplied with

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NURSING IN SPECIAL MEDICAL DISEASES.

*-plenty of cool filtered or distilled water or with Vichy
water. The object of giving the patient plenty of pure
water to drink is to flush out the kidneys and to aid in
the elimination of the worn-out material generated in the
body by the fever.

Tepid baths are given to lower the body - tempera-
ture. A bath every two or three hours may be ordered.
Besides reducing the temperature, baths are excellent for
restlessness and sleeplessness ; they soothe and quiet the
patient. In a severe case the patient's temperature should
be taken every three hours.

CotHplicetlioHs. — Some of the complications of typhoid
fever are pneumonia, hemorrhage, peritonitis, perfora-
tion, and diarrhea (PI. 3).

Two of the most dreaded complications of typhoid
fever are hemorrhage and perforation, and it is the lia-
bility to these two complications that makes it absolutely
necessary for the patient to keep perfectly quiet, not ris-
ing for anything without direct orders from the doctor,
be the case ever so mild, as sitting up causes pressure
upon the ulcerated part, and might result in perforation.
Purgatives must not be given by a nurse on her own
responsibility, as they might irritate the bowels and
cause perforation.

Hemorrhage. — The intestines, though very thin, are
supplied with large and small blood-vessels. In typhoid
fever the intestines are in some parts ulcerated: one of
the ulcers may eat its way into a blood-vessel and cause
hemorrhage, which is indicated by a sudden fall of tem-
perature, a small, rapid pulse, a pale face, an anxious
expression, restlessness, demand for air, iaintness, and
blood in the movements,
^^L With children ulceration of the bowels is less likely

320 PRACTICAL POINTS IN Nl/RSWG.

than with adults, consequently the dangers of hemor-
rhage and perforation are less. The rash may be absent.
but the brain-symptoms are marked, and generally tht
temperature rises suddenly. In very old people the rash
may also be absent.

Trratntent of Hemorrhage. — In treating hemorrhage
the foot of the bed should be raised as high as possible.
If the bedstead cannot be raised, then the bed-spring
should be raised and the head of the patient should be
lowered. Ice or ice-cold cloth.s may be applied to the
abdomen. Morphia (gr. J) may be given hypodemialic-
ally; it will both stimulate the heart and secure rest
and quiet. The patient must be kept perfectly quiet on
the back, .so that the blood will coagulate in the vessels
and prevent further hemorrhage.

Perforation is due to the breaking of an ulcer of the in-
testine ; the contents of the bowels then escape into the
abdomen, causing inflammation of the peritoneum, and
resulting in peritonitis. The symptoms of perforation are
sudden and sharp pain in the abdomen, which is distend-
ed and tender, vomiting, a fall of the body-temperature,
a small, rapid pulse, and all the symptoms of collapse.

Treatment of Perforation. — The treatment until the
arrival of the physician consists in the application of
hot fomentations to the abdomen and down the limbs.
stimulation, and morphia (gr. ^) to secure rest and quiet
and to relieve the pain.

The nurse must be calm, cheerful, and equal to any
emergency. Whatever happens, she should not lel her
patient know, cither by word or by look, that there is
anything wrong ; she must remember that the patient is
watching her very closely, and is guided by the expres-
sion of her face.

1^ AZ'XS/.VG IN SPECIAL MEDICAL DISEASES. 221

Tympanites, which is distention of the abdomen through
the accumulation of gas in the bowels, is relieved by
turpentine fomentations or by plain poultices and the
rectal tube.

Bed-sores may be prevented by bathing the patient's
back with alcohol or with a solution of salt and whisky
(2 teaspoonsful of salt to a pint of whisky), or by pow-
dering the back with oxid of zinc, fuller's earth, pow-
dered starch, com-starch, bismuth, or borax. If the skin
breaks, the part should be covered with the while of egg.
When the urine and the feces are passed involuntarily
or when there is much skin moisture, rubbing the back
with olive oil or vaselin will prevent the moisture from
being absorbed. In the absence of alcohol, the parts
should be kept perfectly clean with soap and water; the
sheets should be kept dry and free from wrinkles ; pres-
sure should be removed and the position of the patient
should be changed often.

Convalescence. — During convalescence there may be a
temporary rise of temperature, due either to excitement,
change of food, or constipation. The diet should be
light, such as custards, puddings, cream-toa.st, soft-boiled
eggs, and jellies. A return to solid diet should be made
only with the doctor's permission. Ver\' few visitors
should be allowed. The nurse should be faithful in the
use of disinfectants, and should never go to hor meals
without first washing her hands thoroughly with soap
and water and a brush. The germs enter the body by
the mouth ; hence by the thorough washing of her hands
before eating the nurse will guard against the germs of

c disease — typhoid or any germ-disease of which she
are — being swallowed with the food.
ig Typhoid Fei'cr. — " Walking " typhoid fever,

222 PRACTICAL POINTS IN NURSING.

as a rule, is of a mild charactt;r ; the patient refuses t
give up and go to bed. Still, there is always the danger
of grave symptoms developing and resulting in death.

Scarlet Fever, — Scarlet fever is synonymous with
scarlatina. It is an acute infectious contagious disease
characterized by high temperature, rapid pulse, head-
ache, vomiling. sore throat, and rash. The tongue is
coated, which coating after a few days disappears and
the papilla become prominent and bright red — the
"strawberry tongue," as it is called. The bowels are
con.stipated, tJic urine scanty and high-colored. On the
second day of the disease the rash appears. It be-
gins as small red dots on the chest and neck, and
gradually extends until the whole body is a bright scar-
let. About the fifth day the temperature begins to fall,
and gradually decreases, the eruption fades, and desqua-
mation or peeling begins. Verj' often large scales will
come off the hands, the feet, and the abdomen. This
peeling lasts for two or three weeks.

In the malignant form the rash comes out late, the
temperature is very high, and death often takes place in
from two to three days; while in the simple form the
rash is present, but there is very httle throat trouble.
With children scarlet fever is often ushered in with
convulsions.

The treatmenl of scarlet fever lies in isolating the pa-
tient in a room as far away from the family apartments
as possible, and in removing all unnecessary articles
from the room. If two adjoining rooms can be used,
the medicines, dishes, disinfectants, etc. should be kept
in the second room; if only one room is available, a
screen may be improvised by covering a clothes-horse
with a shawl, a blanket, or a sheet, and behind this screen

AtVSmC m SPECIAL MEDICAL DISEASES. 223

rerything may be kept. A small table may be placed
outside the room, and provided with a slate upon which
the nurse writes her requirements, the things needed
being left for her on this table.

The nurse should keep the air of the room perfectly
pure and the temperature at 65° F. When ventilating
ihe room, she should take care that the air does not
blow from the sick-room into the other rooms of the
house. A sheet wet with some disinfectant should be
hung over the door. Nothing must leave the room
«-ithout first being washed in a disinfectant or in boiling
*-ater. The diet is liquid. The patient should be given
lo drink plenty of pure cold water, which will flush out
the kidneys and aid in eliminating the worn-out mate-
rial generated in the body.

Baths or cold packs may be ordered to reduce the
fever, followed by oiling of the body with cocoa-butter,
sweet oil, or vaselin. This treatment, besides reducing
the fever, will assist the peeling and prevent the scales
of skin fl>ing about, and thus act as a preventive against
the spread of the diseetse. The nurse should have every-
thing ready before beginning the bath, and the bed- and
body-linen thoroughly aired before being changed.

The nose, mouth, and throat of the patient should be
kept perfectly clean. Soft rags should be used to wipe
away the fecal dischai^es, and they should be burned as
soon as used ; if this is impracticable, they should be
thrown into a pail of disinfectant. If the throat is
ordered to be sprayed, the nurse should stand a little
lo one side when spraying, so that the patient will not
cough in her face.

The ears of the patient should be watched very closely,

1 any pain or discharge should be reported to the

224 PRACTICAL POINTS W NCRS/NC.

physician. Inflammation of the middle ear, a very cotn^
mon condition after scarlet fever, and deafness, are often
due to carelessness on the part of the nurse. If the pain
is severe, one may, until the arrival of the doctor, try hot
flannels or a bag, made in half-moon shape, filled with
salt and heated. This bag should be applied around
the ear, never over it, because the heat might cause the
walls of the canal to swell, which would bring them
together. Dry heat will give great relief

ComplkatioHS. — Uremia, dropsy, and nephritis (inflam-
mation of the kidneys) are complications very apt to
appear. The urine must carefully be watched and meas-
ured. The nephritis and dropsy may be due to cold
taken during a bath or during convalescence, either
through carelessness of the nurse or obstinacy of the
patient. The symptoms of dropsy are pufiiness of the
face, the eyehds, and tlie limbs, paleness, headache, and
smoky-colored urine. With children uremia is very
often ushered in with convulsions. Uremia is caused by
urea (a very poisonous substance of the urine) being re-
tained in the body, owing to the kidneys not properly
doing their work. The symptoms of uremia are head-
ache, suppression of urine, nausea, and the odor of urine
in the breath; unless relieved, these symptoms are fol-
lowed by convulsions, coma, and death. The pulse is
slow and full; the temperature is subnormal.

Uremic convulsiaits may be relieved by a hot pack or a
hot-air bath, and morphia (gr, J) hypodermatically ad-
ministered if possible, which will quiet the spasms, en-
courage perspiration, and stimulate the heart. An enema
or a cathartic of oil or of Epsom salt may be given to
clear the bowels. Hot fomentations or poultices may be
applied over the kidneys to relieve the suppression of urine.

NUXSIMG m SPMCIAL MEDICAL DISEASES. 22$

^DehriHtn must at once be reported. Should it set in
after the physician has made his visit, cold may be
applied to the patient's head.

Dcpr($sion must be met with stimulants. The patient
should be well nourished, a,s the fever is very exhausting.

Com'al($c€iKC. — ^Tlie patient will probably require iso-
lation for four weeks, be the case ever so mild. A thor-
ough bath and a complete change of clothing must be
given before he goes into another room. Some doctors
like the patient to be in an adjoining room for two weeks
before mingling with the family. The patient must be
kept away from ail draughts. The convalescence is
slow and must be guarded.

Typhus Fever. — Typhus fever is an acute contagious
disease caused by an infecting germ and influenced by
overcrowding, bad food, bad air, and impure drinking-
water.

Symptoms. — ^Typhus fever begins abruptly with a chill,
followed by high fever, severe pain in the head, the back,
and the limbs, muscular weakness, and great prostration.
The temperature rapidly rises, and about the third or
fourth day it is 104 or 105° F., with a corresponding
increase of pulse, from 120 to 130 beats, which are at
first full, bounding, and compressible, and later weak
and often dicrotic. The bowels are constipated, the
urine is scanty and high-colored, the face is dusky, and
the tongue is covered with a whitish fur which in severe
cases becomes black. There is also a peculiar odor
characteristic of the disease.

About the fifth day there appears over the body an
eruption, consisting of rose-colored spots, which after
two or three days become darker. The difference be-
tween the rash of typhoid and that of typhus fever is

that the eruption of tj'phus docs not appear in successive

crops, it does not disappear upon pressure, it begins to
fade from the end of the first week to about the middle
of the second week, and is much darker.

In severe cases death may take place in a few days
from coma or from heart- failure, while in mild cases the
improvement begins about the end of the second week.
the temperature falls suddenly, and convalescence is
rapid.

Treatment. — The patient is to be isolated, and disinfec-
tion of the clothing and the excreta must be thoroughly
effected, The exhaustion, which is extreme, is met with
stimulants. Bed-sores and heart-failure are to be guarded
against. All visitors are to be excluded, and the patient
is to be kept bodily and mentally quiet The nurse must
not hesitate to feed the patient by the rectum if it be-
comes necessary. The high temperature is treated with
cold baths or packs; the headache and delirium are
treated with cold applied to the head and absolute quiel
maintained. The air of the room must be kept fresh and
pure, and the temperature even.

The complUatioHs of typhus fever are catarrhal pneu-
monia, inflammation of the kidneys, and swollen paro-
tid glands.

Small-pox. — Small-pox is an acute cont^ous dis-
ease. The varieties are — discrete, confluent, malignant,
and varioloid or modified small-pox.

Symptoms. — The disease begins with a chill, high fever,
vomiting, intense pain in the back, limbs, and head, sleep-
lessness, and a full and rapid pulse (from loo to 120 or
more). The temperature reaches its height (104-105°
F.) about the second day, and at the fourth day it begins
to fall. About the third day the eruption begins to

XURSfffC m SPECIAL MEDICAL DISEASES. IIJ

1 the forehead and face, and consists of small,
round, elevated red spots, which feel like shot. When
the eruption appears the temperature falls and the pa-
tient feels very comfortable. The eruption gradually
spreads over the entire body. On or about the sixth
day these small hard spots become clear vesicle-s or
blisters, and two or three days afterward they change to
pustules; then the secondary chill sets in, the tempera-
ture rises to 104 or 106° F., with a corresponding
increase in the pulse. Pu.s oozes from the pustules,
which in about three days dry up and form crusts hav-
ing an ofiensive odor. After a week or so these crusts
&11 off and leave the "pock-marks." There is delirium,
the face is swollen, the features are disfigured and often
unrecognizable, the bowels are constipated (though there
may be diarrhea), and the urine is scanty. The second-
ary fever in a mild case may gradually subside on the
third or the fourth day, and convalescence set in.

!n the confluent form the pimples are very abundant
and they run together ; there is a fetid discharge from
the nose and the throat. The symptoms are more severe
than in the discrete form.

The malignant form ends in death in a few days,
before the rash appears. Varioloid, or the modified
form, occurs in a person who has either been vaccinated
or has had a previous attack.

The nursing consists in isolating the patient and using
every precaution against the spread of the disease.
Members of the family must protect themselve.'; by vac-
cination ; the air of the room must be kept pure, and
the temperature even (about 65° F.). The fever may be
treated by cold baths or packs, and pains in the limbs
, either by ice or by heat — whichever is the

•t

PRACTICAL POINTS IN NURSING.

more comfortable to the patient. The pitting (
certain extent be prevented by darkening the room,
keeping it thoroughly ventilated, covering the patient's
face with a mask soaked in either carbolic-acid or corro-
sive-sublimate solution, or by applying some simple oint-
ment which will relieve the pain and heat. To prevent
scratching, the patient's hands may be tied up in soft
cloths.

When the crusts fall off they must be burned. The
eyes, nose, and mouth must be kept clean, being washed
several times a day. The diet consists of milk, broths,
egg-nog, oysters (which are almost all albumin), oyster-
broth, and beef-juice. Crushed ice, lemonade, or soda-
water may be given to relieve the thirst. Stimulants
may be given if necessary.

After the case is ended everything that can be burned
must be so destroyed, and the room and the furniture be
fumigated and disinfected several times (see p. 234). It
is a dread disease, and the germs, like those of scarlet
fever, are very long lived.

Measles, — Measles begin with all the symptoms of a
severe cold. About the third day the rash appears on
the face and forehead, ajid then spreads over the body.
It consists of small red spots of different sizes, shghtly
elevated. The temperature rises to 102° F,, and in-
creases when the eruption appears. At the end of two
or three days the eruption fades, the temperature sud-
denly falls, and desquamation, or peeling, begins in the
form of a fine branny powder, very unHke the peeling
seen in scarlet fever.

The Nursing. — The patient is to be isolated, as the
disease is contagious; the temperature of the room
should be even (about 70° F.), and the room must be

J^V/tSlIfG m SPECIAL MEDICAL DISEASES. 229

slightly darkened on account of the condition of the
eyes. Baths should be given to assist tlie peeling. The
liiit is cither liquid or of light food, according to the
amount of fever. The bowels must be kept regular.
The eyes, nose, and mouth must be kept perfectly
clean. The patient must be guarded against exposure
to draughts, and must be kept in bed, be the case ever
so mild, until the peeling is over. After the patient has
left the room any tendency to cough must be repjorted.
Disinfection and fumigation should be practised as for
scarlet fever (see pp. 223. 234).

Complications. — Some of the complications are pneu-
monia, bronchial catarrh, and inflammation of the eyes,
nose, thruat, and ears.

Diphtheria, — Diphtheria is an extremely infectious
disease, the germs of which have their seat in the throat.
The pobon is carried through the body, and may give
rise to certain forms of paralysis, which is partly due to
the action of the poison on the ner\'ous system, and
partly to its interference with the nutrition of the va-
rious tissues of the body.

The temperature ranges from 100° to 105", or io6° F.
in severe cases, with a correspondingly increased pulse,
The tonsils are red, swollen, and covered with membrane.
This membrane may be of a gray or a yellowish-white
color, and gradually change to a dull gray. When
the membrane extends to the nose and the larj'nx, this
condition will be manifested by an offensive discharge
from the nose and nose-bleed, and by a gradual loss of
the voice and difficult breathing. Soft cloths should be
used to wipe away the discharges from the nose and the
mouth ; these cloths must be burned or thrown into a
^^«nfcctant as soon as used. The discharges are highly

230
infectic

PRACTICAL POINTS IN NURSING.

All cuts and scratches of tlie iiursi

; the smallest amount of discharge
surface is capable of producing

1 han<£

:ious.
should be covered, ;
that may get on any r
blood-poisoning.

The Nursing. — The patient must be isolated. The
room is to be properly ventilated, and the temperature
of the room should be 65° F. Moist air may possibly
be ordered, which can readily be secured by keeping pans
or kettle.i of boiling water in the room, or. if there is a
fire in the room or furnace-heat, by wringing sheets out
of water and hanging them up to dry.

Steam inhalations may be ordered for the throat, or
gargles or sprays. Peroxid of hydrogen is very com-
monly used for the destruction and elimination of the
false membrane, and if the throat is not very sensitive,
this drug may be used undiluted, applied with a swab.
If this cannot be done, the throat may be sprayed with
one part of peroxid of hydrogen to 4 parts of water.
A glass atomizer must be used, because the peroxid of
hydrogen decomposes when in contact with metal.

The antitoxin treatment for diphtheria is the injection
into the body {generally into the broad of the back) of
antitoxin serum, by means of a large hypodermic syr-
inge. The operation is performed by the attending
physician.

The nourishment and stimulants must faithfully be
kept up. Often the throat is so swollen that the patient
cannot swallow, and resort must be had to rectal feeding.
Crushed ice or ice-cream will prove very grateful to the
patient, besides helping to reduce the inflammation. The
ice-cream adds to the amount of nourishment taken, as
it is made of milk and eggs. Paralysis of the muscles
of the throat is not uncommon, and the patient must not

f/UKSmc IN SPECIAI. MEDICAL DISEASES. 23 [

return to solid diet without permission from the doctor.
There may also be temporary paralysis of the muscles
of the eyes and of the limbs.

The nurse must watch the urine; it will be high-col-
ored and scanty, and there may be retention, owing to
paralysis of the bladder. The depression is very great,
and heart-failure often occurs through sudden sitting up
or sitting up too soon. The patient must not be allowed
to sit up without direct orders from the doctor.

The nurse must guard herself by good, nourishing
food, fresh air, and the faithful use of disinfectants. The
germs are less likely to infect the lining membrane of
the throat and larynx if these parts are in a healthy
condition; but when the tonsils are inflamed the germs
find the conditions necessary for their development, and
diphtheria is the result. When the case is ended thor-
ough disinfection is necessary,

Trathfotomy IS often performed in diphtheria when the
larjmx is obstructed through extension of the diphtheritic
membrane and there is danger of suffocation. It is also
performed in membranous croup for the same reason as
that in diphtheria. With the instruments the nurse has
very httle to do, but she must have at hand plenty of hoi
waUr, basins, tape, scissors, strong white thread, a fan.
stimulants, sponges, a firm, hard table, and a small
pillow, which can be made of a folded sheet. The patient
is placed on the table, and the clothing is slipped well
under the shoulders; the patient is then rolled in a sheet
or a blanket, which is pinned securely, so that he cannot
struggle or get loose {PI. 4). If the nurse is asked to
hold the head, she should hold it firmly and not too far
back, lest the patient be suffocated before the operation
is begun. When the trachea is opened there will be a

through the sUts on each side of the shield, and carried
round the neck and tied at the side (Fig. 63). The
trachea-tube is made double, so that the inner one may
be taken out and cleansed. The after-care consists of
three things: faithfulness in maintaining the patient's
strength with nourishing food and stimulants, keeping
the tube free from membrane, and the air of the room
moist and warm (temp. 80° F.), because in tracheotomy
the air does not first go through the nostrils and become
warmed before reaching the lungs, but it goes directly
to the lungs through the tube. This protection
further effected by folding a Hght muffler of gauze
the aperture of the tube. The patient may be
the rectum if necessary.

Everything should be made ready before beginning

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NVBSI/fG Iff SPECIAL MEDICAL DISEASES. 233

anse the inner tube, which should not be kept out

longer than necessary. If the tube is oiled a little, its

Ptemoval will be facilitated and the mucus prevented from

iKcumutating. The discharge should be noticed — if it be

;, dry, or moist. A small piece of flannel or of cot-

■ton-wool spread with vaselin and placed between the

ftube and skin will protect the edges of llie wound

gainst the pressure of the tube and prevent irritation

and chafing.

Should the tube suddenly be coughed out, it should
quickly be replaced ; if this is impossible, a small cath-
eter may be in.serted or a small rubber tube, which can
be kept in position by means of a safety-pin run through
the end of the tubing, a cord or tajie being slipped
through each side of the pin and tied around the neck.
, Should either of these measures fail, then the part should
mht kept wiped out with absorbent cotton, and the patient
laised in the best breathing position possible until the
■rival of the doctor, and stimulants be given if neces-
lary.

Intubation. — ^This, as the abo\'e operation, is performed
when the larynx is obstructed either from acute or
chronic disease or from a foreign body. The duties of
nurse in intubation will be, in case the patient is a
child, to hold the child upright in her arms, with its
knees placed firmly between her own, while an assistant
Stands behind her chair and holds the head in the proper
position (PI. 4). The patient should be fed well ; he
will swallow better with the head to one side. Ice-
cream, crushed ice, and all foods in small amounts may
e given.
If the tube is coughed up or swallowed, the doctor
bust be informed. If swallowed, it will probably pass

: may not h^^

PRACTICAL POINTS IN NURSING.

through the bowels without any trouble. It may n
necessary to reinsert the tube ; however, it Js always
well to ask the doctor what to do under such cir-
c urn stances.

Fumigation of Sick-room after Contagious Diseases:
Sulphur Fumes. — After recovery or death of a patient
from contagious disease everything in the nature of
books, playthings, etc. that can be burned should be
so destroyed, and the remaining things be washed
thoroughly in carbolic-acid solution (i : 20) or in boil-
ing water, and the room fumigated, The germs, which
are very long lived, may lie hidden in clothes, books,
and other things if these are packed and laid away;
they will also lie in the corners of a room, and will
develop months or even years after the case has ended
and do all the harm of which they are capable. The
fumigation should be very thorough. All the cracks
in the room should be closed either by stuffing them
with cotton or by pasting paper over them. All draw-
ers and closets should be opened, and the pillows and
mattresses should be ripped. A tub or a large pan
should be partly filled with water, and in this be placed
two or three bricks on which to stand a smaller pan. In
this smaller pan is put the roll sulphur, which must be
broken up into very small pieces and be saturated with
alcohol. The water in the large pan will both guard
against fire and furnish moisture in the form of steam.
After everything is secure and there is no possible way
for the sulphur fumes to escape the sulphur is ignited.
If alcohol is not at hand, a few red coals will ignite the
sulphur. The room door is now closed, the key-hole
and all the cracks of the door are stopped up. and the
room is left for twenty-four hours, when it is opened and

VRSING IN SPECIAL MEDICAL DISEASES. 335

aired for twenty-four hours longer; then everything, 111-
i eluding the walls and floors, must be washed with either
ft corrosive-sublimate (1 : looo) or carbolic-acid solution
i(i : 20) and exposed to the action of the sun and air for
■ B number of days.

If, when preparing the room for fumigation, a hole is

Kbored through the middle of the top window-sash, and

■tfiere is passed through this hole a piece of rope of suf-

icient length to extend to a window below, the sick-room

Vnrindow can be opened from the outside at the end of

e fumigation. When closing up the cracks in the sides

f the window care should be taken that they are filled

rbi securely, so that the sulphur fumes cannot escape

through them, but at the same time that the window

can easily be pulled open.

Moist fumigatiott is obtained by filling the room with
steam generated from kettles of boiling water, or, if there
is a register or a fire in the room, by hanging up wet
sheets or wet blankets. This procedure is continued
I until moisture falls from the walls and the furniture, to
V which moisture the germs cling ; then, while still moist,
4e walls, furniture, and floor are thoroughly washed
with corrosive-sublimate solution (i : 1000), and after-
ward exposed to the influence of the sun and air.

Another method of disinfection is to close the room
for twelve hours, until the dust has settled, and then to
wash ofl^ the furniture with corrosive-sublimate solution
(1 : 1000). Newspapers are then spread upon the floor
and the walls are rubbed with stale bread; the crumbs
fall upon the newspapers, which are afterward Liken up
and burned. The disadvantage of this method lies in
the inability to get into the crevices.
When a patient dies of a contagious disease, the body

^3^ rA.iCr/CMl FOtXTS /.v A'mstffC.

should bo washed with a disinfectant and be wrapped in
,1 shix'i wniTii; out of the same ; the funeral must be
strict'.)- priiatf.

Tho dross of the nunc must be of wash material, and
sho sho;iid near ' ""'- p. A member of the
Umily should r< ;imes and when she is

sUvpinj^. :>hc s. sleep in the sick-room

ii lh:< cm po^ he should go out for

,» H \v'x each da; lired she may be, first

ni.ikirij; ,in ontin. ing, or she should go

JTito an .iiljotfiinf window top and bot-

tv'tu, ,i!iii Wall; 1*1 : the open window.

Phthi^$ 1^ tub ings, commonly ealled

■■i\vi>-,:i;!:'t;oTi."' and i:i infectious through the cx[x;ctoni-
t'.-- ;:" :;;.■ '..iticr are allnwod to dr^-, the germs of the
,i:^i.i-i' lv;;;j; I'lo^n about in the dust. A sputum-cup
(1":^ ^\^^ >>':".i,iiiii:ii; sonic antiseptic solution should be
u-.-.i b\ ills- i\ilio;it ami bo cloanod at least three times a
,I.u- \\w .'tivT oxoroiions must also be disinfected. If
th, ■.'.i:^';n 1- a',\i.- to i:o about, he should be told the
inu'vMt.i:K\ ot\-\:>tvtoralinj; in pieces of soft cloth, which
v.m Ih- I';:;:'c.i a\\<.\ !^>l in handkerchiefs, which are to be
«.i-Ik-.i K;— n^ inu-t not bo allowed, as the infection
i,i:i I'i- t:.i!i-nii:ts\! by -ores lh.it may be on the hps ;
i!ii;l\,- -]i.'-,:M .i l->M'.;hy jXT-on sleep in the same room
«ii!i .1 . oi'.--.;ni;'!i\i' 1; i-: \ on" important that cuts and
^,1.11, h,> Oil \W h.iii.ls -houkl Ik- well covered, as there
i< .!an;>i oi' tlio -piUinii coming in contact with such
inj\iiJL-^ .iii.l oi' the 5;ci-ms onlcHni^ the body through
the lnok.ii -kill riie mir-e will therefore sec how
fs^cnti.il ii I-, whon on duty in contaojous cases, to take
i^iiMt cm- of lui li.uitls. Tlic same precaution applies
W till- [Mlicnl. all out-; .iiul scratches bc-ing covered so

JfUHSI/fG IN SPECIAL MEDICAL DISEASES. 237

t the sputa or the excretions cannot come in contact
the wounds, and in keeping the skin perfectly

■ forms of Phthisis. — There is an acute and a chronic
form of phthisis : the acuU form at first is not unlike pneu-
monia 1 there is chill, a rise of temperature, profuse per-
spiration, difficulty in breathing; the expectorations at
first are rust-colored, and afterward become purulent-
All these symptoms rapidly increase, and death occurs
in a few weeks or a little longer. In the ehronk form
the patient may linger for years.

Patients with phthisis, whose cases arc generally hope-
less, esteem the kind attention of the nurse, there being
very little that can be done for them beyond making
them as comfortable and as happy as possible.

Simple Croup. — Simple croup or false croup is a dis-
ease of children, and begins with all the symptoms of a
severe cold — dry cough and suppressed voice, caused
by mucus collecting in the nostrils and larynx, which
becomes dry and hard ; consequently the patient is in
great distress and makes spasmodic efforts to breathe.

The piitient should be propped up in the best breathing
position, and hot fomentations applied to the throat; an
eflbrt should be made to produce vomiting with luke-
warm water and salt, or by tickling the throat, or by
running the finger down the throat, followed by any
kind of oil, melted vaselin, mutton tallow, etc. A cold
cloth should be wrapped around the neck and the pa-
tient put into a hot bath (temperature from lOO" to 102°
F.). and a simple enema to clean the bowels should be
given. The temperature of the room must be kept
even (70° F.), and the air moi.'it. The attack usually
occurs at night, and a second attack can generally be

23S PKACTICAL POINTS IN NUKSING.

prevented by keeping the bowels open and by not allow-
ing the child to sleep uninterruptedly through the night ;
it should be given a drink of milk or of water, which
will tend to prevent the mucus collecting.

MembrEinouB Croup. — Membranous croup, or true
croup, is by most authorities considered the same as
diphtheria. The mucous membrane lining the larynx is
inflamed, and a tenacious mucus covers the swollen
membrane, which gradually thickens until the breathing
is obstructed. There is high temperature (102-104° F)
and a small, rapid pulse. Until the arrival of the doctor
the nurse can only apply the same remedies as those
used for simple croup. Stimulants should be given if
necessary. If the obstruction is persistent and threatens
to cause suffocation, tracheotomy or intubation will have
to be performed. The patient's strength must be kept
up by proi^er nourishment and stimulants.

Should the patient appear to be suffocating, the nurse
may, until the arrival of the physician. tr\- to remove the
membrane with a cotton-stick or with her finger ; in fact.
at such a time she will be justified in doing anything
that will save the patient's life. Calomel fumigation (PI.
5) often affords relief from the urgent symptoms.

■Whooping Cough. — Whooping cough (pertussis) be-
gins with all the symptoms of catarrh of the trachea and
bronchi (the air-passages), high temperature, and rapid
pulse. About the tenth day the cough becomes vio-
lent, the deep, loud, long-drawn, shrill inspirations which
will be heard are probably due to spasmodic contraction
of the glottis. During the attack the child may become
perfectly blue; the veins in the neck become swollen,
and in some cases will be thoroughly exhausted after
coughing, while in others the child will rapidly recover

NORSfrnj m SPBCIAT. MEDICAL DISEASES. 239

c! continue to play. The patient must be isolated from
other children, and be given light and nourishing food ;
the air of the room must be kept pure and the temperature
even. Steam inhalations and counter-irritants to the chest
may be ordered. Anything that seems unusual about the
child must be reporti;d. Should convulsions occur, a
warm bath should be given while waiting for the doctor.
and cold cloths be applied to the head. The disease
may last from four to six weeks, or even longer. The
paroxysms of coughing occur oftener at night than dur-
ing the day, and generally, where there arc a number of
children with the disease in the same room, when one
begins to cough the others also begin. Among the
complications are chronic bronchial catarrh, pneumonia,
diarrhea, and phthisis. Whooping cough is very Jnfec-
p tious through the discharges from the nose and throat.

H 2, Functional and Idiopatiuc Diseases.

Influensa [la grippe) is an acute infectious disease
characterized by fever, pains in the head, back, and limbs.
great prostration, chilliness, sneezing, hoarseness, and
cough.

The treatment is rest in bed and Uquid diet. The pains
in the head, chest, and limbs may be relieved with hot
applications. Phenacetin, 5 grains in half an ounce of
whisky every four hours, may be given. It must be
remembered that phenacetin is very depressing on the
action of the heart, and, though some persons can take
doses of from 15 to zo grains, death has been known
to result from a smaller dose. This fact is mentioned
because the drug is very carelessly used, no thought
being given to its action on the heart ; it should not be

ptaken — in fed, no drug should be taken — without the

PRACTICAL PO/NTS IN NURSING.

sanction or advice of a physician. The patient must
be guarded against draughts, and be stimulated if tlic
pulse indicates heart- failure. The eomplkations are ca-
tarrhal and croupous pneumonia, inflammation of the
kidneys, and heart-failure. One attack does not mean
immunity from another.

Croupous Pneumonia, — Croupous pneumonia, which
is acute inflammation of the proper substance of the lungs.
is generally confined to one lung; when both lungs are
involved it is called " double pneumonia." The disease
usually begins suddenly with a chill or a chilly feeling
which lasts a long time, high temperature (102 to 104° F.),
pulse rapid and full (loo to 120 or above), sharp pain in
one side, and the patient can breathe only with difficulty;
consequently the respirations are quickened to thirty-five
or forty per minute, they are shallow, and often irregular.
There is a short dry cough, accompanied later by a rust-
colored tenacious sputa, which must be kept for the
doctor's inspection, The bowels are constipated, and
the urine is scanty and high-colored. Delirium is not
uncommon.

About the seventh or the ninth day there may be a
sudden drop in the temperature, profuse perspiration, and
a general improvement may take place, while in severe
cases a sudden drop of temperature to subnormal, small,
rapid pulse, coldness of extremities, and a blue appear-
ance would indicate collajise, which must be met with
stimulants and heat to the body and a mustard piaster
over the heart. Tf the patient cannot swallow, the stim-
ulants must be given per rectum.

Until the arrival of a physician the nurse may a|^ly
to the chest flaxseed or mustard poultices or fomenta-
tions. The room must be a sunny room, having an

A'C'XS/.VG /JV SPECIAL XEDICAL DISEASES. 241

open fire if possible, and be kept well ventilated, free
from draughts, and the temperature at 70° F. ; if the
perspiration is very profuse, the patient should be wiped
dry with warm towels, and fresh clothing which has been
well aired be put on. When the physician arrives he will
give directions, which must faithfully be followed. He
may order ice-bags or compresses, which will often give
great relief, or hot poultices, which must be changed
every two or three hours. Some physicians object to
poultices on account of their weight and because of
the frequent change fatiguing the patient, and prefer
to envelop the chest in a cotton jacket, which can be
removed gradually by cutting off from the bottom about
2 inches each day. The cotton jacket is readily made by
basting two layers of sheet cotton-wool inside an under-
shirt. Oil silk is basted on the outside to prevent evap-
oration of the moisture exhaled from the skin. When
the temperature is very high, cold baths are given,
which, besides reducing the fever, will quiet the respi-
rations and soothe the patient.

The ditt must be liquid and nourishing — milk, broths,
beef-juice, koumyss, egg-nog, wine whey, etc. The pa-
tient must be kept in bed, perfectly quiet. The prostra-
tion is often great, in which case there is danger of
heart-failure. The disease reaches its height about the
seventh or the ninth day. As the patient improves the
diet is increased to soft solids — custards, puddings, cream
toast, eggs, scraped-beef sandwiches — gradually prepar-
ing the way for a more solid diet. Pneumonia is a self-
limited disease; hence the nurse must do all in her
power to support life until il has run its course. It is
also infectious through the expectorations; the sputum-
cup (Fig. 64), lined with paper, which can be taken out

2+2 PRACTICAL FOISTS IN NVXSINC.

and burned and the cup boiled about three times a d
should be used to receive the expectorations.

Bronchitis. — Bronchitis, which is an inflammation of
the bronchial tubes, is caused by exposure to cold, es-
pecially when the body has been overheated. It is also
a complication of some of the infectious diseases — mea-
sles, influenza, and typhoid fever. An acute attack begins
with chilliness, a sore and tight feeling in the chest, in-
creased by coughing, which at first is dry. but later is
accompanied by a muco-purulent sputum, which becomes
very profuse as convalescence sets in ; the temperature
is lOo to 101° F., with a corresponding increase of the
pulse. Hot mustard poultices or fomentations must be
applied to the chest, and hot drinks and hot mustard
foot-baths be given. For the relief of the dyspnea, which
is difficulty in breathing, the patient must be raised into
the best breathing po.sition possible and be given inhala-
tions of steam. If the breathing is very difficult, t
patient apparently dying from suffocation, an i

ficult, tl^^

NUKSrJVC /JV SPECIAL MEDICAL D/SEASES.

243

cales
■Uial

should be given to expel the mucus from the tubes, and
heat applied over the heart.

The air of the room must be kept moist and the tem-
perature even (70° F.). The diet should be hquid. The
patient must be guarded from all draughts, the bowels
be kept open, and stimulants be given if the pulse indi-
cates heart-failure.

ABthma also calls for heat over the heart and lungs,
lations of steam, hot drinks, hot foot-baths, and
plentj- of fresh air.

PleuriBy. — Pleurisy is inflammation of the pleura, the
membrane covering the lungs. The symptoms are severe
pain or " stitch " in the side, short, dry cough, and short-
ness of breath, owing to the pain caused the patient in
breathing. There may be little or no expectoration, and
the cough may be suppressed on account of the pain
the coughing gives the patient. Hot mustard fomenta-
tions should be applied over the seat of the pain. If
there be no mustard at hand, plain fomentations or
a flaxseed poultice may be used; the patient should
be propped up with pillows, thus making the breathing
easier.

If there is effusion of Hquid into the pleural cavity,
the amount of urine passed may be very small. The
amount excreted must be measured and reported. An
increase in the amount is a very good sign, as it shows
that the effusion is being absorbed. The effusion into
the cavity causes pressure upon the heart, the lungs,
and other organs, which may be pushed out of place;
paracentesis or tapping is then performed, and the
amount of liquid drawn may vary from a pint to three
quarts.

., — Sometimes the collection of pus in the

244

PRACTICAL POINTS l.V A/'UKSl.VG.

pleural cavity becomos purulent; then we have what is
called '■ empyema." For this condition the pus is removed,
and the pleural cavity is washed out with disinfectants, a
drain.ige-tube is inserted, and an antiseptic dressing put
on. In simple cases, when only a small opening is made
with a large hypodermatic needle or a very small trocar.
a piece of adhesive piaster or collodion dressing will be
sufficient to cover the opening. The nurse of course
prepares antiseptically for the operation. It is remark-
able to see the great change for the better that takes
place after the operation, providing there are no com-
plications.

The temperature mu.st carefully be watched; its rise
may indicate a fresh collection of pus in the cavity.
In case of emergency, when the cavity has rapidly filled
up and the patient is in danger of dying during the ab-
sence of the physician, the nurse will be justified in draw-
ing off some of the fluid, but it is generally well to ask
the attending physician, if he lives at a distance and the
nurse is distant from other medical aid, what he would
like her to do in this emergency.

Angina peotoria is neuralgia of the heart ; the patient
has severe pain around the heart and there is difficult
breathing. Hot alcoholic stimulants should be given
and heat applied over the heart.

OastritiB, which is inflammation of the mucous mem-
brane of the stomach, is often due to imperfect masti-
cation of food, drinking liquid too hot or too cold, or
drinking any of the corrosive or irritant poisons.

The symptoms are severe pain and a burning sensation
at the pit of the stomach, vomiting, the vomit being
sometimes streaked with blood, intense thirst, small,
rapid pulse, and all the symptoms of collapse.

yVKS/NG Iff SPECIAI ifED/CAL DISEASES. 24S

Trealiitenl of Gastritis. — A physician must be sum-
moned, and in the mean time the nurse can apply hot
fnmentations or a mustard plaster over the seat of pain.
If it is known that a poison has been taken within
a short time, she should try to wash out the stomach,
which operation, in the absence of the stomach-pump,
can easily be done by using a fountain syringe or by
giving large quantities of warm water to drink until the
gastric contents become clear. The patient must be fed
by enemata, and the stomach be given absolute rest for a
few days, unless otherwise ordered ; then the nurse should
begin the feeding with a few drops of milk and lime-water.
equal parts; if this is retained, she should gradually in-
crease the dose and the interval between the doses.
Crushed ice, ice-cream, iced chamjiagiic, or very cold
Seltzer water, given in very small quantities, will often be

I retained. The patient should be fed slowly, and the diet
gradually be worked up to egg-nog, oyster-broth, raw
oysters, arrowroot, custards, etc., though the change of
diet must not be made without the physician's orders.
Peritonitis is inflammation of the peritoneum, the
serous membrane lining the abdomen. Peritonitis
may be due to cold, to blows upon the abdomen, to
inflammation of any of the organs in the abdomen
covered by the peritoneum, or it may follow an opera-
tion upon the abdomen. It may also occur in typhoid
fever after perforation of the bowel, the contents of the
latter escaping into the abdomen and the peritoneum
becoming inflamed. There may be a chill, severe pain
in the abdomen, which is distended and tender, vomit-
ing, constipation, high temperature (from tor to r03''
F.), small, rapid pulse, and respiration high and shallow,
^owing to the pain caused by breatliing. The expression

PRACTICAL POINTS IN NURSING.

nt when iii'^^^
lich

lor

of the face is drawn and anxious. The patient when \fp
bed lies on the back with the knees drawn up. which
position relaxes the muscles of the abdomen. A roll or
a pillow placed under the knees will remove the straiit,
that the patient ha.s to make in order to keep up
knees.

Trcalnunt. — Poultices or fomentations are applied to'
the abdomen, and the weight of the bed-clothes re-
lieved by a cradle. The nurse must not give purgatives
on her own responsibiiit>-, as there is danger of irri-
tating an already inflamed and tender membrane and
ing perforation. When convalescence begins, the
patient should be fed well with nourishing food, but re-
turn to solids should not be made without the physician's
orders. The nurse will know at tlie end of a few days
if the patient is to live or to die : if death is immini
there will be loss of strength and collapse.

If the peritonitis is the result of perforation of
bowel, as in typhoid fever, hot fomentations must be
applied, the patient to be kept absolutely quiet, and the
foot of the bed elevated. Gas-accumulation can be re-
lieved by in.serting a rectal tube.

Appendicitis is inflammation of the vermiform aj
dix. the inflammation being .sometimes due to the pres-
ence in the appendix of foreign bodies, such as grape-,
lemon-, orange-, or melon-seeds, or concretions of fecal
matter; other causes are intestinal catarrh, a bli
the abdomen, unusual physical efforts, or cold. A]
pendicitis is more common in men than in women
various reasons. Men work harder and are subject
more violence than women. The intestines may bccoi
inflamed through constipation or hard drinking, the
flammation extending to the appendix. The appeni

lays

: be
the
ui; re- ^^_

IfUSSMG m SPECIAL MEDICAL DISEASES. 247

is supplied with blood from one artery, a branch of the
mesenteric artery which supplies the cecum, Catarrhal
appendicitis is generally caused by extension of catarrh
of the cecum to the appendix. If an abscess forms, an
operation is necessary or perforation may take place, re-
sulting in septic peritonitis and death within a very few
days. The operation is also considered in the catarrhal
form, as the patient is always liable to recurrent attacks,
each subsequent attack increasing the danger to hfe, that
may result in perforation and general peritonitis. Per-
foration is a dreaded complication caused by the rupture
of an abscess into the peritoneal cavity. The symptoms
of perforation are sudden pain, a small, wiry pulse, and
subnormal temperature; or there may be a rise of tem-
perature, and the distention of the abdomen may be
increased.

The symptoms of appendicitis are severe pain, swelling,
and tenderness on the right side of the lower part of the
abdomen, rise of temperature, constipation, and, later,
vomiting.

A patient ill with peritonitis lies in bed with both knees
drawn up, and usually in appendicitis the same position
is assumed, or the right knee alone may be drawn up,

Tlie treatment is medical and surgical. For a catar-
rhal attack the treatment is absolute rest on the back,
liquid diet, an ice-bag, or hot turpentine or mustard
fomentations or poultices. The appendix is removed
when there is an abscess and also in case of perfora-
tion (unless the shock is too great).

The writer here desires to impress upon the nurse the
absolute necessity of perfect antisepsis for this opera-
6on, as it can only be successful when she has obtained
thorough surgical cteanhness. The source of infection

348 PRACTICAL rO/\rs IN XCKStXG.

at ail operations (not only when tlie abdominal cavity
is to be opened) is often the hands of the surgeon, the
assistant, or the nurse, and the instruments, sponges, and
dressings ; any fault or neglect on the part of the nurse,
no matter how small, may cost the patient his life.

The work of the nurse until the arrival of the surgeon,
who must be summoned immediately, lies in securing for
the patient perfect rest and quiet and the application of
hot mustard or turpentine poultices or fomentations.
The bowels must be moved with a soapsuds or an oil
enema, gently and carefully given. When the surgeon
arrives he will decide as to the line of treatment ; if an
operation is decided upon, everything must antisep-
tically be prepared as nearly as possible under the
existing circumstances.

A question often asked is whether a nurse is justified
in giving morphia before the arrival of medical aid. In
the writer's opinion a nurse is not justified in giving
morphia when a physician is within easy reach, because
it covers up the symptoms and the physician cannot
judge the case; it may also stupefy the patient so that
he cannot give clear answers to questions ; but if she is
distant from medical aid and the patient has severe pain,
then she may give, hypodermatically if possible, ^ gr. of
morphia, which will relieve the pain and vomiting.

After a catarrhal attack, when the appendix has not
been removed, the pitient must be very careful with
regard to diet and personal hygiene, and should wear
a flannel abdominal protector, because sudden changes
of temperature arc liable to affect the bowels, which are
very sensitive, and cause a recurrent attack.

DyBentery h inflammation of the mucous membrane
of the large intestine. The symptoms arc chilliness, some

jnafs/jm in sp&cial medical diseases. 249

fcver, small and frequent movements from the bowels
mixed with blood and mucus, and tenesmus, or constant
straining and painful efforts to evacuate the bowels. Dys-
entery begins with diarrhea, straining, griping pains in
Ihe abdomen, which Is very tender, and the characteristic
movements, which are very offensive and which must be
thoroughly disinfected.

Treatment. — Tlie patient must be put to bed and use
the bed-pan in his defecations; he must not be per-
mitted to get up, as there is danger of ulceration,
perforation of the intestine, and peritonitis. A cathar-
tic of magnesia sulphate, 2 teaspoonsful. or i ounce
of castor oil with ij drops of laudanum, should be
given to clear the bowels of the irritating sub.stance ;
the laudanum will relieve the pain and the desire to
stool. Hot turpentine or mustard poultices or fomenta-
tions should be applied to the abdomen.

The (iift should be liquid — boiled milk, gruels of
(lour, com-starch, or arrowroot. The bed- and body-
linen must be kept perfectly clean and changed often.
Dysentery is not contagious, but if the movements are
not disinfected, they decompose and the cpidcmU form
may result.

Cholera morbue, which is inflammation of the mu-
cous membrane of the stomach and intestine, is caused
by irritating food, such as unripe or decayed fruit and
vegetables, and also by sudden changes in temperature.
There arc severe cramps in the stomach and abdomen,
violent vomiting and purging, the discharges later resem-
bling rice-water ; great prostration.

Trml'iunl. — Hot applications to the abdomen and
body must be resorted to at once, and stimulants ad-

inistcred if necessary. Ice will relieve the intense

FHACTICAL FOfXTS /,V A-L'SS/A'C.

thirst. A liquid tSet most be given — milk, gruel^
broths, and egg-aog.

urbea. — In treating acute diarrhea the pa-
tient tnu5t be put to bed and fed on liquid diet — boiled
milk, com-starch, rice and flour grueU, etc. A laxative of
castor oil I ounce and laudanum 1 5 drops may be given
to remove the irritant and relieve the pain.

nruma is caused by the retention in the blood of
certain waste material, consisting chiefly of kr^a. which
should have been eliminated by the kidneys ; this reten-
tion of urea gives rise to the disease called "uremia."

Uremia may abruptly begin with convulsions, followed
by coma, or there may be premonitory- symptoms, some
of which are headache, nausea, vomiting ; scantj- urine
deficient in urea; dimness of \-ision; the mind dull, deep-
ening into stupor, followed by coma. Sometimes covul-
sions precede the coma, which terminates in death unless
the poison causing the attack is rapidly eliminated. The
pulse is slow and full; temperature subnormal. When
the convulsions occur they may rapidly take place one
after the other, the patient generally being unconscious
between the attacks. The pulse during the convulsions
may be found small and rapid, and the temperature be
raised.

TAe- Irtalinent must be prompt If the nurse is far
from medical aid, the first thing to be done is to put
something between the patient's teeth to prevent the
tongue being bitten. The patient should then be given
a hot pack or a hot*air bath, which will increase the
activity of the skin and also act as a sedative ; morphia
(gr. J) should be given to stimulate the heart, induce
perspiration, and secure rest and quiet.

The bowels must be moved with salts or by an e

anenen^^H

NURSING IN SPECIAL MEDICAL DISEASES- 2$ I

The second convulsion can be controlled by giving a
little ether if it is at hand ; if not, then the hot bath
should be repeated, hot drinks be given, heat applied
over the kidneys and to the feet, cold to the head, and
the morphia repeated every three hours if necessary.
If the pulse Is weak, heart stimulants should be admln-
i-;tered. Uremia may occur In scarlet fever, pregnancy,
Blight's disease, and in other diseases.

Cerebro-spinal memngitis is an infectious disease
beginning with a chill, very severe headache, pain in the
muscles of the neck and back, that very soon become
rigid, so that tlie head is bent backward and the back
is straightened ; the arms and legs are flexed ; vomit-
ing, deUrium. and constipation are present; there may
be intolerance of light and sound and deafness or blind-
ness. After a few days a spotted rash may appear.
The disease attains its height in a very few days, and
the temperature may rise to 105° F. or higher, with
convulsions, stupor, coma, and death, or the symptoms
may gradually disappear and the case end in convales-

Treatment. — Ice-bags or ice poultices are applied to the
back of the neck and spine, and it is a good plan to apply
heat to the extremities to avoid any depressing effect from
the cold. The diet must be liquid. If the patient can-
not swallow, he must be fed by enemata. and the nur.se
should do all in her power to sustain life. Stimulants
must be given if the pulse indicates heart-failure.

Cerebral apoplexy, or cerebral hemorrhage, is caused
by the bursting of a blood-vessel in the brain, which
accident may be due to disease of the cerebral blood-
vessels, The size of the clot varies, it may merely be a
f oozing, or it may 611 a hemisphere of the brain,

252 PRACTICAL POINTS IN NURSING.

and the amount of paralysis is generally due to the size
of the clot. If the clot is small, the paralysis may be
slight and finally disappear.

The prtmonilory symptoms are headache, dizziness,
languor, ringing in the ears, and a numb, weak feeling
on the affected side, and there may be gradual paralysis
without unconsciousness.

If an attack comes on suddenly, the patient either falls
back in his chair or to the ground unconscious ; the face
is flushed, the breathing stertorous, noisy, and slow, and
the cheeks puff out at each breath ; the pulse is slow and
full, and the temperature subnormal, due to shock. The
pupils may be unevenly contracted.

Treatment. — The head and shoulders must be elevated,
the clothing about the neck be loosened, ice applied to
the head (particularly to the affected side), and heat to
the feet and the body. The mucus must be wiped from
the mouth and throat. There should be given a cathar-
tic of croton oil, 2 drops in a little sweet oil or glycerin,
dropped on the back of the tongue, where it will be ab-
sorbed, and the bowels be emptied by enemata. Stimu-
lants must not be given unle.ss ordered by the doctor or
unless the pulse is feeble, as they increase the hemor-
rhage into the brain. To obtain im'oluntary s-.vai/tnving
the liquid or powder is placed far back on the tongue
and the nostrils and lips are closed.

The nurse must watch for convulsions, which may be
tonic or clonic. A ionic convulsion is a stiffening of the
muscles of the body without involuntary movements,
while a clonic convulsion consists in involuntary move-
ments of the body. As a convulsion may begin tonic,
it is very important for the nurse to notice in what part
of the body the convulsion begins, and if the pupils of

NURSING IN SPECIAL MEDICAL DISEASES. 253

eyes change during the day. or if they remain dilated
contracted, or if they are unevenly contracted.
If recovery takes place, the patient must have nourish-
and easily digestible food. He will need the most
■ful nursing on account of the paralysis. The nurse
lould guard against bed-sores by keeping the patient
id the bed perfectly dry and clean. The patient must
be kept absolutely quiet and free from all mental uxcite-
ment; another shock generally follows the first, as the
blood-vessels of the brain are in a diseased condition. A
certain amount of paralysis usually remains, according
to the degree of severity of the case. One patient may
recover con.sciousness, be thoroughly sensible of every-
thing that is being said and done, but be totally unable
to speak, this difficulty lying not with the muscles of
the tongue, but in the brain. Another patient may be
able to utter words, but unable to connect them so as
to make himself intelligible. Hecause a patient is unable
to speak it does not follow that he is also deaf Many
times the hearing is very acute, the faintest whisper be-
ing heard; hence the nurse must be very careful as to
it she says when in the patient's room.
differential Diagnosis. — As apoplexy is often mistaken
intoxication or for opium-poisoning when the patient
IS found in the street, it will be well for the nurse to re-
member that in apoplexy there is unconsciousness, ster-
torous breathing, and paralysis, the movements of the
patient being confined to the sound side of the body ;
the pupils of the eyes may be found contracted or dilated
or uneven. This contraction denotes irritation, and the
dilatation denotes compression of the brain. In opium-
pmsoning the pupils are very narrowly contracted — the
I pin's head; there is unconsciousness, but no

PRACTICAL POINTS IN NUKSJNC.

paralysis. In itttoxUation the pupils may be contracted
or moderately dilated, dilating still more as the patieni
come.s to his senses. The smeil of alcohol on the breath
is of no assistance in determining the condition of the
patient, as spirituous liquor may have been given by the
first person who found the unconscious patient.

VaxoXy^a.— Hemiplegia is paralysis of one side of the
body ; paraplegia is paralysis of the lower half of the
body ; and monoplegia is paralysis of one limb, such as
I or a leg. By paralysis is meant total loss of
power or motion and of sensation ; that is, the patient
cannot move the part paralyzed because there is no
power or motion in it, neither may there be any feel-
ing or sensation. When the loss of power is only par-
tial, this condition is called "paresis." It will be appro-
priate to say here that the nerves have their seat in the
brain, and at the base of the brain they cross from side
to side ; those at the right side supply the left side of the
body, and those at the left side supply the right side of
the body, so when the right side of the brain is injured
or diseased it ts the left side of the body which is para-
lyzed, and vice versa.

The treatment of paralysis consists in good hygienic
surroundings. Extreme cleanliness is necessary to pre-
vent the formation of bed-sores. Massage and electri-
city are employed, which in some cases have effected
partial and even complete recovery.

There is complete helplessness of patients in this class
of cases; they are totally dependent upon the nurse;
they feel thetr helplessness very keenly, and also appre-
ciate the kindness and cheerfulness with which the nurse
does everything for them.

Spilepey. — Epilepsy is a disease of the nervous sys-

KUHSING IN SPECIAL UEDICAl D/S£AS£S. 25$

The attack may occur either with or without
"warning. The patient may fall to the ground entirely un-
conscious, with a pale face and the breathing be almost
stopped. After a few seconds this passive condition
passes away and there follow convulsions, which cease
after a few minutes, and the patient falls into a deep,
heavy sleep, awakening without knowing what has hap-
pened. The patient, however, may fall, remain uncon-
.scious, and recover in a few minutes. In the milder
form the patient suddenly stands still or may pause in
what she is doing, then recovers her sense.s and continue
her work. After the severe attack there generally re-
main headache, despondency, and a very tired feeling.

Some patients have the attacks only in the daytime.
white others have them at night. Some patients, again,
can tell when an attack is coming on. and by doing cer-
tain things can ward itoff. as, for instance, by rubbing the
part where the sensation is first felt, or if the thumbs or
toes turn in by straightening them out. This sensation
is called the " aura epileptica ;" that is, the sensation
which sometimes comes before an epileptic fit and by
which the patient can tell when the fit is coming on,

Tki tnatment of epilepsy lies in first putting something
between the patient's teeth to prevent the tongue being
bitten ; then in loosening the clothing about the neck
and chest, and in not restraining the patient unless the
body movements are excessive, in which case the arms
and legs are grasped and the movement.s followed. One
can thus keep the patient from hurting herself or others.

The nurse must notice the eyes — are they fixed? are
the pupils dilated ? — the color of the face, and on which
side the convulsions began, and whether the unconscious-
ness is complete or partial. Epileptic cases should never

PRACTICAL POINTS IN NURSING.

be left alone, but should be watched day and night, as a
fit of temporary insanity may take the place of convul-
and the patient may injure herself or others.
The patient must be kept free from all mental and
physical excitement, and take plenty of exercise in the
open air. The diet may chiefly be vegetable. A free
action of the bowels should be secured each day.

Hysteria is very often mistaken for epilepsy, though
one can generally recognize hysteria by noticing that
the patient takes care not to hurt herself; she camiot
bear the eyeball to be touched ; there is no grinding
of the teeth nor biting of the tongue, nor the complete
unconsciousness found in epilepsy. There are different
forms of hysteria, from simple fits of laughing, crying,
and screaming, and imagining all sorts of ills and ail-
ments, to hysterical convulsions, paralysis, and insanity.
In dealing with this class of patients, and indeed with all
nervous patients, the nurse needs an ample amount of
patience, tact, and firmness. A strict watch must be
kept over such patients; they are very skilful in deceiv-
ing their attendants ; frequently morphia and other things
received from friends are hidden in the bed and taken
when the nurse is attending to other duties. Various
treatments are prescribed for the simple form, from a
cold bath to an emetic, the patient being under the im-
pression that she is taking morphia ; the violent vomiting
and retching that ensue cure both the hysteria and the
morphin habit, but moral suasion must be tried fii^t
In some cases there is also complete loss of sensation
in certain parts of the body, while in other cases there
is pain in the head, stomach, abdomen, and limbs. This
pain is not imaginary to the patient ; to her it is very
real and calls for treatment. Through love for sj-m-

mmswo rff special medical diseases. 357

Khy, however, the patient will pretend to have pain

len she has none, and when her attention is drawn
» other things the pain will vanish.

It is the same with hysterical paralysis : the patient
really believes that she is paralyzed and cannot walk.
Encouragement does a very great deal for this imaginary
condition, and frequently patients will gradually improve
if encouraged to walk, and the paralysis will disappear
in a very short time. All excitement must carefully be
avoided, and hysteria must never be mentioned before
the patient. Globus hystericus is a feeling of choking, a
sensation as of a ball rising in the throat.

Neurasthenia is nervous prostration brought on by
overwork and study and by other causes. Moral treat-
ment is of as much importance here as in hysteria, with
the exception that one cannot .sympathize with an hyster-
ical patient, while a patient ill with neurasthenia requires
sympathy, together with the firmness, kindness, and en-
couragement that are used in hysteria.

The treatment of nervous prostration and also of the
severe forms of hysteria is known as the rest cure, which
is complete isolation from family and friends and perfect
rest of mind and body. The patient is allowed to sec no one
but the physician and nurse, since the presence of friends
requires conversation and mental effort. Absolute rest in
bed is necessary. The food must be nourishing, easily
digestible, and given at regular intervals. Massage and
electricity are employed to take the place of active exer-
cise. For tile treatment to be successful the rules laid
down by the phy.sician must be faithfully carried out.

Drops? is an unnatural collection of fluid in the tis-
sues or the cavities of the body. Cardiac dropsy usually
the feet and ascends.

258 PRACTICAL POINTS W NURSING.

Diabetes is of two kinds — diabetes mcUitus, charac-
terized by the presence of grape-sugar in the urine, and
diabetes insipidus, characterized by the excretion of a
very large quantity of pale urine of a low specific gravit}'.
and generally free from albumin and sugar. In diabetes
mellitus the urine is increased in quantity. Sometimes
the amount passed in the twenty-four hours is very large,
from 2 to 6 quarts ; the specific gravity of the urine
ranges from 1015 to 1050.

Nursing. — The diel should be restricted in this dis-
ease; everything containing starch or sugar being
omitted, saccharin and glycerin being sub.stitutcd. It
will be the nurse's duty to keep an accurate account
of the amount and frequency of urine passed, and also
to see that only the diet ordered by the physician is
given.

BheutnatiBm. — Acute articular rheumatism is cha-
racterized by inflammation of the joints. There is also
high temperature (103 to 104° F., and sometimes higher)
profuse acid perspiration, pain, tenderness, and swelling
of the affected joints.

Nursing. — The bed should be made up with blankets,
and a flannel bed-gown be worn by the patient, for the
reason that sheets and gowns of muslin become very
wet and cold with the perspiration. The utmost gen-
tleness must be observed when changing the bed- and
body-Iincn or when changing the position of the patient,
because of the e.\treme pain.

The room must be kept of even temperature (68° F),
and the patient be guarded against all draughts, the
affected joints being wrapped in cotton batting. The
diet should consist of milk, soups, egg-nog, etc, and the
thirst relieved with lime- or lemon-juice.

.VC'SSfJVG IN SPBCTAL MEDICAL DISEASES. 259

The medicinal trealment is generally satol, salicylic
iicid, and salicylate of sodium to relieve the pain and
ri;duce the temperature. When giving the salicylates
iJie nurse must watch for the physiological effects, which
are noises in the ears, deafness, nausea, vomiting, perspi-
ration, and delirium. The fever may be controlled by
the cold pack or cold bath, or bathing with tepid water.
Massage and electricity are often employed.

The pain may move from joint to joint, or may affect
only one joint. When only one joint is affected, it is
called "monoarticular" rheumatism, and if more than
one joint, it is called "polyarthritis." As there is great
danger of heart-feilure, the patient must not be allowed
to rise from the bed without permission from the doctor.
Severe cases of the disease may develop cerebral symp-
toms : there will be restlessness, delirium, very high tem-
perature, with a small, rapid pulse, pale and rather blue
face, convulsions, and death.

Acute muscular rhenmalism is an affection of one or
of a group of muscles. The disease may repeatedly
occur in the same patient; therefore one attack does
not mean immunity from another; there is always a
tendency to the disease. Its treatment is similar to that
of acute articular rheumatism. Cold and dampness must
carefully be avoided, and the patient should wear woollen
garments next the skin.

Diseases of the Skin. — A few words on skin diseases
will close these medical discussions.

Eczema is an inflammatory disease of the skin, and of
it there arc many varieties. It is often due to irritation
through using hard soaps and to putting the hands in
certain fluids.

Scabies, or the itch, which is contagious, may be ac-

26o

PRACnCAl. POINTS IN NURSING.

quired by shaking hands with a person thus affected or
by touching anything that she has used. There is an
intense itching of the hands between the fingers, of the
axilla, and of the inner part of the thighs, that grad-
ually spreads over the body. It is worse when die
patient is warm, and especially when she is in bed,

Bingworm is also contagious ; a child thus infected
should be isolated from other children.

Herpes zoster, or shingles, is often due to debility,
to damp clothing, and exposure to cold.

Ttratment of Stin Diseasis. — The treatments of all
skin diseases differ very much, each case being treated
according to the method of the physician in charge.
The utmost cleanliness with regard to the patient and
nurse is necessary, many skin diseases being infectious.

Ointments are generally ordered for all the above-
described cases, as they exclude the air and are very
soothing. The nurse must be very careful to guard
against infection, and to wash and disinfect her hands
thoroughly after attending the patient, who must also
be kept perfectly clean. Some of the skin diseases are
very difficult to take care of; others, again, are almost
disgusting in their character, and it is very hard for some
nurses to conceal their feelings when dressing the parts:
the patient, too, is often very irritable, All this calls for
a great amount of patience, kindness, and sympathy on
the part of the nurse, who must try to hide her emo-
tions when doing the dressings, for the patients are very
sensitive and narrowly watch her face. We have here a
noble example in the Sisters of Charity, who. as was
said by Dr. Myles Standish, " with kindness in their
manner, gentle care in their hands, and the love of
God in their hearts and soub, could care for and dress

tm/SSMG m SPECIAL MEDICAL DISEASES. 261

without expression of loathing and disgust the gangrene
then so often seen in tlie surgical wards, and the most
loathsome disease. All honor to them! They taught
the world, both physician and the layman, the value
of nursing."

Caringr for the dead is one of the duties the nurse will
have to perform. The writer need hardly admonish the
nurse to be very sure that the last sacraments are re-
ceived,' and that the friends be notified before the patient
becomes unconscious. The nurse should remain with
the patient to the end, and not let her die alone.

When the end has come the following instructions
should be followed: Straighten the Hmbs, close the eyes
by pressing the hds down with the fingers, and then
leave the room to the family for a while. After the
family have left the room the bed-clothes must be re-
moved and a fresh undcr-shect put on the bed; take
away all pillows but one. Wash the body with soap and
water and some disinfectant, and guard it against expo-
sure the same as if the body were conscious. The rec-
tum and vagina must be packed with cotton of any kind
to prevent discharges. Sometimes it is necessary to
pack the mouth and nostrils for the same reason. Put
a napkin, drawers, under-vest, night-gown, and stockings
on the body. Comb and dress the hair In the way that
it was usually worn by the patient. Arrange the lips
and prop up the jaw with a roll ; do not bandage, as this
will wrinkle the skin, it being desirable to have the face
look as life-like as possible. Clean the nails.

' there are wounds on the body, they must have a
\\ dressing put on ; wounds about the head can be
rbe nnrae ihould see that all hi'r patknU, Catholic or BxilestaDi,

262 PRACTICAL POINTS IN NURSING.

covered with a small cap made of black silk. Tie t
limbs with a bandage and cover the body with a sheet
Put the room in perfect order and remove all signs of
the illness. If the case has been contagious, the body
must be washed with disinfectants and be wrapped in a
sheet wrung out of the same; the funeral must be pri-
vate and the room afterward fumigated (see p. 234). ^^|

VI. THE NURSING OF SICK CHILDREN.

Care of the New-bom. — The sudden contact with
the outer air is generally a shock to a new-born infant
The temperature of the room should be 76° F. for the
first week, and the temperature of the water for the bath
be 98° F. Everything should be made ready before be-
ginning to bathe the baby. It should be wrapped in a
blanket and one part at a time be bathed without the aid
of soap. The body then is thoroughly oiled to remove
the cheesy substance called " vemix caseosa" which
protects the skin of the child while in the womb.

The nurse will find this cheesy substance very thick
upon the .scalp, and if not removed it may cause inflam-
mation ; indeed, it may cause inflammation if allowed to
remain on any part of the body. After the body has been
thoroughly greased, it must be washed with soap and
water, care being taken that the soap does not enter the
eyes. White castile is the best soap ; it is the least irri-
tating. The babe should be thoroughly dried and pow-
dered with corn-starch, which is about the best powder
to use for an infant unless the nurse can have talcum
powder. Some physicians do not want the baby to have
a soap-and- water bath after the oiling, but simply to hait

THE NURSING OF SICK CHILDREN. 263

the oil wiped off and the baby dressed. The body of
the babe shouM be examined to see that it is perfectly
normal ; any abnormality must be reported. The flan-
nel used in giving the first bath should be burned.

Dressing the Cord. — The navel cord i.s dressed by
wrapping it in sterilized gauze or antiseptic cotton, the
binder put on, and the cord placed on the left side of the
body, because if placed on the right side it would press
upon the liver, which at birth is larger than the other
organs, and which reaches down to the navel. The
binder must not be pinned too tight or the gas cannot
pass through the intestines.

Dressing the Infant. — The clothing of the new-bom
consists of a shirt, a diaper, socks, and a flannel slip,
which, made after the manner of the muslin .slip, fastens
in front and extends from 8 to 10 inches below the feet.
Over this comes the muslin slip, made about 2 inches
longer than the flannel one. These slips afford warmth
and hghtness and also looseness, so that the body can
expand, the body not being bound by bands about the
abdomen and chest, as when the old-fashioned skirts
worn : the first of these .skirts was generally pinned
so tightly about the abdomen that the gas could not
escape from the bowels, and the child had colic ; the
skirt was also brought up over the child's feet, so that
Ihey could not be moved. The second skirt was pinned
so tightly around the chest that the chest could not ex-
pand. Taking the old method of dressing all together,
the child was so uncomfortable that it cried a good deal,
and every cause was thought of except that of the cloth-
ing being pinned too tight.

Th(

lese two garments or slips can

\ the other and both put on at once. In

be put (

; within

264 PRACTICAL POINTS IN NURSING,

waist of the flannel slip may be made of muslin, and the
skirt be attached to it. All the garments are fastened
with small pearl buttons, and if instead of flannel there
is provided an elastic knitted-wool binder, which is slip-
ped on over the feet, there will be needed only one
safety-pin, and that for the diaper.

After the dressing the baby is laid in the crib or a
clothes-basket, covered lightly, and the eyes shaded
from the light. A baby should sleep during the first
few days twenty hours out of the twenty-four, and will
do so if it is left alone and not taken up for exhibition
or to be rocked, or carried about, all of which tends to
keep the child in a perpetual state of excitement, thus
making it nervous.

Bathing the Baby. — Until the cord separates, which is
on the seventh or the ninth day, the infant should be
given a sponge-bath every morning, and after the separa-
tion a tub-bath. The temperature of the water must be
98° F., tested with a bath-thermometer. The child must
be lowered gently into the water. The head is supported
with the left hand and the body washed with the right
After five minutes the child is taken out, laid on a warm
blanket, and thoroughly and gently dried. The skin
must be kept well powdered, especially in the folds, as
it is very sensitive and the air and water act as an irri-
tant. If there is chafing, the chafed parts should be
covered with soft linen.

Defecation and Urination. — The first bowel movements
of a baby are dark, almost black ; if cloths are placed in-
side the diaper, they can be burned. This color of the
feces gradually changes to a bright yellow, which is the
normal color ; any departure from this condition shows
that something is wrong and it must be reported, and

THE NURSING Of- SICK CHILDREN. 265

also if the baby passes urine. It is not unusual for no
urine to be passed durinjj the first twenty-four hours.
If at the end of twelve hours the baby has not urinated.
hot fomentations should be applied over the bladder and

» kidneys, which treatment will generally cause the blad-
der to contract and the urine to flow. The diapers must
be changed as soon as wet, and the parts be bathed and
powdered.

Nursing of the Infant. — The baby should be put to
the breast regularly every two hours during the day, and
only when it awakes during the night. It should suckle
about fifteen minutes. A baby's stomach holds only
about i^ ounces. Feeble babies must be fed oftener
day and night. The mouth must be washed before
and after each feeding with water to which has been

I added a little borax.
When the baby cries tlie nurse should find out the
trouble. Very often the trouble is some little thing.
hich as being thirsty, which a little clear cold water will
telieve. The infant must not be put to the breast unless
fc is time. Babies get tired of lying in the one pcsition ;
ihey cannot turn themselves, and they waken and cry;
therefore their position should bi; changed by taking
hold of the clothing at the shoulders and limbs, and
gently turning them; they will not awaken, and besides
making them more comfortable the change will lengthen
their sleep.

Artifidal Feeding. — If the baby must be brought up by
Ai7ff(/ (bottle feeding), the physician will direct the cha-
racter of the food to be given and the nurse must faith-
fully carry out his orders. Usually the food consists of
equal parts of milk and water until after the first month,
when the water is gradually diminished, until at the fifth

tA- HOttSING.

«&^ Ac hjOe is given plain. If the

'isa^Bt «tt tfae in&nt, a Ubiespoonful

the trouble. The bot-

in which they are

«■ W fafl poiccth* clean. The rubber

■side and out, and should be

Mes before being used, and be

Ac iMcivals of feeding. The

hcsoU^d iKi^ mA tbcn filled with cold

a teaspoooful of baking-

4f H i$ rcqiwed to sJerilise the

I be sterifiscd to last twenty-four

I be p(X wk each bottle for a single

fccdae. TlKaHMlksardic books should be stoppered

t coom, vUdi *-ill absorb the germs of

tfae air and keep them away from

tlic milk. The best apparatus for

sletilinDg milk is the Arnold ster-

•fi*"" 0^- 65). In the absence

of this stcribzer the bottles can

be placed in an ordinary boiler

of cold water either on sticks or

on a folded towel to keep them

from touching the bottom of the

vessel, ihc water reaching to the

necks of the bottles. The water

should come to a boil, then the

boiler cover be put on, and the

boiler removed from the fire, and

fir.. f.^-Arn.. .Knhjer. j^^.^ ^^ stcam for about one hour,

after which time the bottles are taken out and put away
in a cool place. The bottles must not be opened until

THE NURSING OF SICK CHILDREN.

267

needed A bottle of the milk should be warmed by
allowing it to stand a few minutes in a pan of hot water ;
the cotton is then taken out and the rubber nipple put
on. If any of the milk is left in the bottle, it must be
thrown away. Sterilizing the milk renders it free from
germs.

Infant Food and Rules for Feeding. — Dr. Meigs' food
is the favorite with some physicians. It consists of —

2 tablespoonsful of cream,

1 " of milk,

2 " of lime-water,

3 " of sugar-water.

Sugar-water is made by adding 8 teaspoonsful of sugar
of milk to I pint of water. Lime-water must be added
to the milk after sterilizing, not before, because in boiling
it chemically changes and discolors the milk.

General Rules for Feeding (Rotcli),

Afe.

Intervals

of
feeding.

Number of

feedings in

34 hours.

Average

amount at

each feeding.

Average
amount in
34 hours.

1st week.

2 hours.

I ounce.

10 ounces.

1-6 weeks.

2y^ hours.

I ^-2 ounces.

i2-i6ounces.

6-12 weeks
and possibly
to 6ch month.

3 hours.

3-4 ounces.

I S-24 ounces.

At 6 months.

3 hours.

6 ounces.

36 ounces.

At^ 10 months.

3 hours.

8 ounces.

40 ounces.

At the time of feeding the baby must be taken on the
nurse's lap, and it must not be allowed to doze over its

268 PRACTICAL POINTS IN NVRStNG.

meal ; ihe baby, however, must not be hurried ; the
bottle should be taken away when the meal is over, and
on no account should the child suck from an empty
bottle. As the baby grows the intervals between the
feedings are lengthened and the amount of food is in-
creased. At seven months the baby may have milk
slightly thickened with good bread or well-boiled oat-
meal once or twice during the day; at ten months a
little meat-broth made with barley or rice, without vege-
tables ; at twelve months it should be weaned. The baby
must have no sohd animal food until after the second
year, and even during the second year milk should be its
chief food. It must not be given tea, pastry, stimulants,
fruit, cheese, or soothing syrups, or any medicine without
proper medical advice.

Infant Dci'clopment. — At the third week the baby may
be taken out doors for its first airing, being carried in t!ie
arms, not in a carriage, and with its head supported. A
baby will hold up its head at from three to five months,
will quickly recognize objects at from six to eight months,
will sit alone at from the seventh to the eighth month,
will walk at from the ninth to the twelfth month, will ut-
ter single words about the first year, and will begin to talk
by the second year. A baby does not shed tears until
the second or the third month of age, and if very sick at
eight months the tears do not flow until convalescence
sets in. The teeth begin to grow between the fourth and
the seventh month. The anterior fontandh — that is, the
middle opening in the top of the head — rather increases
in size during the ninth and twelfth months, and then de-
creases, and should be closed at eighteen months. The
baby must not be allowed to stand alone before twelve
months ; the leg bones are not very strong and they

ms mntsiNG op sick children. 269

tey bend ; when sitting up its head and neck should be
supported. A baby should gradually increase in weight,
after the second day, from 3 to 5 ounces each week. It
loses weight during the first two days.

The temperature at birth is 99° F., pulse from 1 30 to
140 beats, respirations fiom 40 to 46 per minute. The
temperature is usually normal after the first week.

Care of Premature Infants. — A premature baby is
one born before full term ; it is usually put in an incu-
bator (Fig. 66), which supplies the infant with artificial

body-heat until it reaches its full time. An incubator
may be improvised out of a large wooden box by having
one side so arranged that it will slide in and out; the top
isalsoarranged toallowapicceof glass tobe inserted and
to slide in and out. Across the middle of this box arc
nailed three wooden strips, which will divide the box into
two compartments, the lower one for the heaters, hot-
>-Water bottles or hot bricks, etc., the upper one being

270 PRACTICAL POINTS IN NURSING.

fitted with flannel or with cotton for the baby. The glass
cover is kept open about half an inch at the foot of the
box, to allow entrance of fresh air to the infant. A ther-
mometer is also placed in the upper compartment, and
an even temperature of 86° F. should be kept. When
the baby is taken out to be changed or bathed the glass
cover is drawn back : when the heaters are to be re-
newed the sliding side is drawn back. If a box cannot
be procured, then the baby should be wrapped in cotton
and be kept in a basket near the fire. The temperature
of the water for the bath must be lOO® F. ; the tempera-
ture of the room should be from 80 to 86° R, and the air
be kept fresh and pure.

If brought up by hand, the baby is wrapped in cotton
and flannel so arranged that the napkin can be changed
without disturbing the baby, which must only be taken
out of the incubator to nurse. Should the attending
physician not allow the mother to nurse the infant, it
should be fed every hour during the day with about two
teaspoonsful of the mother's milk, given by means of a
medicine-dropper.

Diseases of Infancy. — Thrush is a disease caused by
decomposition of food in the mouth of the child, and is
characterized by small white spots on the tongue, the
sides of the mouth, and the gums, that may spread to
the throat and stomach. To prevent this disease, the
mouth should be thoroughly washed after each feeding
with water to which has been added a little borax.
Should the disease appear, wash the mouth every two
hours with borax-water (about 15 grains to I ounce of
water).

Colic is relieved by the application of hot fomentations
to the abdomen, and internally i teaspoonful of anise-seed

THE ffVRSWG OF SICK CHILDREN.

271

a (which is made by adding 10 drops of the essence
of atiise-seed to a cup of boiling water), 1 teaspoonful
for three doses, or plain hot water will bring up the gas.
Colic is due to cold or to the accumulation of gas in the
bowels, and it generally yields to heat. The child lies
with the knees drawn up, its cries are sharp, long, and
loud, and they die away as the pain is relieved.

If the food does not digest well, the movements will
be green, and in them there will be curds of milk. This
condition must promptly be reported to the physician.
Lime-water or baking-soda (about half a teaspoonful
added to the milk) will often correct the indigestion ; the
white of an egg well beaten up and added to about 6
teaspoonsful of cold water and a little sugar-water will
also give the stomach a rest for a few days from milk
digestion, besides being nourishing. If the baby is nurs-
ing, give half a teaspoonful of lime-water to the same
amount of water before putting the child to the breast.

Bmvel Obstruction. — Blood in the movements and con-
stipation may be due to obstruction of the bowel. The
child screams with pain : the abdomen is distended and
tender ; there is vomiting ; the respiration is difficult, and
tliere may possibly be convulsions. Until the arrival of
the physician hot fomentations may be applied over the
abdomen and a soapsuds enema given. To gh'e the enema,
everything must first be prepared and laid on a chair or a
table near by ; the nurse takes the baby on her lap, and
lays it on its left side, with the knees drawn up. The
tube, which for a very small baby should be the smallest
tube that comes with the syringe, should be oiled, the
air expelled, and the tube inserted in the rectum and the
bulb gently squeezed. Pressure is applied over the

rtum to retain the enema for a short time.

272 PRACTICAL POINTS IN NURSfJVG.

Diarrlua. — In diarrhea the bowel-movements will be
found acid, and sour-smelling, and will contain particles
of undigested food ; their color will be green. The baby
has, besides the frequent movements, griping pains in the
abdomen, vomiting, and restlessness. Diarrhea Is often
caused by improper feeding and changes in the temper-
ature during the hot summer months. The extreme heat
depresses the system and leaves it susceptible to the
slightest change.

The treatment of diarrhea lies in getting rid of the irri-
tation, by giving either an enema of half a teaspoonful of
castor oil in hot, sweetened milk, or in the same amount
of glycerin or of hot coffee. The baby should be kept
in bed and be given for a few days, instead of milk, the
white of an egg well beaten and added to an equal
amount of cold water and a little sugar. When the
vomiting is persistent the stomach is to be 'foj/tci/ out.
A small rubber catheter, with a funnel attached to one
end, is used, and the washing is done in the same man-
ner as that for an adult (see p. 70).

Vomiting may be caused by over-feeding, when the
milk will be returned clear because the stomach cannot
hold the amount ingested This condition is not serious ;
but when the milk is returned curdled and sour, it is due
to indigestion or it may be a symptom of some disease.

Cholera infantum begins with vomiting and diarrhea,
weak, rapid pulse, and symptoms of lowered vitality and
collapse.

Treatment consi.-its of high starch-and-laudanum ene-
mata to check the movements. Heat must be applied to
the body or the child may be put in a hot bath {temp, of
105" F.). The food for a while is generally white of egg
with 4 drops of brandy, alternated with 10 drops of Val-

THE NVSSTNG OF SICK CHILDREN. 273

ine's or expressed beef until the appearance of undi-
gested food is removed from the bowel movements. The
air of the room must be kept pure and fresh. When the
child is strong enough to be taken out, it should be kept
outdoors tlie greater part of the day. Cholera infantum
is caused by impure air and improper food and exposure
to heat.

^ Rickets, which is also due to improper food and impure
, Ls a disease of the bones owing to an insufficient amount
animal matter in the bones, that makes them soft, so that
they ea,sily bend. The child is restless when asleep, throw-
ing off the bed-clothes ; when awake it is fretful and irri-
table, and cannot bear to be touched; the abdomen is
distended ; the head is large ; the anterior fontanelle (the
middle opening in the top of the head) is found open at
the time when it should be closed — that is, at about
eighteen months ; the teeth arc late in appearing ; there
may be hydrocephalus (dropsy of the brain) ; and the
long bones of the legs are so bent that tht- child is
knock-kneed. There are other symptoms, all caused
by the want of proper nutrition, and the child presents a
sickly, puny appearance.

The treatment of rickets Hes in nourishing food, perfect
cleanliness, pure, fresh air, and massage, and in not allow-
ing the child to walk, to stand, or to sit until its bones
are strong enough to bear the weight of the body.
Many cases of knock-knee are caused by the child be-
ing allowed to walk or to stand before the bones of
the legs are strong.

Comnilsions may be due to indigestion, worms, pins,
etc., or to brain-excitement in rickets, or to irritation of
the nerve-centres in teething. A great number of the
of children are ushered in with convulsions,

274

PRACTICAL POINTS IN NUKSING.

^L somel

^H tlioro

^H mcasi

which take the place of the initial chill in the adulL
They may come on suddenly or gradually.

Triiitmcnt. — The first thing for the nurse to do is to
put the child into a hot bath (the temperature about from
lOO to 104° F.), without waiting to undress it, which can
be done in the water. Tlie head should be kept raised
and cold applied to it. The hot-water bath will dilate
the blood-vessels of the body, thus diverting the blood
from the brain to the body. If the attack is the begin-
ning of any of the eruptive diseases, the heat will also
bring out the rash, besides relieving any pain in the
abdomen or elsewhere. The baby is to be kept in the
bath about five minutes, and is then taken out and
wrapped in a warm blanket : an enema is given to clear
the bowels. A physician should be summoned.

Teething, which usually begins about the seventh
month, may be accompanied by many disturbances, such
as diarrhea, indigestion, convulsions, all of which should
receive attention.

Worms, which are of three kinds — tape-worm, thread-
worms, and round-worms — are caused by impure drink-
ing-water and food, and also by feeding food that is not
properly cooked. The j/>w//owj are numerous: itching
and rubbing of the nose and external parts, vomiting,
restlessness, grating the teeth during sleep, convulsions,
etc. ; but wc must wait until the worms are seen in the
movements before attributing to them any of these
symptoms. The worms are generally found in the
lower bowel, and are passed in the movements, though
.sometimes they are vomited. The bowels should be
thoroughly cleared by giving the child a dose of castor
oil, followed by an enema of salt and water, and these
measures continued daily until the worms have all been

72BS NURSING OF SICK CHILDREN.

275

issed. no more being seen in the movements. The
Expulsion of a tape-worm belongs to the physician.

Protrusion of the binvel may be remedied by placing
file child on its back and elevating its buttocks. The
Fparts should be washed with tepid water and the bowel
I replaced, then a pad or compress wrung out of ice-water
be applied, and kept in place with a napkin. If this
treatment does not succeed, a physician should be sum-
moned. Protrusion is often caused by constipation and
the straining efforts of the baby. A baby should be

Iiaught regular habits, which, with a little patience, can
Be established.
I Ophthalmia neonatorum is inflammation of the con-
junctiva, which is one of the coats of the eyeball. Its
pauses are numerous, but in the new-bom it is generally
«aused by infection during birth from the urethral
or vaginal discharges of the mother. In this case the
fault lies entirely with the nurse in not cleansing the

I eyes immediately after the head is bom, and also in not
Washing the baby's hands, because in this way any
mucus on its hands is rubbed into the eyes ; it is also
Caused by using the same cloth and water for washing
me eyes that have been used for the body. Any red-
bess of the eyes or the eyelids must promptly be re-
ported. If cold compresses are ordered, they must be
changed every two minutes.

Syringing the eyes is best done with a medicine-drop-
per. The dropper is filled with the ordered solution, which
may be of boric acid : in applying the solution it should
flow from the outer to the inner comer of the eye, thence
to a piece of cotton or of compress. The eye must be
kept perfectly clean, and all pieces of cotton or compress
used about it must be burned. Ophthalmia is a germ

List
tot
thi

276 PRACTICAL POINTS IN NURSING.

disease and is highly contagious. If the nurse has to
touch the eyes with any solution, she should twist a
piece of absorbent cotton around the end of a tootli-
pick or a match-stick, a fresh piece being used for each
eye, these eye-swabs being burned immediately after-
ward. These cases are very fatiguing, but the baby's
sight depends upon the faithfulness with which the phy-
sician's orders are carried out. Many cases of blindness
are due to neglect. The nurse must protect herself by
not touching her face, eyes, or hair unless her hands
have thoroughly been washed and disinfected. Every-
thing employed about the eye or eyes must be burned,
and on no account be used about other parts of the body.

Snuffles, or cold in the head, may be relieved by keep-
ing the baby warm, oiling the outside of the nose, and
keeping tlie nostrils clear by cleaning them with a small
piece of cotton twisted around a match-stick.

Infant paralysis Is recognized by the baby having no
power over its limbs. Sometimes the infection is ushered
in with convulsions and a high fever, and vomiting, tlien
follows a wasting of one or more muscles. The limb is
at first tender, and the baby may cry when it is touched.
The baby must be kept warm, good nourishing food be
given, and massage and electricity applied.

Tongiif-tif. — Sometimes the band beneath the baby's
tongue is too short and the baby cannot nurse. It is
then tongui'ticd. and the band will have to be snipped.
This is a simple and almost painless operation, taking only
a verj' few minutes, and no anesthetic is required, neither
is there any loss of blood. The nurse can see the baby's
/uw_^rwc by placing a little sugar on the lower lip of the baby;
this will cause it to put out the tongue to get the sugar.

The temperature nf babies and that of some of the

THE NURSING OF SICK CHILDREN 277

older children must be taken in the rectum, the ther-
mometer being oiled before it is inserted, and carefully
watched lest any sudden movement of the child should
break the thermometer, the mercury and fine glass
entering the rectum. The baby should be placed on
its left side on the nurse's lap.

Pulse and Respiration, — The pulse can only be taken
correctly when the baby is asleep. The pulse is very
easily affected, the least thing sending it up, together
with the temperature, and increasing the respirations.
The pulse at birth is about 140 beats per minute, and
gradually it decreases with increase in age, as follows :

First monUi the pube is about 120

First to second year it is about 1 10

Second to fifth " «« " icx>

Fifth to eighth •* " " 90

Respirations at birth are from 40-50

First month, about 40

First to third year, about 35

Third to fifth «« " -25

Signification of the Baby's Cry. — Until the child be-
gins to talk its cry is its only language. If the cry is
long and persistent it is usually due to hunger, or the
child has earache, in which case the hand is drawn up
to the ear. If there is pain in the head, the hand is
also drawn up to the head and the cry is sharp and
piercing, the face flushed, and there is restlessness.
With pain in the abdomen the cry is long, sharp, and
loud, and gradually ceases as the pain subsides. The
knees are drawn up to the abdomen. If the pain is in
the chest, the cry is sharp and suppressed, with the
cough which accompanies it; the nostrils dilate and
contract.

278 PRACTICAL POINTS /,V NUffS/JVC.

DiBeaaes of Childhood. — Any of the diseases which
attack grown persons may also attack children.

Typhoid fci'er is apt to run a milder course in children
than in adults ; the nursing, however, is just the same. A
-Strict watch must be kept of the temperature for hemor-
rhage, which is indicated by a sudden drop of tempera-
ture and a weak, rapid pulse. The bowel-movements
after the hemorrhage are dark red, but if the feces are
not passed for some time after, they resemble tar. The
child must be kept perfectly quiet (not allowed to move).
so that the blood will coagulate in the blood-vessels and
prevent further hemorrhage. Cold water or crushed ice
may be given in small quantities; only the amount of
water or ice it is intended the child to have should be
put into the tumbler ; if there is more and the tumbler is
taken away, the child will cry for it. Baths and packs
are given in the usual manner. Ice can be applied to
the head by crushing the ice and making an ice poul-
tice which can be stitched upon a night-cap. This will
prevent the poultice falling from side to side. In the
absence of rubber there may be used flannel or towels,
which are fastened to the pillow, so that the weight of
the poultice will not be on the child's head.

With children ulceration of the bowels is less likely
than with adults, consequently the dangers of hemor-
rhage and perforation are less. The rash may be absent,
but the brain -symptoms are marked and generally the
temperature rises suddenly.

Mi-ningitis is inflammation of the membranes of the
brain.

Symptoms. — The child is restless, listless, drowsy, and
fretful ; loses flesh ; grinds the teeth when asleep, ,
the pain in the head causes him to wake up 1

ileep, a^^
ip widj^H

THE NURSING OF SICK CHILDREN.

279

scream ; he cannot tolerate the light or the slightest noise ;
the pulse is increased ajid the temperature is raised. These
symptoms deepen ; the drowsiness increases, followed by
delirium. The pupils of the eyes may be dilated or evenly
contracted, or the child may squint ; there may be convul-
sions. Finally there is complete coma.

The treatment of meningitis lies in keeping the child
perfectly quiet in a darkened room and in applying cold
constantly to the head. The bowels must be kept open
and the child be fed by the rectum if necessary. The
child must be kept perfectly clean. As the stupor .sets
in the urine and the excreta will involuntarily be passed.

Mumps is inflammation of the parotid and other sali-
vary glands situated beneath the ears. There is fever-
ishness, headache, restlessness, chill, and vomiting, and
then the swelling begins. The disease is both conta-
gious and infectious, and for this reason an affected child
must be isolated from other children.

Treatment. — The child must be kept warm and hot
fomentations applied to relieve the pain, or the neck and
fece may be covered with absorbent cotton or flannel.
Oil rubbed into the skin will relieve the tight feeling.
After four or five days the swelling begins to subside
and the pain is relieved. Soft food should be given.

hieoHtinenee of urine needs the care of a physician, as
it may be due to some trouble with the bladder, or the
urine may contain too much acid. Children who have
this trouble are very often whipped and scolded by both
parents and nurses : this is a great mistake, and is wrong
to a child, unless the nurse is sure that the incontinence
is due to carelessness.

Chorea, or St. Vitus' dance, is a nervous disease of
childhood, and is characterized by the involuntaiy

2S0

PRACTICAL POINTS IN NURSING,

■ofo

of all 1

i of tl

K the stn

muscles c

body, that ceases when the child is asleep. In mild
cases recovery takes place in from four to six weeks:
but in severe cases, when the whole body is involved, the
child may die, either through inability to take nourishment
or to sleep, or from heart complications. The afTcctcd
child must be isolated from other children or they will
imitate its affliction. Good nourishing food must be
given, and the child be kept free from all excitement
Rheumatism being one of the complications of chorea,
any stiflhess of the joints must be reported. The child
must be treated very kindly and gently sjTOken to ; a
sharp word has been known to throw a child into con-
vulsions. Should convulsions set in without any appa-
rent cause, such as fear, worry, or excitement, they may
be the beginning of some complication. In severe cases
of chorea the patients are kept in bed. There is always
the liability to recurrent attacks, and women who have
had an attack in childhood may have a recurrence of
the disease during pregnancy.

Surgical Diseasee of Children. — The surreal dis-
eases of children are similar to those of adults, and
demand thi: same treatment. After any trouble with
the bowels, such as peritonitis or appendicitis, the child
should wear a flannel abdominal binder, because sud-
den changes in the temperature are liable to afiect the
bowels; the binder will keep the bowels warm and
guard against recurrent attacks; the bowels must also
be kept open. Pain in the knees or the hips must be
reported ; it may denote hip disease.

Hip-joint disease (Coxalgia) is caused by a blow or a
fall, or it may originate from tubercular inflammatioD,0
structure of the hip-joint or scrofula, the j

mmatioD,Q^^
: patJenlj^l

THE NVKStNG OF SfCK CHILDREff.

381

Ihcriting either of these diseases. The germ lodges in the
Bend of the femur or thigh-bone. If the disease is of

■ tubercular origin, tubercular meningitis may set in. The
ftchild must be confined to bed; he must not sit up.
1-Every little while he will scream in his sleep on ac-
Icount of pain caused by a mu.scular spasm which brings
B.^e inflamed surfaces of the joint together. Any kncxik-
Ifalg against or jarring of the bed causes great pain.

Children must have plenty of fresh air and sunhght;
sdiey cannot live healthfully without; also good nourish-
ling food, of which milk should be the chief.

Nurse's Management of Children, — A child who has
■been used to home-training and to having every whim

■ satisfied does not take kindly to the nurse, and often
^wili not allow her to do anything for him. Therefore,
Bit is generally well for the child to see the nurse in
Btiie room for a little while, the mother acting under her
^directions, and after he has become accustomed to the

nurse's presence the way will be much easier. If the
first thing the nurse has to do is to dress a painful
part, she should not go up to the child and begin the
dressing, but she should talk to him about his play-
things ; then, after a while, with a little tact, she can look
at the part, touching it very gently ; if this causes no
pain and the child thinks the nurse is not going to hurt
him, he will let her do the dressing, the nurse all the time
keeping up the conversation to attract his attention to
other things. With children the nurse should be firm
and at the same time be gentle ; she should let yes mean
and no mean no. If the nurse has difficulty with a

L>diild at first, he will see that she i;

I and that her

KiOrders are to be carried out. On no account must the
hild be deceived. A child will often take the most dis-

282

PRACTICAL POINTS IN NURSING.

^k room,

agreeable medicine from a nurse whom he loves and by
whom he has never been deceived, because she says that
it is easy to take, the patient having a child-like faith in
her, when no power nor persuasion could make him take
it from a nurse who was unkind or who has deceived him.

Children live in the present, the past is soon forgot-
ten. We should encourage their little efforts to be good,
provide them amusement, and sympathize with them in
their little troubles, A little boy (about four years old)
went into his father's study holding up a finger which
had been pinched by the door, and, with a look of pain
on his face, said, ■' Look, papa, how I have hurt my fin-
ger." His father, who was busy writing and did not
want to be interrupted, said rather impatiently, " I can't
help it, dear." The little fellow's eyes filled with tears,
and as he turned to leave the room he said in a low
tone. " You might have said ' Oh ! ' " Children live in a
world of their own ; their little trials are just as great
to them as are our greater ones to us, for "there is no
misery like the misery of childhood;" a little sympathy
for a pinched finger or a stubbed toe, a bumped head, a
smashed doll or toy. is always a great comfort to them.

In conclusion the writer begs to remind the nurse of
what has been said about sympathy and kindness to her
patients. They are so dependent upon her for comfort
and sympathy that a gentle word or a pleasant smile,
kind attention to their needs, and regard for their feel-
ings, though little things, give great consolation. Sym-
pathy and comfort are especially necessary before an
operation, of which all patients naturally have a dread
None can realize what the feelings of the patients must
be as they go bravely (outwardly) to the etherizing
room, or what a comfort it must be to them to know

THE NURSING OF SICK CHILDREN. 283

that some one who fully sympathizes is with them. It
is here that they want their own to be with them, and it
is here by kindness and sympathy that the nurse can, in
a measure, take the place of their own. " The small
kindnesses," says M. A. Kelty, "the small courtesies,
the small considerations habitually practised, the sympa-
thy in our every-day work, give a greater charm to the
character than the display of great talents and accom-
plishments ; " and in Felix Holt, George Eliot says : " A
supreme love, a motive that gives a sublime rhythm to
a woman's life, and exalts habit into partnership with the
soul's highest needs, is not to be had where and how
she wills : to know that high initiation, she must often
tread where it is hard to tread and feel the chill air and
watch through darkness. It is not true that love makes
all things easy ; it makes us choose what is difficult."

. tnclMomliuie mntry; }» riihl nubcbvUn AFIeryj 4. codmod caroii<l ifrrry
■■riui uttrt : 6, left o-niiliiHi ormld «nciv ; 7, ItA uillBry wten : t, (upcrlm am

T. pylor

PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 385

PHYSIOLOGY AND DESCRIPTIVE
ANATOMY.

I. PHVSlOLOCiV.
Blood-circulation. — The circulation of the blood
through all the parts of the body, taking with it the mate-
rial for nutrition and gathering up thu waste material, is
caused by the action of the heart, the arteries, the capil-

Fio. 6; —The hun

laries, and the veins. The arteries carry the blood from
the heart, and contain pure, rich red blood. The aorta,
the largest artery leading from the heart, branches off
into smaller arteries, which finally become very small,
_and which are termed capillarks. These vessels are

286

PRACTICAL POINTS I.V NURSlffG.

very tiny, yet they allow a constant stream of blood ti

pass through them; they are very numerous and nea

the surface of the body, so that in pricking the finger n

get an oozing of blood which comes from the capillarit

The capillaries connect with

the I'eins, which at first are

very small, but they grow

larger and larger until they

merge into two large veins,

the vena cava superior and

the I'ena cai'a inferior, which

bring the blood back to the

heart, and which are on the '

right side of the heart.

WiVEANA TOMY.

ex, or the small end, pointing down and
; important muscular organ has two dis-
tinct parts, each of which is again divided into two parts
connected with each other. Each of these four parts, or
chambers, holds about 2 ounces; the two upper cham-
bers are called "auricles," the two lower "ventricles"
(Fig. 69). There are openings between the right and
left auricles and ventricles guarded by valves ; the one
between the right auricle and ventricle is the tricuspid
valve ; that between the left auricle and ventricle is the
mitral valve (Fig. 68). There are two other valves, one
in the right ventricle, where the pulmonary artery be-
gins, the other in the left ventricle, where the aorta be-
gins. These valves are called " semilunar valves " (Fig.
68), and the object of these valves is to prevent the blood
flowing back when the heart dilates.

Mechanism and Course of the Circulation. — To return
to the two great veins. The venous blood, which is
loaded with impurities and is dark colored, reaches the
two great veins, the vena cava superior and the vena
cava inferior, which join together and empty into the
right auricle; this chamber contracts and forces the
blood down through the tricuspid valve into the right
ventricle, which contracts and sends the blood through
the right semilunar valve and pulmonary artery into the
lungs. In the lungs the blood throws off" its impurities,
takes up a new supply of oxygen, and becomes pure,
bright-red arterial blood. This change is due to the
respiration. This pure blood returns to the heart by the
pulmonary z'cins, which empty into the left auricle ; this
contracts and forces the blood down through the mitral
valve into the left ventricle, which also contracts, and
sends the blood through the left semilunar valve into the

2SS

PRACTICAL POINTS IN NURSING.

aorta, which is the largest artery in the body. The firs
branch of the aorta is the coronary artery, which sup-
plies the heart itself. The branches of the aorta arc
many, and they grow smaller and smaller as the distance
from the heart increases, carrying the pure blood to all
parts of the body ; the last of these branches are the
capillaries, which are so small that they are invi.siblelo
the naked eye. The blood, when passing through the
capillaries, loses its bright-red color and becomes dark,
because the different tissues take from the blood what is
necessary for their support, and give in return the waste,
worn-out material ; the oxygen disappears from the
blood to a great extent, and the blood on reaching the
veins becomes dark blue, being full of impurities. The
blood then returns to the heart and thence to the lungs,
where its impurities are thrown off with the breath.
The blood takes up a new supply of o.xygen in the
lungs, and repeats its journey through the body.

There is one instance where the arteries carry venous
blood, and the veins carry arterial blood ; it occurs in the
ptilmonary circulation, generally called the *' lesser " cir-
culation. In this circulation the venous blood enters
the right auricle and ventricle, and pa.sscs through the
semilunar valves xn'io^z pulmonary artery, thence to the
lungs, where, as we have seen, it is purified and made
into bright-red arterial blood, and returns to the heart
by the pulmonary vein.

There is another circulation, called the " portal " cir-
culation, in which four large veins — the inferior and su-
perior mesenteric, splenic, and gastric — form one lai^e
trunk called the " vena portie." This portal vein collects
the blood from the stomach, the pancreas, tlie splc<
and the intestines, and carries it to the hver, '

tlie splcen^^^
whereJ^^I

PHYSIOLOGY AND DESCRIPTIVE Alf ATOMY. 289

jnxcs with the blood that is supplied to the liver. The
1>Iood then passes from the capillaries of the liver into
small veins, the hepatic 7vins, which carry it to the vena
cava inferior.

The greater or systematic circulation begins at the left
ventricle, thence through the aorta, and is distributed to
all parts of the body, going through capillaries and veins,
and then reluming to the right auricle.

BeepiratioD. — The air we breathe is mainly composed
of two gases, oxygen and nitrogen, there being more
oxygen than nitrogen. The oxygen is absolutely neces-
sary to support life ; still, alone it would not support life,
because it is too stimulating; hence there can be danger
from too much as from too little oxygen. The nitrogen
serves to dilute the oxygen. There is also 3 small quan-
tity of carbonic-acid gas, which is very poisonous, and a
certain amount of watery vapor, which, when exhaled, is
invisible, except in cold weather, when it is seen to issue
from tlie mouth or the nostrils in the form of a white
cloud.

Mechanism 0/ Respiration. — Each time we breathe the
air passes into the lungs through the nose, mouth,
larynx, and trachea, thence to the bronchial tubes and
air-cells of the lungs. The muscles of the chest ex-
pand, the diaphragm contracts, allowing the lungs plenty
of room to expand, the ribs are lifted, the lungs expand,
the air-cells open, and a fresh supply of oxygen is in-
haled. This action is called "inspiration." The second
movement is called " expiration," in which the diaphragm
relaxes and rises in the form of a dome, the ribs descend,
the chest contracts, the lungs, which are elastic, shrink.
and the impure air is driven out. We breathe in oxy-

Q and give out carbonic-acid gas, which must not be

290 PRACTICAL POINTS W NURSING.

inhaled again, and to which there Is a faint odor, but un-
noticeablo except when present in large quantity.

Upon entering a poorly-ventilated hall or a room in
which there are many people, one will at once notice
the bad air. It is due to the carbonic-acid gas expired
by each inmate, there being not enough oxygen to purify
the air. Lighted gas-jets also consume the oxygen.

If there is too little oxygen to purify the blood, the
venous blood is distributed to the heart and thence to the
body, and there is a feehng of faintne.ss and suffocation.

Our bodies must be supplied with fre.sh air, food, and
drink; we cannot live without them. One knows the
need of food by the cravings of the stomach, the need of
water by the dryness of the mouth and throat, the need
of pure air by the feeling of suffocation.

Animals, like human beings, take in oxygen and give
out carbonic acid. Plants take in carbonic-acid gas and
give off oxygen in tlie day-time ; in the night they take
in oxygen and give off carbonic -acid gas. It is for this
reason that plants should be removed from a room at
night. ■

Besides the lungs, the skin and the kidneys assist^f
rcmovuig impurities from the body. ^J

The Digestion. — The organs of digestion are the sali-
vary glands, the stomach, the liver, the pancreas, and the
intestines. These so change the food we eat that it can
be taken into the blood and nourish the body.

The alimentary canal (Fig. 70) is about 30 feet long;
it begins with the mouth and ends with the rectum. It
is in this canal that the process of digestion is carried on.
The first part, which extends from the mouth to the
stomach, is called the "esophagus" (gullet), and con-
ducts the food to the stomach. The stomach is the most

PMVSrOtoeY AND DESCXIPTIVR AlfATOMY. 29I

part of the canal ; its left end is enlarged,
ISC il is on the heart side of the body is called
the " cardiac dilatation." The right end of the stomach
narrows and connects with the
small intestine. The small in-
testine is a continuation of the
canal, is about 20 feet long, and
lies in convolutions in the abdo-
men ; it ends in the large intes-
tine, which is about 5 feet long,
and which runs up the right side
of llie body (ascending colon),
crosses over under the liver and
stomach (transverse colon), de-
scending the left side (descending
colon), and ends in the sigmoid
flexure and rectum (Fig. 70).

Mastication and Deglutition. —
The food when taken into the
mouth is cut and ground by the w,-
teeth, reduced to a fine pulp, and
mixed with the saliva, which
changes the starch that the food
contains into sugar by its active
principle, ptyalin. When suffi-
ciently masticated the food is carried backward to tlic
opening which leads into the pharynx, and is thrust
into the latter, the soft palate being lifted and its pillars
brought together, while the backward movement of the
tongue causes the epiglottis to incline backward and
downward over the glottis, thus forming a lid over
which the food can travel without dropping into the
;es. The epiglottis prevents the food from

PRACTICAL POINTS IN NURSING.

passing into the trachea, and the soft palate keeps it
from passing into the nasal cavities.

Stomach and Intestinal Digestion. — When the food
passes into the stomach it is rolled about and thor-
oughly mixed with the gastric juice until it is reduced
to the consistency of jjea-soup, called " chyme." It then
passes through the pylorus (a narrow opening at the
right end of the stomach), and the duodenum, the first
part of the small intestine adjoining the stomach. A
large quantity of the fluid (chyme) is absorbed through
the walls of the stomach and joins the blood-circulation.
When the food or chyme passes into the duodenum it is
mixed with the pancreatic juice and the bile, and is con-
verted into chyle, a milky fluid formed by the digestion
in the intestines of fatty particles of food. After passing
through the small intestines the food gradually loses its
nourishing properties, and finally enters the large intes-
tine, where it acquires its characteristic fecal odor and
color.

Secretions. — Some of the secretions of the body are :
saliva, perspiration, sebaceous matter, tears, gastric juice,
pancreatic juice, intestinal juice, milk, bile, and mucus.

In the month is the saliva < „ ^ ?. \, which changes
iPtyalinJ ^

starch into grape-sugar.

In the stomach is the gastric juice — water. pci>sin, hy-
drochloric acid — which digests albuminoids.

In the intestines are the juices of the intestines — bile,
pancreatic juice, water — which digest fats, starch, and
albuminoids.

Parotid Gland. — The parotid gland is situated below
and toward the front of the car. It secretes the saliva,
and it is inflammation of this gland that causes mumps.

PBYSIOLOGY AND DBSCRJPTiVi

293

Excretions. — The excretions are eliminated from the
ly by the skin, the lungs, the kidneys, and the bowels.

Urinary Org-anB. — The urinary organs arc the kid-
the ureters, the bladder, and the urethra (see page
The kidneys purify the blood by removing from

waste and worn-out material. They also regulate
te amount of water to be removed from the body, and
the amount to be retained in the body for resorption.

The Urine. — The urine is one of the excretions of the
body, and contains waste and worn-out material held
iolution, or " salts," as they are called, among which
rea, uric acid, urates, chlorids, and earthy phosphates.

The normal quantity of urine passed in the twenty-
four hours is from 30 to 50 ounces. The color is a light
amber, the reaction acid, and the specific grax'ity (by
which is meant the weight of the urine) averages from
■fOiS to 1024, or may be as high as 1030 without there
peing any disease. There is a characteristic aromatic odor.

The amount of urine is varied at difTereiit times,
more being passed during the day than
the night. Food and drink increase the
quantity. After profuse perspiration the
amount is decreased; while, on the con-
trary, cold decreases the activity' of the
skin, and consequently the flow of urine
is increased. Some diseases are charac-
terized by an increase or a decrease in
the amount passed ; as, for instance, one
of the first symptoms of diabetes melli-
tus is the increased amount of urine
passed daily, which amount may be as ^
high as 80 or ICO ounces, of a specific
gravity ranging from 1020 to 1045, which may indicate

PRACTICAL POmrs Iff JVL-XSI.VG.

Ttain

an abnormal amount of sugar in the urine, and the
may be a clear light yellow, without any sediment.

When there is an excess of sugar or urea, or of any of
the other substances in the urine, it does not follow that
the kidneys are diseased ; they may be perfectly heahhy.
and the change be due to some nutritive or other dis-
turbance; but when we find albumin in the urine, the
kidneys are generally diseased.

In acute diseases the quantity of urine may be dimin-
ished and its color and specific gravity be high. When
convalescence sets in the amount increases and the spe-
cific gravity may be found below the normal.

The odor of the urine is affected by taking certain
foods and medicines.

The ^o/or of the urine varies from a light amber
dark red (PI. 7). In nervous diseases the urine is
often pale, like water. In fever cases it is a high red color,
and is generally thick and loaded with sediment, because,
as the amount of food taken into the body is much less,
the wasting process is more active ; hence the amount of
solids in the urine is increased. Medicines influence the
color. Biie may give to it a dark-brown or a greenish
color, as will also carbolic acid ; iodoform will give to it
a dark smoky color.

The rcaclioit for the twenty-four-hour amount is acid.
After meals it may be neutral or alkaline. The reaction
is taken with blue litmus-paper, which, if the urine is
acid, will be turned red. If the urine is alkaline, it will
turn red litmus-paper blue, and if it is neutral (neither
acid nor alkaline), it will have no effect upon either red
or blue litmus-paper.

The specific gravity of urine is taken with the urijn
eter (Fig. 71). When taking the specific gravify-

P.LE ;e.l.».

LICHI YELLOW,

YELLOW.
nEDDISH YELLOW.
YELLOWISH RED.

BROWNISH RED.
REOOISH BROWN.
BROWNISH BLACK.

cor<I>ti|loVusel|W„lfl|,

FHYSIOLOGY AND DESCRIPTIVE ANATOMY. 295

urine is poured into the tall glass and in the middle is
dropped the urinometer. the number of degrees being
read from off the scale at the level at which it rests.

Tests of Urine. — To test for albumin a test-lube is
half lilled with unne and heat applied until boiling
occurs. If albumin is present, the urine appears cloudy,
and this cloudiness does not disappear on the addi-
tion of a few drops of nitric or acetic acid. Another
ready way, if nitric acid is at hand, is to pour some
of the acid into a small glass, incline the glass, and
pour down the side of it an equal amount of the clear
urine, which will spread over the acid ; if albumin is
present, there will be a sharp white ring between the
urine and the nitric acid. Very often we get this white
ring when the mixed urates are present, and it might be
mistaken for albumin ; but if urates are present and not
albumin, the white ring, or "zone." as it is called, will
not appear where the urine and nitric acid meet, but
higher up, and later will spread into the urine, and if it
is heated will disappear. When normal urine is poured
on nitric acid a brown ring appears between the urine
and the acid, due to the action of the acid on the color-
ing matters. Hence, when there is an abundance of
coloring matter the albumin precipitates may be simi-
larly colored.

A pretty test for sugar is to add to the urine an equal
amount of sodii hydrate, which will make the urine
alkaline, then add drop by drop a solution of sulphate
of copper; if sugar is present, the mixture turns a dark
navy-blue color. If this mixture is boiled, there will re-
sult a reddish-yellow precipitate ; tliis is Trommer's test.
Another test is to lake urine and liquor potass^ equal
parts, and add a little bismuth subnitrate ; this solution

296 PRACTICAL POJNTS IN NURSING.

when shaken and boiled, if sugar is present, will t
perfectly black.

2. DEScRiPTrvE Anatomy.
The anatomy of the body will not minutely be con-
sidered, but merely a brief description of the skin, the
muscles, and the bones, and the situation of the different
organs of the body will be given.

1. Skin. — ^The skin is the covering (integument) of the
body that protects the parts beneath it, and that regulates
tile heat of, and gives off waste material from, the body.
There are two layers of skin — an outer layer, the cpidir-
mis, and an inner layer, the cutis (derma) or true skin.
The latter is supplied with capillaries and nerves, and
bleeds freely if cut or pricked. The epidermis does not
bleed. Just below the cutis is a layer containing (at and
the larger arteries of the body. On some parts of the
body the skin is thicker than on others, as the palms of
the hands and soles of the feet, while in other parts, the
mouth, nose, rectum, etc., the skin apparently ends,
which is not the case; it is only very much thinner,
having two layers as before, the inner l.tyer (endotlie-
Hum) containing blood-vessels and nerves; the outer
layer, which is similar to the epidennis, is called the " epi-
thelium." The black color of the skin in the negro and
the tawny color among some of the white races are due
to the presence of pigment in the cells of the cuticle.
Developed from the skin arc the hair and the nails.

2. BonoB of the Body. — The bones are the frame-
work of the body ; they afford protection to the important
organs, and are covered with a fibrous membrane called
the "periosteum." There are in the body about 206
bones of different shapes and lengtlis. They arc divided

—i§

\\ ^^^

L i

-T.

Tbc Uumin M«le SkcleUm.

PBVSIOLOGY AND DESCRIPTIVE ANATOMY. 297

into three groups — ^bones of the head, of the trunk, and
of thf extremities (PI. 8), The femur or thigh-bone is
the largest, longest, and strongest bone in the body, and
the stapes (one of the httle bones of tlie ear) is the small-
est bone in the body.

The ends of bones, when jointed movably with others,
are covered with cartilage, having within the joint free
surfaces of great smoothness, which surfaces are lubri-
cated by the synovial fluid secreted from the synovial
membrane which lines the joints. The bones are further
held together by fibrous tissue in the form of ligaments.

Bones of the Skull. — The skull is a box of bone con-
taining the brain, which is a soft, pulpy substance and is
the chief organ of the nervous system. The skull is
composed of two plates of bone from which the brain is
separated a little distance.

The thickest part of the skull is at the back, where it
is half an inch thick, and the thinnest part is at the tem-
ples. Just above the eyes on the forehead the two plates
of bone are separated half an inch or more, so that when
a person is kicked by a horse or otherwise injured, the
outer table may be indented to a considerable extent,
and it may even affect the inner plate without injuring
the brain.

Bones of the Trunk : Thorax. — The thorax, or chest,
is bounded by the ribs, the breast-bone, and the back-
bone. The chest contains the heart and the lungs, and
also the large blood-vessels.

There are twenty-four ribs (twelve on each side), of
which the seven upper ones are called " true ribs ;" the
five lower are " false ribs." All the ribs are attached to
the spinal column by ligaments and cartilage, which hold
them in position. The seven true ribs are connected

298 PRACTICAL POINTS IN NURSING.

with the sternum (breast-bone) by means of fibrooS
bands. The 8th, 9th, and 10th ribs are each attached to
the lower border of the rib above it. The I uh and 1 2th
ribs are called " floating ribs," having only one attach-
ment, that of the spinal column. The sternum is the
breast-bone. The clavicle, or collar-bone, is a long bone
which articulates with the sternum and scapula. The
clavicle connects the upper extremity, which is divided
into shoulder, arm. forearm, and hand, with the body.
The scapula, or shoulder-blade, is a large, flat, triangular
bone held in place by the clavicle and muscles.

The spinal column, or the back-bone, extends from
the base of the skull to the lower extremity of the back,
and is composed of twenty-six bones called "' vertebne,"
piled one upon the other, making a strong pillar for the
support of the head and trunk. Between each of these
small bones is a layer of cartilage of an elastic character
which allows the body to bend in many directions.

The seven cen'ical (or neck) vertebrse extend from the
base of the skull to the shoulders, the twelve dorsal
(or back) vertebra: extend from the shoulders to the
lower ribs. Between each articulating pair of vertebrie
is an opening on each side for the passage of nerves
throughout the entire length of the column — the spinal
cord. The five lumbar (loin) vertebrae extend from be-
low the ribs to the pelvis, the bones of the sacrum and
the coccyx forming the extremity of the spine.

The pelvis is formed by the sacrum, the coccyx, and
the two ossa innominata. The female pelvis contains
the uiovib, ovaries. Fallopian tubes, bladder, and rectum
(see p. 308).

Bones of the Rvlremitics. — The humerus \s the largest
bone of the arm, and articulates with a shallow joint-

surface on the shoulder-blade. Under each arm is the
axilla, containing a great bunch of nerves and blood-
vessels and numerous glands. The forearm is com-
posed of two bones — the radius and ulna — the radius
being on the outer or thumb side of the forearm, where
we feel the pulse. The elbow-joint is called a " hinge-
joint," the movements being limited to flexion to an
acute angle and to extension in a straight line. Below
the forearm is the wrist, and next the hand.

The lower extrtntUy consists of the thighs, the legs,
and the feet.

The femur or the thigh-bone, has a round head, and
fits into a deep cup-shaped socket in the hip-bone.

The patella, or knee-cap, is a small flat bone situ-
ated in front of the knee-joint. The two bones of the
leg below the knee are the tibia and fibula. The tibia
is the stronger of the two, and is on the inner side of the
leg. It is joined to the femur, and the fibula, which is
long and slender, is joined to the tibia, and both articu-
late with the ankle-bone (astragalus).

3, MuBcIesof the Body. — The muscles are the fleshy
portions of the body, and by their contraction and relax-
ation are organs of motion. They arc divided into two
classes — those subject to the will, or voluntary muscles,
and those not subject to the will, or involuntary mu.scles.
of which the muscles of the heart and of the intestines
are e.Kamples. The muscles ditfer in length and form,
being long, short, broad, round, and flat. The smallest
muscle in the body is the stapedius (one of the muscles
in the ear), which is only \ of an inch in length, and the
longest muscle in the body is the sartoriiis, which is
over 18 inches in length, reaching from the hip to beli
the knee.

1 ^^1

300 PRACTICAL POINTS IN NURSING.

Running up from the sternum and clavicle to the
mastoid process is the sUrno-cleido-'mastoid muscle ; be-
neath this is a large artery which supplies blood to the
face and head, and the jugular vein, which, if opened,
may cause instant death.

The diaphragm is a sheet of muscle which separates
the cavity of the chest from the abdomen.

Tendons. — Tendons are white, glistening fibrous cords
which attach certain muscles to bone. The largest
tendon in the body is the tendo Achilhs inserted in the
heel-bone.

Fascia. — The fascia is a fibrous membrane covering
the muscles. It is very tough, does not stretch, neil'
can pus penetrate it.

4. Heart, Blood-vessels, and Lymphatica.
heart is a large muscular organ situated in the front part
of the left side of the chest, pointing toward the left, and
enclosed in a membraneous sac called the " pericardium."
The movements of the heart are involuntary — that is,
are not under the control of the will — and, though the
walls of the heart are constantly expanding to take in a
fresh supply of blood, and contracting to drive out the
blood, the heart has after each contraction a short rest
of about two-fifths of a second, which, as it comes regu-
larly every second, amounts at the end of twenty-four
hours to about nine hours of total rest (see Blood-cir-
culation, p. 285).

ArUries. — The aorta, which is the largest artery in the
body, springs from the heart. When it leaves the left
ventricle it forms an arch, then gives off branches which
divide and subdivide until they become yittry small ves-
sels, called " capillaries." The carotid arteries supply the
head and the neck. The subclavian arteries are

:nng

ithf^B
7)^1

ire in Uh^^

PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 3OI

Upper part of the chest. The axillary is a continuation
of the subclavian, and passes through the armpit and
down the inner side of the arm as the brachial artery.
This artery divides at the elbow into the ulnar and radial
arteries. The ulnar is on the inner side of the forearm,
and the radial is on the outer or thumb side, and both
supply blood to the hand and fingers. The aorta de-
scends through the thorax into the abdomen, and is
called respectively the " thoracic " and the " abdominal "
aorta.

The internal iliac artery supplies the walls and organs
of the pelvis. The external iluic runs along the brim of
the pelvis down the inner side of the thigh, where it
takes the name of the femoral artery, whose pulsations
can be felt in the groin. The femoral passes into the
back of the thigh and knee, and is called the "popliteal
artery." The leg and foot are supplied by the tibial and
peroneal arteries.

The lymphatics are the vessels which take up the
lymph from all parts of the body, with the exception of
the intestines, and return it into the venous system.

5 . Brain, Cord. Nerves, and Organs of the Senses.
— The brain is composed of gray matter at the surface
and white matter in deej^er portions. It is divided into
the big brain, or the cerebrum, and the little brain, or the
cerebellum, and is enveloped from within outward by
three membranes, the pia mater, the arachnoid, and the
dura mater. The brain is supplied with about one-fifth
of the amount of blood that the body posses.ses. The
brain gives off" twelve pairs of nerves which supply the
head and face (the organs of special sense), the heart,
the lungs, and the stomach.

Spinal Cord. — The medulla oblongata is the enlarged

PRACTICAL POINTS /.V Ni'RSrNG.

upper portion of the spinal cord witlun the skulL It re-
sembles the cord in being composed of both white and
gray matter. It is the headquarters of the important
lines which go to the heart, lungs, stomach, and
other prominent organs. The spinal cord is compo-sed of
gray and white matter, the gray matter being inside the
cord. It is covered with membranes similar to those of
the brain, the pia mater, the arachnoid, and the dura
mater. It is also divided into two halves, and gives off
thirty-one pairs of nerves, which supply the trunk, the
extremities, and portions of the head and neck (sec p.
298). At the beginning of the spinal cord the nerve-
fibres (see p. 254) cross from right to left, so that the
nerves at the right side of the brain supp!)' the left side
of the body and vice versa. Thus, when one side of the
brain is injured it is tlie opposite side of the body which
is aflected. This crossing is called the " decussation " of
the nerve-fibres.

The Hcn-ous system consists of the brain, the spinal
cord, and the nerves. Through it all the functions of
the body, both mental and physical, are performed.
Thought, sensation, and motion are all under the ci)n-
trol of the brain, which is the seat of government.

The brain, which is the chief organ of the nervous
system, may be regarded as a central telegraph office;
the gray matter along the spinal cord is the district
offices, and the nerves are the telegraph wires.

The nemes are composed of silvery-white fibres, and
funiish both sensation and motion. The sensory (sensa-
tion) fibres begin in the .skin and end in the brain, and
carry messages to the brain. The motor (motion) fibres
begin in the brain and end in the skin, and carry mes-
sages from the brain. When we want to lift up anything

ner

■^ 1

PHYSIOLOGY AND DESCRIPTIVE Atf ATOMY. 303

o move a hand, an arm, or a foot, the brain sends a
message over the nervous system to the muscle of what-
ever part we want to move. The muscles contract and
the part is moved. These are the nerves of motion, or
the motor nerves. Again, when we are being burnt with
a hot iron or injured in any way, however slight, the
nerves of sensation reflect the message to the brain ; then
'e feel the pain, and the brain instantly sends down the

;ssage over the motor fibres to move the part away.

The spinal cord gives off thirty-one pairs of nerves,
each nerve issues from the cord by two separate roots —
motor and sensory (motion and sensation). The cord
has the power of reflecting messages without sending
them to the brain ; as, for instance, if a message conies
up a sensory fibre that a foot is being injured, the gray
matter of the cord has the power of sending a me-ssage
the foot, through the motor fibres, to move the foot,

ic muscles contract, and the foot is moved.

The vasomotor nerves are the nerves controlling the
(lood- vessels.

Riflix aelion is involuntary action, such as winking or

lUghing and sneezing when the throat or nostrils are
ing to get rid of some irritating substance.

Eyfs. — The eye, strictly speaking, consists only of the
eyeball or eye-globe; but connected with the eyeball
externally are muscles, nerves, blood-ve.ssels, as well as
other parts specially designed for its protection (sec p.
112). The cavities containing the eyeballs are called
" orbits," which are about 1 \ inches deep. At the bot-
tom are small holes through which enter the optic

se. — The nose is composed of bone and cartilage.
r. — The ear is divided into three parts — the ex

304

PRACTl 'L rOJNTS IN NUKSI^^G.

;he internal

ternal ear or auricle, the middle ear, and the internal
ear (Fig. 72).

The aurick i^pinnd) is composed of cartilage covered
with skin {A), and has a tube about an inch long called
the " auditory canal " {G). The cavity of the middle car,
or the tympanum, is separated from the external canal by
the drum-membrane {T). This drum-membrane is about
one-eighth of an inch in diameter and j^^ of an inch in

thickness, and has three layers — one of skin, one of
fibrous tissue, and an inner layer of mucous membrane —
and is also supplied with blood-vessels and nerves. Tht
ear should not be picked with pins, as there is great d
ger of perforating the drum and causing deafness.
ntuidU car (P) contains the small bones of the ear, ti
incus, stapes, and malleus, which are the smallest I

PHVSroLOGY AND DESCRIPTIVE ANATOMY. 305

in the human body. The middle ear is connected with
the back part of the throat by the Eustachian tube (£),
the blocking of which causes deafness. The internal car
or labyrinth consists of the vestibule { Vf), the cochlea (S),
and three semicircular canals (/J), also the ends of the
auditory -nerve, the nerve of hearing. Behind the ear is
a prominence, the mastoid process, closely connected
with the ear and the brain. Any disease of the middle
ear may extend to the mastoid, and diseases of both the
middle ear and the mastoid are always liable to affect the
brain. "

6. Respiratory, Digestive, and tFrinary OrganB. —
The trachea (Fig. 73, 3) extends from the larynx to the
lungs, then divides into two branches called "bronchi."
These again divide into smaller tubes called " bronchial
tubes," which finally terminate in extremely fine air-cells.

The lungs (Fig. 73, 4-6, 7, 8) are the organs of res-
piration. They have a light, spongy appearance, and
crepitate or crackle when pressed with the fingers, owing
to the contained air in them. There are two lungs, one
on each side of the chest. The right lung is larger
than the left and has three lobes ; the left lung, being
smaller, owing to the room taken up by the heart, has
only two lobes.

The abdomen contains the stomach, liver, spleen, intes-
tines, kidneys, and ureters. It is the largest cavity in the
body, and is separated from the chest above by the dia-
phragm and from the pelvic cavity below by the brim of
the pelvis. It is not, like the chest, protected on all
sides by bone, and consequently its contained organs
are easily injured.

The stomach lies on the left side directly under the
iieart (see p. 290).

3o6 PRACTICAL POINTS fJV XC'RS/nG.

The Ih-er, the largest gland of the body (weighini
from 50 to 60 ounces), is situated on the right side of the
body under cover of the ribs. Attached to the under
side of the liver is a bag called the " gall-bladder." large
enough to hold about 1 ounce of bile, which is a green-
ish-yellow secretion of the liver. Jaundice is caused b

stoppage of the gall-duct, the bile being carried into
the blood and throughout the circulation,, and givi
the whole body a yellow appearance.

and tnvinp

PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 3O7

^ The pancreas, or sweetbread, lies across the abdomen
jelow the liver, nearly touching the spleen on the left.
The secretion or juice of the pancreas is concerned in
the digestion,

The spleen is situated at the heart end of the stomach
beneath the diaphragm. Its function is obscure.

The peritoneum i.s the serous membrane which lines
the abdomen and covers the various organs.

The intestines are part of the alimentary canal {see p.
2901 continuous with the stomach ; the small intestine is
about 20 feet long, and lies in convolutions or coils in
the abdomen, ending in the large intestine, (which is
about 5 feet long, and runs up the right side of the body,
cros.scs over under the liver and stomach and down the
left side, ending with the rectum. The duodenum is
the first part of the small intestine near the stomach.
The ileum is the lower half of the small intestine ; the
ileo-eeeal valve is the valve between the ileum and the
cecum.

The eeeum is the head of the colon, and lies in the
lower part of the right side of the abdomen. Opening
from the cecum is the vermiform appendix {Vi^. 70), a
narrow worm-shaped tube from 2 to 5 inches long. Its
opening is guarded by a valve, but sometimes food, seeds,
fruit-stones, or hard fecal matter slips into the appendix,
and inflammation may result (appendicitis).

The eolon is the first part of the large intestine, and
passes up the right side as the ascending colon, across
the body as the trans7'erse colon, and down the left side
as the descending colon, where it forms the sigmoid flex-
ure (Fig. 70). which is curved like an S. and which serves
to remove the fecal matter from the body, this action

» done by muscles of its t

The colon ends in

PRACTICAL POINTS IN NURSING.

the rectum, which is from 6 to 8 inches long, and which
terminates at the anus.

The omentum is a fold of the peritoneum l^ng in
front of the bowels like an apron.

The kidneys are situated at the back part of the ab-
dominal cavity, one on each side of the upper lumbar
region of the spine. They are about 4 inches long, 2
inches wide, and i inch thick ; the right kidney is a
little lower than the left on account of the large space
taken up by the liver. The kidneys excrete the urine,
which is carried by a tube {from 12 to 16 inches long)
called the " ureter," attached to each kidney, and em[^-
ing into the bladder. The urine passes drop by drop
from the ureters into the bladder, which holds about a
pint, and which is emptied by the process of urinatioD.
If the urine is retained in the bladder a long time, it may
decompose, or rupture of this organ may take place
through over-distention.

The bladder is situated in the front portion of the pd-
vis, is ovat in shape, and holds about a pint

The urethra is a small canal that conveys the urine
from the bladder. The opening of the urethra (the
meatus urinarius) opens immediately above the entrance
into the vagina.

7. Internal Female Organs of Qeneration (PI. 9). —
The womb or " uterus," as it is more commonly called, is
a hollow, pear-shaped organ about 3 inches long and 2
inches broad at the top, or fundus, and about 1 inch thick.
It consists of the fundus, which is the rounded upper
portion, into each side of which enters a Fallopian tube,
of a body, and of a cen'ix or neck, which projects into
the vagina, and which is about i inch long. The os uteri
is the mouth of the womb. The womb is situated be-

PHYSIOLOGY AND DESCRIPTIVE ANATOMY. 3O9

tween the bladder and the rectum, and any distention of
either of these organs alters its position ; for instance, if
the bladder is distended with urine, the womb is tipped
backward, and if the rectum is distended with fecal mat-
ter, it is tipped forward.

The broad ligaments^ which are composed of folds of
peritoneum, connect the sides of the womb with the
walls of the pelvis, so that the womb is suspended in the
pelvis.

The Fallopian tubes are from 3 to 5 inches long. They
are attached at one end to the top of the womb, while
the other end has a fringe-like appearance, called the
" fimbriated extremity," part of which is attached to an
ovary.

The ovaries are two small oval bodies about i \ inches
in length. They lie on either side of the womb about i
inch from its top, and are enclosed between layers of the
broad ligament.

APPENDIX.

I. GENERAL RULES FOR FEEDING THE SICK,
AND HOW TO MAKE CERTAIN ARTICLES OF
FOOD.

I. Serving the Food.
The question of serving food, which is one of educa-
tion and training, is of vast importance in the successful
nursing of private patients. Much depends upon obser-
vation and tact. Little things art more apt to influence
the condition of the patient than large ones, and, no
matter how much medical care the patient has received,
or how successfully a difficult operation has bei;n per-
formed, or how attentive the nurse has been, the advan-
tages may all be lost through some trifling mistake in
I the serving of the food. The laboring man is content
to eat bread and meat with his fingers and to drink
tea from his dinner-pail, but it would make a refined
toan or woman very unhappy to be compelled to eat
from broken dishes and to be served by a nurse who
qnlied the liquids, who held a cup or a tumbler at the
rim in offering drink, instead of holding it at the bottom
or by the handle, who served the food cold, who tasted
the food in the patient's presence, who had unclean
hands, or who wore a soiled apron.

The serving of food requires a great deal of judgment
and good taste, and in no branch of her work can a nurse

312 APPENDIX.

be of more service to a sick patient than in her ability to
serve properly the food. The taking of food is the chief
event of the day for a sick patient, and the patient'*
mind should be diverted froni her illness in the anticipa-
tion of the meal, which should be served daintily and, if
possible, should something unexpected.

The tastes »>f the r, should be consulted

as far as possiblt *ise to ask the patient

beforehand concc fare, as it is often the

unexpected whic she expresses a prefer-

ence for a Certain « supplied, provided it

is sanctioned by ■

Punctuality she iji serving the meais;

as frequently the appeuie \.... un; lost if the meal is de-
layed beyond the accustomed hour. When a patient is
very ill only the simplest foods are given, and these are
prescribed by the doctor. Fluids can conveniently be
taken by suction through a bent-glass tube or by a
pretty feeding-cup with a spout, the cup being carried to
the bedside on a small tray covered with a spotless nap-
kin. The mouth of the patient must afterward be wiped
dry with a fresh clean napkin (not with the comer of a
face -towel). \Vhen convalescence sets in it becomes
nece.ssarj' to vary the food. The dishes selected .should
be savory, sufficiently varied, and suited to the digestive
power of the patient.

In preparing the tray the nurse should be sure first
that it is clean on both sides, then to cover it with a
.spotless tray-cloth, and the dishes, which should be the
prettiest and best that the house affords, should be sys-
tematically arranged upon it. The tray must not be
crowded, and discord in color should always be avoided.
A few flowers in a small vase or laid loosely on the tray

FEEDING THE SICK.

will add to its attractiveness. Too little rather than too
much food should be served, and plenty of time be
allowed for the meal, so that the food will be thoroughly
masticated and mixed with the digestive juices. Hot
food must be served hot. the dishes having previously
been heated and wiped dry on the outside, and cold food
must be served cold, lukewarm food being unjialatable.
Pains must be taken not to spill the liquids.

When a patient is permitted to sit up out of bed for
an hour each day, it is generally best to utilize this hour
for dinner, which, being the principal meal of the day,
will then be thoroughly enjoyed, and will also be better
digested by the patient. If the patient lakes the meals
in bed, care must be taken that a comfortable position is
secured and that the legs are not cramped by the food-
tray.

Every nurse of to-day knows .lomething of the sci-
ence of bacteriology, and that foodstuffs, especially the
animal portions, become spoiled through the presence in
them of bacteria. Nurses have also heard lectures on,
and understand the vast importance of. asepsis in sur-
gical nursing ; they would not think of doing a surgical
dressing without first making their hands and everything
to be used about the dressing aseptic, as the lack of such
care might cost the patient her life. The nurse should
be equally careful about cleansing the hands before hand-
ling food, because, not knowing what germs are on her
hands, it is possible thus to infect milk or other food
with the bacillus of tuberculosis or of other disease. It
is in the weakened stomach of the baby and of (he inva-
lid that bacteria develop and cause harmful results. That
one has good health notwithstanding the careless prepa-
ration of the food he eats, that he eats fruit which has

314

APPENDIX

passed through an endless series of dirty
cools the liquids he drinks witli ice gathered from ponds
impregnated with every form of bacteria, and tliat a
healthy stomach has the power to destroy many gei
are no arguments against absolute cleanliness and n*
ness when serving food to the sick.

A surgical dressing must be done before meal-time, and
all traces of the dressing cleared away. The bed must
be arranged, the patient's hands and face be bathed, and
the room set in order before serving the meal. While
eating the mind of the patient should be diverted by
cheerful conversation, and the tray be removed as soon
as the meal is finished.

In most fevers patients are allowed to have a lil
supply of water or bevcrage.t, such as orangeade, lemi
ade, etc., which flush out the kidneys and aid in elimii
ting the worn-out material generated in the body by
fever. Eight grains of sodium bicarbonate, soda-water,
or Vichy water will render sour lemonade eflerve-scing
and will make a very refreshing beverage. Cold drinks
should be sipped slowly, the thirst being relieved much
better by sipping fluids than by quickly drinking them.
Strong black coffee should be added to milk ; it is a
heart- and brain-stimulant, and is very useful in typhoid
fever when the patient seems to be sinking into a stupor.
The dUt-kitchcH outfit may consist of the following
appliances and accessories:

A spirit- or gas-light chafing-dish;

A single porcelain-lined saucepan ;

A double porcelain-hned saucepan ;

An 8-ounce measuring-glass;

A minim measuring-glass;

A cooking-thermometer;

ibeB^H
min^^^H

FEEDING THE SICK,

315

A mince-meat machine ; spoons ; a glass funnel ;

Borax ; sodii bicarbonate ;

Pancreatin powders.
These, together with other essential articles, should be
kept, if possible, in a small room next the patient's bed-
room, where light foods can be prepared.

Diet in Convalescence. — ^The following sick-room
dietary has been prepared as a guide for feeding conva-
lescents. The diet for convalescence from typhoid fever
may also be selected from it

First Day.

Breakfast : Mutton broth with bread-crumbs.
Lunch : Milk-punch.

Raw oysters; thin bread and butter with
crust removed; sherry wine.

Cup of hot beef-tea.

Milk toast ; jelly ; cocoa.

Dinner :

Lunch :
Supper :

Lunch :
Dinner :

Second Day.

Breakfast: Oatmeal with sugar and cream; cup of

cocoa.
Soft custard.
Small piece of tenderloin steak, to be

chewed, but not swallowed; baked white

potato.
Glass of milk.
Buttered milk-toast (crust removed); jelly;

cocoa.

Lunch :
Supper :

Third Day.

Breakfast : Soft-boiled egg ; bread and butter ; coffee.
Lunch : Milk-punch.

3>6

Lunch :
Supper :

APPENDIX.

Chicken soup; tender sweetbreads ; Bavarian
cream; light wine.

Raw oysters ; bread and butttr ; tea.

Breakfast; Oatnn

and cream ; a tender
ed potatoes ; Graham
oflee.

Lunch :

Glass.

Dinner;

Chicke

;d potato ; bread ; tapi-

Lunch ;

Cup of

oth.

Supper:

Buttered dry toast (crust removed); wine

jelly ; banquet crackers ; tea.

Fifth Day.

Breakfast :

: An orange; a scrambled egg; oatmeal with

sugar and cream; soft buttered toast;

coffee.

Lunch :

Milk-punch.

Dinner :

Cream-of-celery soup ; a small piece of ten-

derloin steak ; a baked potato ; snow pud-

dint; ; bread ; wine.

Lunch :

An egg-nog.

Supper :

Calfs-foot jelly ; .soft-boiled egg ; bread and

butter; cocoa.

Sixth Day.
Breakfast : Oatmeal ; poached eggs on toast ; coffee.
Lunch : Cu]) of chicken broth.

Dinner: Chicken soup; small slice of tender roast
beef; baked potato; rice pudding; bread.

RECIPES.

317

Lunch :
Supper :

Glass of milk.

Baked apples ; raw oysters ; bread and but-
ter; orange jelly; tea.

Lunch :
Dinner :

Seventh Day.

Breakfast: An orange; mush and milk; scrambled

eggs; cream toast; coffee.

Cup of soft custard.

Mutton soup ; small piece of tender beef-
steak; creamed potatoes; sago pudding;
bread; wine.

Cup of beef-tea.

Sponge-cake with cream ; buttered dry toast ;
wine jelly; cocoa.

Lunch :
Supper :

Eighth Day.

Breakfast: Boiled fresh fish; oatmeal; Graham bread;

coffee.
Chicken-broth.
Potato soup; breast of roast chicken; mashed

potatoes ; macaroni ; blanc-mange.
Cup of mulled wine.
Cream toast; lemon jelly; chocolate.

Lunch :
Dinner :

Lunch :
Supper :

The dietary for succeeding days may be selected from
that of preceding days. Change of diet may cause a
temporary rise in the temperature and pulse.

2. Recipes for Invalid Foods and Beverages.

Simple Farinaceous Foods. — Arrowroot. — Mix i
teaspoonful of Bermuda arrowroot with 4 teaspoonsful
of cold milk. Stir it slowly into half a pint of boiling
milky and let it simmer for five minutes. It must be

JlS RECIPES.

stirred all the time, to prevent lumps and to keep it from
burning. Add half a teaspoonful of sugar and a pinch
of salt, and if desired one of cinnamon. In place of the
cinnamon half a teaspoonful of brandy may be used or a
dozen large raisins may be boiled in the milk. If the
raisins are preferred, they should be stoned and the
sugar may be omitted.

Com-starch or rice-flour gruel is made in the
way.

Boiled-flour Gruel. — Moisten I pint of flour with 3
ounces of cold water; make it into a ball and lie it up
tightly in a strong cloth. Slightly dampen the cloth,
sprinkle it with flour, and boil it hard for ten hours;
then take off the cloth, and let the ball dry in a slow
oven for ten hours more. Grate 2 teaspoonsful of flour
from the dry ball, mix the grated flour with cold water
to a smooth paste, and stir it into a \ pint of boiling
milk. Simmer about three minutes, and sweeten.

Oatmeal. — Salt to taste 3 parts of boiling water ; then
stir in slowly [ part of oatmeal (H. O.) ; boil rapidly
from twenty to thirty minutes ; serve either hot or c(
with cream or milk and sugar.

Oatmeal Gruel No. 1. — Take 2 tablespoonsful of
meal, I saltspoonful of salt, and i quart of boiling wa(
Boil one hour. Strain and serve with milk or en
(Mrs. Lincoln).

Oatmeal Gruel No. 2. — Pound \ cup of coarse oat-
meal until it is mealy. Put it in a tumbler, and fill the
tumbler with cold water. Stir well; let it settle; then
pour off the mealy water into a saucepan. Fill again
and pour oflfthe water, and again repeat this, being care-
ful each time not to disturb the sediment in the bottoin,
of the tumbler. Boil the water twenty minutes.

jidly

». Seasq^^l

ith salt. Thin with a little cream or milk. Strain and

; hot (Mrs. Lincoln).
Beef*teas and Extracts. — The best pieces for beef-

; the round and i

3 they c

contain the most
and best-flavored Juices. Wipe the meat with a wet
cloth and remove all fat and skin. Beef-tea should not
be allowed to boil, but should be kept at the temperature
hich albumin coagulates, which is from 134° to 160°.
iiling water coagulates it, and beef-tea made in this
Tway is without value as food. It is a stimulant. Beef-
extract is the pure juice of the meat. Beef-tea is the
juice diluted with water. The meat should be cut into
small pieces, as, more surfaces being exposed to the
iter, the juices will be drawn out more quickly. Beef-
should not be .strained, as the sediment contains the
itritious part.

Mince finely 1 pound of lean, juicy

■f. from which all the fat has been removed; put into

wide-mouthed bottle or fruit-jar and cork tightly. Set

jar in a kettle of cold water over a slow fire, and

it boil for three hours. Strain and season with salt

and red pepper.

Bottled Beef-extra,ct. — Cut ! pound of lean beef
into small pieces. Put it into a large-mouthed jar or
bottle. Place the jar, covered, in a kettle of cold water.
id heat slowly until near the boiling-point. Keep it at
is temperature for two hours. Strain and press the
to obtain all the juice. Season witli salt. The
iter in the kettle should come nearly as high as the
Bleat in the jar. In administering beef-extract, be care-
ful to stir up the sediment.

Beef-juice. — Place a ^ pound of lean, juicy beef on a
broiler over a clear hot fire and heat it through. Press

320 APPENDIX.

out the Juice with a lemon-squeezer into a hot cup, aW'
salt, and serve hot with toast or with crackers.

Beef-tea. — Free i pound of lean beef from fat, ten-
don, cartilage, bone, and vessels; chop up fine, put into

1 pint of cold water to digest two hours. Simmer on
range or stove three hours, but do not boil. Make up
for water lost in the evaporation by adding cold water,
so that a pint of beef-tea represents i pound of beef
Press the beef carefully and strain and flavor to taste.

Beef-tea may rapidly be prepared by placing the jar
containing the meat, finely divided, without any water,
in an oven for twenty minutes, then add boiling water
according to the quantity required.

Beef-tea Peptonized. — To a \ pound of raw beef, free
from fat and finely minced, add lo grains of pepsin and

2 drops of hydrochloric acid. Put this mixture in a
large tumbler and cover with cold water. Let it stand
for two hours at a temperature of 90° F., being fre-
quently stirred. Strain and serve in a red glass, ice-
cold. Peptonized food does not keep well, and should
never be used more than twelve hours old.

Beef-tea with Oatmeal. — Mix 1 teaspoonful of well-
cooked oatmeal with 2 tablespoonsful of boiling water,
Add I cupful of strong beef-tea and bring to the boil-
ing-point. Salt and pepper to ta.ste and serve with toast
or with crackers. Rice may be used instead of the
oatmeal.

Raw-meat Diet. — Scrape pulp from a good steak,
season to taste, spread on thin slices of bread; scar
bread slightly and serve as a sandwich.

Meat Cure. — Procure a slice of steak from top of the
round — fresh meat without fat ; cut the meat into Strips,
removing all fat, gristle, etc. with a knife. Put the meat

FECIPES. 321

Sirough a mincer at least twice. The pulp must then
be well beaten up in roomy saucepan with cold water or
skimmed beef-tea to the consistency of cream. The
right proportion is 1 teaspoonful of liquid to S tea-
spoonsful of pulp; add black pepper and salt to taste;
stir the mince briskly with a wooden spoon the whole
time it is cooking, over slow fire or on cool part of cov-
ered range, until hot through and through and the red
color disappears. This requires about half an hour.
When done it should be a soft, smooth, stiff J>uri'c of the
consistency of a thick paste. Serve hot. Add for first
few meals the softly-poached white of an egg.

Sweetbreads. — Keep llie sweetbreads in cold water
until ready to use ; then remove the fat, pipes, and mem-
branes. Put them into boiling salted water, add i table-
spoonful of lemon-juice, and cook twenty minutes.
Drain and cover with cold water. Let them stand a
few minutes, then drain, and they are ready to be pre-
pared for the tray.

Broths. — Chicken Brotli. — Skin and chop up a small
chicken or half a large fowl: put, bones and all, with a
blade of mace, a sprig of parsley, i tablespoonful of rice,
and a crust of bread, in a quart of water and boil for an
hour, skimming it from time to time. Strain through a
coarse colander.

Clam Broth. — Wash thoroughly six large clams in
the shell; put them into a kettle with 1 cupful of water;
bring to boil, and keep it boiling one minute : the shells
open, the water takes up the proper quantity of juice, and
the broth is ready to pour off and .serve hot. Add a tea-
spoonful of finely pulverized cracker- crumbs, a little but-
ter, and salt to taste.

Mutton Broth. — The lean part of the neck or loin

322

APPF.A'D/X.

m Wash

should be chosen, be cut up into small pieces, and all
superfluous fat be removed: about i pound of mutton
thus prepared should be placed in a saucepan containing
I pint of cold water and placed on the fire ; as the scum
rises to the top it should carefully be removed; when
this ceases let the broth boil for about two hours, strain,
and flavor. A teaspoonful of pearl barley, added when
the broth begins to boil, is often acceptable. Warm up
as wanted.

OvsTEKs. — Fricaeseed Oysters. — To I cupful of milk
add a J cupful of oyster liquor. When the liquids boil
add I teaspoonful of flour and J teaspoonful of butter,
rubbed together ; boil until it thickens ; then add i
dozen oysters: cook until the oysters are plump and
their edges curl; serve immediately, plain or on toast.

Peptonized Oysters. — Mince 6 large or 13 small
oysters; add to them, in their own liquor, 5 grains of
extract of pancreas with 15 grains of sodium bicarbonate
(or one Fairchild peptonizing tube). This mixture is
then brought to blood-heat (98" F.), and maintained,
with occa.sionat stirring, at that temperature thirty min-
Lrtes, when i pint of milk is added and the temperature
kept up from ten to twenty minutes. Finally, the mass
is brought to the boiling-point, strained, and served.
Gelatin may be added, and the mixture served cold as
a jelly. Cooked tomato, onion, celery, or other flavor-
ing suited to individual taste may be added at beginning
of the artificial digestion,

Oyeter Stew. — Take i pint of oysters, 1 pint of milk,
I teaspoonful of salt, J^ cupful of water, I tablespoonful
of butter, I saltspoonful of pepper. Scald the milk-
Wash the oysters by adding the water, and remove all
ir^bells. Drain, saving the liquor. Put the liquor into

XEC/FES. 333

I stewpan and heat slowly. Skim carefully. When

ir, add the oysters and cook- slowly until the edges

it! and they are plump. Add tlie hot milk, butter.

alt. and pepper, and serve. Do not let the oysters boil,

s that toughens them and renders them indigestible.

Oyster Broth. — Cut into small pieces i pint of oys-

■s ; put them into a ^ pint of cold water, and let them

aimer gently for ten minutes over a slow fire. Skim,

ain, and add salt and pepper.

Puddings. — Arrowroot Pudding-. — Add the yolks of

I eggs to the plain arrowroot recipe (see p. 317). with

( teaspoonful of powdered white sugar, mix well and

ike in a lightly buttered dish for ten or fifteen minutes.

CuBtard Pudding. — Break I egg into a teacup, and

nix thoroughly with sugar to taste; then add milk to

Karly fill the cup, mix again, and tie over the cup a

mall piece of linen ; place the cup in a shallow sauce-

I half full of water and boil for ten minutes.

If it is desired to make a Light Batter Pudding, a

K>onful of flour should be mixed in with the milk

efore tying up the cup.

I Corn-flour Pudding. — Take 1 pint of milk, and mix
Irith it 2 tabiespoonsful of the flour: flavor to taste,
len boil the whole eight minutes ; allow it to cool in a
mould, and serve up with or without jam.

Bice Pudding, — ^Take i teacupful of rice ; wash and
pour over it boiling water, and let stand five minutes;
then drain off the water and add a cupful of sugar to the
rice, a little nutmeg, 2 quarts of milk, and one egg. Bake
slowly about two hours, stirring occasionally until the
last half hour, then brown.
Sago Pudding. — Same as above recipe, sago being
—substituted for rice.

324 APFENDIX.

Snow Pudding,— Dissolve half a box of gelatin in i
pint of cold water; when soft, add i pint of boiling
water, the grated rind and juice of 2 lemons, and z\
cupsful of sugar. Let the gelatinized water stand until
cold and begins to stiffen. Then beat in the well-beaten
whites of 5 eggs. Pour into a mould and set on ice.
Serve with Custard Sauce — i quart of rich milk, the
yolks of 5 eggs, with i extra eggs added, and a \ cup-
ful of sugar. Flavor with vanilla.

Soups. — Chicken Soup, — An old fowl will make a
more nutritious soup than a young chicken. Skin, cut
it up, and break the bones with a mallet. Cover well
with cold water, and boil slowly for three or four hours.
Sail to taste, A little rice may be boiled with it if
desired.

Mutton Soup. — Cut up fine 2 pounds of lean mutton,
without fat or skin. Add i tablespoonful of barley, i
quart of cold water, and a teaspoonful of salt. Let It
boil slowly for two hours. If rice is used in place of
barley, it will not need be put in until half an hour before
the soup is done.

Potato Soup. — Mash 6 boiled potatoes, i quart of
milk, \ pound of butter. Season with pepper and salt
While mashing the potatoes add the butter and gradually
pour in the milk. Stir well and strain through a sieve,
and heat once more. Beat up an egg and put it in the
soup-tureen, and pour over it the soup when ready to
serve.

White-celery Soup. — To a \ pint of strong beef-tea
add an equal quantity of boiled milk, slightly and evenly
thickened with flour. Flavor with celery-seeds or pieces
of celery, which are to be strained out before serving.
Salt to taste.

Miscellaneous Dishes. — Macaroni. — Take of the
macaroni \ of a pound and break into inch-lengths, and
cook twenty minutes in 3 pints of salted boiling water.
Turn it into a colander and pour over it cold water and
drain. Make a sauce of i tablespoonful each of butter
and flour and i^ cupsful of hot milk; salt. Put on a
dish alternately a layer of macaroni, then a layer of the
sauce, covering the top layer with fine bread-crumbs
and with bits of butter dotted over (a httle cheese may
be grated over). Bake until brown.

Creamed Potatoes. — Put I tablespoonful of butter
into a frying-pan, and when it bubbles add 1 tablespoon-
ful of flour; add 1 cupful of hot milk; salt and pepper
to taste. Then put in i pint of cold boiled potatoes,
cut into small dice; cook until thoroughly hot and
, serve.

Omelet. — Take 4 eggs, 4 tablespoonsful of milk. ^

faspoonful of salt. I saltspoonful of pepper, Boat the

slightly with a spoon until you can t.ike up a

toonful. Add the salt, pepper, and milk. Mix well.

tablespoonful of butter into a hot omelet-pan.

' When melted and hot pour in the egg, letting it spread

over the pan. When the egg begins to harden, draw

the cooked part back toward you, letting the uncooked

r*gg take its place. So continue until the egg is of a

Bcrcamy consistency. Place the pan over the hottest

Fpart of the fire for a few seconds to brown the omelet

slightly. Fold over and turn out upon a hot plate (Mrs.

Lincoln).

Poached Egge. — Have a frying-pan nearly full of hot
water, not boiling but simmering. Add 1 teaspoonful
of salt. Pl.ice in the pan as many muffin rings as there
Are eggs to be cooked. Break the eggs carefully into

326 APPENDIX.

the rings. Dip the water over them with a spoo
a film has formed on the top of the yolk and the white
is firm. Remove the rings and take up the eggs with a
skimmer. Ser\c on buttered toast. Place a bit of but-
ter and a little salt and pepper on each egg.

Scrambled Eggs. — Take 4 eggs, J teaspoonful of
salt, I saltspoonful of pepper. \ cupful of milk, i table-
spoonful of butter. Beat the eggs slightly, add the salt,
pepper, and milk. Put the butter into a saucepan ; when
melted and hot add the eggs. Stir over hot water until
of a soft, creamy consistency. Serve on buttered toast.

Soft-boiled Eggs, — Drop 2 eggs into enough boiling
water to cover them. Let them stand on the back of
stove where the water will keep hot, but not boil, for
eight minutes. An egg to be properly cooked should
never be boiled in boiling water, as the white hardens
unevenly before the yolk is cooked. The yolk ^id
white should be of a jelly-like consistency.

Chicken panada is made by rubbing together in a
mortar the meat from the breast and wings of a roast or
a boiled chicken, with an equal quantity of stale bread;
then add gradually the water in which the chicken was
boiltd or other broth; boil for few moments and mb
through a fine sieve.

Infant's Food, — About I teaspoonful of gelatin should
be dissolved by boiling in \ pint of water. Toward the
end of the boiling i gill of cows milk and 1 teaspoonful
of arrowroot (made into a paste with cold water) are to
be stirred into the solution, and from 1 to 2 lablespoons-
ful of cream added just at the termination of the cook-
ing. It is then to be moderately sweetened with white
sugar, when it is ready for use. The whole preparation
should occupy about fifteen minutes.

Prepared Milk. — Peptomzed Milk — Cold ProceBB.
*— Into a clean quart bottle put i peptonizing powder
(extract of pancreas 5 grains, sodium bicarbonate 15
grains) or the contents of i peptonizing tube (Fairchild);
add I teacupful of cold water, shake ; add i pint of
fresh cold milk; shake the mixture again, and place
on ice. Use when required without subjecting to heat.
Milk so prepared will have a faintly bitter flavor; it may
be sweetened to taste or used in punch, gruels, etc.. like
ordinary milk.

Warm Prooess. — Mix the peptonizing powder with
water and milk as described above; place bottle in water
so hot that the whole hand can be held in it for a minute
without discomfort; keep the bottle there ten minutes;
then put on ice to check further digestion. Do not heat
long enough to render the milk bitter. Peptonized milk
may be sweetened, flavored with grated nutmeg, or
taken with carbonated mineral water. Put the mineral
water first into the glass, then quickly pour in the pep-
tonized milk, and drink during effervescence.

Sago Milk. — Wash I tablespoonful of pearl sago and
soak it over night in 4 tablespoonsful of cold water. Put
the sago into a double kettle with 1 quart of milk and
boil until the sago is nearly dissolved. Sweeten to taste
and ser\'e either hot or cold.

Koum;&B. — Take an ordinary beer-bottle with patent
shiflable stopper ; put in it 1 pint of milk, the sixth part
of a cake of Fleischmann's yeast, or i tablespoonful of
fresh lager-beer (brewer's) yeast, J tablespoonful of white
sugar reduced to syrup; shake well and allow to stand
in refrigerator two or three days, when it may be used.
It will keep there indefinitely if laid on its side. Much
waste can be saved by preparing the bottles with ordi-

328 APPENDIX.

nary corks wired in position and drawing off the koumyss
with a champagne tap.

Toasted Bread. — Toast (dry). — Cut thin sUces of
bread into strips; toast carefully and evenly without
breaking, slightly butter, and serve immediately on a hot
plate.

Cream Toast. — Take i cupful of cream, i saltspoon-
ful of salt, 2 slices of dry toast. Scald the cream. Add
the salt, and pour it over the toast, or make the same as
milk toast, using cream in place of the milk. If pre-
ferred, the slices of toast may be first dipped in hot salted
water.

Egg Toaat. — Take 1 egg. i saltspoonful of salt, i
cupful of milk, 6 .slices of bread. Beat the egg sliglilly.
add the salt and milk. Soak slices of bread in this unlii
soft. Butter a hot griddle, put on the bread ; when one
side is brown, put a bit of butter on each slice, then turn
and brown the other side. Serve with sugar and cinna-
mon (Mrs. Lincoln).

Milk Toast. — Take I cupful of milk. \ tablespoonful
of corn-starch. \ tablespoonful of butter, 2 slices of dry
toast, I saltspoonful of salt. Scald the milk. Melt the
butter in a saucepan ; when hot and bubbling add the
corn-starch, Pour in the hot milk slowly, beating all
the time until smooth. Let it boil up once. Then add
the salt. Toast two slices of bread. Pour the thickened
milk over the slices. Let it stand five minutes. Scr\'e.

Peptonized Milk Toast. — Over 2 slices of toast pour
I gill of peptonized milk (cold process); let stand on
the back part of the range for thirty minutes. Serve
warm or strain and serve fluid portion alone. Plain
light sponge-cake may be similarly digested.

Invalid's Lunch. — A nice way to prepare a very light

SIT

nch for an invalid (to be taken with a cup of tea) is to
;t 3 milk crackers; then pour boiling water over
lem. drawing it off immediately ; spread jam or mar-
ilade over the toasted crackers and pile them up on a
Ksh. Set the dish of crackers in the oven while making
tea, and take both to the sick-room. This lunch
jWill prove appetizing and refreshing if unexpected.
Desserts. — Baked Apples. — Core and pair 2 tart
>ples ; 61i the core-holes with sugar; grate over the
httle nutmeg; add a little water to baking-pan
id put in oven and bake until the apples are soft. Serve
ith rich milk or cream. Sprinkle with icing sugar if
not sweet enough.

Bavarian Cream. — Whites of 6 eggs beaten very
light ; I quart whipped cream ; i ounce of gelatin (soak
one hour in cold water, drain, and dissolve in a little hot
water) ; flavor with i teaspoonful of vanilla. Beat the
eggs and cream together, add the sugar to sweeten,
flavor, then add the gelatin. Beat again until the mix-
ture begins to thicken, and pour into moulds. Serve
very cold with cream.

Blanc-mange of Eice. — Simmer a J pint of milk with
tablespoonful of pounded white sugar until near boil-
then stir in 2 ounces or i large tablespoonful of
ground rice previously mixed with a ^ pint of milk until
smooth ; boil for ten minutes, stirring all the while, and
pour into a moistened mould and ser\-e cold.

Soft Custard. — Take of corn-starch 2 tablcspoonsful
1 quart of milk; mix the corn with a small quantity
the milk and flavor; beat up 2 eggs. Heat the re-
mainder of the milk to near boiling ; then add the mixed
com. the eggs, 4 tablcspoonsful of sugar, a little butter,
and salt Boil the custard two minutes, stirring briskly.

330

APPENDIX.

Calf' H-foot Jelly. — Thoroughly clean 2 feet of a
cut into pieces, and stew in 3 quarts of water until
duced to I quart ; when cold take off the (at and se|
rate the jelly from the sediment. Then put the jell
into a saucepan, with white wine and brandy and flai
ing to taste, with the shells and whites of 4 eggs W(
mixed together ; boil for a quarter of an hour, cover
and let it stand for a short time, and strain while
through a flannel bag tnto a mould.

Lemon Jelly. — Take half a box of gelatin, i cupful
of cold water, 1 pint of boiling water, 1 cupful of sugar,
\ cupful of lemon-juice. Soak the gelatin in the cold
water twenty minutes or until soft. Add boiling wat
sugar, and lemon-juice; strain (Mrs. Lincoln).

Orange Jelly. — Dissolve half a box of gelatin
cupful of cold water. Take the juice of 6 oranges and
of 2 lemons, r cupful of sugar, and 1 cupful of boiling
water. Stir all together and strain. Put in a cold placi
and serve with "kisses" or a white cake. Thi
can be attractively served by placing it in the skins
the oranges cut in half and the edges notched,
pulp of the oranges must carefully be removed, and
skins thrown into cold water until required, then dri«
inside and filled with the jelly.

Tapioca Cream. — Take 1 pint of milk, 2 tablespooi
ful of tapioca, 2 tablespoonsful of sugar, I saltspooi
of salt, 2 eggs. Wash the tapioca. Add enough water'
to cover it, and let it stand in a warm place until the
tapioca has absorbed the water. Then add Ihc milk and
cook in a double boiler, stirring often until the tapioca
clear and transparent. Beat the yolks of the eggs,
the sugar and salt and the hot milk. Cook until
thickens. Remove from the fire, Add the whites

mtil I^^H
tes «^^|

e e^s, beaten stiff. When cold add i teaspoonful of

inilla.

Peptonized-mtlk Jelly. — First take about half a box

r Nelson's gelatin, and set it aside to soak in i teaciip-
fiil of cold water until needed; take i pint of specially
peptonized milk, heated hot; pare i lemon and i orange,
and throw the rinds into the specially -prepared milk ;
squeeze the juice of the lemon and orange into a glass,
strain, and mix with it 2 or 3 tablespoonsful of wine or
of brandy ; add to the milk, stirring well ; strain through
gauze, and when cooled to a syrupy consistence, so as to
be almost ready to set, pour into moulds and set in a
cool place. Do not pour the milk into the moulds until
it is nearly cool, otherwise it will separate in setting.

"Wine Jelly. — Take half a box of gelatin. J cupful
of cold water, i pint of boiling water, i cupful of wine.

k cupful of sugar, i lemon. Soak the gelatin in the
Id water until soft. Add the boiling water, wine, sugar,
d lemon-juice. Strain. Keep on ice until ready to
rve (Mrs. Lincoln).
Junkat. — Sweeten to taste i quart of fresh milk in a
..^allow dish, and stir in liquid rennet 1 tablespoonful;
set near the stove, where it will get warm, and as soon
as it begins to thicken set it on ice ; serve with preserves
and cream. This is an excellent dish for invalids; it
may be flavored by grating nutmeg on the surface or by
adding a few drops of brandy.

Irish Mobs. — Wash thoroughlya handful of Carrageen
moss, pour over it 2 cups of boiling water, and let it
stand where it will keep hot. but not boil, for two hours.
Strain, add the juice of 1 lemon, and sugar to taste.

Irish-moss Blanc-man^e. — Take I quart of milk. ^
cupful of Irish moss, i saltspoonful of salt, i teaspoon-

332

APPENDIX.

^^1 ful of vanilla. Pick over and wash the Irish moss, and

^^1 let it soak in cold water fifleen minutes. Drain off the

^^1 water. Add the milk and cook in a double boiler until

^^1 it thickens when cold. Strain. Add the salt and vanilla

^^1 and turn into a mould. When cold serve with sugar

^H and cream, also with sliced bananas (Mrs. Lincoln).

^H Snow-eggs. — Take a small teacupful of new milk and

^1 boil it in a small, shallow saucepan with a little sugar;

^H while it is boiling break i egg, putting the yolk and

^H white in separate cups ; whip up the white to a tine light

^H froth, and when the milk is quite boiling take a large

^H spoonful at a time of the white, place it on the top of

^H the milk for a moment or two, then turn it, and when

^B sufficiently solid lift it out on a slice; then mix up the

^K yolk with some sugar, add the boiling milk, mix and

boil again for a few minutes, then pour around the white
and serve.

Whipped Oream. — Mix 2 gills of rich cream, \ cup
of pulverized sugar, and 2 tablespoonsful of sherry
; put on ice for an hour, as cream whips much
better if chilled; whip with an egg-beater, and as the
froth rises skim off the latter, and lay it on a sieve to
drain, returning the cream which drips away, to be
whipped over again. Place on the ice a short time
before serving.

"Wine Whey. — Put 2 pints of milk into a saucepan
and stir over a clear fire until nearly boiling; then add
3 gill (2 wineglasses) of sherry wine, and simmer a
quarter of an hour, skimming off the curd as it rises.
Add I tablespoonful more of sherry, and skim again for
a few minutes; strain through coarse muslin. Lemon-
juice (2 tablespoonsful) may be used instead of the
sherry wine.

Beverages. — Chocolate. — Take 2 squares of vanilla
chocolate to each coffee-cupful of milk. Grate the
chocolate and wet Jt with cold milk and stir into the
milk when it boil.s. Whip a tablespoonful of cream, and
beat it into the chocolate just as it is taken from the
stove. This makes i cup of rich, delicious chocolate.
Do not let it boil, as it becomes oily and loses its fine
fresh flavor.

Coooa. — Allow I teaspoonful of cocoa for each cup ;
add sufficient hot water to form a paste ; pour on boilmg
milk (or milk and water) and sweeten to taste ; five min-
utes" boiling will improve the cocoa (Wilbur).

Coffee. — Stir together 3 tablespoonsful of freshly-

I ground coffee, 4 of cold water, and half an egg. Pour
)ipon them i pint of boiling water, and let them boil for
five minutes. Stir down the grounds, and let the cofiee
Itand where it will keep hot, but not boil, for five minutes
longer. Sugar and cream should be put into the cup
first in serving, and the coffee poured upon them.

Coffee (French). — Some persons preferfiltcred to boiled
coffee. Filtered coffee is best made in a French biggin,
consisting of two tin vessels, one fitting into the other,
the upper one being supplied with strainers. The coffee,
very finely ground, is placed in this uten.sil, and the boil-

»ing water allowed slowly to percolate through it. The
pot should be set where it will keep hot. but not boil,
bntil the water has gone through. Pouring it through
the coffee a second time will make it stronger, but it
loses in flavor. Cafe nolr is always made in this way.
Crost Coffee. — Take i pint of crusts — those of Indian

I:ad are the best — brown well in a quick oven, but
not let them burn ; pour over them 3 pints of boiling
ter and steep for ten minutes. Serve with cream.

334

APPENDIX.

Nutritious Coffee. — Dissolve a little isinglass org

tin (Knox) in water; put J^ an ounce of freshly -ground
coffee into a saucepan with i pint of new milk, wliich
should be utarly boiling before the coffee is added ; boil

'-s ; clear it by pouring
J it back again ; add the
n the back part of the
:. Beat up i egg in a
the coffee ; if preferred,

d like coffee a \ cupful

boiling water, and let it

a quarter of an hour;

nilk and sugar. This is nice

both together fo" *
some of it into a
isinglass, and lea
range for a few i
break fast-Clip, am
drink without thi

Bio© Coffee. —
of rice. P<iur ov
stand where it wil
then strain, and add boiled r
for children.

Egg-nog. — Scald some new milk by putting it, con-
tained in a jug, into saucepan of boiling water, but do not
alloiv the milk to boil. When cold, beat up a fresh egg
with a fork in a tumbler with some sugar ; beat to a
froth, add a dessertspoonful of brandy, and fill up tum-
bler with the scalded milk.

Lemonade. — Squeeze the juice from i lemon. Add
2 tablespoonsful of sugar and I cup of water. Strain
and serve.

Lemon Sherbet. — Take 6 lemons, i tablespoonful of
gelatin, i quart of cold water, i pint of sugar. Soak
the gelatin in \ cupful of cold water twenty minutes.
Then add ^ cupful of boiling water, the juice of the
lemons, the cold water, and the sugar. Strain and
freeze.

The water used in soaking and dissolving the gelatin
should be part of the quart of water. In freezing, use
one part salt to three parts finely broken ice. Rock salt

XECIPES. 335

1*1$ most generally used. If you have no freezer, a very
I good shertiet may be made by freezing it in a tin pail
Ipacked in a pailful of salt and ice. Let it stand fifteen
I minutes. Remove the cover, scrape the frozen mixture
■ from the side of the pail, mix thoroughly, cover, and let
lit stand fifteen minutes more; then scrape down again.
Repeat this process until the mixture is frozen sufficiently
(Mrs. Lincoln).

Egg Lemonade. — Beat i egg with i tablespoonful of
sugar until very light; stir in 3 tablespoonsful of cold
water and the juice of a small lemon; fill glass with
pounded ice and drink through a straw or a glass tube.

Sterilized Milk. — Put the required amount of milk in

clean bottles (if for infants, each bottle holding enough

for one feeding). Plug the mouths of the bottles lightly

r with rubber stoppers ; immerse to their shoulders in a

nkettle of cold water; boil twenty minutes; or, better,

ksteam thirty minutes in ordinary steamer; lirmly push

the stoppers in the bottles, cool them rapidly, and keep

in refrigerator. Warm each bottle just before using.

Milk and Albumen. — Put into a clean quart bottle i
pint of milk, the whites of 3 eggs, and a small pinch of
salt. Cork and shake hard for five minutes.

Milk-punch. — Take ^ pint of fresh cold milk and add
2 teaspoonsful of sugar, and stir well until dissolved;
then add 1 ounce of either brandy or sherry wine.

MuUed Wine. — Take a ^ cup of boiling water into
which put 2 teaspoonsful of broken stick -cinnamon and
6 whole cloves, and let all steep for ten minutes, then
_ strain. Now take 2 eggs and 2 tablespoonsful of sugar;
at them together until very light, and stir into the
d water. Pour from height into tliis mixture a cup-
l of sweet wine boiling hoi (the wine should not be

336 APPENDIX.

boiled in a tin vessel). By pouring this preparation from
one pitcher to another several times it wilt become light
and foamy. Serve hot.

Orangeade. — Substitute orange-juice for that of lemon
in the ri^cipc for Lemonade.

Orange Sherbet. — Take i^^ cupsful of orange-juice, 1
tablespoonful of gelatin, \ cupful of cold water, \ cup-
ful of boiling water, 1 cupful of sugar, i pint of cold
water. Soak the gelatin in the cold water. Then add
the boiling water, the orange-juice, the sugar, and the
cold water. Strain and freeze. Any kind of rruit-juice.
sweetened and diluted, may be used in place of the
orange-juice.

Tea. — Scald out the teapot and put in the tea, using I
teaspoonful for each cupful. Pour on bmling water, and
let teapot stand four or five minutes. If allowed to
stand too long, the tann'tn in the tea is developed, which
not only darkens the tea, but also renders it hurtful.

Flaxseed Tea. — Flaxseed (whole), i ounce ; white
sugar, i ounce (heaping tablespoonful); lie once- root, J
ounce (two small .sticks); lemon-juice, 4 tablespoonsful.
Pour on these materials 2 pints of boiling water; let it
stand in a hot place four hours; strain off the liquor.
Albumen-water, — Stir the whites of 2 eggs into a \
pint of ice-water, without beating; add enough salt or
sugar to make it palatable.

Apple-water. — Slice into a pitcher \ a dozen juicy
sour apples; add i tablespoonful of sugar, and pour
over tliem i quart of boihng water. Cover closely until
cold, then strain.

Barley-water. — Wash 2 ounces (wineglassful) pearl
barley with cold water. Boil it five minutes in fresh
water; throw both waters away. Pour on 2 quarts

MINERAL WATERS. 337

boiling water ; boil down to i quart. Flavor with thinly-
cut lemon-rind ; add sugar to taste. Do not strain unless
at the patient's request.

Qxun-arabic Water. — Dissolve i ounce of gum-
arabic in I pint of boiling water, add 2 tablespoonsful
of sugar, a wineglassful of sherry, and the juice of i
large lemon. Cool, and add ice.

Ldme-water. — Pour 2 quarts of hot water over fresh
unslaked lime of the size of a walnut ; stir until slaked,
and let stand until clear, then bottle. Lime-water is
often ordered with milk to neutralize acidity of the
stomach.

Bice-water. — Pick over and wash 2 tablespoonsful of
rice ; put into a granite saucepan with i quart of boiling
water; simmer two hours, when rice should be softened
and partially dissolved ; strain, add saltspoonful of salt ;
serve warm or cold. May add sherry or port wine, 2
tablespoonsful.

Tamarind-water. — A very refreshing drink may be
made by adding i pint of hot water to i tablespoonful
of preserved tamarinds, and setting aside to cool.

Toast-water. — Toast 3 slices stale bread to a dark
brown, but do not bum. Put them into a pitcher ; pour
over them i quart of boiling water ; cover closely and
let stand on ice until cold ; strain. May add wine and
sugar.

MINERAL WATERS.

Alkaline waters contain sodium carbonate and bicar-
bonate in comparatively large amounts. The conditions
in which these waters produce their best effects arc —
Chronic gastric catarrh, especially with hyperacidity
and catarrhal inflammation of the mucous membrane of

^^^>ia,gc

338 APPENDIX.

the biliary passages. Good results have been obtainec
ill acute catarrhal nephritis ; also in lithemia, gout, and
chronic rheumatism.

Carbonic-aoid orators owe their potency to the pres-
ence of carbonic-acid gas. Any variety of water maybe
found impregnated with this gas, whose presence possi-
bly increases the diuretic effects of the water. Fever-
patieiits find these waters very agreeable. The addition
of this gas acts as a sedative to the gastro-mucous njem-
brane, and when taken cold and in sips relieves nausea
and tends to check vomiting. Carbonic-acid water
added to milk is admirably received by some patients
with irritable stomach, and occasionally milk will be
accepted in this form when it is absolutely refused in the
pure state. Another very popular use to which these
waters are put is in diluting wines.

Chalybeate waters arc those holding in solution one
or more of the iron compounds, most frequently ferrous
bicarbonate and ferrous oxid. Iron waters owe their
virtues to the presence of iron, which usually exists in
the form of tile bicarbonate of the protcvid, held in
solution by an excess of carbonic-acid gas. The ordi-
nary indications for the use of iron are met by employ-
ing waters of this class. They are useful in anemia, but
usually have other constituents, who.se administration
may or may not be indicated in certain cases.

Purgative waters usually owe their properties to
sodium sulphate and magnesium sulphate. When a
gentle saline laxative is indicated, these waters often give
better results than either Epsom or Glauber's salt, and
are therefore of greater service. In congestion of the
liver, chronic gastric catarrh with atony, jaundice, lithe-
gout, and in the obese, the regular use of water of

339

K this class properly selected and administered yields excel-
lent results.

Saline waters contain common salt in solution, also
small quantities of the chlorids, of the alkalies, and of
alkaline earths. This saline when taken into the stomach
dissolves albumin and starches ; promotes digestion and
absorption of food ; supplies the intestines with chyme
I rich in albumin and starches; enters the blood, which
■carries the salt to all the tissues of the body after sup-
"plying its own needs. The usefulness of these waters,
however, is very restricted. Good results may be ex-
pected in certain dyspepsias with defective gastric secre-
tion and sluggishness of the bowels. In certain cases
of dyspepsia these results are best obtained by adminis-
tering the water early in the morning, before breakfast;
when rapid absorption is necessary it should be taken
hot. Preference should be given to those springs chained
with carbonic-acid gas, which greatly increases the pala-
. tableness of this class of waters. The therapeutic dose
b-is from i to 5 f3 daily.

■ Sulphuretted waters are due to the presence in the

' water of sulphuretted hydrogen gas, and they usually

contain the sulphates of sodium and potassium. When

taken internaliy, they augment peristalsis and perspira-

[ tion. Frequently sulphur springs are used as baths, and

■with good results, especially in chronic skin-afTecdons —

Bjhich as eczema — in rheumatism, and in gout. The

ftwaters are useful in constipation, and are asserted to

Huve produced good results in cases of chronic bronchitis

■and phthisis. In all these diseases they are administered

tntemally and used externally as baths.

APPENDIX.

ri. WEIGHTS AND MEASURES.

APOTHECARIES WEIGHT.

Pound-lb. Oiin=L»-V D™

■3. Sen,

ililo-B. G,

r - t; =.

14 =

5760
+80

' in.¥>

= 3'oS

3 -

- 3.885

' ^

- I.I9S

APOT

i) MEASURE.

GalloD-C. Pinn-U.

FJuidni^bau.

-fS

Miaitai-ni.

1=8-

1024

61.440

138

76S0

480

APOTl

COMPARATIVE VALUES

flECARlES'

AND

METRIC

UU)

MEASU

KES.

0.308
0.370

0.493

18 =

1.12

5 =

18.50

0544

20 -=

1.23

6 =

12.50

0.616

80 -

1.84

7 -

16.00

r::t.

Cubic

Fiuid-

Cubic

30.00'

8 -

23&-59

w» =

59' SO

59.14

9 =

266.16

II =

650.62

S-j.oo

10 =

29573

24 ■=

710.00

( 18,19

iz =

355-00

28 -

82S.26

.43.00

14 -

414.00

3* -

946.3s

17742

10 -

473.17

33{i» -

107.00

532.32

128 =.

S785.4S

' More accura

icly, 19.57 c.

WEIGHTS AND MEASURES.

341

APPROXIMATE MEASURES.

One minim' varies from one to two drops.^

1 fluidrachm = (about) I teaspoonful.

2 fluidrachms » <* i dessertspoonful.
\ fluidounce => « i tablespoonful.

2 flnidounces » «* i wineglassful.
4 fluidounces => <* i teacupful.

HOUSEHOLD MEASURES.

4 teaspoonsful of liquid = i tablespoonful.

1 pint of liquid = 1 pound.

2 gills of liquid = i cup.

2 rounded tablespoonsful of flour = i ounce.

1 tablespoonful of butter = i ounce.

2 cups of granulated sugar = i pound.
2} cups of powdered sugar == i pound.

ANTISEPTIC SOLUTIONS^ (e. Q. THORNTON, M. D.).

Drug.

Boric Acid

Calcium Chlorid . . .
Carbolic Acid ....
Corrosive Chlorid oH

Mercury (corrosive >

sublimate; . . . . j

Creolin

Ljrsol

Potassium Perman-

eaiute

Solution of Hydrogen

Dioxid

Thymol

Zinc Chlorid. . . .

Com-
mercial
form.

Powder.
Masses.

Liquid.

Solution.

Two tablespoonsful to a pint.
Two teaspoonsful to a pint.
Six teaspoonsful to a pint.

Strength.! Per
cent.

Crystals. Seven and a half grains to a pint.

Liquid.
Liquid.

Crystals.

Liquid.

Crystals.
Crystals.

Two and a half teaspoonsful to a pint.
Two and a half teaspoonsful to a pint.

Half a teaspoonful to a pint.

Eight tablespoonsful to a pint.

Five grains to .t pint.
Two teaspoonsful to a pint.

33
50
20

1000

50
50

250

iSoo
50

0.1

.07

1 A drop is popularly, although erroneously, supposed to be a minim. True, there
are 60 drops in a fluidrachm of water, but this is the case with only a few liquid med-
icines. Tne size of a drop depends on the shape of the vessel from which it is being
dropped and on the adhesixttness of the fluid dropped : consequently, a drop is a very
indefinite quantity. Tinctures, spirits, and other alcoholic fluids drop from 120 to iso
drops to tne fluidrachm, whereas thick syrups and a few other liquids drop less than (x>
draPiXo the fluidrachm (Thornton).

'These antiseptic solutions are of ordinary strengths, and are intended only for local
appltcation. They may be prepared with either hot or cold (preferably distilled) water.
'I o liffCrVKM/ the strength of either solution the quantity of water must be increased i
for example, if a x : 9000 corrosive-sublimate solution is required, the proportion would
be 7^ gr. to the fnart.

AcetnmOnl

" SdU*.

AcM, AccUc

■' AdBl, Dil. . , .

•' Cubolic ....

'■ HydrochlOTic . .

" Hydrocyatilc . >

" Nitric '.'.'.'.'.

" NiErs-hydrochlor.

" Pbnphor. Dil, .

" Sulphuric ....

" Sulpli. Aronuit. .

" Sulph. DIL . . .

" Sulphuntum . .

MOtit FerxSar

Aqua.: ;^.' '.'.'.'.

Broinin ....'.'.'.'.
Chlorofeim, Put. . . .

Buchii H. .

DigiulbFI.

" Bkoue FI. .

■' Ipecac. Fl. .
Rbd Fl. . .

VillmancFi.

Zlntfb, n.

Glycerin

Hydnreyruni

Liquoi Acidi AneiKx) .
^- Fcrri Chloiidl .

W-

log

7«

3«

■£

ISO

,SQ

ijt

7*.

Capilci .
inAoUi . . .

Imiipwi . .

" JEthait Nitnai
Syrupui Acads . ,

Sim^ .'

CiDihuriifi* .

F^Chlor.'

Opli Ompb.

Opll DcoJot

m Calchki Bad.

Cokhlcl Sen.

Aconilin Jcrysuli)
ApcDiDTpnin miiriolc
Alroptn Milphaic .
AlTCbln sulpluta .
CvoIb hydraeMonH
Cvaift hjAnbnmMo

Dickairii (lolubli) .
Gehcifiin murialc .

Hyc«m h^rdrobroma

llorplup tulphau .
Tatlrll for hypodm

Sul^.''

UuobIbINo.*. '

iSuhih

Sulpb

KVPODERMATIC

UaTpbin ■ndatraein. Na. i.

Morpfaln Suli

Alroplii Sulr
Monihin boj' —

Pilocarpts hydnxUi
Pilocirpin nlimc .
Pbntulgni ■ lulph.

Klrychuii lulphaie -
Strychnin aulphaM .
-cpihrtd by prpmipcnl manubcluRn, ocb tablcc

JU1 tip in n caic wUh u uood bypoderoic tyringv

5^54
ViM

;
I

CONFINEMENT TABLE.

s
s

g
s

-}
<

=,-

?■"

IS'

SR
♦ -

f.-

3-
ITS,
3?
5S

Bif
^5

"2
II

R'
?"

iTS,
J«

Sir

- 2"

90 -^

lis
Sa

a'
?"

if 8.

?«

8!?

"KO

s—
«'

■sa

» -

«'

ffS,

as-

SIS
8S-

8
S."
«'

ira
ss

- «

s-'

If"

ss-

8R-
2m

8-"

•S"
?=>

oO ^

•S"

«"

J=,

ffS,
5S

8S-
2S

8,"

a--
«"

^8,

a-s

8^
IS

as
'a

APPENDIX.

IV. ABBREVIATIONS.

U., ana, equal parts of each.
A. c, anit ciii4m, before meils.
Add,, ai/de, aOiI to it.
Ad. lib., aJ Ii6,l„m, us ~^» ">-"
Alt. dieb., a/ten,,i ,/u/,m

Alt. hor., allcrnd horii

Alt. noc, alltinS notte.

Ante cib., (7n/r i-/i5h/«, b

Applic, applit,uue, nppiy

Ai)., aqua, watei.

Aq. font,, afua/oii/mia, s[

Aq. bull., aqj,„ biiUitai, Dom

Aq. des

ilatillaln, distilled

Aq. pluvial., irjruii p/uvialis, rail

Aq. pur., aqua para, ]>ure water.
His hor, or iii //om, eveiy tw

hours.
Bis ind., iis in liin, tiviee a ilay.
Bull., hullial, let it boil.
C. or Oing,, (ongius, a gallon.

Cap., capiat, Icl him lake.

Cent,, centigrade.
Cochleal., toihkatim, by s|x>on[uls.
Cochl., cixhltaif, spMinlul.
0)Ch, mag., cochlear magnui,

(ables)>oon.
Coch. med., roMear mr.Uum.

dessertspoon.
Coch. parv., ,o<hhar pii>--ii!'i.

Canf., tanfftlU, a confeciion.

Con., cortex, bark.

Cuj., ittjta, of which.

Ti--"et. honl., dteoclum h»rdn, btr-

b., iimbitHs (a bed), Ifing

1., d/stilla, distil.
lietiir, let it be given.
Jilutus, dilute.
, Smidim, oDC-holf.

in p. tcq., Jividaitir in farta
nala, divide iolo equal pans.

Duo,, duo, Iwo.

Emp., emplastrum, a plaster.

F., Kahtenheit.

F. mist., y(n/«jtt/H™, make ami xlure.

Far., faradic.

Fe.,/,r™™. iron.

Filt., filtta. filter,

F. i>il„ fial piliila, make a pill.

Kol.,/W«t, afomenUtior.

Vki\., frequenter, frequently.

Fl., or UJiuidHi, fluid.

F't.i^n'', let there be made.

V"^. Jiuidrachnia, fluidrachm.

¥%, /iiidiiHcia, fiuidounce.

CB.ie; gargarisma, a gargle.

Gm,, gramme,

Gossyp,, gctsypium, cotton-wool.

Gr,, frranum, a grain, or grana.

Git., gutia, a drop, or^«//<f, drops.
(lUtlal., t^uttatiin, by drops,
llg., hydrargyrum, mercury.

ABB RE VIA TIONS.

345

Hinid., hirudines, leeches.

Hor. decub., hora decubiHks^ at bed-
time.

Ind., in dies, daily.

Inf., in/usum, an infusion.

Inject., injecHo, an injection.

Lat. del., lateri dolenti, to the
affected side.

L., litre.

Lb., libra, a pound.

Lib. or lbs., libra, pounds.

Lim., limones, lemons.

Liq., liquor.

Lot., laiio, a lotion.

M., misce, mix.

Tl\,, minimum.

Mac, macera, macerate.

Man., manipului^ a handful.

Mass. pil., mcusa pUularum, pill-
mass.

Mel., mellita, honey.

Mist., miitura, a mixture.

No., numero, in number.

Noct., nocte, at night.

O., octariui, a pint

Ol., oleum, oil.

Ol. oliv., oleum oliva, olive oil.

O. m., omni mane, every morning.

Ov., ovum, an egg.

Oz., uncia, ounce.

P. or Vug.,pugillus, a pinch

P. c, posl cibum, after meals.

Pil., pilula, a pill.

Pond., pondere, by weight.

Pi., pint.

P. R. N., pro re natd, as occasion
arises.

Pulv., puhns, a powder.

Q. d., quarter in die, four times a
day.

Q. P., quantum placet, as much as

you please.
Q. S., quantum sufficit, as much as

is sufficient.
Qt., quart.

Quotid., quotidie, every day.
Q. v., quantum vis, as much as you

wish.
R., recipe, take.
Rad., radix, root.
Rect., rectificatus, rectified.
S. or Sig., sigHGy write.
Scr., scrupulum, scruple.
Sem., semen, seed.
Sol., solution.
Spr., spiritus, spirit.
Sp. gr., specific gravity.
St., stei, let it stand.
SS. or s., semissis, a half.
Sum., sumenduSy to be taken.
S. V. G., spiriius vini gallici,

brandy.
S. V. R., spiritus vini rectificatus,

alcohol.
S. F., spiritus frumenti, whiskey.
Syr., syrupiiSy syrup.
T., temperature.
T., tery three times.
T. i. d., ier in dies, three times a day.
Tr., tinctura, tincture.
Troch., trochisci, lozenges.
Ung., unguenium, ointment.
W., weight.
7^y drachma^ a drachm.
f^y uncia, an ounce.
9, scrupulum, a scruple.

2 dis., every two hours.

3 tis., every three hours.

4 tis., every four hours.
6 tis., every six hours.

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358

APPENDIX.

1 I

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III

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DOSE-LIST.

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APPENDIX. ^^^H

:::7 Xll:;

: : i ::::::

: » ; : : : i:r:|h

1:1^-1 h^^

|l
III

III

llllilfellllltl

GLOSSARY.

The belly ; Ihe caviiy
n ibe chcsl and the groins. In
dominAl injuries a. nunc has usu-
" to keep her pali«Dl al rcsl and
h for iigta of perilonllis. L^par-
\j U Ihe operalioD likely lo be

Perlainiog Id the ab-

_ isele which draws

^Unb from the median Ime of ibe
body.

AimormaL Irregular.a deviation

AbCTtlOIl. Miscarriage before the

^ Abt
■eVnuK

3a th.

Ml. A collection of piu in i

. the result of inflammation

IHcisappean without being openec

Fb said to be duftried. An abioes

id should pucker, and (he edge:

inodorous, and modenilely
Wool and other

lexpectcd lymftom.
lecooelienr. An obsieiriclan, n
idwifv.

A. a. B. mxtnre. An anesthetic :
leohol, a parts chlorufonri.
ns elher.
Solutions of medicines in

1 of il

which Ihe

fits,

llMtle AoU. Vinegar.

AohUlM Tendon. The large teo'
don going into the heel.

Add. A compound which i^
capable of uniting with alkall«, bui

and turns blue litmus paper red.

Vinegar and lemon-juice are acids.

Aiddlty. The quality of being

Aoontta. A poisonous anodyne,
sometimes used as a cardiac sedative.
Il increases perspiration.

Acrid. Sharp, burning,

AoUon. Tbr. mode in which one
object influences another. Actions
may be divided into several classes.
ns chemical, organic, and physical.
Vllisl actions are those necessary to
life ; piysielegical actions are those
which ore normal ; faththgicat ac-
tions are those presented in a diseased

AonpimatDrs. Insertion of nce-

Aeuta. A severe but short attack
If disease.

AddntitOT. A muscle which draws
ow.iril the median line of the body.

AdbeilDn. The process by which
evered tis.sues unite.

AdlpOH, Fatty.

AdJUTUIt. A secondary ingredi-
nt in n prescription, aiding Ihe chief

Adult. A person who has passed
Ihe agL- of maturity.
Adynamia. Defeci of power,

ASIboHjDU. Anv mode in which
mind or body is modified or affected :
disense. febrile nfliiclian, cardiac uf-
feclion, etc.

Afltoant. Conveying fromsurlace
to centre; applied lo the lymphatic

Ifl9

37°

Pouring water upon Ihe
body ai a remedy.

AftM-1)lrth. A voicular organ
which nounsbci Ihe felus and is ex-
pelled arier labor: placenta.

AfUr-Mre, The care or nursing

Aft<Br-p4bu. Pains Ciom uterine
contraction rollowing labor.
AAer-trmtment. (Set After-tare.)
Ag>lactU. Lack □( milk in a

AkhS- An mterntitlem fever at-

ing fiU. If the fit! occur every 04
hours it is called " quolidiEui ague " :
if every 48 hours. " tertian ague " : if
73 hours, a " quatlaa " ; if 96 hours,

case should have her thermometer,
hypodermic syringe, and enema.
Taking the temperature during hot
atid cold fits is very important. If
quioin is not given as a medicine, it
is often given as a subcutaneous in-

Alr-baO. A mattress made of
india-rubber and filled with air.
IVa/rr-ieJi are filled with water.

Alr-oall. An air-sac; an oir-vesl-
cle of Ihe pneumonic tissue.

Alr-cnallloiu. Cushions of vari-
ous shapes made of india-rubber and
filled with air. which the nurse blows

JUr-pMa*geB. The respiratory

Alalia. Defect of speech caused
by paralysis.

AlUno. A person with white hair.
bir skin, and pink eyes; laiused by
pigmentary deficiency.

Albumin. A proteid substance,
the chief constituent of the body.

JlbntOlttlUik. A disease of the
kidneys, marked by the appearance
of albumin, a substance resembling
white of egg. in the urine, Brighl's
disease. Ttil far alktuKin; the appli-
calion of heat gives an opacity that
does not clear on the addition of
nitric acid.

or spirits, Walch for delirium Ir

mens and morning vomillng-

AUmentary OasAl. The

through which the food passes fr
Ibr mouth to the anus.

Alkali. The opposite to
a soapy substance, Tumste
paper 10 blue. Soda and potash ai

AlOM. The juice of scv
ties of aloe ; astringenl and calhaiti
AlopMla. .Absence of h

A remedy whh
works 'by an unknown procen.

Alnin. Crystals of aluminum at
potassium. Very astringenl, sligh^

;led on

aeptic.

bleeding ,
AlveoU. The sockets.
Ambidaxtar. Equally skilful iri

AimblropU Indistinct

g blini

Abnormal al
Defect of intellect, \

A voblile oJkali *
. pungent odor. Stimulant, 1
ised as an expectorant. Chlorid i^

mmonium is ot^en given

lalation, when it generally btls (o
he nurse 10 charge the inhaler.

Anmaila, I^oss of memory.

Amnion. The sac directly endr-
ling Ihe fetus in utero.

AmnloUe Fluid. (See Lignar

L. The removal 0

B inflan

Anurse should note Ihc number o(^
alures and sutures tised. The st
ping to keep the flaps together
be 34 inch broad for forearm i(
inch for Ihigh. The slum|
kept raised, and with I
weighing on it. Wslcb Eonsui
for bleeding or collapse.

*v;l. A radical composMl i
carbon and hydrogen. Amyl nlMJ
is sometimes inhaled (5 drops fl

M) in angina pectoris, epilep

Ijdng down.

AamertMe. Vibrations in the
pulw-bcal ; marked an the upward
line by the sptiygmograph.

*" ■ '" '" 'uicd sensibU-

^■kiJUMrM

^* MTUclure of

theli

ABuarM. Serum i:

_ .... The knowledge of the
MTUclure oif the body, learnl by dis-
leclioti. Ocnli with the skeleton,
Riu&cles. etc.. and is generally (aught
m L-untieclion with suigical nursing.
*"""'» A deficiency of led cor-
piiHles in the blood, generally ac-
companied by pallor of the lace and
palpitation oT (he heart. Note the
dress ol (he patient— if tight; the
Mate of Ihc bowels, and watch for
tnin. Pills containing iron,
lud's Pills." are often given.

isibility topain.
•ilkttia is loss of feeling of a
part of the body produced by
of Ihe ttnesthelio.

The agent which
produces insensibility. Before a pa-
tient it, put under an anesthetic the
nurse must sec that (here is nothing
in the mouth (false teeth must he re-
moved), and (hat all clothing is loose,
Ko solid food must be (aken by Ihe
patient (or 6 or 8 hours before thr
anesthetic is given. Walch if the
palienlbeeomeslivid. or if Ihe breath-
ing becomes shallow and irregular;
dangerous symptoms.

It producing cc

^Mlbuinin.
^■UUud's

^^^itedpi

■ spray o

Tlie

agulation of the blood in

called upon to apply digital i
ptesiion — compression by the
gcrs. Sudden death is frequen

the«

id (he ni

itely el

ie has lc

Angina PMtoiU.

focaiion, with pain at the heart. The
attack is sudden; the patient must
not be left alone, and the prescribed
remedies must always be at hand.
AnkTllMU. An immovable state

of a joint.

'--'^' • remedy to procure

AsUMlmlntla. Applied to reme-
dies for tspulsion of intestinal worms.

AnthT»». A carbuncle or malig-
nant boil. Ciariim anlhrax is con-
tracted from animals, and is b(al in
30 per cent, of cases. The pustule

AntbTpnoUe. An agent to pre-
vent sleep.

Anttttote, The corrective lo a
poison ; thus alknlies are given incases
of poisoning by acids.

AutUabrlB. Against fever; an

cial acetic acid, used to reduce tem-
perature, Cnrrj^n.- may cause alarm-
ing svmploms,

AnUmony. A salt used as a car-

spiraiion. Poison, Anlideli. lea or

Antlpertadle. An agent (o prevent
(he regular return of certain symp-
toms. Thus quinin is used in ague as

AnUpUogifUc. Relieving inflam-

AutlpTiatlc.

Antlpyiln. A drug, used in the
form of a white powder, to reduce
high temperature. It begins (o act
in 15 minutes. Causes penpi rat ion.
and, in IBIE cases, cardiac weakness.
CatilioH: may cause alarming syrap-

AllUMPHl. Eiclusion of the germs
(hat cause putrefaction ; the totality
of measures taken to prevent septic
poisoning.

AntUepttc. Against putrefiiclion.
A nurse hus much to do with Ihe
proper use of aniiseptics. especially

taction starts in a wound, there is
Iodoform, carbolic

acid, chlorine, terebene. cuoilyptus.
thymol, and Candy's fluid are the
commonest antiseptics. Strict atten-
tion must be paid to all orders given

c her hantSs in soma disln-
[ectanl both before and alter dress-
ing a woimd. The amiiseptu spray
'a an appantlua constiling of n lamp,
boiler, and jat conlaining the cai-
iHjIic acid, used to throw a spray
during operalions, or the dressing

AatlUizlii. A aubsmnce or scrum
a disease by sub-

5 inJL-c

caii^ ; applied to Ihc

Anna. The lower
■he reclum, the opening through

artificial anas is an opening made
into some higher portion of the in-
testinal canal, when for some leason
the proper anus is absent or useless.
The operation to moke an artificial

Aorta. The large :

lery rising
heart, and
hole body.

AofUoVftlTB. The upp<
the right siiie of the heart,

Apulant. A mild purgative medi-
cine, such as cascara, usually given

Aphonia. Loss a

fau

eords.

:. due

e ulcers In the
moulh; lhe"ihrush" olinfanls. The

rangement. 'Ilie mouth of Ihc infant
must be cleansed with bora*, or with
some similar prcpaiBtion, a^er each
nursing.

ApnM, Suspended rcspirallnn.
Sometimes seen in chloroform nn*

AjK^iaxj. Sudden iosensibility
from presstire on Ihe brain. Paraly-
sis of one side of ihe body, stertor-
ous breathing. The patient is kept
recumbent, with ice to the head, and
a purgative is usually given. Note
if Ihe pulse grows weak and the sur-
face cold. Great variations of tem-
perature, with giddiness, mny point

Appeiullx Venniforml*. A n

which we

vemiifona appendix occurs in tyi^li-
tis. and may lead to peritonitis. Kr-
lapse must be wdtehcd for. Surgicail
inlcrferencc often has to be resoncd
lo, and. in some cases. bp>n>tomy is
performed, and the ^ixndli n-

facl of applying
nnylliiiig. lU a plaster, bandage, etc,

Aprrasla. An intermission of
fevc.

Aqnk. Water : Ihc abbreviation Is
af.. while og. iull, stands for boiling
water: aj. dot., dblllled water; aud

Nitric acid. A
■ used In tsling.
\lust lie used with care, for if il
comes in contact wllh ihe fingers it
cnuses a bum. AntidoUi : magne-

Atm1». The broini circle about
(he nipple of the breasl.

' nrtar. An inslrumeni for

ing the s|iecific gravity of

I'ln^Iure of arnica is used for bruises
ArMIIte. A poison ; given fre>

L-nlly,

t white

powder. In skin diseases, Sliould he
given after food. Report at once if
Ihc longue gets a while fiir. or diar-
rhen or gastric pains commence.
Attlidot/i for overdose: magnesia,
with tincture of iron, chalk and

Tabe-I Ike vessel! ih rough
vnieii me (iIchmI is propelled by Ihe
lenrl lo the peripheral organs. (Bee
4n7i.iry, Bryiehiai, F€mor*t, and
TitialS
ArUrltU. Inflaromation of the

ArtHT' -^ lube which conreyi
he purified blood from Ihe henn lo
he capillaries. Bleeding from an
iitery is brighl red, and Bows in

I, jBli. Anuree sbonld knowihe point!
Jt it which it is possible (oarrcM bleed-
V^lg by presmic on the artery; Ir

rt than the site of injury. In nm

PipuiBtinn, etc., tbeievered arteries an
^~*"'~""'" " "jsofsilkorof catgut

duty of the nurse is
buttle at hand in ca

II the fluid,

ftr. ItelDiing to Ihejoi
fttUm. A joint or Junct
Lof iKinca ; the meclianism of joinli

liculalion of a skeleton 1& —
■>JB>iincr in which ihc bones are joined (
Ftogelhcr. The mevaUe articulations
l«f the bones are of various forms :
■ i. Those in which the bones glide
B'^wn plftlie surfaces, as in the ariicu-
lijuioo ol (he libuta with the tibia;
^•.Thoseanlculniions known as" boll-
id-aocket jcHnls." such as the hip-
"nl; 3. Those having a hingc-!ike
"^"^■" '-"--'- -«ard and back-

of fluid withdrawn. She should also
liave ready a flannel bandage. 13
Inches broad, lint, stiching-platter,
hot water, sponges, pins, and brandy.

ing diet.
AuUullMlini. The process of

the circulatory sysieni.

AiOisllla. Failure of strength,
debility.

artliTM A disease marked by
patoiysms of diflicull breathing,
with sense o( suffocation. Asthma is
illy chronic, and not dangerous

tillol

The

duty of the nurae is Id have any in-
halations or medicines orderedaiways
' id, in ease an allack comes on ;
3 note the sputum. The patient
be kept strictly to the diet
has great cITbcI in

AtTDtds. The active principle of
l)i-lludonna. Used as a sedative in
asthma, neuralgia, spasms, etc., and
hypodermatically to check sweating,
etc Applied to the eye, il soothes
and causes enlargement of the pupil.
It is a poison. Aiilidotti: sulphate
:metio, ammofiia, and

GLOSSA/fV.

BmL Tbe couch or support on
hich the body may rui In sJcep and
I ifcknesi. (Far the difiereni forms
id voriclim of beds, see p. 3a.)

Bad-ar*dl*. A semicircular up-

feed-clothes with a diseased oi an In-
jured part.

Sad-pu. A large shallow vessel
iar receiving the (ecal and urinary
discharges from bedridden patients.

Bad-rMt. An apparatus for prop-
ping up patients in bed.

] childbirth, Anordinaryroundtowel,
I or a piece of flannel \)i yds. in
, length arxd 18 In. in breadth, will do
. for tbe mother. The iQfo.iit needs

' inches broad and long enough to go
well round the body and overhip.

BlpBTOns. Bearing twins.

BlitU. Ilie debvery of a child;
parturilion. Plural birth, the birth
of more than o single child ; poslhu-
mffiubinb. the birth or a child aRer
the death of its blher; firtmatun

rik. a child born

Tu), ir a case is likely
to be a long one, each morning after
— .-.. .. natienl. rub some spiril,
. . . rfiylaled spirit or whisky,
the parti of the sltin which show
-_ Iach, particularly the lower part
'Of the hack, then dust with powdered
March, Change the patient's position
•a often as poHible. II is a sign of
bad nursing when bcd-sorea appear,
■nd Ihey musi immediately be re-
ported to the doctor, who will prob-
ably order line drrasing. and have
the patient put on a water-pillow.

maiWlowtUU A drug used to

loolhe pain ; to check sweating and

■^e secretion of milk. (See Alfofin.)

BuuoloAeUL An alterative and

n dis-

forii/

id add a f^w di

s of niti

add. when, if Ihi

prcMnt. a play of colors— siolct,

graen. and red — will occur,

HIllHU. A leim applied to diges-
tive disturbance arising from irregu-
lar biliary secretion.

Mndir. A brond band passed
tighrty round the abdomen after

re full 1c

lifeles..;.

Blztll-maTtt. .K patch of congeni-
tal discotoratian of the skin due to a
dilated condition of the capillaries.
" Mother's mark."

Stomachic sedative and
Causes black stools. Over-

. ■. A small surgical knife.

usually curved, for making incisions.

BUddar. Thesacwhich holdsibe
urine. Sudden injury to the bladder.
such as rupture. Is generally followed
by shock. To procure perfect rest
for the patient and to measure the
urine are points Ibr special attention
from the nurse. The L^lin term for
the bladder is ittica.

Bland. A term applied to mild
and soothing medicines and applica-

BlMdlng. (See Hemorrkagt.-)
BllBl-lpOt. Point where (be optic
nerve enters the retina : it is abso-

BUMar. An agent producing a

blistering fluid, or a plaster |can-
thnrides). The nurse genemlly is
entrusted to apply the blister; the
part mu4( first be washed with sonp
and warm water, and the plaster fas-
tened lightly with a bandage, or. it
fluid is used, outline the spot with
olive oil to prevent the fluid spread-
ing: paint on with a camel's-hair
brush. A blister lakes from sii to
twelve hours 10 rise. To dress, snip
the most pendant part of the bleb.

376

APPENDIX.

A perpetual bliMter is a blister kept
open for a longer or shorter time by
means of appropriate dressings.

Blood. The fluid that circulates
through the heart, arteries, and
veins. Arterial blood, " red blood,"
so called because contained in the
arteries ; venous bloo<l, that contained
in the veins.

BlOOd-cacU. Microscopic fila-
ments of coagulated blood found in
the urine.

Blood-clot. The coagulum, or
jelly-like mass formed in blood when
exposed to the air.

Blood-current. The "flow" of
the blood through the arteries and
veins.

BlOOd-poilonlng. A term denot-
ing any ailment arising from the in-
troduction of decomposing organic
matter or putrefactive germs into the
blood. (See /^^wiViand Septicemia.^

BlOOd-semm. A yellowish, thin
fluid constituent of blood, separating
from the blood-clot or fibrin in coag-
ulation.

BlOOd-yesselB. Tube-like struc-
tures for conveying the blood through-
out the body.

Boll. Popular niime for a small
tumor or furunculus.

Bone-repair. The healing of a
broken bone. (Seep. 173.)

Borax. Boric acid and soda; used
as an antiseptic, and as a soothing
drug in dise.ises of the throat, nares,
etc. Also to promote catamcnial dis-
charge.

Boric Acid. A mild antiseptic in
the form of white crystals, used to
impregnate lint and wool, which are
colored pink to distinguish them.

Bougie. A slender instrument for
dilating contracted passages, made of
metal, elastic-gum, whalebone, or
catgut.

Bouillon. French term for broth.

Bounding Pulse. A pulse in which
a weak beat is succeeded by a strong,
full beat.

Bowels. (See Intestines.)

Brachial Artery. The artery of
the upper arm extending along the
inner side.

Brain. The general contents of
the skull. (See Cerebrum.)

Breast. The upper anterior part
of the body between the neck and
abdomen ; also the Mamma (q. v.).

Breaat-bOlie. A flat, oblong bone
at the anterior part of the thorax.

Breaat-inilUP* An instrument for
drawing the milk out of the breast.
BreatlL The air exhaled from the
' lungs ; applied also to the act of in-
spiration.

I Breatlling. {^^ Respiration.) Ab-
I dominal breathing is that in which the
, abdominal walls move decidedly and
\ in which the diaphragm is actively
engaged ; thoracic breathing is respi-
I ration in which the thoracic walls are
actively moved.

' Bregma. Two spaces on top of
; an infant's head where the parietal
' bones join the occipital and frontal
bones.

Brigllt's Disease. Disease of the
kidney, associated with albuminuria
and often with dropsy. The treat-
ment may include vapor baths, hot
packs, cupping, sponging, the injec-
tion of pilocarpin,and other methods
of increasing perspiration, which the
nurse must attend to. The urine
must be measured, tested for albu-
min and examined for casts and epi-
thelium. The diet ordered must be
strictly adhered to. Convulsions
should be watched for.

Broad Ligaments. The suspen-
sory or broad ligament of the liver.
Also the suspensory ligaments of the
uterus.

Bromidrosis. Offensive sweating
most common in the feet. Cork soles
should be worn, and the stockings
dusted with boric acid.

Bromids. In large doses are val-
uable hypnotics, in small doses they
lessen cerebral excitement. They
consist of a combination of bromin
with potassium, sodium, or ammo-
nium. In epilepsy, bromidof potas-
sium is found very useful.

BroncbiA. The bronchial tubes
or air-tubes between the larj'nx and
the lungs.

BroncbiUs. Inflammation of the
bronchial tubes; it may be cither
chronic or acute. (See p. 242.)

Bronchocele. Enlargement of the
thyroid gland ; goitre.

PSntt. The French fi
' d used With regard lo

trafHtmnU, crackling; de ifiailt,
humming; Jt /re/limrn/. fricwon ; dt
p0l fili. cracked-pot ; A rapt, rasp-
tng; iff i«i>^r(, bellows sound.

_ . ._ ^ drug cxiracled from

of biyony. Purgative ;

■Jm on the kidneyi.

ibo. Swelling or (he groin witti

_ ^lUittlion ; generally syphrlitic.

anil' Ihererore to be apprOBched with

care by the nune. Old dressings Id

be bmni Dl once, and forceps only to

be uied in removing Ihcm.

Btulm. Drug used as a diuretic

and n

cid.

I Fluid. A solution of

The

kaloii

iLlcd " physo!
ns an antiseptic in ophthalmic cases.
Il conlracts the pupil.

Oalonlni. A concretion found in
the various reservoirs of the body,
usually called " atone" or " gravel."
' the bladder,

s for the

lilhol-

.ongef

low if the patient rallies from the Rrsl
shock. In changing the dressings
only a small piece of the injured Bur-
bee miul be ciposed to the air at
once, hence the dressing is usually in
Krips. Whiting and water, olive oil.
or immersion in water, are the u&ual
means of excluding Oie air. Skin-
gntfting may be performed subse-
quently to assist in staHIng grnnula-
lion. The smell of a bum is very
ditagrceabie. but can to a cerlnin
ewent be overcome by the use ol

BntWOkl. The nates, or Heshy
pan of the body posterior lo the hip-
^-'-"s. formed by the masses of ihe

from the fixed oil of the

It has a pleasant

and is used largely in

Depraved habit of the

Oad>««r. A

CkflUn. The alkaloid of colTee ;

rebml slinmlant nnd piiwcrful

- -' 1 given hypo-

id litholapnxy

The calendar
■ twcKih pirl of

other = to 39 days, la hours, 44 min-

OalloiU. Hard, insensible, thick-
ened.

OftlltlB. The new material formed
Viben a Iracluted bone unites.

Oalontol. Subchlorid of mercury.

specially in bilious cases and in in-
fentile diarriiea. Sometimes used as
an ointment in skin diseases. Watch
for mercurialism.

Oalorlo. Heat.

Oamphor. A volatile oil, used

alarming symptoms) and external ly as

Outal. A term applied In any

passage of the body other than ducts
of glands, blood-vessels, and air-pas-
sages, (Sec Audil0tj Canal, p. 374,
and Alimentary Canal, p. 370.)
awem. A mnlignani growth, a

operation, and then there Is the risk
of recurrence ol the disease in a
fresh port. In cancer of the Uterus
the operation is hysterectomy. Can-
cer takes three forms: Scirrkma.oi
hard cancer, most common in the

usually i
cer may_

laid. 0

tfiiktiiat cancer,

-^- "- Sof^ CBB-

r months;

378

APPENDIX.

niethodsof rclieviDg pain as ihe physi-

OftralSOEOa. Cancer.
Oardlu. Rclaime lo ihc hfait.

cian orders. The smell of cancer is

which records ihe bealing of ihc

Oancmm Orla. Ulceraiiiiii of the

hearL

moulli in ill-fed children.

Gailai. Decay of Ihe bane, and

Ouuubls tndiOA. Indian hemp.

hashish : a soporific.

has lo secure rest of Ihe diseased

Cumnlk. Surgical name for n

Tnelal lube, anch as ihai inserlFd in

wound, and to note the discharee—

Ihe Ihroal after Iracheolomv,

panicularly U il contains pieces of

CMlUlArldM. Drird Spanish flies,

bone.

OumlUttV*. A remedy lor flatu-

Oioiltchouo. India-rubber.

lence. ZJotfi'i contains opium and

CtpUlarlei. The minule blood-

must be used with caulion.

OaroUd. The principal (right and

■cries.

Icfil ancry of the neck.

GapElcum. Cayenne pepper
useful stimulant,

O&psule. A small usually ovoid
case or shell, made In ivio parts filling
together, and composed of gelatin.

OulKIIle Add, A powErful anti-
septic produced From caal-lar. In
its pure state il is called " phenol."
Taken internally in large doses it is a

i the a

dered chalk, milk, and alkaloids.
Carbolic acid may be absorbed into
the system when it is used ni a dress-
ing ; the nurse generally first discovers
this by Ihe urine, which. on standing,
lunu a veiy dark green. This musi
be reported to the doctor. CartHilic
lotion is used for Ihc hands ai Ihe
sirenglh of i :4o; for the spray, for
moistening pads, etc., at the sirenglh
of 1 ■.to. Nine parts of acid lo one
of glycerin is used as a caustic. Cai-
tion.- Several deaths have occurred
from nurses leaving carbolic acid
within Ihc patient's reach. If possi-
ble keep it under lock and key.

OwbOBAW, Compound of car-
bonic acid and a base.

OubonllLlxia. Charcoal. Given
for chronic diarrhea and dyspepsia,

Cutrande. Severe inflammnlton
of a piece of the skin and adjacent
■issue : a large and painful boil. The
palienl's diet will need particular
Btlenlion, as carbuncles are a sign
of weakened conslilutlon ; it is possi-
ble Ibat spmy I real men 1 may be
tried , or the boil may be opened
and the wound dressed. I

The'

Ocrron OIL Linseed oil and lime,
water in equal parls ; adrcssing usal
for burns.

CutlU^. Gristle; a semi-lrans-
parenl substance of the body, very
elasiic, and softer than bone.

Oamael*, A small fleshy growth ;
hence eartiocnta tadirynmlis^ the
small, red globe of Ihe inner comer
of Ihe eye ; and taruiaulit mjrrti-
formts, Ihe granulallons n>uiid Ihe
ruptured

OiMiv*. Bacnda. A mild laia-
CucaiilU. Drug used as an as-
OilM. A single instance or eiam-
The chief poinu

-(I)

isiory <

health of (he pitlienuhls accupatiim,
his habits of life; (a) history of the
present illness from Ihe very Arst

OftMtln. Analbuminaiecumpaneoi
of milk,

OutUe BOkp. Soap made from

OMrtor OIL Anaperieni medicine
of unpleasant laslE. Il is besi ad-
ministered to adults in coBee or In
brandy and water. Pour sonii> cof'
fee inio a cup and shake the cup so
thai the sides are wel with cofliwi

^^^^^^^^ Gr.OSSARY. 379

pour Ibe oil into the cenire of (he r doI in uw. the Inslminent should

coffee ; make the patient open the

be kept in i : 30 cafbolte solulion;

Bpi widely and Ul die oil pasi well

just before and jusi alter using, ii

lo the back of the Ihroal. Give a

should be washed ihrough with a

ithnk of pure coffee just before and

stream of warm water. Tlie method

jatt after Ihe oil. For ehildren,

of passing Ihe ralheler can only be

powder a desKtlspoon with puiver-
bed sugar, pour in the oil. powder

learned bv practice.

Cktbode. In eleelricily. Ihe pan

IB sur«u« with sugar. Give a drink

of mUk jiut before andju^t after Ihe

pole, ' '^ ^

OkOl. The mcinl>ranes about the

child : « lo 1 ounce for an adull.

head and lice of an infant al birth.

OUU. A cast ii a fibrous ur plas-

Oanrtla. Asubslancewhichbums

tic mut thai hai taken the form of

living tissue. The most commaa

■ome eavily in which it has been

form is nitrate of silver, pointed like

moulded. Casts are eiUier intesti-

a pencil, and held in a metal clip.

nal, nasal, renal, imchcal, etc.. ac-

The nurse musi be careful lo keep

Ihe causiic covered, and. in using il,

Ual, hity. fibrinous, granular, tnu-

musi only touch ibe prescribed area.

Petchlorid of iron and sulphate of

copper are slightly causiic.

CaiU. and Iftial Ca,t,,)

OaulOTlM. To sear or bum with

Oatal^ar. A disease producing

a cautery or a causiic.

periods of nance, during which ihe

OUEMrr. The aclual caulery is

Ihe application of healed melal lo

Ihejr are placed. A pinch of snuff lo

living tissue. Caulery irons arc of

the nostrils will sometimes break Ihe

different shapes, and consist of a

trance. A nunc for these cases musi

straighl piece of iron filed in a han-

dle ; Ihe tip of Ihe iron Is either a

OwtipUtw, A poultice.

point, a buiion, or a bulb. They arc
healed in the lire liU red; if Iben

(hUnet. Opnciiy of ihe lens of

the eye, causing blindness i( noi re-

lighlly louched on a bleeding sur-

moved. The operaiion is usually Iri-

face will anesi hemorrhage. Cat- ■

deelomv. The nutw has lo secure

petlecl resi lo Ihe patient in a dark-

wilh a wire made hot by eleclricity. ■

ened room. Probably alropin, co-

PaltnlMl canltrj is burning Ihe flesh ■

eain. or some oihcr drug will have

by means of chemicals. Thtrmo-tau- ■

(0 be dropped inlo the eye al inter-

lery Is Ihe cauleriialion «l flesh by H

vals.

means of heal gcneraled on galvanic ^H

taUirb. Inflammalion of Ihe

Ihe llurmK-iaiiltry are no* laigcly V

lo Ihe nose and throat, but olso to

replacing the acluat caulery. H

Ihe internal organs at times. Thus

OtTlty. A hollow, either normid.

we hear of " got trie catarrh. " An

as Ihe abdomen, chesi. etc., or diiur-

ordinary cold in (he head Is mm/

latiirrt, Inhalalions may be ncces-

cavilv.

0»yenneP*pi.»r ";.■.• 0/n.f««.)

OkMdtn. An asltiogent, given

Cecum. ^ ...: h ..r«-/- _■

chiefly in diarthca and dysentery.

Je-,.,. .. -.liialed ■

bet"..!. :!..' ileum ■

iieaied lo make ligmurcs.

and.,,..,:.., ., I.„g,ln- ■

OUhuUC. A purging medicine.

talin,- i;„.-;,...i.„ .,.,.) r.-lalloM ■

loch as senna.

of Ihe c«um rendi-r it i-ctuhatly H«- ■

OtaultK. An inslrumenl torwllh-

ble lo iwo forms of disordur— accu- H

drawing water fn>ni Ihe bladder;

mulation of Ihe conlenis of Ihe all- ■

made either of silver, IndiatuM.er.

mcntarv canal and inflammaliun. ■

^^^^^^^^^

380 APPIi

nelwork connecting the niajorily of
the minute parts of the body.

OantlSTftde. French method of
tnarking lempcralure ; Ihe (reeling
point i& a", Ihe boiling point 100°.
(See Timpiraturt.)

OenUrnumne. The one-hundredth

OepbalAlglft. Pain in the henc
■'cLpliiilL' " is uied (o conipoun

CeptLalhemfttomK. A bloody ti

CepIialOtrlb«. An Instrument coi

used lo crush llie (eialhead.
Derate. A gren^ substance coi

]

■A/D/.W

ObanAe- L'nravelted, shi
len, uwd for dressing wou
Oliait. A ruled sheet of pi
hich Ihe nurse reconlsthe te
ire, pulse, motions, etc.. o\

CliaitM. Papets od which

CIuttMliic. The noise made by
the teclh striking together repealedljr
and rapidly, as under Ihe inRuence
of cold or of fright.

Chaau-ClOUk. A conrH: cutlon

used in cheese-making (or wr^ipping

the cheese.
OhBBt. (Sec Tiffraif.)
Cheyenne- Stokei BrefttMoK-

joflc

cndily b

IhmitwDl not
plied to ihe sk

0«re1>elliUll. The little hrsin at
th,: li.uk „f ilie head, between the
ciTi'l^rniii iind Ihe mcdulln olilongala.

Oerebral. Kelaiing (o Ihe bmin.

Corebrnm. Tlie big brain, occu-
pviiiK ilKTriinium.

Cenunen. Waiy secretion of the

Oerrlx Uteri. The neck of Ihe
Deiarekli Section. An abdominal

will

■n for I

g the I

s fitsi performed
successfully on n woman in 1493.

dlftflnc. I^xcoriations, abrasioins,
and inflammation produced by fric-
tion of pans, or between Ihe folds of

Cttarcoal. Prescribed ru a medi-
cine in dyspepsia, and generally given
as tabloids. A charcoal poultice is
made of equal pant of flaxseed meal
and powdered charcoal.

lorlnight. Uive hght Itwd a
from eotd ; prevent the patif
scratching Ihe pimples, or s
be made. Infeciions.

OhUblalH. A blain or sore pro-
duced by cold : no erythemaloiu
condition of Ihe hands or feet, ac-
companied With inftammallon, pain.

OUJdblrtll. The ncl "of bringing

forlhachild.

cum.

ly appear-
0 cold or

A senKitioD of cold accom-
panied by shivering, usually n]
iTig shortly nf^er ciposi
wet. Il is usually ihe nrst sympiom
of grave acute disorders, as pnen-
monin * and is a promineni symptom
of various forms of malarial (ever,
(See /figar.)

CblTOpodUt. One skilled in eul-
tioK anil eilnicling corns,

Cblmrglckl. Surgical.

CUoral. While opaque hypnotic .
.Infiiliifr for overdose, fresh air, am-
munin, arlificia) respiration.

OUnilne. Aniisepiie. Used as a
lotion tor sores ; also as a gargle, tn-

OtalorofDrm. A colorless liquid
used <o produce anesthesia by in-
halation. Chloroform mnsl alwnys

GLOSSAHy.

381

be kepi in the dark. Tlie prirale
nunc has sometimes to adminbler
chloroform ; a umpLe iahaler is made
of a Moall wire mask ov«r which a
piece of flannel is slivtchcd. or a few
drops of chtoroform can be sprinkled
on a (owcl and held close (a the par
lirnt't &ce. Chloroform is only ^e
wbcn railed with air; so ai inlervals
ibe lowel must be removed and Ihe
palicDl allowEd a brealh of air, Un-
coDuioiisnGSs is reached when all the
musclta Afc relaxed, and the palienl*s
liand drops when raised. The eye-
ball should mrvet be touched, as it
may cause inflammalion. Many
ulses have been known through this
practice of the elheriier. AiUuioti
lac BO dverdoie, fresh air and arti-
Hciol rewiralion. If the nutse is ad-
minislerinB the chloroform, she must
be very careful to watch the respira-
tion of the patient. Before the anes-
thetic is administered, liilse teeth and
tight clolhing must be remotred. No
solid meal must be given for six hours
before Ibe operation, but a little beef-
lea may be given two hours before.

Ik prepared for the vomiting which

OhlOnMla. A peculiar form of
anemia common in females about the
period i)f puberty. It causes weak-
ne^, rapid heart-action on exertion,
nnd lamlncss, lor all of which a nurse
must be prepared. It is generally
met by iron Ionics, ica-air. and
strengthening diet.

ClUUCOSiWB. Agents which de-
crease the bjle in the blood.

Cbolara. .4n epidemic disease.
Sjm/ittmi ; Cramp, vomiting, and
rice-water evacuations. " English "
ehulerais the mild form; "Asiatic"
IS the severe form. Much depends
upon the nursing; the paiii^ni must

I* given prompiiy. Tlie K"-"J1 i1:ui-
ger is from cuUapsi;. Tlit paLu'nl
should, if possible, he placed in a
separate room. Only llie persons in
attendance should enter the room.
If the apulmeni should nol allow uf
lUfficient isolali

choleraic patients, or who live with
them, should obey the following
rules; Neither food nor drink should
be taken in a room occupied by a

Stlenl. The mouth should be care-
ly rinsed before each meal, and the
s and forearms washed with a
solution of borax. The bee, bend,
lands, and, if possible, the whole
body, should be washed dally with
r conbilning ibo grains of borai

1^ removed to

Lhosiiital. Tlios.

and h;

wiflly.

iheaof mfants; ll fi'ijuirLS iinmecl

on. Dietisof the ulmo^llinporlai

Oulerft Korbu. An acuie
lanhal inflammation of ihe mu<
membrane uf the stomach and in

Olioiaft. St. Vims' dance; intol-
unlury twiichings of the muscles;
most common m children, who gen-
erally grow out of it. These coses
must not be left alone, and every
elTort must be made to prevent chil-
dren from hurting Ihemselvei. Diet
nourishing. Balhs and gymnastic
exercbies may be ordered.

Obarlun. The afler-b^rili ur outer
envelope of fetus.

CbTOOlO. A lengthy mild disease.

OtirlDlla. Milk-like urine.
Obyma. The pulpy miisi, of food
ihich pa^M^s frum the stomach into

(HmMx. Tlie

1 healed

CllU. Eye-lashes.

"■"-' Peruvian bark, which

in malarial fevers fur
reducing the ranges of temperBmre.

ClrculAUon.

APPENDIX.

Ihr blood from Ihe

learl, through
id capillBfies
p. 287I.

ciicuUr piece uf the prepuce : B^n-
erally peifomied on young children.
The child bos lo be kept very quiet

OlirlUMlB. Contracted granular
jtatc or on organ, usually applied !□
the liver or the lung. A cirrhous
liver if generally produced by drink.

CirwUL Rewmbling a varii.

Citrate. Compound of citric acid
and a base.

Cltrle Add. Acid prepared from
lemon-juice. Mokes an aslringcnl
yet soothing lotion.

GlATlolB. The collar-hone, going
from each shoulder to the breast-
bone across the front of the chest.
Fractured clavicle is set by a firm
pad. 4 or 5 inches square, placed in
the axilla, the forearm is bandaged
over the ehesl, and Ihe point of Ihe
elbow kept well back. No anesthetic
needed as a rule.

ClaiTiu. A com ; a thickening of

OleRPslata. A

in the roof ~
nose and 1
The child i
fed, and a
the milk p.
of the ihro

milk is lial

m Ihe I

nital split
10 thai the

fonn one cavity.

' sal upright when

CllmkotBTia. The

penod

I females : often
Ihe healt

needs great attention.
Cllnlo. Bedside.
Ollnleal Thsmiometet'. A slender

gliBs instrument used to discover Ihe
temperature of the body. [See Ttm-

Olltoill, A small organ of erec-
tile tissue, found in Ihe female in
front of Ihe pubes. The seal of sei-

Clonic. Spasmodic contractions.

SiiC-^

and aromatic proper.

Ihei

Oltlb-flMrt. Talipes. A congemljil
turning of the foot in a wrong direc-

wearing by the child of a light iplint.
which may efTect a cure. Massage
is useful in the case of infants.

Ol7«ter. An enema, or injection
per anus.

CoMnlatloii. Thickening of a
fluid into curds.

QOOKln. A powerfiil local anes-
thetic, much used by t>ciilisB and
dentists. II enlarges the pupil of the
eye. Useful to slay the craving for
opium or drink. The hypodeimaiic
injection of cocain prodnees severe
symptoms on some people, and anti-
dotes (amyl nitrite and morphmj
should always be si hand.

from

Chfo

Ldulgenee i.

Oocoyx.

OmiblM. The cavity of ihe inle

Codaln. A preparation of opliui
ised to soothe the nerves and ii
luce sleep. It allays cough, and

Lseful in diabetes, etc.
Ood-Uw Oil. A medicine tts«

irfy'in

sumption d

e.patticu-
li ought

weight. It should be given ofiw
food, plain, if Ihe patient will lake ii :
if not, noBled in milk, coffee, or or-
ange-juice.

OolcUcnm. A drug used in gout ;
it reduces the blood<pressuiv. and
lessons muscular irriubihiy. Poison.

Colic. Severe pain in Ihe belly:
generally allayed by hot fomcnla-

ColltU. Innamraationofthecolon.

Poultices, opium injections, or mor-
phia suppositories. In mfmiramoMt
coHHs or enleriHi costs arc possol

ColUtpM. Severe sudden prostra-
tion. Sjrmfliim] : pallor. fiiiatDeA of
pulse. \i neon seiousnes.^. Trtarmtnf :
lay patient perfectly flat, keep warm.

383

give ul voUllle or alcohol En small
doses^ watch (he puL». Hypoder-
matic injeclion of brandy may be

aiiificial respiration, if Ihc brealhing

CoUlLT Bone. (5f c ClaiHclr.)
Collodion. Cun-coiion diuolvpd
in alcohol and used in surgery to form
a folic skin. When painted over a

hardens as It dries.' and forms' a
slight prelection to the tender skin.
The stopper must never be kept out
of the collodion bottle formore than

OoloejnUl. A drug used as a
rapid and drastic purge.

OalOn. The part of the large in-

.___ A watery fluid flow-
ing irom the breasts the first two or
three days after confinement, befijre
the true milk comes.

Oolotomf. Incision of the colon -.
a serious operation which may be
performed in the lumbar or inguinal
" "" " ss of fistula, obslruc-

r ulceration of the

of the

Oondjrla. A round projection a
the ends of some bones.

Ooudy'i Fluid. A valuable ami
septic, prepared from permanganati
of potash. Everv monthly nursi
should use ii when syringing is or
dered for her patient.

CanncUoDM. SoR pasles contain
ing drugs,

■ The condition ol

childbirth.

\ term applied t<
irupiions in which the pustules rut

those present at birth.

Cai>C«sUai). Torpid stagnation
of blood in a part of the body, as in
the lungs or brain. Congtition ef tlii
tings is brought on by chill, and the
nursing treatment is warmth, rcsi,
Haxseed-meai poultice to the affected
part, and light diet. The lempera-

inflammi

sensibility,!

lupor, sleep, fcvei
of coma. I of c

. Sebaceous se
Of the hair-fall ieles, commonly calif
" black-heads." and most frequent c
the face.

OonipllMitlon. The occurrem
during ihe course of a disease i

drug which qu
also the cent
I Used specially

modifying symptom.

of the conges-

al nervous system.
AnlidBlts: SlomAch-

A lighdy folded pad .

to secure local piessure. |

"nio impregn.ilion

OoncretlOlM, liony deposits: cal-

OobohhIoii at \b,« BtaIa. Sud-
den interruption of the functions of
Ihe brain, and consequent uncon-
sciousness, through H blow or &11,
Kest and quiet are necessary, and
Ihe application of cold to Ihe head

d warmth to the extremities. In

OoiiJUDCtlTltlj:

the

(which see).

of tl

ophthal-
ed slate

Rlld e

Oonatlpatloii,

of the bowels ; the nurse mi
report to the doctor when
of Ihe bowels takes place in twenty.
four hours. The remedies arc usu-
ally either an enema or a laxative

A wasting away,
caused by disease of the lung*. (See
Pklblni.)

APPENDIX.

a contagious diHase can only be
tiught by those who come iolo di-
irci conmct with the paiicni: ii is
not communicable through the M-

_ — .. ^« — j,_ A simple febrile

lerrupicd by any allempt ax ireat-
mirni. The paiient musl be kepi
rijcunibcat, cool, and fed on lighl
diet. Noli^ icmpcralurc.
OonbaoUon. The act of dnwing

Coatiulon. A bruiso.
OanTKlascMiDa. The period of

(ient, preveni rash deeds, or (itilgue
arising from too many vlsilora; sup-
ply light nutritive food at frequent
inlervalt: xvoid idl talk about the
post iUness. and watch for a relapse.

OonTolntloiu. Tlie folds and
iwisi^ of the brain or the intestines.

Oonmllloni. Violent spasms of

scular

usually the i
.rofoi "

[) infan

is ni^tied to ipaimodic movements
of siiOTl duration and allernote
periods of relaxation, as in epilepsj.
Tiwic convulsion signifies a contianl
rigidity. f/^ixM Is due to the altered
stale of the blood in diseases of the
kidney. Convulsions occur in epi-
lepsy, tetanus, hydrophobia, and
chorea. (See Ettamfiia.)

Oopalbk. -\ diuretic: the oleo-
resin is also given in capsules for
aicirides. etc,

Ottrd. The connection between
motlier and child at birth; after
vnishing the infant, the remnant of
the coT^ should be dressed with pow-
dered starch, and a square of anti-
septic gauic.

Oore. The central slough or sub-
-i: of a boil or carbuncle, formed

Oarntft. The dear, gUu-likc fronl
of Die eyeball.

Ooia Btarch. A Suur made (rum
the starchy putu of Indi.in com.
used for puddings, etc,

Ooronml Bvtim. The joint ol
the patielAl and frontal bones of the
skull.

Corpont Lntek. Vetlow bodies in

OorpiUBla. A minute protupUsmic
body — for instance, the rvd and while
corpuscles of the blooU.

CwraoUTt. A drug which modi-
fies the action of another

OorroalTB. Eatmg ii

CorrortTe Bnblliiikte. Perchlorid
of mercury. Antiseptic; poisonous.
The solution i in looo is vrry osehil
in infectious fevers ; It is seldom used
for instruments, as it cormdet stctl.
Ai/iJolts.- flout, milk, trhile of egg.

OorjiK. Cold ID the bend, unl
catairh,

OoiUL Relating to the nba.

OofUra. Constipation.

Cotton. The while fibre obtiiiMd
from the cotton-plant [.Cuijfiiml.
Aisirient cullon is the fibre prcpucd
by removal of oily inatten lor use In
su^ical operations, etc (See CM^
Jina. Anliirfitit teUim.)

Gotton-voaL (Stw CMCm.]

Oong h. Violent, sonorous expit*-
lion after closure of the glolll*.
//d£*iiij-couEh is a short, broken. diT

Coiutar-aztwuloii. Exientioabr

means of holding back the uppvr
part of a limb while the loww i>
pulled down.

Oon&lei-mUKBU. The4rufsiiMd
to produce counier-irriuiion [4. il).
called rube&cienls. epipastics, "cri-
cants or blistering agents, and pucM*

Oonntar-lrTltetlim. Causing iirt-
lalion of one pan ut tbe body ta ■B'
■ — L__. ^Ijp called ■' detif*-

OoKalglk l^in in the hip-jtnnt.

,e.. //>>»>«/. 1

Ooatll. InSamination uf the hip-

Fricti

n the injured pntt of

nny give

OTMilotoniy. TliF operaiion of
pdrfor.iimg (he head of ihe fetus dur-
ing panurtlion, crushing it, and re-
movrng (he fragmetits.

OnUlliuiL The skull.

Orarat. A bandngc of iriangular
shape, uicd as a lemporarj' dressing
for a wound or n ^actute. (See
B^mdag,.)

OreoUn. A drug nearly related to
carlMlic acid; antiseptic and disin-

OncMoU. An oily amiseptic
liquid got from wood-lar. Used as

remedy for (oolhache; also as a
styptic, an anlispnsmodic. and on al-
terative. Gives Ihe uriac a blackish
color.

Orepltatloa. The grating sound
of two ends of a fractured bone rub-
bing together. Also a grating sound
heard on auscnltalion in cases of
pneumonia.

CnttnlRll. Imperfect men tAl fac-
ulties, oflen accompanied by goitre.
Most common in Swilicrland.

Ccllls. The deciding pomt of a
disease, from ■ ' ' ' '
begins

>f Ihe !

» of danger thai ai

OnpplllK. Blistering or bleeding
by menns of bell-shaped glasses. Put
a few drops of spirit of wine in Ihe
gbssand swirl ii round till the inside
is moisi 10 the brim, A plug of col-
lon-WDol on a sliclt should then be
dipped in Ihe spitil. lighted, and
passed quicldy round Ihe glass; Ihls
will produce a large momentary
Hame. and the glass must be imme-

theglas;

:of tl

dry cupping; if it is iiitl cupping thai
is ordered, the glasses aie removed,
tiumeroiis small incisions are made
in the risen skin, and the glass is re-
placed (after having been exhausted
again), and a steady flow of blood
will soon fill the glass. The wound
can be dressed with some simple

Cupii Snlphu. Sulphate of eop-

iiillv ,

OrotObet. A hooked ii

e blue biood of ihe ■

Orobm OU. Used as a liniment

the skin.

and as a swin purge; causes red

Ojrt. A lumot containing fluid.

eruption on Ihe akin. Poison.

or stmi-fluid, in a membranous MC.

Onmp. Acute inflammation of the

OrttalBlk. Pain in the bladder.

bryni and Irachea. most common m

young children. A nun* should

of the bladder ; often chronic. The

nurse will have to measure nnd lest

and crowing sound which are pre-

urine, and probably give douches. If

child may sulfecate if attention is not

obstinate, perineal incision in the

male, or colpocyslolomy in Ihe fe-

male, may have to be pcrfotmed.

Crnnl. Relating lo the Ibigh.

Cyitocals. Protrusion of Ihe

bladder.

OyrtOMOP*. An inslrumenl for

lion of a noteworthy and sudden re-

examining (he bladder; sometines

lighted by eleclticily.

386

Cyitotoma. A s urgi c:

APPENDIX.

case peritonitis supervenes.

D«ftd. The laying dUI of the dead in
is Ihe nune's duly: the eyes must be pi
fJDsed by genlJc pressure of the

by a bandage passing under Ihe chin
and lied on Ihe lop of Ihe head. The
body must be washed all over one
hour after death , orifices packed with
coltan-wool, and clean garmenls put the

cide. Too olten ■ patieni has ec
milled suicide " in ihe absence of Ihe
nurse." The nunc should never be

OoIMum Tmbwu. Mawia-a-

fiotn. The trembling delirium due lo
excessive use of alcoholic !ii|uo[i
The palieni must he humored nnd
soolhed in every way, and walchiil
Collapse must be ap-

DallTUT. I^nuritioni childbirth.
■ « delivery is the bitih o( a
the death of (he molhrt,
cumuUiion of gaies in the

Daltold. The muscle which Ibrmi

DflbUltanU.
Debility. V

cepiion, and thrown

if the shoulder

lion, as between healihy and gan-
grenous tissue.

DammilU. Feebleness of Ihe
menial facullies. inconsequent ideas,

l>eminlo«iita. Agents which pto-
lecl sensitive surbces ftom inita-

Ottcoctlim. The eiitaci obtained
from ixny subslnnce by boiling, sinimenl placed on the leeth lo «s&lsi

Dacmnpoiltion. Putrebction. hearing.

DecnasAUon. An X-like crossing, l Dentlse. The hssae which foims
especinlly of nerves or of nerve-like ihc body of a loolh.

Dentition. Teething ; inEnnts have

-iween, and S molars at the back.

Detec&tlon. Theaciofevacuaiing
the bowels.

DarOrmltr, Abnormal shape or
slrucuirc iil a body or any of its
parts.

Degwwrmtlon. Abnoimal changes
in Ihe tissues. ^M//0»<degenenilion
is that of the tissues of blood-vessels,
spleen, hver, etc.vfhich became wax-
like. Fally degeneralion i« when the
muscular fibres degenerate into tat.
and thus become incapable of work.
A term used especially of Ihe muscles
of the heart.

Deglutition. Act of swallowing.

DeleoUaiu, The fecal or other
eicrcmeniitious matters discharged
by Ihe body,

DeUlltim. F.itravaganl talking,
mving, generally due to high fcver.
The nurse must watch the patieni
carefully, as he is ns irresponsible for
his deeds as for his words, and may
escape from bed, or even commit sui-

cnih 1

1 rule.

years all the teeth ^ould be present.
During leelhing the gums become
swollen : the child must be kept from
catching cold ; diarrhea, convulsions,
and rashes must be watched for ; the
temperature should be taken every
evening. (See also TfrM,)
Beodonuit. A subsisnce that vilt

ehlorin, chlorid of lime, quicklime.

Deodoriier. Destroyer of smetli -,
the chief deodorants are chlorid of
time, sulphurous acid, nitrous add.

DepUatOTT. An agent hr remor-
ng superfluous hain from the body.

Depletion. Act of emptying:

ileeding: purging.

GLOSSARY.

physical or raimtal conditiun. In
surgery, displacement inward of the
ikull, often giving rise to pressure

DaniuUtll. InflammatioK of ihe

of blood to a. pan.

"Xhit Irtatmt*! olmoit entirely cansis

pastry, piilaloes, and bread have to
tw avoided: meat, Gsh. eggs, butter,
cbiew, and greet) vegetables are
allowed. The nurse will have lo
measure and lesl urine: the quantity
may he a& mucb as4 or 5 quarts in 14
boun; the specific gravity may be
ai high OS 104a; the urine m diabetes
turns Fehling's solution yellowish-
brown, Diaitlei iniifidus. character-
lied by a greatly increased flow of
urine of a Tow specific gravity, asso-
ciated with a marked degree or iliirsl.
The urine is pale, almost colorte&s,
and with aspccificgtavily but slightly
above that of water. Many of the
cases progressively emacialu and
finally die of exhaustion. Diabrits
mttliais (see Gfyanria).
~' ■ . The decision as to the

reof aJ

illnes:

Dlkphtkim. The muscle sepnrat-
mg the chesi from the abdomen.
PHtftyiU. The middle part of

387

DlMTlMft. Frequent loose evaciin-
tions of the bowels. Very weakening.
Diarrhea should immediately be re-
ported (o Ihe doctor, and Ihe evac-
uations kept for inspection. Il is
especially dangerous in children.

Dlutol*. ThiT

Dicrotic.

loubie

Diet. System of food. As a rule,
/a// ^vr consists of an ample allow-
ance of meat, bread, vegetables, pud-
dings, etc. ; miJdU ditl. of mutton,
lisb, bread, milk puddings, and eggs
in moderate quantities; /ever, or
" light " diet, of beef-tea, chitjien-
broth, and milk: no solids.

DlgMUon. The process of con-
vening the food eaten into chyme
and chyle, so that it can be ^sorbed
into Ihe blood.

Dlf Utlra. Relating to or favor-
ing digestion. The dignlivt or gas-
tric juice] are the normal secretions
of the glands of Ibe stomach.

Dlcltal. Pertaining lo the finsers.

DlglUlb. A drug eitracted from
the foiglove, and used to stimulate
the action of the heart. It causes
decrease of pulse-rale, and increase
of urine. Poison. Marked intermit-
tence of pulse lo be immediately re-

DIUtation. Increase in %\a, en-
Lirgemenl.

DUtienti. Medicines supposed to
increase the fluidity of the blood.

DlpUImla. Infectious inflamma-
tion of the throat, with formation of
false membrane, which lends to close

tiie earlier symptoms of diphtheria
are like those of a heavy cold ; the
temperature does nol run very high.
Gtayish-wbitc patches appear on Ihe

APPENDIX.

loosils and on the inlcrior of Ibc
thioat; this is Vlx falit membranE.
The palimt shoald be isolated, and

thorough diiiiifeclion of everything

TTie nurse must be carehil never !□
inhale the patient's breaih. In severe
cues, where tuffocalion is imminent,
irachEolomy or inlubation may be
performed. Death may be due to
blood-poiHUing. sudden heart-fail-
ure (permit no exerlion on the part
of ihe pBlieut), or secondary pneu-

MpIapU. Seeing double.
Slpwimkiila. .\n irresistible mania
(or drink, occurring al regular inter-

cascs has a hard time; Ihe general
health of the patient must be attended
lo, he mml never be allowed to get
hungry or thirsty. Strong cofTee
and salt'bcef lea ahaold be given

DlMetor. A grooved surgical in-
situment used to guide another in-

DUarUcnlatlon. Ampuution at

cirbolic acid, sulphur, chlorine!

Olalllfftetioil. (See Fumiffolion.)
DlslocUion. Displacement of a
bone out ol its socket. An anesthetic is
not usually necessary for Ihe operalion
□[ reducing a dislocation ; all thai
will be needed will be two or three
bandages, two or three lung towels,
and some powdered starch. After-
ward the patient must be kepi quiet.
Compoumd disioiatioH, rupture of the
coverings of ' ' ' '

DUOrtar. A tli^t form of dis-
ease. Fancriiiiial disorder is an on-
explainable disorder in the woiliing

DoruL Relating lo It

- 1. The hack.

The quantity ol
which when luken will produce tbers-
peuiic effect.

DotielM. A shower of water. Hot
douche til" F., cold douche 50° F.

Dorer'a Fowdar.

gredicn

leof w

h Ihe I

i pecacuanha and opium .
reoses perspiration.
DTkOhm. Weight of tograins, or
in ituid measure 60 miniins (about
one leaspoonful).

DnlBACa - tntWI. India-nibber
lubci of diffetcnl sices tor inserting
in ^suppurating wounds and sons.
When not in use. they should be kepi

XMien used they are snipped up and
down each side, and a safety-pin or
some long threads of silk are put al
Ihe mouth, lo keep Ihe lube ftuni
slipping out of sight into the wound.

DrmaUo. Strong, severe.

Drualnc. The cleansing and ap-
plying of healing remedies 10 a
wound. A nuise must always have
ready the applications for a dressing
before the appearance of the surgeon
or student who is going to perform it.
Surfital dressafs are those applied
in opcnlmns (see p. 176).

Sropiy. .An unnatnnl effusion of

tir<, of Ihe body. Dropsy has bven

s.iid lo be a symptom, not a diseaK.

and It frrquenlly sets in loward Ibe

of cancer, heart disease.

389

Dropsical patients need the
' ' caie in moving them. The

mtnost likely lobe pertonned

n. To deprive □( life by im-
io B Duid.
_. Any chemical subsldocr
iDple or compound) used in the
imenl of diiease.

Heal wilhonl rooisiure.
' Snok A canal ot lube; luually u

oi a gland empties. The ii/iarvducls
are the hepalic. cystic, and com-
munis clioledochus duct! of the liver
■nd gall-bladder. Lacti/erim, dmcls
are thecanalsofihe mammary glands.
Dnodeniun. The Urst part of the
tmall intestine, beginning at the

l>an Hster. A strong membrane
Immg the interior of (he cranium and
ipinal column.

TtjtmaUarf. Inflammation of Ihe
inlesljne, accompanied by bloody
evacuationi. Absolute rest, aiiention
to diet, and regular administering of
remedies. Chills must be avoided.
Enemas are frequently ordered. The

Sochymaila. A bruise ; .in effu-
sion of blood under the skin.

Eclunpsik. Serious puerperal
convulsions, with mpid molions of

BCTftaenr. An instrument for re'
moving piles, mnlignant growlhi, elc.

Soiemk. An eruption on the skin ;
nol conlagious, but very unpleo;

local remedies are often lef
nurse to apply ; washing 1:

Tlie

der will probably be oi

a niiLsk of li

Child

ir aides

10 prevent scratching. A chill Will
increase Ihc disease in children.

EdUU. Swelling of a dropsical

nature; when Ihe Rngeris pressed on

the part affected Ihe flesh pits and

foi inspeclioD. The petjcnl is liable i docs nol rcgnin ils color and fonn for

suffer from weakness i
DyiniMioriltea.

ll o

wiin ine cure oi the laltci^ or il
may be due to causes which require
surgical interference. If only occa-
sional, hoi fomenuiions lo the abdo-
men, bot drinks, and a hoi bottle to
Ihe feet and back may give relief.

Dyipepilft. Indigestion ; careful
alleniion lo diet. Note ihe condition
of the longue and the evncualions.
Be prepared for itrilatiilily and mel-
ancholy on Ihe pari of the palient.

DripbafU. Uifhculty in swallow-
ing.

SjnpIlkaUL OifHcully in speak-

DyipbrmBUU Loss of power to
qieak the words wanted.

DjnpUK. DiOicult breaihing.
DrrtOOU. A difficult l;lbor.
QjmslB, Difficult discharge of

edema should bi
EfferrauBiit
Slll«nn«a. .

.light and geni
I and friction, d

In I

S any

: wilh the finger
ow of fluid into

BlbOW-JOlnt. The articu
he arm and furearm,

ElMtrldtr. A nnlutal fi
rjied by chemical .iciion, fr
n.ignelism.

Sleatrode. The point i

A skin disease,
nlargemenl of the
led. llischtunic;

APPENDIX.

BaJwale. A disease prcvxltDl tl
B particular localil)',

BndMardlltl. lnfl»nnuUc>ii u(

ihp lininG mcnibrane ui tbc heart.

■pptird Often occun aftci rhcumatiin) of

■ ' renal discsse; seldom direclly EiUL

The liDlDg mem-

The lining mcnt-

ona. A reclal inJKtioo for
^>Dal OT nutritive puipotei. The
mesl ased is commonly a
[c, « bulb from which go two
: one tube hu an ivory mouili-
vliich ii iaserled inlo (he snia.
bcr is put inlci Ibe fluid In be
tA. InajdmintslcrlngBnencam,
a lie on lb* left

UM pftueni to lie on ID* icn ^
rldi knees drawn up, hare &• ^1
oontalninj: tlur enematH on > ^V

oontalninj: tl

K>M«U 1 - T pro- ' of th.- ivimgc, and, st.incli»e brhm

»lu,T ^luii-.i.ns. fKtlins ibe Ihmaljthe p*tienl. insert it eenlly : pn
».;'! J K-jthrr ^ LiiX' draughts of Tiously the air should have bee
)vi<i.l wjKi. sjlt sitrr. or mustuil sque«ied out of Ihe syringe and It
iai! watcf. inll prvvluc< the desii«d , fluid drswi ■ - - -"

BBmtsicoo*- A mediciDe vfaicb

BmdUeatB. Sy'tloDins ud sootli-

(See Tffkoid

S»<!Lmg produced
hi ,i-r. .1^ ilri>;"\ ;. c.iustvl bi liquid.

SmjtlrictnL IV '

Ha. InRammation of Ihe

pn r>.;>r-iiii-v >>n)i. not iin leatn- srnall inlesline. A disease accom-

"1^ panied bv much pain, and needing

Smplftrtmm. A pl.islrt. careful nursing. No solid food is

~ Spisms caus- permitted, and ^Uaolule rest in the

I-1-11.1 fonijrd. recumbent postion.

A v'OLlKtLon of pus in BotarOMl*. Hernia, consisting of

EBtWOtomy. Opening Ihe peri-
l mmure of oil. such toneal cavilv and raising and opening
,..-,v.u-ii>vi oil. niih wjter, by aid of . Ihe distended bowel. Like all forms
cum. Flo. of intestinal suisery.it is serious, and

Euma). TTie hird outer ctatinK needs careful nursing.
of tht tvh.th. Bnton*. Parasites Uving within

Bnc*iibAloc«la. Intrusion of the the bod y

Eac«pb>ioB. Thr brain. of unne. Give no liquid near bcd-

Eucrned, Tumors contained in lime.
a SAC or cvii. | Ej^ldemlC. A disease attacking a

EndarterltU. Inflammation of . number of people in the same place
the Immg ni.mbranc of the arteries. \ al one time. Epidemics are usually

CLOSSAXV.

■< accounliMl for by Ihe disease being
other infceiious or conlagious.

EpldoittU. The oulermosi bycr
of ihc skm.

Epl«a«trliim. The region over
Ihe M-nwch.

EplClDtUi. The Ibin flaps of car-
Ltfluge which guard Ihe entrance to
~K glottis or nindpipe.
BpUaplT. A disuue at Ihe brain
KflMrkcd by the occurrence of con-
■" ■ c fits. Pencverance in treat-
Is Ihe chief hope of cute, hence
ll behooves nurses or allendanti lo
very palienl and careful. A
_ II III is called f4lil mal. a severe
Mtgrond ot haul mal. The fits a

bye

Uy Slighl ill-hentth, lack of atlenlion
■> Ihe bowels, for insUnce. The
•e must note if the fit commences
rVilh ■ cry, where the convulsions
liegin, and how they spread, if the
thumb ii flexcd.and how long the fits
fall. There is nolhmg lo be done
foe the patient but to put him flat on
■be floor, unloose lighl clothing, put
m cork or pencil between the teeth to
prevent Ihe longuo being bitten, and
otherwise prevent him from injuring
him self.

EldpbJvU. A process of bone at-
tached by cartilage lo the ends of
bona, and from which growth takes
pU«.

Bplpjota. The omentum, a mem-
branous eipanslon which floats upon
■he Inlesllnrs.

ByllllrtOlllr. Incision of labia in
diArculi part uri lion.

BptipUtlM. Agpnit applied to
the skin to produce discharge, such

•T*"^'*^* Bleeding from the
now,apt to become serious in dcbili-
Isled or anemic persons. Applica-
tion* of ice-bags tu Ihe back of the
neck and to the forehead, or plug Ihe
now with llnl dipped in vincgvir or

Filaments of

or some olher disease of the kid-
neys.

BpltbeUimi. The outermost
bloodless luyer of the mucous mem-
brane; corresponding with the epi-
dermis of Ihe skin.

Brest. A drug derived from a
fungus which grows on rye; ilia used
especially in labor cases to contmct
Ihe uterus and arrest hemorrhage. It
prolongs the length and force of pains

Srgotln. A form of ergol specially
used hypodcrmalicallv lo urtesi
bleeding.

BlOtlan. Ulceration of pans.

Bniotatlmi. Klaiulency. with ex-

Bmptloa. \ breaking out on Ihc
skin.

SryilpelM. Contagious inflam-
mation of the skin, lending lo spread.
accompanied by (ever and pain in
the pan afTccled, li ii necessary for
a surgical nurse lo keep watch for
erysipelas, though, in these days of

1 seldon

ap.

pears. The tymplomi are redness
round the edges of the wound, vom-
iting, rigors, and a rise of lempcro-
ture — all this must immediately be
reported lo Ihe surgeon. The pa-
tient and nurse are isolated and great
care must be taken lo disinfect all ar-
ticles used. Theperiod of incubation
for erysipelas is from three to seven
days; on the second or third day
afler rigor, a diffuse red rash with
swelling appears, Consiilulional ery-
sipelas of the head and lace is not
uncommon. Erysipelas conlagion
produces puerperal fever in parturient

Non-ci

e, often followed by rt

1 Ihe

of Ihe
orlllied

pirt in dry gangrei
EiaptaLKtU. The canal which runs

Eaienoei. Strong solutions of one

part volatile oil in four of rectified
spirits. Usuallygiven in n few drops

392

APPENDIX.

laAiioSmiri^^^^

EtlMTliAtlon.

A volaiile Uijuid much i of the spuiam-cup, and bof nulyi.

lanestlielic. Il muil never pcamncc— if of apranc Color. Jraih

car an uncovered light, ai is litely ; in tromAilii the enptiiiira-

\r ID eiploile. Spirits of i tion a frothy, nbundaol, and otlro

\tr .ire diurrtic nnd carmin- streaked wiih black, and gf ■ jpecn-

i^-yeJlow cokir, from Ihe pmcncc

Annthesia or un- of pus: ia cennamflitn itte triprKiart-

iroduci'd by the in- lion varies from a small qtiantttj' of

'apur of ether, frothy Huid to absndutl gnKuish-

bonc of (lie note, yellow ofTensive pblegm or ipuiuni.

the olbictory oervo often streaked with blood.

BspTMilon. The reco^iubie

be science of the manifestation through the facial bnr>

ciusaiion 01 uiiease. amenls or the voice of any subjective

Bnutlyptm. An nmlscplie much \ feeling,
usedincDlnrrhalafTcclions: it is used SxpnlabO. Theactof driving oai.
OS an inhalation in plilhi^is. Il i^ « 1 SzUuilOlt. A ccrtuin pull ui
colorless, oily liquid, with a pungent. Height applied to a fractured or dis-
smell. located limb to keep il simieht.

I mnscle whici

through wh
£tlolOB7'

EvatacUauTiiba. The canal from ExMnior.
the Ihruai 10 the

impletely tt-

EtulacblMi ValT*. A fold in the I SxtlrpaM

Trrinbr.inc uf the rigli I auricle o( the | move.

hrail. ExtTMitt, M edicinal preparations

SvacnaUon. Discbarge of excre- 1 made by citracting the ingiedienli

mcnl Trum ili<- body. (See iVnv- ' of vegetable substances, Aanmut

of the

prcparalion.

itaTlna OMtaUoo. Pnc-

tide the uterus : id tb« aEi-

I^«nu of Bnid
from lis proper channel into «or-
rounding liwuc,
ExtremitiM. The limbs : the wt-

Bxndatton. Ooiing^ slow eicdpe

ExGreUoD. The throwing off of

frtPiing |>oini is 31°. the nonwil bou
of Ihr human body 98 V- <>>• tudiBK
poini aia" (see TkirmamttirV
Faint. \ short twoon. Li* Ac

a long illness, unleis the n

rftllopUa TnbM.

dom from chills, and llghi noiir
diet,

Tlbra. Thread-li

^^ nnwtn.
^^Maaaer wall c

^■bt of loDici
^^nKaiueifgi'

The thigh-bone,
wall of Ihe middle ear.

nU of the
Offea

nellinK.

Mor. Strong unplea:
Mdb. An unborn en no, c
diUj tram the fourth month.
Wnn. Diw*se marked hy 1
e body, quick pxilse, lauili

>j-libi

Electricity generated
. Containing flour

■ddingi, gruel, bread, etc. ; no
"uds. The membrane whii
es the muscles.
ftnOM. The throat, the ba

TtifUM. A contagious cula
disease, most common on the
It is marked by a
scab. The nurse musi oe careiui
about disinfeciion,

TMtrlftisB- An agent for allaying

ratolle. Relating to fever.

Tteal. Relaiiug lo the feces.

Fmm. The reCuse material ex-
pelled from the bowels by the onus.

FMnndaUOB. impregnation.

Taalil*. Lacking strength : weak.

rfrtlni ArlijitUl Feeding Is the
introduction of food into the body
by artificiat means, such as the tlom-
ach-puRip, or tn the fbim of an

cUtd by food other than the mother's

hing

i^rrnerve^hbres, cenlnpelaj Abrcs
'eying sensory impulses lo the

1 of ih.
n exposi
•s coagulation.
Flbulk. The small bone oi

e of (he lower leg.
FlmbrlK. The fringe-like

■ nity of ll

Flnt iBMntlOtl. A surgical Ic
for healing of a wound by bri
the edges directly together, so Ltiat
they onile without the neeeasily ot
granulations lo RIl in spaces.
applied lo va-
ous grooves oi me body.
mtnlK. Any unnatural passage
by which an internal or);an com-
" " with another, or with ihe

Fit. A sudden

APPENDIX.

(See Gra)ifiam.'\ a

uid and applied \t
jr the allevialion of pain. The n
lonnel should be pu) in a ba^n and
oiling ¥niler poured over il, then
lit il quickly into the centre of a

i each hand. Iwi&t opposite ways till
I. . a . jj ^^n wrunj! out, apply

as hot a

Wllh H

e born

Fori

;l bandage.

30 arops of turpentine on the I
immediaiely before applicalio:
■n Bfiam Ibmentatian, spr
30 drops of laudanum on in me same
"My. Fomentations need frequent
ch^ging. evety hour

le IS 10

1 the

; an opening

skull bone of an in&nl before the shi
jkull h-is hardened.

iutu ihc bi>d}. For

Jtnamt» maJt, whieh senualel the

trfl and right auricles in the fetus.

FnrMpa. Surgical pincera used
lor lifting and moving instead of
tuing the Gngei^ Dnamg ferstpi
•re shaped like scissocs. irilb blunl,
flat points; ^meting firctfs are
shaped like sugar-tongs. Every nunc
should tarry forceps, and use Ihero :
Ihejr need 10 be kept clean, and to
be dlsiniFCted always before and
after use. Otitrlric fBrtrps arc of
diffrrrnt sites and shapes, and are
used for grasping Ihe head of the

.lifficu

t in ■ natural poshiai _..

id-bogs. For setting a bscture.
anesthetic is usually given. Per-
1 test is the only cure, and (he
rse must see thai it is carried oat.
CoUti /ract¥tt. a fracture of the
wrist : c^mrnuailtd fradun. when the
bone is splintered ; aw^litattd frac-
ttirt. some injury is a^drd to the
fracture : thus (raciured ribs may be
complicated by injury to Ihe lungs ;
compemnd fraetHrt. a fraclun with an
open wound from the skin to Ihe
broken bone ; gmm~iliit. one side
of the bone being broken, the other
bent ; imfacttd. Ihe end of one hag-
meni being Brmly driven into Ihe
tissue of the other : simfU, one in
which the seal of future does not

THsttoB.

htheai

Medical rubbing or

Should always be done

mities toward Ihe heart.

Frontol. Kelating to the fore-

Frort-blt*. Injury to the skin or
the body from eiireme

:old.

FnUeri luttL

Iccting vapors, a room in which an in-
fectious case has been nursed. When
the room is vacated a fire should l>e
lighted in Ihe fireplace.and all papers.

ightedinlhehreplace.andaU papers,
ildlinen.old clothes, and other objects
of small ralne. burnt (here, if they
have been cootaminaled. The chim-
ney, windows, and other openings
should Iben be shut, and in (he mid-
dle of the room containing the fumi-
I tuie and bedding a pan with some
j live coals should be placed. On Ihe
, coals should be put a layer of sand.
and on thai a quantity of sulphur
(broken inio pieces), propunionale to
'le siie of the room. 1 lb. to looo
cnbic n. The door should then be
ihuL Aflerbeinghermetically closed
and eipused to the sulphur fames for
twent;'-four hours, the room should
be fully aired by opening the win-
bone : fmf- I dows, and must not be agala octu-
Umb diortened and | pied fi>r at least a week after bemg
Keep the limb at . disinfected {see p. 034).

Iliat part of Ihe
*nM iind Ihe elbo

luch as ft'iii lainrmalis. the thi
>w of the frontal bi>ne. wl

ia>oni ut Ihe piulen

FoBettOB. The special work of an

Kaise Ihe limb. Keep the part warm

organ.

by Ihe aid of hot-water bottles.

FnndUMnt. The anus.

Ougle. A liquid medicine Ibr

?Wldu. The base of an organ.

washing oui the throat.

■iuaUy applied lo Ihe ulenis.

OUTOt. An improvised loumi-

Fimsna. A microscopic, parasitic,

vegetable growth.

FdlilB. The umbilical cord.

OlMtrftlgia. Unpleasant bummg

Pbt. An unnatural coaling of ihe

feeling in the s.on.ach due lo mdi-

gciiion.

nnmoiilu. A little boil con-

Oaatrto. Relating m the stom-

taining a cenlral core.

ach.

OutrlB Ferer. Fever accompa-

nied by catarrh of ihe slomach. and

lienring a close relmionship lo enteric

OalMtlB. Disorder of the milk-

S^lMQITtlM. Excess of milk.

OaBtrle JulcB. ThedigesUvefluid

OalL A billcr secretion found in

the gall-bladder.

QutrttU. indammation of the

OaU-bladltor. The membranoos

sac which holds the bile.

Ihe uterus through the alKlomen.

bile.

Porro-Cesarean oueralion.

OkU-rtUM. Calculus in Ihe gall-

bladder, ir the stone passes into Ihe

luouih into the slomach.

Oania. Fine tarlatan used as a

there is great pain. Local applica-
tion of beat and injections of morphia
are usual. Diet importanl.

OtUtS Aold. An astringent ; used
to conlrol bleeding and lessen the
nighl-sweats of phthisis.

Oalnudam. Electrkily generated
by means of a battery of cells with
caiiion and SBC plates in acid solu-
tion. Praclicnlly the application of
continuous currents as distinct from
alternate currents.

OMlgUHI. Ad cnlargemenl of a
aerve forming a semi -independent
MrvF^cenlre. Also swelling of the
_ iknth of a tendon.

Death of a pan. It
wilh discoloration of one of
exlremilies. generally Ihe toes,
nadually becomes morlilicaiioo.
hardening of the arteries ami
luenl defective circulaiion of a
II old peO[rie sometimes brings
' 9 of dry gangrene called
■■ Jfrjj/ gangrene

surgical dressing, and generally im-
pregnated with some an liseplic. Cflf^
tolUganie. unbleached tatlalan im-
pregnated wilh carbolic ncid, resin,
and paraftin : usually prepared In
lengths of 6 yds. by i yd. and used
in nntiseplic dressings. Should be
kept in a tightly -closed tin box.

OavftK*. Koried feeding.

Oalnoiliim. A nerve-soothing
drug prescribed in leionus. mania,

the pupil. Watch Ibr frontal head-
ache or double vision. Poison.

. Ptoductionof human

0«&iUIla. The

Kjpins, or privBlcs.
OsnUan. A lu

■ery

drug,
Oenu ValXtun. Knock-knee,

I steadiness of Ihe body, usually a

companied with '

'- e Vertigo.)

GLOSSARY.

397

Ihe

The

: appendage of
r consisis of a

Saut. The muscular organ which
pumps Ihe blood through the syslem.
The heart Is silualed behind the
breasl-bone in front of the chesi with
the apex, or small end, poinling
nilher to the left under Ihe lefl
breast. If the ear be placed over a
' healihy heart, a sound like that of
j gtnile breathing ii heard occurring
quality I with the rise of the heart -, this U im-
irvs. i mediately followed by a short sharp

: foil

bulb an<l * shoA.

Halr-fOlllQla. Little pit in the ! the natM
skin in which Ihe root of the hair is \ any devi

Imaginary ap- j blue. Ibt
e bult of disease of the of Ihi^ lace, ai
I causes panting.

A nurse should ll
ids.s.

: long

Win

icribed for piles, diarrhea, and bleed- qi
ing from vnrious parts. ei

HWellp. A congenital sUt in Ihe
upper lip. sometimes double, and in
then consisting of two slitb. The ' in
child is generally operated on very i lii
j-oung, and Ihe stil strapped op by |
specially cut strapping. It is must ic

and to feed ii with great care, or the pi

lilt may open l^^in. Hare-lip u fre- , S
qurnily associated with lUfl falali , flus
(which s«). pro

smelling-salts is a carbonate of am-
monia, and in that form is generolly
called " harlshorn." Poison.

HftTWIlUI Oantll. The minute
canals which permeate bone.

B»r r«»«r. Atlaeks of parox-

from them. In heart

generally turns

anxious expmsion

I the least exertion

All hearl eases need

unbroken

slightest movement or

Heart-fUlivs. Failure of Ihe heart
BMt. Hudy-heal indicates a tem-

The

ling the

.9 of iodids and aniisepll
is the usual local treatment,
respirator may be worn with advn
lage. Sea-bathing and Ionics may
ordered.

wasting diacaio. i nc
I always present, usually
coming on al night, when the paticnl
is balhed in perspiration and is very
weak. By careful changing <if linen,
genlle sponging, and arrangement of
bed, much can be done by Ihe nunc
to ease Ihe distress of the patient.

HMl-bona. The largest bone o[
Ihe fool, the calcaneum.
HalleboTe. A poisonous drug,
essant. Aniidpli for

Vomiting blood
■\i. Dark-colored and
Recumbent position.

e^iecial in the fronuil region.

used a

llic Fallopian lube i

398

™l!y

sign of n

■moky o

of III

clarel-colored. Resi; ice-bags
tiack. A&iringenls will protmbly be
given imemallv.

BUnleraaU'. Headacbe on one
iide of ihc head nnly.

HemlpIegiA. ratnlysis or one side
of ihe body. Walch for conslipa-

Beminituatt. 'nn i\

IhP brain.
HamoKlobin. Priiicip:

il of rr.

Coughing up blood
from Ihe lungs, Kroihy. and of a
bright red color. ResI, no talking,
ice to suck. All food niusi be cold,
no stimulants. Waith thu tempera-

HBmorrlwge. A flow of blood.

Hamorrholdi. Pile^.timall tumors
about the anus. Usually the result
of eonitipotion or pregnancy. Regu-
larity of the bowels mutt be secured.
Bleeding piles may necessitate injec-
tions of iced water or mild astrin-
gen IS.

H«nio*Utlc. An agent to attest
a fl.™ ,if blood

HBpftUtI, R.-hitinii to tlic liyer.

HapiMoa. Medic
the liver.

HepatltU. Inflan

HBTBdltary. Til

one 5 parents.

Bmnkplirodlte.

m of Ihe

Bemlft. Commonly called ■' rap-

nal organs thtough the surrounding

the bowels. /Hfuinal himia is
through both abdominai rings; dirtet
through the eitctnal ring, and
aHi^t through the internal ring,
Strangtiliiied. so tightly constricted
that gangrene results if opemlion
does nol relieve, Scrala! '

truded pan if possible, and
then worn to prevent (he rupiuie
cutting again. A rupture not am
able to la sis is termed irredacitlt.

Hamlotomr. Dividing the c
stricting band of a strangulated
hernia and returning the piolruding
part. The patient, atler Ihe cita-
tion, musl be kepi recumbent; no
rood must be given save Ihe light diet
ordered,

BaroiD. Severe treatmeni of Ihe
kill-or-cure type.

Harpea. Acute inflammation Of
(he skin, with eruption. Hirfia uufcr
^ows in rings of vesicles nrour "" '*
body, and is usually eaJled '
gles"; cinina/m, chiefly aboi
head, is called "ring-worm."

irritation, a dusting-powder, or
mild astringent lotion.

mcoOVCb. A short, noisy,
untary inspiralion, caused by
modic contraction of the diapbtagni
fallowed by a sudden closiite of Ihe
glottis. Agravc symptom*
ring in aserious case of illt

Blprjolnt nnaM. Inflamniaiion
of the hip-joint, most common in
children, and extremely painM. The
child is usually put in splints, and
extension applied lo prevent Ibe
painful jerking of the inflnoied joioL
The nurse's duty is lo avoid any jar-
ring or movement of the patient,
to keep the bed fresh and
Ihe general health good,
very careful in lilting Ihe patient.
lo move slowly and gently. Absci
often actonipanv hip-joint '*

Hlianta, tliiiry.

Blatology. Science of tbe mini
tissues of Ihe body.

Homaopatbr. 'Medicine wi
on the syslem of like cures
Started by Hahnemann, Homi
pnthic medicines are mostly given
infinilesimal dotes,

Hot-viAarBa|. A rubber bag
which hoi water of any '
be introduced for topical

ibstaniiall)'

ingin

} Ihe BC

descend- same as 1

ve. the

GLOSSARY.

Bamor. Any fluid of ihe body
oihci iN.xn the blond.

HydratOCM. A medicine which
helps ihe diKharge of walrrfrom the

Hy^JNTfTlU. A Mirt of ecuTTiH
•aiuird by taking raercuty.
Hjdrutliroil*. Accumulnlion of

1 iiomachic tonic, and as a local ap-
(ilitniitin for tores and uLcers.

Bydxenils. Excess of walcr In
Die blood.

BjrdltKeU. Watery lumor In the
scroll! Ill In inbnls. acupuncture
may In- performed; in adulls, the
tre.iimcnt n luually injection, wiih

BydroOV^ialU. Water on the

brain : a disease, most common In
children, thai causes Ihe head to

Hrdnoraalo AoUL A local seda
live, nllays Irritation. Also anil
spasmodic. Poison. (Sec Prmni

liu L-n trance tc
Hyold. llici

399

1 the »3gina.

lame of a bone shaped
mc a 1. ni iiic root of the toDgue.

HjOMyaanu. Henbane, a poi-
lunous anlispuniodic and narcotic.
Enlarges (he pupil of Ihe i

Bydiomk. Watery sw
HydromKra. Ace u mi

HrdrophoMA. Madness of an

of a rabid dog. Tranquillity Is of
Ihe grealesl imporlance, and the
num: may do much to secure this
■nd allay (he terrible ieart of the
palient. Keep Ihe room dark and
quiet The saliva of a hydrophobic
palient is supposed to be capable of
conveying Infection, so > nurse must

_mtlca. Tlie walcr-

■ scientilic s(nndpoint.

of tt

n Ihe .

"JS:

iulphale of eii

HyperemU. E<c

HrperpliuU,

.f ti

f growt

HTPaTprreZla. <Cic«s of fever,
shown by a very high lempenilun.-.
Cold batlis Uem|>eralure fts"! or cold
packs with ice-water are often used
to n:diice Ihe temperature; qulnln.
salicylic acid, and other drugs are

perature. (See Pack.)

HypwtroiOir. Excessive growth
of a pan ; it is called /alte when
caused by a deposit withm Ihe part
and not by the general growth.

s applied Ii

colorless, pungent
id, iLwd rarely as a loponfic.
Bypnotle. Agent for cuuslngsleep.
HypnotUm. Suieofunconsctous-

BjVtuHbomtTtUit. Slight melan-
cholia, llie chief sympiomit mental
■ Ihe hen

Jiof

sions that

many disc

^rpodamutlii. Under

under the skin by me.in^ of a hypo-
dermic sjiringe. The in|cclion Is
usually given In the fleshy |iatl of
Ihe chest, thigh, abdomen, or arm.
This syringe is marked In minims
or drops, and filled with a fine
hollow needle. In giving an Injee-

;h up a pie.

' of Ihe 1

with

Ibc left hand ; hold the syringe be- 1
(ween the thumb nnd middle finger
of the right hand, with the first fingec

and under Ihe piece <rf pinched-up
skin ; slowly and steadily press down
the piston -. withdraw Ihe needle
gently and prera n finder on Ihe

the return of the fluid. The syringe
muslbe kept perfectly clean ; abristle
kepi in the needle will keep il from
getting clogged with dusi, etc. All
drugs used as hypodermalics are
highly conientratcd, and many of
Ihem. auch as morphia, atropia, etc.,
arc poisonous. One-sixth at a grain
o( morphia is the hypodermatic mosl

HrpoiMtTla. Term

HypOClMBSL The

Ic«-ba(. A bag ol waterproof
material filled with ice for applica-
tion to any pan of the liody.

lelior. TheitaincalorleBdiicharge

IcMniB, Jaundice : a yellow dis-
coloration of Ihe skin, caused by
abscirplion of bile into Ihe blood.

Uloor. Mental weaknes, which
dates from birth ; (eeble-mindedness.
Few know how much can be done
with idiul children by pnliencc. The
kindergarten melhcMl of teaching
them is admirable. Physical train-
ing forms an impurlanl part of Oit
treatment. A nurse who can secure

. child will be able to cure him of all

' dirty habits, and even tmin his mental

'" "lies lo a varying degree. An

child should be placed in a

ilutpiigh till' aliilomcn or Ihe vagina.
HritertA. A nervous disease

very oflen by dislike lo food, painful
impressions, and untruthfulness. The
nursing of these cases is very frying,
and can only be successfully carried
on if the patient is removed from her
usual surroundings, and her bmtly
kept at a distance. Indntle patience,
and persistent cheerfulness mingled
with a certain amount of sympathy,
may work wonders. A good nurse
will soon perjuade a pslieni who has
bsled for months lo take food nalu-
rally again. Terrible weakness and
even paralysis are brotighl on by

UUWJMruy. An individual pe-
culinriiy in regard to ihe aciioo of
certain drugs, their action and effect
being enlirely dilfercnt lu what is
enpecled,

IlM-eMal VftlT*. Valve at ibe
jimclion ol Ihi.- Iitrgc and small iii.

The

ia of Ihe womb.

HriMrotomy- Cesarean sectin
opening inio the womb. The i
sirumeni used is called a " hyster

tuiio IrterlM. There are five
iliac arteries: i. Cirmmjltx. arising
from the exiemfll iliac : a. ifmmim,
the continuation of the abdominal
aorta, dividing into (3) the tiltmiil,
and <4) the inttntal Hue. The bibir-
caticin Is about at Ihe but lumbar
venebra. The exteranl Iliac becomes
Ihe/rMora; after passing under Pou-
part's ligament. The branches of
the inlemni iliac supply nearly all the
pelvic organs.

m&e Beglim. Ine region con-

The Shalt of the hi

niulon. A decepti

JAxy. 401

panied liy morbid appetile and mental

IndOlKlt. A lerni applied 10 n
I p;iinlc5i sQte which ii alow lo heal.
Stale of being wedged . Indnratlan. The process uf hntd-

enrnt.

Inertia. Sluggishness; applied to
the womb when it will not contracl.

Influit. A new-born child ; «. male
should weigh al birih jH Ibt., a
female 7 lbs.; it should increase 6 to
7 ounces in weight weekly.

InftoUOfl. Thecommunkaiionof
n disease through the atmosphere. Il
is panicularly the nurse's dDly In in-
I.....: — ._ the spread

ttf. Exemption from dis-
■eby Tiucinacioitorbysomeanato-
~i proceduiE. CI by previous ill-

endering

To do ot 10 per
■jriliing on the spur of the nioi
Je» ipecial occasion; to contri'

ttainilH of tiM Haut. ^L-ns^

W B Stroke felt on placing the I
K ni (he heart, occurring as the ve

^r the I

elcic.

il lo a heruia
Dg itkto with

msUan. The eight front
buonpnuUila. A full pulse, the
;^lfta of which cannot be aritsled by

Inability to reiain

evacuations oF the bladder or of

___ bowels. Incontinence of urine is

^en a disease of childhood. Much

of the nune in training in good
habiu. (See Ennrtsii.)
btOnbaMon. The petiod b^lwel^n

1 the

illne

change the diaper. Great care
necessary lo keep the boi; »i

tnana. A small anvil-shaped bi

-sbyll

IniUtnUoit. An effusion
nto the cor

ough

of fluid

A diseased stale
marked by heat, redness, swelling,
and fever: it passes on lo congestion
of the parts, and possibly to suppura-
tion or monihcalion. Thus inflam-
mation of Ihe lungs may become
congestion ; the congested paru maj'
dry up and die. and cavities are
formed, and phthisis may sel in. The
Greek term for innammalion is
"itis"; hence we gel glDEStlis. inflam-
mation of the longue : perilonitii.
inflainniaiion of Ihe peritoneum ; and

lUllkUoo. Blown out
Epidemii

catarrhal

: Inftodlbnlnm. A term applied to

! several funnel-shaped urgans of the
body,
Infnnoi. Ao infiision : prepared
V pouring boiling water on a drug,
nins i< stand and then straining.
IttCMUU Food taken into the

InffttlnaL The region at

geucnilly accom-

of the

of the symphysis pubis.

InlialallOIi. Ael of breathing in

vapor or fumes into the mou5i, a
form of lieaimcnt frequently ordered
in disorders uf the throat or chest.

APPENDIX.

402

ves&el Bitcd with a mouth-piece com- , .
ing QUI of the lid : ll>e hot water and
the medicament ordered are put in
tiie vessel and the patient lakes the |
mouth-piece in his mouth and in- 1
spireii the vapor which rises through [
U, A teapot makes a very goo43 in- |
hnJer, ihe patient keeping the spout

(en to pieces, cleansed wltt
il-bnish. put together.

The arresl ot some
•j by the reatraining influence

iitlety of the body p

The pelvic

InoenlAUon. The mjeclii

iliseaifd fluid from the Imdy

iTealure into the body '

caif lympli a used to

owing a
aviiy of tiie body,
IiutilBtton. Suie of a body i4
ounded by non-conducton of eT'

lother,

poisoning.

IntrKTaniHU.

Ihet

; disease of of a
reason. The

other

It prircipnl types of the af
are melancholia, mania, delusional opera
insonily. and dementia. (See Puir- childi
fieraJ mania.) The nurse must
argue with an insane patient

.ateh t
what violenc

rthe

Passing a Tube down
and leaving it there: an
mmelimes pertbrmed on
lib ftiphtberia instead ol
V. 1 1 needs cateful nurs-
l>e coughed up

sulTers.

she musi never strike the patient
back again. In restmining a mad
person, calch hold of the gai-
t the limbs. ~

bltOMIIMMpUoa. The reception

her ; common in children and eaus-
B obstruction of (he bowels, aikd
ig for prompt treatment.
UwUm. Rubbing in of medi-
cines with a vie* to efTecl absorpi
Generally resorted lo when
.._... ... — tolerate the n

GLOSSAKV.

soil

r an ounce and a half. Any chit)
lay arml tbu [nvolulion and causE

lodln. A paisanoui element ob-
lined from the ashes of leawEed.
erv uhIuI as an anliaeptic. The
lun is painted on the skin to

cauu kitiMitpllc

given intcmiillyforscroftiU.ctc. Re-

picl at rince any catarrhal symptoms,

loOotorm. A form of iodln con-

sislinK of yelJow cryslali or a pritn-

rose-colorcrl pourdvr. ll possesses a

L Mrong and liuling odor. 1i is largely

h iHcd to (lust on wounds, its action

■ bdng anliieplic and sllmulnting.

V lodoforiD gauie. wool, and linl are

employed. The symploms of poi-

Dning from iodolbrm are vomiting.

B tall ucina lions, red skin rash, and

^*ttky urine.

lOdeL OintmcDI conuining lodin.
■nd having Ihe same properties as
iodoform, wilhoul the strong smell.

IpMWRuahft. A prompt emclic,
secured from Ihe root of a Brazilian
pitni. Greatly used for children in
cases of croup and whooping-cough.
In small doses il is h stomachic and
cxpeilot«nt; when used .15 an emclic.
aoRie 60 dropi are given.

Ma. The colored circle surround-
ing Ihe pupil of Ihe eye.

Iran. When ordered ai a medi-
eine, should be given after food and
through I lube. Dialyied iron does

d kepi saturated with ci

the air getting out at the door h»nd
into other parls of Ihe building.
ncll. A skin eruption. (See

JmbOraJldl. A drug contmnmg
pilocarpin and jaborin- U increases
pcrspinilion and siimnlates ihc hpuri.

Jalaii. A drug which purges rap-
idly, acting in from Iwo to four hours.

jmnndlee. Disease of ibe liver
causing yellowness of ihe skin ; usu-
ally brought on by over-indulgence
or by chill. Inbnts often become
jaundiced, and should then be kept

d Ihcbi

p.ilient. avoid fat and sugar as
much as possible, and give n» wine.

itjmma. The upper portion of
the small inlcsline.

Joint. Point of union of two

Jngnlar. RrLuing to the neck.

growth of Ihe skin.
KldnaTl. Two organs in the re*

gion of the hollow of Ihe back which

not injure leeUi. Iron causes blacli

the kidneys, ihc nurse has 10 measure

.tools.

bradmrua. That which is inca-

KUogrunnia. One thousand

pable ofbelne relumed 10 its proper

IMfMlaB. Constani application

Kino. An astringent.

Of ■ lotion to a pan.

Snook-knaa. The inward curving

InttuA A drug which caiiM-s

o[ the knee.

excitation and slimulales ucliun.

XotunrH. Fermenledmaiesmilk:

mitUtim. An inflamed stale;

nulnlive nnd easily digested. Given

also, the Stimulus necessary to Ibe

in cises of wasting- (Seep, 317.)

KypbOaU. Humpback delormily

l^AlBin. The hip-bone; the back

(curvalurel of the spine.

IMUtUm. Set apart; an bolalion

Labial. Rdniing 10 the lips.

lagiousorinfrcUousdiseases.and the

Labia llalOTa. Two large folds

nurse has 10 follow siricl rules lo

at Ihi- momh ot Ihe pudendum ; called

prevent Ihe spread of the diseiisc.

also Ibc ■■ Inbin pudendi majus,"

A sheet hung over the door 0! suifi

LabU Minora, i wo smaller folds

wUhin Ihc majora; csllcd also Ihe
■■ nympha."

Labor. The progress of the birlh
of a child. There are three stages.
{i) The ijilaliilion ol the mouth of
Ihe womb, (i) The passage of Ihe
felus through [he canal and its birth.
(3) From the birth of the child lo the

ml before full
: pains of. at

t lator is Ihe bi

Ihe I

m of, I

.r-pams

lar and short, rewmbling colic, ant
occur with a ceriain tegularily.

LabTrlntll. llie internal ear. con
sistltis nf n scries of cavities.

Laearated. A lacerated wound ii
one with lorn or irregular edges ; no

Laetunmul. Relating lo the tear
d the glands which :

The I

flchrymal sac 1

Laciagoffoe. Drug for inducing

LactaUon. The process or period
of sucyng.

Lacteal!. The lymphatic vessels,
which convey ihe chyle from the In-
teslinnl canni,

LactUbTDUB DngU. The i:aDals

c /«/,

ifc, with point

and two edges, sharp.

Lanotnatliif. An adiecrire ap-
plied to sharp culling pains.

Lanugo. The downy growth or
firai hiilr of the fclus.

Laparotomr. Cutting into ihe
abdomen : s srHnus upemtion in Ihe

Larynge^. Relating to llie

LaTTDglBmuB Btftdvlu. Spas-

mg noise ; niosi common in intents.
(See Cri'Uf.)

LaiyngltU. InfUmmation ol ihe

laryni, causing loss o( voice. Com-

'crgymen and public ipeak-

eis. May be cfarooic or acule : Hx^^^^

LaryngO*COP«. A reflector used
for exammmg the throat.

Larynx. Ihe upper part of the
windpipe, frain which Ihe voice-
sounds proceed.

LawltnJe. A state of exhaustion
or weakness arising from causes other
than Eiiigue.

Lataat. Noi visible, lying hid tor

Lataral. Relating lo the ude.

T..n.i.i.nm Tinclurc oF uplutn,
poison. Given in a lew drops ll re-
lieves pain and procures ateep ; it
also arresU diarrhea. Sprinkled on
a poultice or fomenlalion it allays
pain. For an overdose the amtidottt
are emetic, external sHmula lion, walk-
ing palient about, artificial respiration.

LancUnf-iaa. Niirous^oxid gas.
given particulnrly by denttsu lo se-
cure short anesthesia.

LazatiTa. A mild purgative.

colic. Baths u

an astringent. The lotic
i rapidly and is coolin
1 makes a soothing om

Difficult casi
the bequeni sevei
ipiuin romentatioi
the ireatment the nut!
o look after. The diet

painters

inmg L

r leu

with plenty of
ngums.

rail. An aquatic worm used loi
Ihe local abstract iun of blood.
Leeches should be kept in a euol
place, in a glass jar filled with rain- or
river-water. The top of Ihe jar musi
carefully be coveted with muslin.
The water should be changed weekly.
The part to which a leech is to be
applied should be waabcd and moist-
ened with cool waler ; put Ihe leKb
in a small wine-glass or tesl-lnbe. and
reverse it on the part If it will not
bile, molaten the skin with sugar and
waler. or scratch the skin gen Uy liU
Ihe blood comes. When the fnic'
has sucked lit fill it drops uS^i
should then be disposed M by Mt
ting il in a very strong toluttosS

I tdl wid water or dry sail, cover ihc
liVeiKliiKhilyaod Ulihel»ch remain
' lil dead.

, Coik or lubei

i\ designed [or nppll-

ny pun ot the body,

f Colli ULiIur \i iiinscd ihrough Ihe

■:iiiB ihe wmpeni-

Leproay.

'iiiiitiil^anal malij;-

tnsiie and boi
LMlOa. Any injury or n

change In Ihe function or lein

LtUuirfy. Unnaui rally

Whilu corpuscles of
, Certain nlkaloidi

piucles of ih« I
LmooortM.

Ilie tilood.

loped In

whilith dischnrge
from the viginn. com manly called
■lie "whiles"; a siga uf weaknes.
UuU be reported lo Ihe doctor.

group of

ibin dlMnKi m h-I

fcMure i> infl;iiniiiulury papuli

LlcoTlM Powil«T. Torm of si

m. Tubular
glands of Ihe small mtcilMie.

UfUMBt A luuKh bund of
Hbronf timie connecting together the
booM al the }oints.

UiatUH. Threiubof silk, wire,
, Mlgwti etc., used to lie arteries or sew

The nurse has lo see thai

_ .__._rw are sleriliied and count
W Bomber tued. Cnlgut. the mosi
imilMMI ligature, ntay be krpi in ii
hitton of cnrtiolic (i : lo) and cut
lltelo lengths of ii inches when re-
f. quired for uw,

LlU*, Oblortd of. A deodorant

Used to dilule milk

Mixed wit
_ oil. it mnkes
Ig fur scalds and burni,
— * Relating to Ihe tnngiie.

equal part

Unt. Loosely woven
tcriul, having one side
Ihe other side rough.

given In scrtped or uniiii
■hough Ihc proper Irrm

Uqnor Amall. The '

'hich til

UtUOTM.

UnnOT BaiigTilnlt. Liquid ponion
if the bl.iuJ.
LlaMrlsm. Aiiiiscpiic surgery.

excess of llthic
J, producing gouty

rtvipepiin.
LltlUMOOP*.

1 nil fmgmenis of i

surgeon's innpecllon

Fusing gravel wit)

' 33-Bt

turn-. Ihe red |Bii«:r 1
UM. About 1 I

LlTor. The organ which ucreies
Ihc bile ; it is silunted in Ihe abdomi-
nal cnvlly on Ihe right side, A yeTI.3w
tinge of Ihe skin marks derangement

[ the!

lo chill.

r palieni gets no
Lolw, Roundeil ilivislon of an

LoboUa. A drug used as nn anti-
spasmodic, and also in encmata. May

LoebU. The discharge following
cunhnemcnl: tl is for two days al-
most pure blood, then turns reddish-
Kray, and becomes clear by the ninth
dav, and then censes.

Loek-JkW. iSee Telantu.)

Looomotor Ataxr- Impaired gall

^p ^^^I^IV

^tas^^^^^^H

406 APPENDIX. ^^^H

Lordoili. Anlerior curvature of

ground ; the cause of intertniHrt^^^*

Uiu ipine.

Lotton. A solulion for Mlcmal

use. Evaperatiig loiions are uwd

10 very vinilent and dangetuui forms

to procure local coldness. Lead

of ilisease which run a tnore rapid

lolion or MU-de-Gilogne and wHler

course than the milder forms.

MAllsnut Ptutnte. Anthm

LnbrtCAtKin. Makmg smooth.

contracted from cattle, causing gan-

oily, or slippery.

grenous carbuncle.

■UUnteiilV. Shamming sick-

of Uic loins; painful but not serious.

Cold musl be avoided. Rubbing in

anltle-bone.

Ihllmu. A little bone of Ibe

nurse's share ; orgalvaniccurrentsor

middle ear.

hoi balha.

HtUplSlllMI BodlM. SmaU capil-

LnmbfcT. The region of ihc loins.

lary ,.i.-is=,c< m the Mrucluff of the

kidney.

LniurCaiuUe. Nitrate of silver,

the growth of proud flesh.

instance, feet first.

LniKl. Thelwootgansofrespitii-

Hmmmt. The breasu, or milk-

tion. situated in the right and left

supplying glands.

side of the cavity of the chest. Kor

lUmnuuy. Relating Iv the

nuning treatment of congestion of

breasts.

lUnunlUs. InBammaiion of the

Lupilll. Hops; the tincture is n

breasts, geuendly occurs during lac-

sedative and stimulant.

tation, and points to Improved diet.

Lupiu. A tuberculous disease of

lUndlbiiliim. The lower jaw.

diseases, in diseases of the kidney.

scrofulous ic^ndency. Nourishing

dirt.

LuxaUan. (See DiilocHiaK.)

KulA-a-pirtll. Drink nuulness:

delirium irenicns (p. f.).

of chtldbinii; p.irlunli.m.

Lymph. A rolorl.>* all^aline fluid

of the human liody used for leaching

LympbAdenlUa. Infl.immalionof

HudpnlatloiL Rubbing anJ

till- lymphatic glands. Tonics and

working with the hands to prooto^^^^

mm fishing diet.

some healing result. ^^^^M

lympluUci. Sm.tll vessels per-

KuMmiu. A muiitiK itf j^^^H

flesh; generally due 10 tntwrcl^^^^^H

lymph.

disease of the mesenteric gUnd. T^^^H

Lytlt- Gr.iduildpcbneofafcver.

MsaMWa. Seieotific rubbincrf^^^

ens the tissues and rulores lotic gen-

erally, acting OS mild ind thorough

ciercise for the patient. All mo»«^

^^ headed.

ments are from tlie extremities loward

^^ KacroCytM. Abnormally large

the heart, and consisi of kneaiGng.

^^H corpuscles present in the blood in

rolling, beating, and nibbing move-

/i/r/iiu^f (whiefiMcjarc ihc lerm ■

^H lUCMaU. A taxoiive uid ant-

^^1 aciil, 'I-heiulpllnle<[':p«<>msa1t| isa

^H pu»eHul purge.

e^ich school of massage has itsl^^^^H

^^1 lUluU. KIBuvia from marshy

lerms oad meihodt. ^^^^H

medical sc

duLTBCter and use ol drugs.

■NcUla. The jaw-bone. In/tri
maxilUry b the bone a[ the low

An e

iipliv,

Finl itBge of

coryia u inlecliauj ; Ihe nuh appears

DO Ibe third dny. commencing un

neck and face, and lasting three day«.

. Keepthepatienlin bedatidleedwith

I I^t dJeL Wati^h for brotichitis or

naltOTi of the eyes or ears. A

period of infection is supposed lola^
• iDonlb, GermnH Mrui/rjisamilde
disease, the rash appearing on th
Ibiirth day, the period of incabolio
beitig ten days. Conviileicence i
(xsually rapid and uninlemipted.

KMtBI. An opening into » pa!
sage. Mtalai urinanui, ilie oiifie

in diphtheri

. I nfiommation of the

•i the brain, a serious

iding felally. Pains

!._ I mplom, the

.ust take the
temperature every four hours, and
watch for signs of collapse. Keep
the room darlicncd and absolulely
quiet ; feed assiduously. Tliere will
probably be delirium.

KenlncoOflle. Protrusion of Ihc
brain through the skull.

— -out. Change of life; the

of the menses, occurring
forty-fifth year, and gen-

ly be due lo many
. at on the back, and
hot vaginal douches are almasl cer-

Heniei. I1ic mcnslrual flow,
KgnrtmMlon. Monthly discharge
frum the vagina, cummonin healthy

ocal anodyne, often
ipplied as a plaster.

KarCturlAUmi. Heart affeclion
md trembling, caused by long use

_ podermatlcally and
internally in cases of syphilis and in
ikin diseases. It is a poison in large
loses, and the aHlidoln are white of
:gg and milk and water, (See Mer-

HutBtaiT. A large portion ol
:he peritoneum lo which the small

HstaboUC. Capnble

from one orEnn to anolhcr,

■etatanni. The Hue bonei oi
itit fnui belitcen Ihe ankle and the

MotrlttB. InHammnlion at (he

■lerococcl. Praclic-iily Ihe same I
■loturltlon. The acl of pnssing I

■f llic Oi

. Thcti

Morbid. Unnatur-i!. diseased.

HDTlbnild. In :i dying stnie.

HontiDE SlCkneii, llie nmim
jf ijtp^nam womt-ii. i-ccurring chiefly
n ilie tntly m-jiiihs "f gE^Uiiion.

MoiphliL. A te^eulile Alkaloid
ised as a sedative tj[ anodyne. In-
ecled under die skin, ll c3ds« iIk
min (d decrCBSc. and sleep ii tn-
luced. An overdose causes death,
:hiefly by paralysis ur the muscles at
-cspiralion. Slimulnlion, artificial

itl. gangrene. Alwuys serioust Ih
ant must pay great •lienlion I
leanliness. and use disinfeclnnu.

aincd I

duties so long as the labor i
HldwlAlT. Obstetrics ; Ih

Ucraiiu. Hcadachr
known as " sick headache
on periodically.

nUMlK. Prickly t

I ail

of the skin. Sometii
T operations or fesers, i
of temperature.

of Ihe doctor if they exceed i in Ihe

34 hours (except in children), or if

the patient goes more than xfhouis

without passing any. Ilie nuise

should also note if Chey ore streaked

usually with blood, contain mucus, or undi-

cuming | gested food, or worms. The color

I should be noticed : il is like pea-soup

~ in typhoid, light in jaundice, gnen in

an infant. Iicfore s<

Wtnl VilTi.

e birth of

L. Skin disease, either

Vonoplesla. Paialysi<
HOQStar. A creatuiTf

Kncold. Resembling mucus.
MueD-puraleut. Containing mu-
ms mmglcd with pus,
KnetU. A viscid fluid of the body

I'bile sedimem. cMfi
then it is shaken.
MulUpUB.

: chfld.

I who has

Kniiipt. Paraiidltb. A higfalv-

infectious swellitig of the tnlivary
glands. Keep the patient ixnialed in
3 warm room : take the l«
ig ; give ■

■e diet.

r light nulT

if Ihe hea^^^^H

GLOSSY /tV.

Mud*. Strong tbsae of the body KMiplas^. Any opcratii

capablr of gnax contracbon. and Ihc {i»irrs a new gmvlh.

manl by which the limlH sire HsphlttU. InOamBution oT Iht

moved. SlmvuleiJe-mairiiuimiiiilr. Wiiacy. Mcosureand tral I

It ^Mge muscle oa each side of the ' waidi for »nal cuts, pus.

neck: 't depresses and rolatrs Ihe palieai belween bbnkeb.
head. Imveluntary mmscU.

under conlrol of Ibe will. k'dnFV.

nrticulalion, or in a low i

.from

MM>

the pup.l 1.1 the eye

motion; the opposite of ttiatry

nerves which, passing lo a ner-e-

muscular tissue o\ Ihe heart. Often

cenire, convey a sensaljoii to the

folhiws acute rtieumatism : cbances

brain. Opiit mtrot. the nerve of

sight arising in the occipital lobe and

■ftqdk. Shon-sighledness.

distributed to Ihe retina of Ihe eye.

Krottea. Drugs which caiist the

pupil lo conlracl.

the ^ine. I'ltiv-HoMr nrrtii are of

MjTTll. A slimulaling and Ionic

two kind^. those which rause con-

concoction of vegetable origin.

traclion, and Ihosc which cause dila-

Rabotli'i ai&uda. Small gland ulat
bcdirs jilujli-ii M Ihe neck of Ihe

ItilffMI

B produced by Ihe u
VarooUe. A medicine

Relating lo the nose.
The bullocks.
A feeling of sickness, b

nvaL The umbilici
of connection of the cor

BseraaU, Dealhofapart; usually
■pphed lo bone. Where there is
«iul bone there is always a sore, and
pieces of dead bone al times work
out through Ihe sore: Ihcr should
^wnys be kcpl for the doctor to

(See L'riuaria.)

VuanlglA. Puins of a nerve or

eni'S ; if of Ihe sciatic nerve it is

^tica; or tic-do ulourcux or he mi -

-aniaifoflhenervnofthebce. Very

lous- j often neuralgia of one part is a svmp-

nar- ' torn of disease elsewhere, and, ihcre-

I fore, neuralgia should always be

I in. ' watched and reported. '

MmtTUtlieilla, Nervous eahaus'

disordered. The pallenl is wcakand
bnciful, and need& lo be treated with
sympathy, yei wilh firmness; the
nurae must be cheerful but quicl. pa-
tient and forbenring. yel strict in
carrying out Ihe doctor s orden.

HtiuntU. Inflammaiion of a nerve.

VenroMt. A class of diseo^s
connected wilh Ihc nervous system.
but arising from n

i-hTth ct

:tecled.

Htntrvl. Neither

iu. A birth-mark, a congenital
■.h of Ihe skin, often curable if

APPENDIX.

1 for a short period after

A bed-cloak nui

mpple. The «na1l r

ihe cenire <A each tirea^
Slppla-ihlelds. Co

gbisa or mdia-rubber p

mtnta or SilTBT.
used ID the (oim of a
bleeding from a lee

itypiic aclian.
Also to check die growth of proud
flesh. As aa astringent lotion, half a
grain (a the ounce, it b nsed lo batbe
the eyes in cases of ophlholmiB. Salt
and water is Ihe anlidote in case of

used in testing for albumin.
Minute doses, prescribed fat indi-
geslion, should be given after food,
Uirough a lobe. If allowed lo Gill on
Ihe linger, il bums the skin. The
antidoUs for poisoning are alkalies,
while of egg, and mitk.

Httrlta or Imyl Useful as an
inhalation in angina pecloris, and in
some cases of poisoning.

Mltrogsn. A colorless gas enter-
ing largely into the compoation of
Ihef ■--

slate. Thus the lempeiatuic of Ihe
body in health is 98.4°. and ihis ii
said to be mcrmtai. Tlie normal respi-
ration in an aduli should be about 16
a minute; Ihe pulse about 70 a

RnlUpua.
icvcr had chil

Hntrlent

hai nourish
MnzTninJ

A form

mtroKlycerln.

An oily

Iquid

highly

explosive

used as a

heart-

nl. and for neuralgia, etc

Somel

mes causes

headache.

Must

never

M taken ne-

r a light. Pobon

Rtkou Ozld.

Laughing g

aneslh

Iic used fo

r short oper

ations

esptcl

lly by den

Kodula. A htt

0 knob-

HoU

Riven

lo bai

ulcers, especially if on the

6ice.a

A of syphi

mplive

origin

In dressing them, Ihe

musi

etiainly be

careful to

touch

paralysis. In lar^ doM*

tannin, chloroform or ether inhaU-

ttftatSbm. Two folds of mucotis
membrane on either side of the
vagina; the lesserotinner lips whtcb
prolecl the orifice of the vagina.

(Mknm. The fibre obtained bj
picking old tarred rope into pieces,
Lised to some exunt in surgical
dressings.

OfttmeaL The meal made from

OMilV. Excessive btness.
ObltetileUli. One who practises

ObiUtrloa. That pari of medicine
and nursing which is connecied *i(h
midwifery, and with the operations
and illness due lu the hearing ol
children.

ObMniOtlOII. Stoppage 01 black-
ing up of a c.inal or opening of the
bodv.

Ooclpital. Relating
ur ih<' head.

. . Ocdpnt. TTic back of the

di$lnfi;clants. ] Occlmlon. Closurr.
Nolofsound I OcnlU'. Ki'laling lo the eye.

J OCHlUt. .Vn eve specialist,
ry and proper 1 OdonttOgla. Toothache

Tooth -like. I

cdml. Term applied to mcdi- | .
wbidi are in the " Phai'maco- , i

11 of r

li. A micro-oreaaistn

^^. . and iuppoAed to cause '

HjlUiuh in children. I

' OU'lUk. Silfc impregnaled with

Willed oil. semi-transpareni, and

vaterprour: used in Ibe antiseptic

" ssing of wounds. Prepared in

Is of about 5 yds. lon^r, and in

Ewidlbs of a;. 39, and 33 inches.

_._. . j^ji application

baring healing virtues, usiuilly con-
Hting of Lard impregnated with some
. Ointment should be spread on
■ritb a paletle-knife. and applied

•■fbunu. Oily.
OlseiMUHl. The bone composing
" elbow.

Relating 10 the sense

of smell.
OUtcOO.
L times given lo children

Opiate. A drug which causes
sleep.
OplfUutonoa. A spasm which

Oplnm. A preparulion of poppy-
juict?, much u«cd ID induce sleep and
10 allay pain. It conlr.icts the pupil.
Children are specially susceptible to
Ihe inSuence of opium. In large
doses it is a poison, the an/iilaUi
being cilemal. iliniulalion, cold
wBler lo Ihe fece, an emelii.

Optle. Relating to the sight.

Orbit. The bony caviiy which

Organ. A pari conslrucled lo ex-
ercise a special function. Orgam ef

Pti~

Onrchla. Inllarnmalion of Ihe
Obpboractomy. Removal of the
OoptiOTlH*. InRammalion of ihe

OpftOt^. Warn of transparency.
ctoudiness, 1

OP««tlim. An acl, especiallV a
surgical act upon ihe body. O/r-
ratii^laiU. the L-ible on which .1 1
palieni lies during a surgical opera- '

in reproduciian ; Ihe genltnlii

1>(C<"7<UF, those silui

kidneys, bladder,

{elating to Ihe organs;

diseise of the heart
thai Ihe structure ilself is af-
fected ; whereas, if the evil is iaar-
fjaic 11 may be ihe result of mischief
elsewhere, causing functional de-
rangemenl of Ihe heart.

OrttwpediC. Relating to Ihe cure

lUed about Ihe eves musi I
Iplly burnt, and the' nurse inn

J her bands in dislnfeclmi; fluii

Cm ophlhilmia is contagious. Or,i;
Ktar ophthalmia is a chrnnir frin
with granulailon of ihe

of dc

Ortluipim. Breathless ness,
patient needing always lo mah

an upnght pos

0« iQUmom.
Ob ITlerl.

Osilfi cation.

OBtalgla. V

Oateltli

Oiteomalacla.

412
Oatsomyalltii.

APPENDIX.

Inflammation of '

OatMrtoma. A surgical saw fo
Ortaotomr. An operalioa on i

1 splin

« kepi quiFl,

Oltwtrlte. An insIruniEDt used
for scraping bone.

Otalgift. Ear-ache.

Otitis. InHammnlion of Ihe mid-
dle enr, marked by rolling uf Ihe head

Hoi poull

ierrd.

may euniain hair, leeih. i
Oranotomy. Eicisit

( &i'ic. and
r lebacous

P«!t Wrai

igi ofweiEibricap-

pij^uLuapaiieni. \ cifid fliiCi ^aHiiS^
in wrsipping the pntleni in a ibcrt
wrung out of cold water, then envel-
oping him in a dry blankei and muk-
iDloah. and leaving him for thirty min-
ulet. or the prescribed lime. An iir
fori consists In wringing o ~

patient, peipctuaiiyt
theygel warm. Thi
Ihe temperaluT

while il it in |

■pplying then
aijj Chang'

le tcmperatuit

an^og tti

n every few minutes
ogress, //at fait is
in dropsy cases, and
is applied in the same mannin' as
the cold pock. Of course Ihc pa-
tient's body-clothing is rvmoved be-
fore a puck is gtven ; and care must
be taken to avoid chill. particttUrly
after (he pack, when the patient musl
bt carefully dried. Paetii^ Ikt f<t-
^Ha consists in inserting in the
vagina pads of antiseptic cotton held
together by a collon string.

PmU. Liltle pledgets of cotton
enclosed inanlisepticgimte.and used
insmtd of sponges.

P»C«t'l DUmm. a bright TOW
p,i1cli on the nipple llul after some

OrUae. Smull vpsiclc! knind n

OTvm, The egg : Ihe embryo b
which the fetus grows. Pluial, «

Ipninr. and Litiar^fiahii,)
■s| Palata. The roofof the mouth.
s. 1 PftUlAtlT*. A medicine which re-

) Palpation. Examination by the

i- Palpitation, Rapid throbbing of

ihc hiMTl. Shoiildalwaysbeteponed
III Ihe doctor. Keep Ihe pitieni at
re'il during the altock.

PaUf. The popular name (at
piira1ys» (which see).

Panacaa. A medicine which cures

chalk and magnesia.
Oseysmi. A co

ens. Inhalations ir

coses. Applied to 1

A long, flat gland be-
Hiisonous acid i bind the stomach : it supplies a juice
irrel ; auHdelts. i which aids digestion to Ibeduadenuni.
Panereatln. The active principle

etnlnenee; ri^^^|

pKpnla. A small, solid pimple.

P*vulla's CanUry. A galvano-
caulcir on ibe synnge *nd ball sys-
tem, in which the heal is oblainetl by

I. Tapping for dropsy;
periutmed on the nbdomcn. theM.
etc., 10 discharge the fluid M.-r;mr;<Ll.
(See^j/iVflrten.)

FaiaJOellTa. A &win sopontic.
huTing a pungeni laiiie. As ii is uf ^in
oily, unplcuanl nature, il I'l usually

strong coffee ,
tKnijtU. Lou o(

of the pawet of mov

Measures musi be lakei

luuaJly I

3rm Ihc vaull and sides of die cr^-
PulatM. The sides of any cavity

Puotld. Near Ibe air ; applied lu
, cmglnnieratc gland under the car.
PaioUUs. Mumps (which see).
Pu-Dxrim. Periodical Increase of

FateUA. 'Hie knee-cap.

I bed-sores,
I. Paralysis

disease ; it may be partial or coni-
pleie. M/an/iit paraiyiu occurs in
weakly children under four years ; the
legs being tisually affected. It arises
from injury to the marrow of liie

walking. The limbs get ihin. and
must be kepi wrapped in thick wool.
and be rubbed night and morning for
a quatlCT of an hour, passing the hand
K/tbelimb. Douching with hoi water
or eleclricily may be ordered. Prevenl
bed-Mires, and give nourlshinK fo"d.

Pu«lyUC nroka. A sudden com-
plete attack of hemiplegia.

PUApUaUMlJ. Keiraction of the
X behind the glans penis.

„— -Vloslft- Paralysis of the lower

Uoflhebody, including the bladder

n under Paralysis must be

irerully heeded.

Parailte. Any living thing which
draws its nourishment from anolhei
living thing.

Pueiorln. Camphoraled tincture
of opium used to relieve pain.

TarraoIiTina. The spongy purl of

Ptrairt*. A slight form of paraly-
FUUUI. The two bones which

progresi of disease.

PaUwlOgleal. Relating to palhol-

PaUl0log7. The study ol dis-

Pstnloni. Open. wide.

Pecouit. Not healthy.

Paotor>L Reladng lo the breast.

Pedlcla. 'llie fool-stalk which

Fedlcnlnt. The louse, a parable
infesiing the hair and skin. An oint-
nicni will be ordered. The head may

Pelllide.

1 skin c

PalTle. Relating lo the pelvis.
PslTlnlBtar. .\n instrument for
mens u ring the slie of the pelvis.
Pelvla. The bony basin composed

Ibe spine, and holding the bowels,
bladder, nnd organs of generation.

Pemidll(iU. A skin disease which
Is marked by eruptions of large blis-

A house!

old r

Papiln. The ferment of gastric

juice, which chiefly causes digestion
of Ihe Ibod in the stomach.

PcpUniMd Foods. Food which
has been partially digested by ani-

Perciuiloo.

triking upon the

APPENDIX.

chp^t, the sound heard being helpful
m diagnosis. Place one finger of the
left hnnil Hal on ihe pnrl lo \>t exam-
ined, and strike sharply with Ihe ends
□f Ihe [hree hngeis of the light hand,
holding Ihem nl the same length.
There IB a certain degree of resonance
in the lound emitted.bul this ii dulled
when there is fluid in the lung, or Ihe
lungisiotid. Only a practised ear
__. --—---■■-m from the degrees
Uie fact of dulness
can be delected by a nurse, and may
be useful lo her, Immtdiolt ftnus-
lifin a that by pulling the finger
againsi ibe patient and striking it.
wilhout the mlervention of Ihe ple«-

4 hole

Ihe feiu

PerloudlUi. IntlammatioD of the
uuler coat of the hearl ; apl lo Ibllow
in eases of acute rheumatism or
typhoid. Perfect rest, light diet, in-
creasing walchfulness to iuiticipa.te
all the patiem'swints. The remedies
ordered must be kept ready at hand.
The patient will probably breathe
better If propped up by plenty of
pillows. On no accouni should the
patient be permitted to make a sud-
den movement.

Tlie outer mem-

Pertaeum. The space belwc
the anus and Ihe vjgina.
Ferloitattm. The membrane ci

tesiinei in forcing onward their con-

PeTltonenm. The membrane or
sac which holds the Intestines and
viscera generally.

POTttonltU. InHammatlon of Ihe

Ceriloncum. Tlic symploms areshal-
iw breathing, vomiting, pinched fea-

tures, abdominal pain with kncct
drawn up, and rnpid pulse. May
Follow any abdamimil operation,
therefore these symptoms must be
watched for, and at once reported.
Trentmeni dilfere with the doeior in
chan^. A cradle must be placed
over abdomen. Collapse diu.'iI he
feared. In peritonilit with perldri'
lion of the bowel, the operiilion of
laparotomy may be performed, Thr

needed for a long time, Deuth may

Olid containing a large
preponderance of oxygen,

Farozlil or BjrdMfan. A power-
ful antiseptic aud germicide : used as
a disinfectant in diphtheria, elc, and
a.s an antispasmodic.

FaitiiHla. Whoopiog-cnugh ; a
contagious spasmodic cotigh. com-
mon in childhood. The first len days
the patient should be kepi indoors;
Ihe disease runs its coune in from
three la six weeks. Watch Ibr chest

A massage move-
meni up Ihe spine ; pick up Ihe flesh,
and roll it between the thumb and
fingers.

the Tugina lo prevent or remedy pro-
lapse of the uterus; genemlly in the
shape of a ring or a ball, and made
of gutta-percha or vnlcanitc.
""''""" Small red spots on the

PttrUiagB. A ms-ssage mare-
aeni, consisting in picking up and
oiling Ihe muscles between Ib«
humli and fingers — it is slow M

septic and cxpcctoran
pel worms.

PMroiU. Slony ; :
a hard part of the lemporal bi

Payer-a PatehM. Small _

situated on the surfiice Of the il

PbaxadMU. Ulcers
which ';pmf| rapidly ai --—^

FtiasDoytBi. Fm; paraliMi oM

PlulknCM. Thesmallbonesofthe
lingcR anti toes.
"*— ■- 'i aulhoriied

paring

PBrnryiixltll. Inflammation of the

Plurrnx. The mrmbranous iac

■ ol ihe mouth and leading

c in the

to the ■

FUeUtlt. Inflammation of th(
veins, uaused bv Ihe coagulalion of
Ihe blooel in the vein.

nUBbOMiiiy. Bleeding a palieni

byoi

a Ihei

PUeBm. Thick expecloratio
coughed up in thesl diseases.
PhlaEDUkalA AllW DolMU. Con

rv painful,'
'a pillow.

labor. The leg t

Slightly raise the

and arrange il so as lo give as mucii
ease tu possible. The danger is of the
clol moving and going to the hcari
and causing sudden death, Thi
swelling usually begins to go down
afler the ninth day. Gentle Iriclioi:
after the eighth week may be used,

To. Sluggish.

Relating to the voice,
. A compound of phos
' a base. Phosphate;

and amount. The night-sweats are
often a distressing symplom. leaving
Ihe patient weak and wretched, and

in providing warm, dry changes. In
coses of pyrenia. the temperature
must be lakcn during the attack.
The palleni should wear wool only :
see that Ihe bed-clothes are liehl.
Before washing or i

,tely =
stimulating food.

rhage comes

FhriKilpcy- The

treats of living bodies
which govern them.

Plft Ibt«r. The hne
surrounding the brain t
conl.

niai. Enlarged veins

cause discharge oC blood;
do not,
Plloeupln. A drug wl

If h

nd spinal

about the
sding pjles

appea

c acid dis-

PIUMpbitila. Excess ol phosphate:

cular disease of the lungs. The pn-
tienl must be weighed, llie diet nour-
ishing, chills avoided, temperature
a, and Ihe spui.T iiuted .is to color

rtspinition.

Plpnte. A small graduated lube
for uking up liquids.

FltyrlUla. A scaly skin disease.
Till- serious variety natra a most
common In men of middle age. Diet
nourishing, no stimulants, /fftta,
which is most common in children.

PlMWtKI. Medicinegiven to please
Ihe pttient, often only tinclurc of
range or bread pills.

PUcanta. The after-binh : a cir-
ilar. flesh-llkc substance surround*
ig the Mus. and expelled from the
oml) after Ihe birth of the child.

PUoantK trmriM.. Presentation
r the placenta before the fetus. In
icse cases hemorrhage must be

sole

Plftnlar. Relating ic
the foot.

PlunUL. The liquid in which the
corpuscles of the blood float.

Fluter of ParU. Used for pre-
paring bandages for slight fractures.

muslin bandage and pass it through

n of »

sed. For

4i6

APPENDIX.

bandai-e in \

ill harden), place the

Uud for keeping

The!

IS left to the ]
Take a piece of glaied muslin un
stretch it on a board wilh drawing
pins, spread the plasler hot with tli
edge of a warm knife. To apply
surgical piaster cut ii into convenier
strips, and hold the wrung side againi
R lin tilled wilh hot water; this is
cleaner method than dipping th

plulera, CO

and work Inward the centre ; never
pull away from (be wound, or you
may lear il open. The marks left
by piasters can be removed with
chloroform.
Pledget. A small compress of

Inn
Ihe c

»the

Flettrlir. Inflammation of [he
pleura. This, like all chesl cases.
needs careful nursing; it is often
found in conjuction with pneumonia
or phthisis. Temperature every 4
hours; poultices will probably be
ordered; lempcreiure of room 65";
fever diet. The sputa must be
watched. In cases of etfusion. aspi-
ration may be performed. Great care
is necessary in convalescence, and

n«nro-piwninoilt«. Pleurisy com-

usually applied lu .1 certain cattle

Plexjmeter. An ivory disc or
other hard substance placed on Ihc
body to receive Iht stroke in mediate
percussion (j. xi.).

Plexiu. A network of vessels or

lin nerves, etc, 1

DUHllk. tnflammalion of the
lungs. Single pHmmty/da means one
lung only is aflecled: daatU fmn-
mania, that bolh lungs arc diseased.
Nearly every physician has a differ-
ent method of treating pneumonia,
but the most common nursing treal-
menl is to keep ihe patieni in bed, in
a room wilh lemperalure of 65° ;
Jackel poultices every four hours;
temperature every four hours; keep
a sleam kelilc going; liquid slima-
laling food frequently. Some physi-
cians, instead of slimutaling diel, ap-
ply hoi jackel poultices. Others,
again, instead of poultices, apply ice-
bags or Leiier tubes. The spuu
musi be kept for Ihe inspection of the
doctor. The crisis usually comes
about Ihe end of Ihe first week, if
delayed beyond Ihe ninth day ihir
case is critical; the convalescence
takes three weeks. Relapse is al-

. the

Air in Ihe pli

wh!c>

usually met wilh slimulan

Btes. Light food frequently. Aspim-

lion may have to be performed.

Pock-muft*. The pits left by the
small -pox pustules.

PmlaplirUiiIil. A drug used as ■

Potion. A substance capable of
producing noxious and even fatal
effecis when absorbed by Ihe system.
For a dassihcation of poisons aad

PolAiliatlan. The tendency to 1

revrrw current in the batlerr cell.

FolltierBac. Anindia-rubbribaE
with long tube and noiile. Used in

PolyoUnle. A hitge general bov
pitiil,

PolremlA. Excess of blood.

PolinillA. Eiccssive flow of ui
of low specific gmvily, and con.
sequent thirst of palienL Meas-
ure urine. Nourishing food. Avoid
' make the patient ww

\ small opening.
kPMlUTePoU. The poleofigal-
— '; haliery, by which cleclnciiy
It (rom the generator.
loa. Poslure or altilude of
t body In obsieiric, gynecologic.
C sorgKul exanilnatioD and opcia-
'~in. The dursal posiiiuo ii lying on
.t bock; the knte-tial position is
' Aie patient oD the knees : Sipis' po«i-
lioD is the patient lying on left side.
(See pp. 137^143)

PcMlbimumB. After death -, a post-
humous child is one bora cifler the
biher's death.

Fott-moTtam. The opening and
eiaminiag of a dead body.

Pnat-partiun. .^ftei labor. Post-
p^rtUJK kfmorrkagf is bleeding afler
the child is born.

Poaton. Should be noted by the
Dime ; the knees are drawn up in ab-
dominal pain 1 the body lies flat in
fevers ; shoulders raised in chest and
heart complaint; nrms overhead in
heart complaint; lying on ofTi^cied

GLOSSARY. 417

femoral artery, '. rendering it specially liable to certain

Prvfitsiuiy. The slate of being
with child. Usual period 38a days.
Morning vomiting a marked symp-
tom. Test urine monthly. Abdimi-
■ frtgnam "'

regnanc

m). For

FramUnie. Occurring before the
pTMBUtatlDn. Position of the

pneu

colic. Slipping off the pillows is a
lien of eihaustion.

>ffHlllnm A useful alkali; the
bicarbonate is given in indigestion
and rheumatic gout: the bromid In
nervous diseases, epilepsy, etc.; the
ioidid in aneurysm, scrofula, etc., and |
10 check milk-secrclion ; and the per-
tiuinganate is a favorite disinfecl-

Fott'l DlMUa. [See Sfina!
Qtn-alurr )

Fon'i Rmettin. Fracture of die
fibtlla close above the ankle, some-
^tnei also with dislocation of the
■nUe. Usoally set in plaster splint.
Twelve weeks' rest necessary.

AnlttCM. One of the most Im-
portant items of nursing treatment
(see p. 95).

PmMrt'n Llxunent. A muscle
of the abdomen, strciching between
the ilium and the pubis.

TlMOrdUL The region in rrnni
of the heart. Prtcordial pain, spas-
moilicpain about the heart, not ot-

whieh prevents the lakingof dlsoasi';
prophylactic.

Prbnaty. llie early stage, or
symptom, of disease.

Piimlpara. A woman who has
borne a child but once.

ProlHUls. A slender rod, some-
remove foreign bodies from the etoph-
agus.

pTabe. A slender rod. usually of

FrogllBthDIU. Korwnrd promi-
nence uf the jaws.
ProgltoilS. The art of foretelling

1 in

who are constipated, and therefore
given to straining. Regulate the
bowels, and when they are acting
press the buttocks together.
PrOUpsiu Uteri. The (ailing

PredlapodtlDD. ?

i of body

avity.

Promontory. A projection of the
inlemalear.
Pronanoa. Downward turning of

FlopIlTUAtla. A preventive of

ProCtUa. Heart-shaped gland at
the neck of the male bbddcr. When

Prottntton. Hxtremc enhausiion
nuscular force; col-

lapse.

1 green oil -silk
and second lay-
eplic dressing.

Prolaln. Proloplasm ; an srIificiaJ

Prond FiNli. Tou vigorouit gran-
ulaiiun. growing up above llie proper
surfnce a( (he wound. Mny have to
be touched with causlic.

FmrtgO. A skin disease marked
by very irriuible and lasting erup-
tions. Tnr, sulphur, and naphlhol
may be .ippbed locally, or by means
of v.ipor linths.

Pmrltn*. Local skin irritallon.
' iif thi.- genitals. Medicaled

Prnwle Add.

alkalies,

Ihe loii

etc. Ailidali
, cold water dashed
c. (See Hydrocynnu Antt.)
. Two muscles of the loin

These abscesses are mos

cariiorai
the greatest care Id
the dressing is left
must be most parliculat in every de-
tail. Nourishing diet, cod-liver oil.
Ilie abscess is usually lanced, adrain-
oge-lubc inserled. and an antiseptic
dressing applied,

PaOfiula. A scaly shin disease
of a chronic character. Medicated

tnncouslv. mnv be part of ihe t

rncol lo be c.-irried oul by the ni

ParcUcftl. Kclaiing lo the n

PtomaJiiM. Minuir alkaloid

Death u

Ireely. The (ever is nsiullr nentP.
reaching a crisis In a lew days; then
if Ihe icmperalure. piil»e, und respi-
— ""- decrease, recoverr is posiibic.
illy results fiom cihaus-

la. Usually liegins
'roni 4lh lo I4lh day after childbirth,
«iih pain in head , restlessness and in-
flninia. Never leave patienl alone :
<eep the child and the family away.

Pnerpwliiin. The period from

lildbirt

when I

has regained its nonnal siic;

'*" _!o Ihe lungs

FnlHltUlft, A drug used panicu-

jrlv in cases nf aires ted mensinialion.
Fillu,U(ML. Beating of the hearl.

>r of Ihe blood in Ihearteries.
PnlM. To feel pulsation, put Ihe

Ihrc.

middle

mdial

arlery atlhewrisl, beneath the Ihumb.
The pulse in health beats about I»
to the minute in inAints. 8« in ehil'
dren. 60 to 70 in raulurily, and 50 in
old age. An imermilltal or irregular
pulse is a sign of exhaustion ; a /uU
pulse is a sign of Ihe early stage of
(ever ; a Ikmxi-Ukt pulse Is a sign of
want of blood, and is common after
hemorrhage ; a hard pulse is one
which is nol easily slopped by press-
ing on it : a soft pulse is easily com-
pressible (see p. 39 1-
PnpU, The iris or centre of the

be give

I. A medicine (or cnus-
>f the bowels. Should
empty stomach.

serious skin disease

by purple patches, eaus*d liy
the escape of blood (ram the vessels
into the skin. Complete rest in hor-
izontal position, and nourishing diet,

Tnmlaiit. I^ls-1ike,

Ptu. Matter given off from an
open sore. Lati£iiU or healthy pu*
is cream colored, nol offensive, and
not venr thick. UiUuatltly pus b
brownish, offensive, and dotted. If
stringy, il is a sign of scrofula. Pus
in the urine shows as a while "'-
ment. (hick and ropy ; il (rial
when lir|Uor poiossK is added.
Pnatille. .\ plmpkcontainnii
Pntreftctton. The rotttaf

GLOSSARY. 4ig ^^H

flir.E<H>d food, and soap and waier are ^^|

rsnci^il to an otfiinsive stage. |

the besi eures for rickeis, but if Ihedi^ ^^H

eB» is U,t advanced, tplinu ma* have ^^^^|

VIS of the kidney. i

lobea|ip1ied,iu>d raw-meat juice and ^^H

cod-liver <»1 be given. Rickety chil- ^^H
dren are specially liable lo colds.&nd ^^H

pus in the blood. anJ marked by ,

ipreience of absceuo. Il usually

must be warmly yet lightly clad. ^^^1

■am about Ihe weond week after j

lUdlftl. Relating to the radius. ^^H

Kadml artery Is the smaller of the ^^M

Dt>1 to convey the conlagiun else- ]

two terminal branches of the bia- ^^^1

er<. Diet nourishing. Tnke pre- ,

chlal. Begins at the bend of the ^^^1

elbow and extends along the radial ^^H

itic* freely. Note the temperature ,

side of (he forearm, passes around ^^^1

1 pulse both morning and evening, i

the outer side of the carpui.and for- ^^^1

fjldroa. The lovrer opening of 1

ward to the palm. ^^^1

stomach into Vbj; iniestine«, 1

B&dlcal. ni,it »liich ^ocs to the ^^^1

:>yTMlA. A slate oF rev.;t, ill-de- 1

" BMliuE. . ... Ihc ^^1

ftrilU. I'usitilhf urine. |

Q. !

"Rale!' 'm'_'M I .iiu''rrd ^^|

in Ibc :ur-pn^s^lK<.'^ i.p<m .uisculla- ^^M

B of inleclcd persons from others.

Run, [See Eruffi^-,.) ^^^M

sessary lo prevent the spread o(

RMDtlon. The effc'ct priHlnced in ^^H

tautu. A fcv« rising and fiill-

Eeftsant. One sulmnnci' tsed as ^^^|

; In periods of four day*. If qulnin '

[■Ten, note if It arrests Ihc pnroi- '

RMUmnr. A temperature scale ^^H

o( Bo equal degrees, from freeiing(o") ^^H

the fetus in the womb, usually fell i

Recrudescence. Return of bad ^^H

Ibe mother at the end of ihe (uun)^

nih.

RictlUB. Iiin.iiiim^iiinnof Ihrrcc- ^^H

tBUkltme. Unslnked lime.

Mnla. A ionic prucurc^d from

1 hart of a tree, ll has remark-

aaatum. The lower end of (he ^^M

rttcnUTly useful in inlermilltnl

large intestine from the colon lo the ^^H

MIS. It ihoaUl be given lH.'fore

RWSttU, Slmighl: applied to cer- ^^M

Eecmrant. Reluming again. ^^H

liJMu.l

QBOtMlu. A fevet hftving -■. pc-

)ii-ruLis. dislocations, etc., as can be ^^H

^^bd of twenty-four hours. II qumm

^^■f (iven, nalE If it arrests the parui-

ReDex AcUon. Invotunmryuclmn ^^M

H£.

c-iu-^ed by irrilaiion uf the m^rve- ^^M

Resimen. A rule of diet. ^^H

^^ SbUM. Madnes* in animsb.

RegursltatlOU. A backward Row ^^M

laeemow. Glands having numer-

ofliloud through defective valves; an ^^^B

ous branehed tubes.

eructation. ^^^1

BuUtU. Rickets; a conslitu-

ReUpM. A return of disease after ^^^1

liunal diKue of childhood, marked

c<.nv;Llescence has once begun. ^^M

^^^ curving of the spine or long bones,

fever due to siarvaiion. l.iglit nour- ^^^H

et given very (requeolly,

warmlh, and clesnlinen.

turning at reguinc
ipplied to BguQ And fevers.
Relating lo Itie kidney.

iapalx. (See //«/.

!■■' .

ilci).

Ketplntton. Breathing, In count-
ing a palienl't reipiraliaa, hide the
but uf whal you are doing: for ia-
slance. when Inking Ihe pulse, note
the rapiralions. They should be

dren 36, in adults 16 ■□ iB. Note
wlietlier Ihe breathing is shallow or
from low down, whether It is regular

silion Ihe breathing Is easiest, and if
accompanied by any noise such as
the crowing of croup, or the snoring

EuplratOT,

>r la keep back muscles during an

:r the 1
1 with CI

)ulh lo

ro. The mode of treal-
menl of palients suffering from hys-

rest, (a) isolation. (3) systematic feed-
ing. (4I massage and electiicily.
BertlMI. Deprived of repose or

ReiuolMtlon. Reviving those
who are apparcntiy dead. The Mar-
shall Hall method of restoring Ihe
npparentlv drowned Is rolling Ihc
body over from the back to Ihe side,
and pressing ibc chest on Ihe raised

KBteatlon. To hold back. In-
ability to void mine.

BeUna. The inner membrane of
the eye. upon which objects are re-

tion of Ihe blood ; if acute, it is corn-
may be chronic or muscular. There
IS always great pain, and ihe nurse
must so arrange The bcd-ciothcs thai
no weight rests on (he affected limbs.
F>ul the patient between blankeis.
The tempeiBture should be taken
every four houra. Fever diet Keep
the temperature of Ihe mam not
higherihan6o° The (wo chief causes
of dealh in cases of acute rheumatism
are heart complications and byper-
pyreiia. The patient mus( never be
allowed to move suddenly, even dur-
ing convalescence. Cold baths 01
cold packs will probobly be ordered
lor hyperpyrexia. Test Ihe urine toi
acid reaction (see p. ags).

BblnltU. InHammalion of Ihe

medicine given as a purgalive.

Slbl. Long lalcnti bones enclos-
ing the chest, seven pairs of true ribs
which join Ihe breast bone, and five
paire of &l5e ribs. FltnOHig riii ait
the two lower pairs ol ribs.

KlokoU. (See HoMHt.)

Blsnr. A sudden attack of shiv-
ering, usually the herald of a dis.

long Ihe rigor lasts, what ihe temper-
ature of Ihe patient was during Ihe
attack, and the hour of its occur-
rence, Rigorsshouldbe immcdinlrly
reported to the sister in charge.

'Bigot VOTtU. The stiffening of
the bodvafter dealh, Artieuh mtriii

A circular skin cnip-
contagious and very diflicall to
if occurring on Ihe scalp. The
ihould be shaved and a cap of
Ik worn. The ointment ordered
be rubbed in daily after wasb-

■silkw.

^^^^^^^^^^^G^Sl^^^ ^^^^42^^^^B

^^■kg ihe pUces with soap and watr r.

of salicylic and carbolic. Given in-

^■tkai-s general health is mainlained.

also used locally as an antiseptic.

^■'A separate brush and comb and

Note any decrease of urine.

^B •Muel musi be kepi for the paiicni.

SaltlMtar. Nitrate of potassium!

^■glin. svmptoniBlic of lock-jnw.

Salt-iolnUm. Sodium chlorid

^H KocbflUa Bait. An nperieni con-

(common salt) dissolved in distilled

^V^toining pula^ and suila.

water. In medicine it is employed to
restore to Ihe system Ihe fluids lost

^^fr BOMOla. A rou-colatcd rash

^^V'dne to ilieht fever, and of no ereat

by severe hemorrhaKC, etc.

■ hnportanee.

S>lTB. Anolnltnenl.

KobelkOlnU. Mild irritsnls which

cause redness o( the skin.

blood.

Bantonln. A worm expel ler.

Ihe patient in bed Ihrre days, and in

Usually giv,-n in cream. After a few

(he house a week.

dOBPs Ihe ^iehl becomes disordered.

SOttWda. Measles (which see).

Bapnmla. Poisoningof puerperal

BWton. Hernia (whii:h see).

women by retention of some decom-

/twfn-rr 0/ a ilBod-v^isti means the

posing mattf t. The cause being re-

bufsllDS of the same.

BuMpartlla. A mild laxative ob-

tained from Ihe root of a Central

American vine. Given in strumous

^H iao. A smalt bag, such OS a her-

and skin cases.

^■aUlsac.

the thigh.

UKd in iliabelic cases ^ it is usually

Seal). An incrustation formed

in Ihe form of lol>loids. two of which

over 3 wound.

(K gr. in each) will ^.weelen a ctip «f

BcBblM. The itch : a conlagious

tea.

A sulphur bath will probably be

cral.

ordered {four ounces of sulphid of

flttOnun. The lowest division of

in a porceUin bath), in which the pa-

flie bock-bone, forming pan of the

pelvis.

tient should be allowed to remain

n. Attthony'i Fir*. Erysipelas.

for twenty minutes. Disinfect (or

StTOw-Bwiee. Chorea.

burn) all Ihe clothing. Voselln wilt

aniipyrelic. A favorite drug for allay-

scralehing.

ing the joint-pains of acute rheuma-

BeaUr Cover up Ihe scalded

part with Ihe dressing ordered (lint

soaked in carron oil probably), and

nolbepui in this .icid.

expose the part to the air as little as

SalleyllO Wool. An antiseptic

possible. Guard against shuck and

wool imprrgn.itcd with the while

exhaustion.

cryiUU of the acid and a small

Boalpti. A siraight knife ; chiefly

qwntitv of glycerin. Thiswoolmust

used in dissect in g.

not be shsken, or Ihe crystals lall out

tcamila. The shoulder-blade.

■nd Httte meeting.

WIM. Containing salts. Acom-

blood-letlmg; used instead of cup.

pound or an acid and an alkali.

P'lE-

faun. The watery fluid poured

bto the month by the salivary gkinds.

instrument fitted with mony little

BUtnSOB. An excessive lecre-

blades, and used to perform scarifiCB-

tim at saliva.

tion.

^B naa. a white powder composed I BoarlM FaTn. Scarlatina; an ^H

422

APPEXDIX.

infectioii* tern accompanieii tiy
redness of the tkin. and mcBt cum-
mon in childrFo. Period of incuba-
lion, lour to elgtit dujs ; rash on ue-
ond day. The rash shows chiedjr on
the chesl and lia^k, and lasts about a i
week. Then ibe fever subsides, uf
Desquamatioii la^ts about fivi

ttovT^H

beSir.

Die

Keeplhi
laled. and a it
solution hung over ll
lion is absolutely nee
disinfection and fui
Fumigatiati^

for ali cla&aes of Imcl

mcmbhini^ of IL.

MtTe. A wDlhiBg mcdicWte.
dUtarofWdar. A popubi ipari-
n Ihc fonn of two powdEn.
I. when tniied. effervesce.
Dl<dnvlM' OhmIs. Thnw at-
it the inlrnuU ear.
Illtty. Docliiie of pQWn aftet

.ynip ■

n. or the application g«imi. The condition t

ipping. may be left to laclion.

■p (he palieni warm, i B«pUa. Anything that cat

A chronic disease I Irefaction.
ing hardness. Turk- ' BapUoamlX. .Seplic matt
ubblng in of lannlin blood: blood -poison in e. \j\

' ■--—1. r™i.

Beleroni*. A hardening of the

Septom. The division between

lile disease. Rate, very fetal.

tricuhmm, which separates the tight

■eolKMU. Literal curvature of

ventricle from the left.

the spine.

Sequela. Morbid conditions re-

ScOTlnittU. Scur^-v: a skin dis-

ease marked l.y dejecli'on and anemia.

some f.irmer illness.

and caused by want of vegetable

SenillL The {lui<1 of Ihe blood in

food. I'lenlv of green vegetables

which the corpuscles floai.

and lemons needed in the diet. Do

SblnClM. (See«-r/«.)

not let the paiicni sit up or make any

«UTer. A tremor ot shaking of

sudden movement, or syncope may

the body ; often concomitant with or

be the result.

symptomatic of fevers, especially

those of an infectious nature.

with a tendency to tuberculosis.

Btiock. Sudden prostration due

Characteriied by swelling and sup-

to pamful impressions; a frequent

puration of Ihe glands of the neck.

ciuse of death after operations and

Kresh air. nourishing diet, cod-liver

accidents, especiallv after bums. It

health are neccssurv. The glands

mav have to l.e remov.'d.

Show. A popular name for the

8erapl«. A weight e<jual to ao

s.inguineous mucous discharge from

grs. troy.

Ihe vagina before labor.

Scurry. Sturl.uius |*bich see).

Blcmold nexnn. Thefleiureor

malter.

kller S; serves to nmove the fccal

tatter (mm the body by muscles of ;
I nod i^nds in the rectum.
BUkwtnn Out. The thread drawn
m killed when rcai'

Ul. Ahip-balh. {Stwp.aa.) <
niSK- A bandage suspended from
the neck [ur the support of a wounded

A flat, flexible, blunl

mdpouliices. Also. inasmaller form,
uhcd lo press down Ihe tongue when
Ihe Ihroal has lo be examined. Every
nurse should carry a spatula.

Bp«elfle. Applied Id a medicine.
i1 means Inlallrble ; applied to a dis-
ease, it means of special characier.

SpaelAe OnTltJ. The weigbl
of a subtilnnce compared

■r llirowi

by giingrr
■mall-pox. (See Varvia.)
SMWUf. Convulsive aclk

Ibe i^iiriiliiry muscles from i

thtn o( the mucoui membrane lining

the n«ul cavity.

■aBfllM. The peculi
breathing nobe bv fntanis affected
[ with cbranii

The Heartaimtr is a fiivorite
edy for acidity of the slomach,
■OwcUin/ is an emetic. The sul-
nUftacalhanic. Tlie ai/rd/c. given
H epilepsy, etc.. mn.y cause serious
"VipCoins. Sodaminl Is a prepara-
~n £>veii fi^r indigestion.
... ... Capublc of being

Spttrsmon^PH' An m-.lrumenl
iiffi«cd lo the wrist, which moves
with the beat of ihc pulse and regis-
ters Ihe ntle and character of the

Spina Blftda. A congenital mal-

rmalion of ihe spine, forming a

Found in innnli,

terminating filially. UiiutI

is lapping and imiSBiiuent

dreuing of absorbenl wool, rather

lightly strapped on. Walch forcon-

Splaal OnTTatnn. Constitutional

curving of the spine. When accam-

panied by caries of Ihe s

called PV>lt's disease.

at plaster of P

orsaresandlhe

-bone or vcrte-

■plronutM'. An Inslrumcnt liir
eiisuring the capacity of ihe lungs,
Bplaialad. I'hickened.
Blllewi. An oval body In Ihe lef)
■ - and purifies

Ihe hlood. Hemorrhage is peculiarly
liable to occur after any operaiion on
ihc spleen. Such ope to I ions are
always serious, and need catefiil

BpUlrta. Stiff pieces at board or
malerial used lo secure rest lo some
injured part The m

splints.

, rell.

gmlfl-pcrcha, etc., are used. An
gftlar splinl has one part al right
angles lo the other, nnd is used for
Ihe arm, the elbow occupying the
angle. An tnlempltd aplinl has the
part just over Ihewound removed to
GiGilJIate the dressing. The nurse's
duty is to keep splints clean and pad
Ihem for use. The pads should be
linen stuffed wilh antiseptic wool.
made slightly larger than Ihe splint ;
Ihe padding miust be even. The pad
can either be sown on by cross
■breads on the wrong side of the
splinl. or Eislened on by three bands
of strapping going right round Ihe
splint. When necessary. Ihe pads
near a discharging wound should be
covered with oil^ilk.

Bponga. A porous substance,
varying in lexture. derived from an
aquatic organism of low order, and
formerly much used in operations.
ArtUctal sponges of absorbent wool
encfosed in antiseptic gnuio ore now
used extensively instead o( Ihe nat-
ural sponge.

Sporadla. A disease which is not

BMrlle. Barren ; i
children.

StorlllMtlOB. Rendered free rrai
; generally by boiling.

'ping.
olMiriieled w

of I

islcning to Ihe sounds of tl
.nd heart ; one end is placed bi
he patient's chesi, and Ifae e
he lislener al the other end. _

:nd5 lo apply lo Ihe can of the IBi

Bthenlo. Stroi _.

etlgliuita. Marks on Ihe skin.

atUlbom. iSom after the roun
nonlh, bul wilhoul ■
iomplele breath,

Stmindk. Drug n
hartia: also in cases of syphilis.^

etUnnlutt. That which caur'

times need splinls. ice-bags, and all
Ihe time and trouble given a fraclure.

Rpntnm. Kiiieciorated matter
from the mouth.

BqvlU. Drugusedasanexpeclor-
ant and diuretic. Overdose poisons.

Stair. A lithotomy inslnii
used lo guide Ihe knife.

BtaiMdlni. A muscle of Ih.

ilitnip-likc bone of the

loulh: also to

Btomfttltla. In flam mi
louth. and ulceration :
ion Id inhnls. Attend
ivc a mild puignlive;
loulh oul frequently wilh a

MOOU. Discharge Iroin the

See Moli(mi.)
StrftUamiu. Squinting

StTuigiilaUoii.
BtTULKUry. I ';

tf the longuc i

n drops. Hoi sponge to pan. l

lear-rcd appearance
scarlcl fcver after a
IS disappeared,
mimction. Usually
' applied to the urethra, and cunse-
quent htabilily to pa55 urine.

StlUnlOU. A creaking sound in

Bticinu. The (issue which fotms
the (auDdation of an organ.

MxotfWBttnM. A poison, used in
small doses rj a heart-siimulani.

Strmaa, Scrofula* or a scrofulous

ghryduilll. A poison, used as a
nerve and spinal siiniulant ylafi-
delt$ : an emetic, strong lea. ether
inhalation.

■ttunp. The part ol a limb re-
mftlning After an ampulaiion.

■tap*. A (bmenlulion (see p. 94).

ttnpor. State of unconsciousness.

Wgflfia. Agent to arresl bleed-
ing; aslringenL

Bvbelftvlaii. Under the shoulder-
bhidc.

BDlpbnrlc ksA&. Vilriul.

[S. Brain mischief caused
liyheal. Symptoms : Headache, sick-
ness, confusion of ideas, refuol of
bod. Pul patient in darkened room,
ind keep ([uiel. Ice to bend

8lip«rf«tatloil. Supposed concep-
tion liy a womnn already pregnant.

Bnpliiktioii. Turning thepalm of

BnppoiltoiT-

nirodut ■ ' -

to Ibe I

r vaginii.

Under Ihe skin.

■llblltVDintlOII. A condition o
imprrfecl restoration of Ihe uterus 1
Its original tiie after delivery in cblii
birth.

SnUnUttOn. Sprain and parti:

Sappraialon. Failure of the kid-

SttppuTBttoi. Gnlhering of pus
under the skin.

8nnur«S. Silk. silver-Ill read, or
calgut used 10 sc» a wound or lie an
nrtcrj' (seep.171). Also ibe union of
flal bones by Iheir margins.

SwelUng. Morbid enlargement of

Bympbyils. Cirowing logelherof

h dis-

StuoOP*. Suspension of the heart's

Siimulalion, wannlh, and artificial
respimtion may have 10 be tried. Pul
the patient flat on his back and open

BrnorlUi. Infliunmaiion of the

SypUIla. Venereal disease, spe-
cific and contagious, lliere an three
stages. Ihe one marked by primary
symptoms, Ihe second a period of
outbreak, and the third certain well-
marked sequeltc. In dressing all

426

APPENDIX.

ills is inherited ; the infant looks old,
head large.

Syrlngo. An instrument for in-
jecting fluids.

STtUde. The contraction of the
heart in its beat.

TabM. Wasting; dorsalis, a dis-
order of the spinal marrow, marked
by loss of power over the voluntary
muscles ; mesenteric, consumption of
the bowels.

Tactile. Relating to the touch.

Talcum. Silicate of magnesia ; a
white, unctuous powder.

TaUpei. Club-foot. Talipes val-
gus, the foot turned outward ; varus,
the foot turned inward ; equinus, the
heel lifted from the ground; caUa-
neus, heel projecting downward.

Tampons. Plugs of antiseptic
wool enclosed in gauze, and used for
introducing into the vagina, etc. A
string is usually attached to the plug
to aid in its withdrawal.

Tansy. A favorite household
remedy derived from a common
plant. Promotes menses, and is a
diuretic.

Tape-worm. Tenia {q. v.).

Tapotement. A massage move-
ment; the hand is lightly clinched
and held hammer-like, used to beat
the muscles with swift, short strokes.
All beating movements are sometimes
included under this term.

Tapping. (See Aspiration.)

Tar. A thick, black, resinous
substance obtained from the wood
of the pine or fir tree.

TareUB. The seven small bones
across the instep.

Tartar. Incrustation on the teeth
if they are not kept clean.

Tartar Emetic. Potassio-tartrate
of antimony ; an emetic ; or in small
doses a sedative.

Taxis. Hand-manipulation for
restoring a part to its natural posi-
tion, such as reducing a hernia.

Tears. The fluid secreted by the
lachrymal gland.

Teeth. The principal organs of
mastication. There are four kinds
of teeth — incisors, canine, bicuspids.

and molars. The first set of teeth in
childhood are called "milk-teeth."
which are only temporary teeth.
They number ao, lo in each jaw.
namely, 4 incisors, a canine, and 4
molars. The two middle teeth of
the lower jaw should appear about
the seventh month. In the adult the
permanent teeth consist of 32 teeth,
16 in each jaw, viz. : 4 incisors (front
teeth) ; 2 canines; 4 bicuspids, and 6
molars. (See Dentition.")

Temperature. Degree of heat.
The average temperature of the body
in health is 98.4° F., but it rises
slightly at night and falls in the
early morning. A temperature of
99^ ° degrees indicates the presence
of fever ; a temperature of 104^ is
serious. In collapse, the temperature
falls below the normal point, and may
be 96°. A subfebrUe temperature
is slightly feverish ; subnormal tem-
perature is below the normal ; an
algid body-temperature is seen in
pernicious intermittent fevers in
which there is great coldness of the
surface of the lK)dy. The tempera-
ture of a sick-room should be 68°
as a rule, rather lower for surgical
cases, rather higher for chest cases.

Temples. The part of the fore-
head between the outer comer of
each eye and the hair.

Temporal. Two bones at the
side of the skull containing the
organs of hearing.

Tenaculum. Small surgical hook
to secure arteries, etc., and used by
anatomists in dissection.

Tendon. A sinew, a cord of fibrous
white muscle.

Tenesmus. Constant futile strain-
ing to evacuate the bowels.

Tenia. The tape-worm. When a
cathartic has been given with the ob-
ject of expelling this worm, it is the
duty of the nurse to sift the evacuation
through fine muslin, and see that the
head of the worm comes away. If
merely the long flat joints of the worm
are expelled, the worm will grow
again.

Tenotomy. Cutting a tendon
under the skin by means of a small
knife especially devised for the pur-
pose. As a rule no anesthetic is uised.

GLOSSARY.

427

Temlon. Stretching.

Tmuot. a muscle which stretches.

Ttlli. A prepared roll of lint or
cylinder for keeping open a passage.

Terobanft. A preparation of oil
of turpentine. From 5 to 10 drops
on a lump of sugar acts as an ex-
pectorant. A teaspoonfiil to a pint
of water for an inhalation.

TermlnAli. The extremities of a
conductor of a battery.

Tertian. An intermittent fever
with attacks every third day.

TeitiolM. The two glands of the
scrotum, which secrete the semen.

Tatrttng. Finding the constituents
of the urine by means of chemicals.
The common tests include acid or
alkali reaction, deposits of urates,
phosphates or oxalate of lime ; pus,
blood, chlorids, bile-pigment, albu-
min and sugar.

Tatamui. Lock-jaw. Severe
spasms occur at intervals, during
which try to prevent the patient
biting the tongue, or in any way in-
juring himself. Perfect quiet and
darkness, as the least irritation re-
news the spasms. Death may occur
about the third or fifth day. Food
and medicine can seldom l>c taken
by the mouth in cases of tetanus.

Tlierapeatlca. That branch of
medicine which treats of the appli-
cation of remedies and all forms of
cure.

TbAnnoiIietar. An instrument
used to measure the degree of heat.
There are several ihermometric scales,
the one in popular use in America
being that of Fahrenheit. The ac-
companying diagram presents to the
eye the difference between the mark-
ings of the centijirrade and the Fah-
renheit scales. Clinical thermometer
is a slender glass instrument used to
discover the temperature of the body.
(See Temperature.) (See Fig. 7, p.

43.)

ThoracenteBlS. Puncture of the

thorax, as the tapping for pleurisy.

Thoracic. Pertaining to the chest
or thorax.

Thorax. The chest ; the cavity
which holds the heart and lungs.

Thread-worm. Small parasitic
worm in the rectum ; rommon only

in children. Injections of salt water
or quassia may be ordered. Oxyuris
vermicularis.

Thrombosis. The consequent
evils attending the presence of a
thrombus, or coagulation of the blood,
which, forming into a clot, obstructs
some blood-vessel.

Thrush. (See Aphtha. )

Thymol. An antiseptic, used as a
solution or spray, also as an ointment.

Thymns. A gland at the root of
the neck.

Thyroid. I'he name of the largest
cartilage of the larynx, and of a gland
in the front of the neck.

Centigrade. Fahrenheit.
Boiling-point )

of water, j

too"

go —
80 —
70 —
60 —

SO —

40 —

JO —

20 -
10 -

Freezing-point \ c
of water. /

- 10

- 20

"212^

—ig4
— 176

-'58
-140

'122
— 104

—Ac?
—JO

?2'

^-/

t — 4

Comparative thcrm(>n)cli ic >c.«lc.

Tibia. The shin-bone ; the larger
bone of the lower leg.
Tibial. Pertaining to the tibia;

nbro

etc., of Ihc body. Elastit Hssat. the
yellow fibrous tissue of the elnslic
ligamenls and membranes.

TolarulM. Capacily to lake n

Toncne-tte. immobility of ili<
longue from a short frenum, ll ' '

TontO. A medicine whi
up the general heallh chiefly by in-
creasmg the apptlite.

Ton^IUUi. Quinsy. InflammB-
(ion of tonsils. Generally caused by
cold or weakness. DiflicuUy in swal-
lowing, hence give bread and milli and
soR food. Swelling oflen disappears
suddenly an fourth day, but il may
go on lo suppumlion.

ToiuUl. Two oval bodies one on
cither side of the ihroal al the open-
ing of the pharynx. When these
glands are removed, rest frnm talking
and eating, and ice lo - ' " •■ -

Torpor, lethargy and *
feeling.

Tonlan. Twisting an ai
arrest bleeding.

the least touch about Ihc bend in
these coses will cause painful spasms.
so Ibe nurse must be careful. Rest
and coutiler^rritation arc usually
tried, or, in obstinate eases, an opera-
tion is performed, and the eoniracled
nerve is stretched.

;. An inslrumcnl used

nine-day iits, a mrc InfantitRH
verv fatal. (See Trhmuf.) -J^
perTorallng ins —
mem uwd to draw off fluids fi
the body,

Trochantar. Twopi _

Juncture of the neck and ihaft of
femur.

TnTpmtliu. Uicd in washing the
ikin, l[ II u neccMary. lo remove all
Krease. Also used to sprinkle on a

isrequlred; it muilnotbeleft on the
patient (oo long. Styptic and anli-
Relievcs flntulence and ei-

Ihs may be ordered. The (ever

ly last three weelts, itnd uomplica-

often (olluw. so the symptums

be watched for and repotted.

Typhoid is infectious through llie

keepatolulion of carbulic acid
in the bed-pan, and tu weil flush tbe
drains and put dawn a liberal supply a
of disinfeclanl. All the palienl^ I
body-linen and bed-cinlhiag must b^ |
soaltcd in carbolic acid or boilinf
water before being sent to the wash-

Tjphiu Fercr- A highly inlec-

Cold bath or sponging
may oe oroered; tcmperalurc every
four hours. Rash comes out on
seventh day. crisis about twellUi day.
Toward the crisii, hean-bilure is pas'
siblc. and slimulanls should be at
hand. Keep the r
laled ; liquid diet, and directly the

pels

Give

tail I

sugar, large dose suspended in yolk
of egg. (Ser nrfie,tt-)

Tnaita. .'\ tough.

Twltcblng. Irregular spasmodic

TympMUtes. Wind-dropsy; a dis-
tended slate of the abdomen caused
by gns in (he intestines or peritoneal

m. Cavity of the middle
ear, eimim.inlv called the ■■ dnim."

Typliold P«Tar. A conilnueil
fever. usu.iDy ,ii1ended with ulcera-

erupLion on the abdomen appearing
on the seventh day. The patient is
kept flat in bed and not allowed to
move; liquid diet every two hotirs,
day and night (any solid food miiy
cause perfbrBlion of the bowels nnil

■nd ntoming. or (or the first ten days
every four hours. Take precauli(
at>fnsl bed-sores. If ordered
sponec the pntienl. put n little tol
TintgaT into the water ; cold pack

APPENDIX.

nmUUciU, The

naootualoiu. The si

nu appreciahle scdimenl. Hic fol-
lowing may be prescnr in unnc and

ITrliunaMar. A tmoli glut insiru-

leni with agradUHlecl slcm, uted (or
lensuring the spcciftc gravity ol

nnipuoiu. Bearing i

Ure». Thtdiief solid c

: two dmchms of u
evaporation to
drachm, add equal parts of tiilHc i

nitrate of urea will crysialliie oul In

abundance. |

ITruilft. [^sencc of utta in the

l)lond ; a sjimplora of Bright's disesuc i

or other disease of the kidneys. Cup- long

ping or poulticing over the kidneys the i

self-

ease with eruptions causing great ir
rilalion, generally the result of eating
some unwholesome (iMd. AvHilhtug
lotion (lime-water and line), dabtwd
on with a sponge, or a liut bath if
very severe will relieve Ihc imtaiioB.
Qterlne. Relating lo the utenu.
Utera-gSrtAtlML The period of
rcgnancy,

Uteraj. The womb:a Heshybody
I the pelvic cavity about 3 inches
ing, and shaped like a pear; here
n grows during the iicrimi uf
cy and the womb enlargies to
All operations Involiing Ihe
-c serious, and musilHsnurKd
gy necologic rules, espeviallir
ith regaid to the use of antiseptics.
OtoIil a small fleshy body hang-
g down at the back of the solV pal-
c. When loo long it ofien irriuies
The canal between Ihe (he throat and has 10 haveapieeecut
ind Ihe bladder, down which off. 'Hiis is a simple operation in-

nramle Fit, Bears some resem- ole
blancc 10 an epileptic seimre. but by
there is no llciingof the thumbs, and
the bn^lh has an odor of chloroform.
Hi Ihe patient from injuring him-

volving n<

... „ . . .. ^^..ing that Ihe patientsuckiceafter-

Ls the ethyl sail of car- ward, and take only Buid food for a

Onthrft. The canal through which

ITrMliTltli. Inflammation of Ihc

urethra.

tme Add. Llthic

Tmcinittliwi. I

enee in wine is discovered 'by its re-

lion from small-pot. tnhnls shodfl

semblance in color to Cayenne pep-

he vaccinated before they atv thiw

per. Liquor polassa; dissolves this

monlhi old, unless they KaTe a skin

red deposit.

eruption orare in bad health.

ITrtlW. The fluid secretei! by the

V««lll*. Thepassagclcadingfrom

kidneys. The normal amount se>

Ihe vulva <o the uterus.

ereled In the 14 hours varies from jo

TlJerUn. A nerve-sedative Ihut

to so ounces in an adult, 10 to 15 in

incre.ues Ihe heart's action, and is

a child, 8 to 10 in an inbnl. The

nlii'ii pruscribed in nervous and

normal color is pale amber and clear,

hvsi.-rical complaints.

the specific gravity is from 1.018 lo

Talgui, Bow-legged, ■

1.0=5. Thereactlonshouldbeslightly

Tapor. An inhalation. M

acid, save after meals, when it is

TurlcelU, Chicken-pox. fl

GLOSSAJty.

tious fever marked by an eruplionol
red pimples on Ihe third day. which,
about Ihc Eighth day. begin lo dry up,
Ihc scab subsequently blling ofT. In
ctiuJfit£Ht small-pox the erupllon all
runs together, there is a high slnic of
fever. Btid great danger: especially
about Ihe third snd ninth days. Use
rags and artificial spongct for wash-
ing ihe patient, and bum Ihetn inime-
duitely -. ir possible, also use old body-
linen nnd bum il. All the bedding,

thoroughly diHufccied. (Sec Fumi-
galum,) t'arieMd. mild small-pox.
Watch for ulceration of the muulli or
nose, inflammation of the eyes, and
symptoms of chest disease. The in-
fection may last two monlhs.

Tftra*. Knock-knee.

T)w. A vessel, or duct of the

Tueular Byatam. The system of

bloori- vessels.

TtaeUa. A bland alniment pre-
pdri-'il from petroleum, ami useful for
dressings, greasing suppositories, etc.

TlUO-mirter. lousing motion in
Ihe vi-iM-ls; applied to the sympa-

TMn. A vessel carrying the blood

from Ihe extremities lo the heutl.

ion -pulsating vea&cli

nurse's duty lo see ihai her ward
or sick-room is properly ventilated.
There are very few diseases In which
it is not permissible lo have Ihe win-
dow open for an inch al the lop,
taking care thai the draft does not
blow straight across the bed. Always
have a small die, excepl in very hot

Ventnl. Relating to the belly.

VaBtrlelu. The iwo lower cliam-

beis of the henn are known as the

TwinlelAa. A drug used
lorms. Also called vtrmi/

VarmUbmi AppMidlx.

US, two large v

f the

swollen

ofthe veins due 10 lack ofaelion uf the
valves. Common in Ihe veins of the
leg. An elastic slocking and resl on
a sob may do good. The '

Of Ihe veins bursting, in which
pressure must be applied over
blecding-poinl.and; ' " "■" —

Vertebra. Ihe small substantial
lones which form the back-bune, at
ertebral column. There are 34
■erlebr^e: 7 cfrwea/ (neck) ; la JbT-
ol (back) ; 5 luaitar (loin).

Vertex. The crown of the head,

Tarttgo. Giddiness, Any move-
ment or sense of movement, either
in the individual himself or in cx-
lemal objects, that involves n real
or seeming defect in the equlllhrum
of the body and is associaled wilh
more 01 leu disluitiance of con-
sciousness. This condition may be
due to pathologic conditions of the
ears, the eyes, the brain, the stomach,
the blood, etc,

TMdM, The bladder.

Teeleal. Relating to the bladder.

Teilouit. A blistering fluid.

VMlele. A blister.

TUHll, Canals by which fluid
is cunveve<l from one part of the body
to another.

e extremity.

Vertrtnle. A small cavity of the

VmwmoUoii. Bleeding: opening

ear: also the angle between the

vein I.J lei out blood, Provide a

nymphi.

easiintiK-glass, into which to receive

Tlouloiu. When one orgon per-

p hliL.tl, :in<l a compress and roller-

forms the work of another, For in-

inil,!);'- tor Ihe dressing.

stance, when bleeding of the nose

VenoiU, Relating to Ihe veins.

TentlUtlon. It is pan of the

alien.

AFFENDIX.

Tlidd. SHcky and (hick.
VltTBOiii HnmoT. The glass-like

fluid in iIiF eyeball, behind the leni.

VlTliaotlon. Scientific intertial
ex;initn.i1iofi of a living animal.

VolMtUs. Thai which evaporates

ickly.

Tnln. 1

gi-neration c

TnlTlUi.

: ihe sloinacb through

e exlemol organi of
a female.
Inflammation of Ihe

Wft(«r-bMU. ( See p. 33. )

WftUr-teUh. Heartburn, wllh
How of bitli-T wnier to Ihe moulh
c.iusc.l by IndiEcsIioll.

Watt. Llnii of electrical energy.

V6Uilas. Tlie termination of
MickliTiK.

WbMton'a JellT. The gelatin-
like connective tissue of the umbili-
cal cord,

WUlkT' '^n alcoholic liquid dia-
lilled from fermented grain 1 a siimu>

fxiultice till It cuincs lo a head, and

Wtooplng-OOtlgb. (See/Vrtdijii-l

Vln*. rhe alcoholic fermented

(uice of Ihe grape. Psrl wine, a

iiKivy wine from Oporto. Portugal.

Shtny, a brownish colored "" "

cnmcs from Spain 1 Ihe so-called
" sherry " wines seldom contain any

VoUBui BodlM. Two gUnd) In
[he small of Ihe back.

Womb. The uterus.

Wood-wooL Ad absorbent wool
used for dnssinga.

Voiuda. A heolihy wound, nni
uniting by hrtl intention, should fill
up from Ihebollum, Ihcedscsshould
not be red or unequal. An absce&s
wound should pucker and Ihe centre
sink (see p. 1S8].

Tsllow Fam. .\n epidemic fever

black vomit, etc. The (tver is in-
feclious, but the nurse is no more
liable to catch il than othen nol in
attendance on the lick. The fim
feelings are of languor and dyspep-
followcd by twenly-fbur hours

h fever

r thes.

■renty-

four houn, the fever decline
ore hcqxs of recovery. I>eath may
result from violent convulsion or
from exhaustion. A mustard plaster
lo Ihe stomach, or hot moslard bath,
allays Ihe sickness and convulsioos.
Beef-lea dccteases the exhauslton.
Mild purgatives arc good, and any
treatment which produces perspira-
tion. The recovery is slow, and food
must be given in very miiitl quitnti-
ties, and be very l^hl. Deofness and
blindness may residt.

INDEX.

Abbreviations, 344
Abdomen, the, 305, 369

condition of the, symptomatic, 50
pregnant, rate of enlargement, 116
Abscess, 192, 369

Abscesses, cause of, following hypo-
dermatic injections, 78
Absorption of medicines, rapidity of,

70
Accidents and emergencies, 172-212
Acetic acid, antidotes, 209
Acetophenone,- 359
Acids, administering, method of, 75
Aconite, antidotes, 211
Action of medicines, 7 1
Affusion, 88

After-birth, management of the, 128
After-pains, 131
Air, composition of, 289
night, purity of, 38
of the sick-room, 37
Air-bed, 33

Albumin, nitric-acid test for, 295
Alcohol, phenylic, 346
Alimentary canal, 290
Ammonia, antidotes, 210
use of, in fainting, 201
Ammonium, antidotes, 210
Amniotic fluid, 118
Amputation-stump, hemorrhage from,

treatment, 194
Amputations, after-treatment in, 163
Anatomy, descriptive, 296-309
— bones of the body, 296
— brain, cord, nerves, and

organs of sense, 301
— ^female organs of genera-
tion, 308
— heart, blood-vessels, lym-
phatics, 300

Anatomy : — muscles of the body, 299
— respiratory, digestive, and

urinary oi^ans, 305
— skin, 296
Anesthesia, surgical, 152
chloroform, 155
ether, 152
Angina pectoris, treatment, 244
Animals, rabid, bites of, 212
Antidote defined, 208
Antidotes. (See Poisons.)
Antisepsis and asepsis, 167
Antiseptic douche, surgical, 65
(See Douches.)
})oulticcs, 100
Antiseptics 168-171, 341

— absolute alcohol, 171
— boric acid, 169
— carbolic acid, 168
— Condy*s fluid, 170
— corrosive sublimate, 168
— creolin, 169
— iodoform, 170
— lysol, 169

— permanganate of potash, 1 69
— peroxid of hydrogen, 170
Aorta, the, 285, 288, 300
Apoplexy, cerebral, 251

consciousness of patient in, 253
diagnosis of, differential, 253
symptoms, 252
treatment, 252
nursing, 253
Appendicitis, 246-248
catarrhal, 247

[X'rforation in, symptoms, 247
causes of, 246
symi)toms, 247
treatment, 247

duties of the nurse in, 248

433

A[^Ddichis,

Appendix viamiforniLi, Z46, 307, 372
Aqua fortis, 346, 37a
Arachnoid, 302
Arm-rraeture, itcalmeni, 17s
Arsenic, antidoies, ? in '■"
Arteries, Ibe, 300

— *orta, 300

— axillaiy, ;

— bracliial, _

— carotid, 31

— femotal, :

— iliac, intei.

— peroneal, 3—

— popliteal, 3r"

— pulmoiiaiy,

— radial, 301

— Eutictaviui, 300

— tibial, 301

-ulnar, 301
function cf I he. 2K5
Articulations ot bones, 297, 373
or the extremities, 298, Z99
AseiKis, 168
Aspliyxia, from drowning, treatment,

zoi. {See XfspiratiiiH.)
Asthma. Z43

position of patient in, 46
Astragalus, the, Z99
Atropin, antidotes, 211, 373
Auditory canal, 304
" Aura epileplica," 155, 374
Auricle (ear), 304
Auricles (heact), 2S7
Axilla.', the, 299

Bauv, sick, cariying of the, 59.

nack-l>one, 29S

Itacteria, 213

Itag, nurse's, ec]ui|>ment of, 15

Bandages, 178-1

1.374

— Desault, i
— diviileil, 181
-figtire-of 8, 181
— four-lailed, 181
—handkerchief, 183
-many-tailed, 181
-roller-, 178. 179

Bandies; — rubber, 178
— Seullelus, 182

— T- handle, iSz

breast, 132

mateiinls of ;

— clialk and gum, 185
— pla-sier of IVis, 184
— silicite of soda, 1S5
— starch, 185

ndaging, i[npr<i]>er, gangrene fnxn,
179

rley-watin- enema. 63

if infants, 264 J

yt the new-born, 263 I

urgieal, 149, 150 I

Lh-thermometer, Si I

bai )

—foot-bath, 55

—hot foot-baths, 84

—hot -ail- iKilh, 84

— =h(,vier bail,, 86

— sponge- bath , . j s

—tub-bath, ss, 83

of acid steam-hath, 86

of cold baths, 83

of foot-bath, hot, 8z

of hot baths, 83

of hot-air baths, 86

of sheet-bath, 87

of sil7-bath, 82

of tepid lialhs, 82

of vapor-baths, 81, 83

of warm bath, 8i
in treatment of scarlet fe*er, 223
leraperalurc of, 81
tepid, in typhoid cases, 319
time for giving the, 81
Bed, fracture, 174
gynecologic, M't M*
obstetric, preparation <rf, 32, I3l

"temporary," 32
of the rheumatic patient, 358
preparation of, in case of bums or

scalds, 199
sick, changing the clothing of, 30

preparation, 29. (See Btd-mak-

INDEX.

435

Bed-clothing, changing the, jo
Bed-cradle, 54
Bed-cushion, 35
Bcd-makiDg, 30-33

—cross-bed, 33
— divided bed, 33
— medical bed, 32
— obstetric bed, 32, 121
— suigical bed, 32
for different cases, 32
for gynecologic examinations, 33
precautions in use of coverings,

29,32
Bed-pads and rings, 35

Bed-pan, how to insert and remove

the, 56

Bed-patients, appliances for the

relief of, 34

— bed-cradle, 34

— bed-rest, 34

— bed-screen, 34

— cushions, 35

—pads, 35

—rings, 35

changing the bed-clothing of,

30-32
preparation of beds for, 29, 32,

Bed-position of patient, sym|)toms

indicated by, 46
Bed-rest, 34

Bed-screen, improvised, 34
Bed-sores, cause and prevention of,

54, 375
of typhoid patients, prevention of,

221

treatment of, 54
water-beds in relief of, 33
Beef, preparations of, fur invalids,

3»9, 320
Beef-teas and extracts, 319-321

Belladonna, antidotes, 211

Beverages, invalid, 332-337

permitted the sick, 314
Bichlorid of mercury, 353, 362
Bile, 292, 306

digestive action of, 292
Binder, obstetric, adjusting the, 128,
129

umbilical, of the new-born, 263
Biith, normal, management after, 127
management during, 126

Bites, insect or mosquito, treatment,
205

of rabid animals, 212
Black draught, 365
Bladder, the, 308

emptying the, 5i» 69.

(See Catheterization.')

washing out the, 69
Bland enemata, 63
Bleeding, artificial, 92-94.

from the lungs, 196

from the stomach, 196

(See Hemorrhages,)
Blister, cantharidal, 108, 375

•* i)erj^tual," 108, 376
Blistering, therapeutic action, 105

time to apply the irritant, 108
Blisters, igm6^io8

dressing of, 108
Blood:

— arterial, 193, 287
— capillary, 193
— venous, 193, 287

com)X)6ition of, 90, 91
Blood-changes, 287, 288
Blood-circulation, mechanism and
course, 287

physiology of, 285
Blood-letting, 92-94
Blood-poisoning, 165, 189, 376

from diphtheritic discharges, 230
Blood-supply, fetal, 118
Blood-vessels, the, 300
Blue mass, 362

pill, 362

vitriol (bluestone), 353
Body-linen, changing, 52, 53
Body-temj)craturc, 41

conditions influencing, 41

fatal indications, 42

in disease. (See Temperature.)

influence of, on the pulse-rate,42,43

normal, 41

of infants, 42

subnormal, 42

sudden rise or fall, significance of,

42,44
taking of the, 43

caution in, 43

variations in, 41

varieties of, 42

Boil, 192

436

INDEX,

Boil, " blind," 192
Bone-repair, 173

Bones, broken. (See Fractures,")
of the body, number, 296
of the extremities, 298
of the skull, 297
of the trunk, 297
Borax, 366

Bowel, obstruction of, of infancy,

symptoms and treatment,

271

protrusion of, of infancy, 275

Bowel-movements. (See Movements.)

Bowels of the patient, symptomatic

condition of, 50
Brain, the, 301
compression of, symptoms, 204

treatment, 204
concussion of, symptoms, 204

treatment, 204
nerves of the, 301
Brain-disease, the sick-room in, 29
Breast-bandage, 132
Breast-bone. (See Sternum.)
Breast massage, 13 1
Breasts, puerperal, care of, 131
Breath of the patient, odor of, 48
Breathing, abdominal, 44
normal, 44

of the patient, character of, 48
stertorous, indications of, 48
thoracic, 44
(See Respiration.)
Brimstone, 367
Broail ligaments, 309
Bronchii, the, 305
Bronchitis, symptoms, 242

treatment, 242
Broths, 321, 323
Bruises and cuts, treatment, 204
Burns, acid, treatment, 206
of the eye, treatment, 207
alkali, treatment, 206

of the eye, treatment, 207
death from, causes, 198
degrees of, 197

— first degree, result, 197
— second degree, result, 198
— third degree, result, 198
Burns and scalds, 197-200
complications of, 199
treatment of, 199, 377

"Callus," 173
Calomel, 362, 377
Cantharidism, 106
Cantharis, therapeutic action of, 107
Capillaries, the, 285, 288, 300
Capsules, medicine, 75
Carbolic acid, antidotes, 209
Carbonic-acid gas, 289, 290

poisoning, antidotes, 209
Carbuncle, 192, 378
Cardiac dilatation, 291
Cases, emergency, duties of the nurse
in, 151

medical, nursing in, 39-1 1 5
Castor-oil enema, 61
Catheter, selection of, 68
Catheterization of patient, 51, 68
following abdominal operation,
164

in the puerperium, 129

operation, the, 69

precautions in, 68
"Caul," the, 127
Caustic lime, antidotes, 210
Cecum, the, 307, 379
Cerate, cantharidal, 107
Cerebellum, the, 301
Cerebrum, the, 301
Cervix, the, 308
Cesarean section, 136, 380
Charts, sick-room, 28
Chest. (See Thorax.)
Cheyne-Stokes respiration, 45, 380
Chilblains, cause and treatment, 207
Childbirth. (See Labor.)
Children, diseases of, 270-281

etherization of, 155

management of, nurse's, 281

sick, moving, 59
nursing of, 262-283
Chills of the patient, reporting of, 49
stages of, 49
treatment, 49
Chittem bark (sacred bark), 357
Chloral, antidotes, 21 1
Chloroform, administration of, 155

anesthesia, death from, 156

symptoms to be watched for,

155. '56
blister, 108
Cholera infantum, treatment, 272
morbus, symptoms, 249

INDEX.

427

Cholera morbus, treatment, 249
Chorea, 279, 381

complications of, 2S0

treatment, 280
Chyle, 292
Chyme, 292
Circulation, portal, 288

pulmonary, 288

systemic, 289. (See Aritrirs^ and
Blood'Hrculation . )
Gavicle, the, 298
Cleanliness, antiseptic, 122, 247
Clothing, bed, changing of the, 30,

body-, changing the, 52

catching fire, what to do, 203

of the new-bom, 263
Coagulation, blood-, 90
Coal-tar camphor, 362
Coated tongue in fevers, 46, 47
Coccyx, the, 298
Cochlea (ear), 305
Cold, application of, loi

both, action of, 82

exposure to, death from, 207

pack, action of, 88
Cold-water treatment of sunstroke,

200
Colic, infant, 270
Collapse, 161
Collar-bone, 298

fracture, treatment, 175
Collodion, cantharidal, 107
Colon, the, 307
** Colostrum," 131
Coma vigil, 215
Compress, breast, 132
Compression, brain, symptoms, 204
Conception, time of occurrence, 1 16

(See Pregnancy.^
Concussion, brain, symptoms, 204
Confinement, date of, how to esti-
mate, 116
table for computing the, 343

nurse's preparations for the, 1 20
Constipation of pregnancy, 119
Consumption. (See Phthisis.)
Contagion, spread of, prevention, 214
Convalescence, dietary in, 315

of scarlet-fever patient, 225

of typhoid patient, management,
221

Convalescence, wrap for patient

during, 36
Convulsions in cerebral apoplexy,
252
of infancy, 273

treatment, 274
of pregnancy, 119
of whooping-cough, treatment, 239
puerperal, 135
uremic, 224, 250
treatment, 224
Cord, navel. (See Cordj umbilical.)
spinal, the, 300

composition of, 302
nerves of the, 302, 303
umbilical, 118, 263
complicating la)x)r, 126
dressing the, 263
tying the, 127, 128
preparing the string for, 122
Corrosive sublimate, 362

antidotes for, 210
Cough of patient, nature of, 47
Counter-extension, 187
Counter-irritants, 104-108
Counter-irritation, 104
Coxalgia, 280

Cradle, l>ed-, improvised, 34
Cream of tartar, 364
Crisis, 44
Cross- bed, 33

Croton oil (counter-irritant), 106
Croup, membranous, 238
nursing-treatment, 238
symptoms of, 238
simple, 237

nursing-treatment, 237
symptoms, 237
Cry, infant's, signification of, 277
Cupping, dry, 93

wet, 94
Cutis (derma), 296
Cuts and bruises, treatment, 204
Cyanid of (x>ta.ssiuni, antidote, 209
Cyanosis, 198
cause of, 47
Cystitis, 51, 69

Dead, caring for the, 261
Death from burns, 197, 198
from chloroform anesthesia, symp-
toms, 156

438 INDEX.

Death from conlagimisdisessca, prep- | Did in ty|di(nd fevET, 217, 318

atiunoflheb(Kl;ifler,l35 |
Irom elher, i[n]iending, sjrmploins I
of, iS3. 154 I

Ironi expusure \a cold, 307
ftoii sepsis, res]»n«bilily (or, 166 I Digestioi

n whooping-cougb, 339

DeHr

ir scarlet fe

i."7

of lj'jil«'iil fever, 3

of t}it pnlicnt, chai
Deodciiant dclincH, 11
Desseris, redpes for,
0ial>etes, 258

insipidiu, 2jS

melSiius, zjS

lilsl symptoms oE

tteainicnl of. 158
Diaphragm, 30a
Diarrhea, acute, trealmenl, 250

of pregnancy, II9
DiEl after gynecologic opemtion, 143
before a surgical operation, 149,

ISO
during the puerperium. 130
followliif; appendiL'itis, 248
following ]ieril<HiitiH, 146
followinc surgical operalion, l6j

in convalescence, effect of change

of lyphoid patient, ill

selection of, 31;
in croupous ]int'um<inia, 241
in deiicicnl milk -secretion, 132
in dialietes, Z58
in diarrhea, 250
in diphtheria, 230, 231
in dysentery, 249
in epUepsy, 256
in gastnlis, 245

.257

V)%

— alimentary canal. 390

— deglutition, 291

-^nleslinnl Htgalii

— mattication, 291

— stomach digestion, V)t
jans of. 390, 30s
<a!af.. aniidnles, 2tl
ilhetio. 239-331
tiloiin ireiitmcnt oT. 330
migalion after, 238
:ubstiun in, 233
urishmenland ~

nr eyes, so

iiMcheotomy in. 231
Dischai^ from nose, e
Diseases, cont^pous, defined. ;
fumigation alter, 234
spread of, media for the. 214
prevention of, 214
functional and idiopalhic. 239-362
infectious, cause of, 213

defined. 213
"miasmatic," 214
of childhood. 279-283
— chorea, 279
' — incontinence, Z79
— meningitis. 278
— mumps, 379
—typhoid fcTer, 378
of children, surgical, 3&i>-383
of infancy, 270-277

— bowel obstmdion, 371

— cholera infanluro, 272

—colic, 270

— convulsions, 373

— diarrhea, 273

—from teething, 274

— o{^thalmia neonatonini,

275
— paralysis, 376
— protrusion of the hooel, 375

—snuffled. 376

— tongue- lie, 376

INDEX.

439

Diseases of infancy : — ^▼omiting, 272
— ^worms, 274
of the skin, 259-261
Disinfectant defined, 167
Disinfection, corrosive-sublimate, 235
following diphtheria, 231
following measles, 229
following small-pox, 228
heat, 171

in scarlet-fever cases, 223
in typhoid fever, 216, 217
in typhus fever, 226
of excreta of consumptives, 236

of typhoid fever, 216
surgical, and materials, 167
Dislocation, compound, treatment,
176
of jaw, treatment, 176
Dislocations, 176
Disorders of pregnancy, 1 19
Disturbances, functional, relief of,
59-70
— catheterization, 68
— douches, 65
— enemata, 59
— rectal feed in jj, 64
— washing out the bladder,

— washing out the stomach.

Dose list, 346
Douche, cold, 88
ear, 113

head, method of giving, 87
vaginal, easy way to give, 67
insertion of tube in, 66
position of (>atient for, 66
time for giving, 67
Douches, 65-68

— antiseptic, 67
— rectal, 67
— vaginal, 65
genital or perineal, 68
Drainage after surgical operations,
164, 165
gauze, 165
tube, 164
Drainage-tube after operation, atten-
tion rec{uired, 164
Dress of nurse and personal habits,

in contagious diseases, 236

Dress of patient for surgical opera-
tion, 150
Dressing of bums or scalds, 199
Dressings, surgical, 176-188
—-dry dressing, 1 77
— tents, 177

— water-dressing, 176, 177
management of, 177
removal of, in bums and scalds,
199
Drip-sheet (sheet-bath), 87
Drops, administering, 74

and minims, 341
Dropsy, 257
complicating scarlet fever, 224
of glottis from scalds, 198
Drowning, 201
Drug-habit, 71, 72
Drugs, absorption of, rapidity of, 70
action of, 71

" cuipulalive," 7 1
Drum membrane of ear, 304
Duct, lachrymal, 112
Duodenum, the, 307
Dura mater, 302
Dysentery, symptoms, 248

treatment, 249
Dysmenorrhea, 205
Dyspnea of bronchitis, relief of, 242

Ear. the, 303-305

— the auricle, 304
— internal, 305
— middle, 305
middle, inflammation of, causes

and treatment, 224
obstruction in the, removal of, 204
syri nixing of the, 1 13
Ear-bath, 114
Ear-douche, 113

Ears, foreign bodies in, caution in
treating, II 5
liciuids in the, inserting, danger of,

114. 115
Eclampsia, 135

Eczema, 259

Edema of glottis from scalds, 198

Eijgs, recipes for cooking, 325, 326

EmlK>lisni, 136

Emergencies, common, I93-212

duties of the nurse in, 151, 212

Emetics in ix)isoning, 209

Enilothelium, 196

Enema, adniinislialion of. Id an ud-

coDicious patient, 57

mMhod of giving an, 10 an in^t.

Tdeulion o(, how Ui
Encmila, 59-63

— EU-lrfugent, 63
—bland, 63

— high, 61
^piirgalive. 6i
— stimulating, 63
in surgical opeiation. I
method iif Mtmintsleri
Uimulaling, in scpiicci
Epidccmis, m6
Epilepsy, 254
(he attack, periods of. 255
irealmew of, 255
Epi-4ntis, 197
Epithelium, 196
Epsom sail, 362

enema of, 62

Ergot after labor. 128

antidotes for, zio

in hemorrhage of pregnancy, I

of puerperium, 134

Eniiition of measles, 12S

uuption of

of SI

fever,

J followi

jirepanilions tor, ijz
[ales for, 153

symptoDu lo be observed liy ihe
ouiw in, IS4
~nni:, improvised, 152
talion, 152-155
tie, hospital, I J

un, gynecologic, positions

>mall-i>ox, 226. 277
of typhoiil fever, 2l6
of lyphus fever, 225
Erysiiwlos, 189
Esciin sal icy laic, 363

sulphale, 364
Esophagus, the, 290
Ether ailministralion, method of,
■53
10 children, 155
anesthesia, caution in, 153
danRerous signs in, 153, 154
dcnih froni, im|iciulinp, symi>-

toms 153. 154
daring labor.

" hau'^ti.iii frum heal, 200

|>ec[ora[inn of patient, character
of. 47
Enpeclorations in croupous pneumo-
nia, disposition of, 241
consumptives, disposition of,
236

Expiration, 2S9

Expression, facial, in hemorrhage,
135- "61. 194. "9
in penlonitis, 245
in septicemia, 166
in shock, 160
in sickness, 47
Eijmlsion, mechanism of, 124
regulating the, iz6

Eye, acid or alkali bums of, treat-

t, 207
foreign biJily in the, removal of.

setting a arop 1

1 Ihe, method of,

154. "55

ointment, method of, 1 13
syringing the, 1I3
Eye-drops, application of. III
Eyes, the, 303

inflammation of. of infancy, 275
syringing the, of infants, melhad
of. 275

INDEX.

441

Face, expression of, in hemorrhage,
135. 161, 194, 219
in peritonitis, 245
in septicemia, 166
in shock, 160
in sickness, 47
Fainting, treatment, 201
Faintness following discharge of the

amniotic fluid, 124
Fallopian tubes, the, 309
Fascia, 300

Feces. (See Movements,)
Feeding, artifidal, of the new-bom,
265
feeble patients, 56
infant, rules for, 267
rectal, 64

of an unconscious patient, 57
the sick, 56
general rules, 31 1-3 17
Femur, the, 297, 299
Fetus, movements of, 118

nourishment of the, 117, 1 18
Fever, enteric, 215
intermittent, 214
low, 215
malarial, 214
nervous, 215
scarlet. (See Scarlet.)
slow, 215

typhoid. (See Typhoid.)
typhus. (See Typhus.)
Fevers, coated tongue in, 46, 47
Fibrin, blood, 90
Fibula, the, 299
Finger-nails of patient, condition of,

50
Fire, accidents from, 203

sick-room, management of, 36
Fistula, 192

Fits, epileptic. (See Epilepsy.)
Flatulence, treatment of, 206
Flaxseed enema, 63

poultice in removing a slough,

preparation of, 95, 96

Fomentation, the, action of, 91
Fomentations, 94, 95

— hot-water, 94

— laudanum, 95

— mustard, 95

— turpentine, 95

Fontanel, anterior, closing of the,

268
Food, administration of, before sur-
gical operation, 150
artificial, for the new-bom, 265

Meigs', 267
infant, 326

record of, taken by patient, 46
serving the, proper method of, 56,

Food-changes in the stomach, 292

Foods, invalid, recipes for, 317-332
— ^beef-teas and extracts, 319
— broths, 321
— desserts, 329
— farinaceous, 317
— miscellaneous, 325
— oysters, 322
— prepared milk, 327
—puddings, 323
— soups, 324
— toasts, 328
Foot-bath, 55
hot, 84

action of, 82
Forearm, the, 299
Foreign bodies, obstruction due to,

204
Fracture, moving of the patient in, 31

signs of a, 173
Fractures, 1 72-175

management of, 53, 173

nurse's preparations for the surgeon

in, 174
removal of patient's clothing in,

53» »73, 174
splints in, application of, 186

varieties of, 172
Friar's balsam, 349
Frost-bite, cause and treatment of,
207
complicati<ms of, possible, 207
Fumigation after contagious diseases,
234-236
moist, 235

preparation of sick-room for, 236
sulphur- fume, 234

apparatus for burning the sul-
phur, 234
Functional disturl>ances. (See Dis-
turbances.)
Furuncle. (See Boil.)

^^ i^^^^^H

^V 443 ^^^1

^m (;AL.-HLAnPF.R, 306

^^m Gangrene, I9r

^H dry or " senile," (gl

^^H

^H symptoms of. 191

cerebral, 251 ^^^H

checking, 1^ llexion. 194 ^^^H

^m inoisi. symptoms. 191

by loumi<)uet, 195 ^^H

^m GBrgln, ito

fainting in, 19J ^^^H

^^H Gax, rectum, passage of, alter npera-

of venous. 195 ^^H

^M liDti. 50, 164

ice. I9S ^^H

^M Gus-accumulalion, rectal, teller of.

■ 246

^m Gaslric juice, 192

frum the nose, Ireatnicnl, 197 ^^^H

^H digestive aclinn of, 29:!

fnim the jslm. checking, ivfr^^^^^l

from the stomach, treatment, ^^^H

^B ireatmenl, 245

orampulation-slump, checkJng^^^H

^^H Genns, di^^eaae, conditions necessary

of typhoid fever. 119 ^^^H

^H media o( leaving The b.idy, jtj

treatment, ix> ^^^H

^^L of phthisis, dissemination of, 2j6
^B Gtaod.lachnrmal, 112

post-panuni, ijj ^^^H

Ireaimcut, t33, 134 ^^^1

^H partnid. function of, 291

puerperal, 133 ^^^H

^H Glauber's salt, 366

^F "Glolius hysttriein,'' 157

symptoms of. 194 ^^^1

^ Glossaiy. 369

in. 196 ^^H

Gloiiis. edema of, from scal.Is. 198

irealmciit, 194 ^^^1

HemoTThages ; ^^^^^|

Golden seal. 359

—primary. 193 ^^^1

Gruels. 318

— recurreat, I9J ^^^H

Gums of the paHent.cmdition of,46

—secondary, 193 ^^^H

Henbane, 359 ^^H

Hair, pnlieni's, dressing of, 53

Herpes losler, 260 ^^^^1

Hand, palm of the, Wcclint- from.

fIiccou,;h, cause and relief, 51 ^^^M

checking. 196

of the palieni, character of, l^^^^l

Hartshorn, 347

Head-accidents. 203

" Hinee-joim," 299 ^^^H

Elead diHiche, S7

Hipjoint disease, iHo ^^^^H
HoflnuLnn's anodyne. 354 ^^^^1

Henlingbyfirs. inlenlion. 188

by second inlention. 188

Hot bath, action of, 83 ^^H

under a blood-ckX, 1S9

Hot-wr bath, 84 ^^^H

Hc«t, the. 300

Humerus, the, 29S .^^^^^1

ils structure nnd valves. *86

Hunger, relief of, by rectal fwJ^^H

neuralt;ia of the. (See Angina.)

Hyeiene of chUdren, 281 ^^^H

Irealmenl, 201

Heal as a disinfectanl. 171

of the vick-rooiD, 29, j6. ago^^^H

dry. application of, tot

— >>r. 37 ^^H

moist, 94

Heal -exhaustion, treatment, 100

Heel-pad. 35

,<ndici>is. 348 ^^^H

Hcmalcmcsis, 196

INDEX.

443

Hypnotics, aetkm of, 73
Hypodermatic tablets, list of, 342
Hysterectomy, after-care in, 165
Hysteria, 256

diagnosis of, from epilepsy, 256

forms of, 256

treatment of, 256

Ice, action of, in inflammatory pro-
cess, 91
in checking hemorrhage, 195
in treatment of sunstroke, 200
serving of, to the sick, method of,

57
Ice-bags, 103

Idiosyncrasy defined, 71

1 1 eo- cecal valve, 307

Ileum, the, 307

" Immunity" defined, 214

Incontinence of urine, 50, 279

in pregnancy, cause of, 119

Incubation of typhoid fever, period

of, 215

fieriod of, defined, 213
Incubator, improvise<l, 269
Indian-meal enema, 63
Indigestion, infant, treatment, 271
Infancy, diseases of, 270-277
Infant, bathing the, 264

cry of the, signification of, 277

crying of the. causes of, 265

defecation of the, 264

development of the, 268

dressing the, 263

feeding of the, artificial, 265
care of the utensils, 266
periods of, 268
rules for, 267

food. (See Fomi.)

new-born, care of, 262

nursing of the, 265

paralysis, 276

pulse of, at birth, 41, 269, 277
how to take, 277

urination of the, 264

weaning, time for, 268
Infants, body-tempemture of, 42

premature, care of, 269

pulse-rate of, 41, 269, 277

respiration of, 45, 277

syringing the eyes of, method of,

275

Infection, diphtheritic, conditions fa-
voring, 231
Inflammation, 90

from frost-bite, treatment, 207

symptoms of, 91

treatment of, 91
Influenza (grippe), 239

complications of, 240

symptoms, 239

treatment, 239
Inhalations of medicines, 80
— dry, 80
— moist, 80
Injection, intravenous, defined, 78

of medicines, hypodermatic, 76

(See Enemata^ and Douches.)
Insanity following hysterectomy,
165

puerperal, 135
Insect bites and stings, 205

in the ear, removal of, 204
Insomnia, treatment, 206
Inspiration, 289
Intestines, the, 291, 307

lengths of, 307.
Intoxication, diagnosis of, from ajx)-

plexy, 253
Intubation in diphtheria, 233
duties of the nurse, 233

in scalds of the glottis, 198
Inunction, mercurial, 78
Inunctions of medicines, 78
Involution, 125, 1 31

method of promoting;, 128
lodin, antidotes, 210

tincture of (counter-irritant), 106
Ipecac, 359
itch, 259
lvy-jK)isoning, treatment, 210

Jacket- POULTICE, preparation of, 97

James' |X)wder, 348

Jaundice, cause of, 306

Jaw dislocation, treatment, 176

fracture, treatment, 175
Jellies, reci|^>es for, 329-332

Kidney, inflammation of. (See

Nephritis.)
Kidneys, the, 308
Kitchen, the, as an operating-room,

145. »5i» 152

Labor, 133-119

duration dl, 136

nomal, binh in, I32, is;
conduct of, 1 26-iia
fint sign of, tz3
sUfiCsf>r, 113-121

preparaliQiLi for, nu

—of ihe be<l. I
—of ihc pnlia

Labor-pains, :j!3, ii^
false or true, diiTcren

Labyrinth (ear), 305

La grippe. ( See Influtnta. )
Laudanum, 363
Lavage, 70

in Kasuilis, 245
Laxatives, adminialenng, 75
Leeches, apphcalion of, 92, 93
Leeching, 93
[^g fracture, Irealtnenl in, 175

Leucorrhea, cause of, 52

Licorice-root, 358

Ligation, 171

Lighlning-stroke, sot

Ijnihs, swelling ot, in pregnant

cause of, llf»
Lime-«iiter, reeii« for, 337

I^kp'w, (See Tilanus.')

Ij^wuoci, 358

I.o[i<>ns, I to

Lugol's solution, 359

Lunch, invalid's, 318

Lung, gangrene of, expectoration i
47

Lungs, ihc, 305
function of the, 287
hemorrhage from the, 196
tuberculosis of. (Sec Phlhisit:

Lux.ilions. (See DUIoi-afiom.)

Lying-in, period at, I3q
Lympbotici, 30a, 301
t-ysis.44

Mad-ix)g, Ute« bf, ireaiiiienl, 3i3
Magnesia, calcined, 36a
Ilusband-s, 361

ge, to8-iio

at, 13'

tihnt paralysis, 376

icurasihenia, 357

nmlysis, 154

heumaiiMn, 2J9

1 rcquirctl in a]i]ilying. 109, no

a|ieulic ellect of, 109

ill proccfi, 305
es, 328

iplications oF, 229
Liiig-lreatmenl. 33S
ajiiiptoms, 128
Meat cure, 320
raw, diet, 310
Meatus uiiiiariDS, 308
Medicine- glasses, care of, 73
Medicines, absorption of, r^dity, 70
action of, 71

— hypnotic, 72

— stimulant, 72
—tonic, 72
tiine required for, 71
administration of, 70--S0
liy inhalation. 80
1, inunetion, 78
l)y the nwulh, 74
hypodermatic, 76
per rectum, 76
precautions in handling, 72
Medicine spoons, care of, 73
Medulla oblongata, 301
Melancholia, |>uerperal, 135
Meningitis, cetetaal, symptoms, 278
Ireatmenl. 279
cerebro-spinal, symptoms, 351
treatment, 251

'. Ss

Mensii

painful, treatment, 305

retarded, relief of, 82
Mercury, inunction of, method of,
78,79

INDEX.

445

Milk, mother's, fiist appearance of,

not to be given before an abdomi-
nal operation, 149, 150
sterilization, 266
sterilized, 335

use of, in typhoid fever, 218
Milk-leg, 135

Milk-secretion, scanty, 132
Mineral waters, 337-339
Molasses enema, 62
Monoplegia, 254
Morphia, antidotes, 211
is the nurse justified in giving,
248
, Morphin, 362
Mouth, patient's, cleansing of, 53

state of the, 46
Movements (bowel) after labor, 130
character of, 50
color of, 50

indications from, 50
composition of, 50
disinfection of, in contagious dis-
eases, 215
in typhoid fever, 216
disposition of, from contagious

cases, 215
in infant, bowel obstruction, 271
colic, 271
diarrhea, 272
in typhoid fever, 216, 278
of the new-bom, 264
Moving the patient, 57
Mumps, symptoms, 279

treatment, 279
Muriatic acid, 346
Muscles of the body :

— involuntary, 299
— longest, 299
— smallest, 299
— sterno-cleido-mastoid, 300
— the diaphragm, 300
— voluntary, 299
Mushrooms, poisonous, antidotes, 212
Mustard plaster, 106

Napkins during the puerperium, 130
Narcotics, action of, 72
Nausea and vomiting, 46

following etherization, 154, 155

of pregnancy, 119

Nephritis complicating scarlet fever,

224
Nerve-fibres, motor, 302

sensory, 302
Nerves, the, 302
action of, impulsive, 302, 303

reflex, 303
of the brain, 301
of the spinal cord, 302, 303
vasomotor, 303
Nervous system, the, 302
Neuralgia, heart. (See Angina.)
Neurasthenia, 257

treatment, 257
New-born, bathing the, 262
care of the, 262-269
dressing the cord, 263.
(See Infant.)
Nightingale wrap, 36
Nipple, cracked, 132
Nitrate of amyl, antidotes, 212
Nitric acid, antidote, 210
Nitromuriatic acid, 346
Nose, the, 303
obstruction in the, removal of, 205
spraying the. III
Nose-bleed, 197
Nurse, the, 17-28
aseptic cleanliness of, in surgical
operations, 122, 247
in obstetric cases, 122
compensation of, 19
conduct of the, in emergencies, 212
tlress and personal habits, 25
in contagious diseases, 236
in operating-room, 156
duties of the, 20

— in circumstances of envi-
ronment, 21
— in conversing with patients,

21, 22
— in dissensions, 22
— in ojxirating-room, 156
— in preparations for the

night, 21
— in preservation of confi-
dences, 21, 22
— to her superiors in hospital

practice, 23
— to the doctor, 22
— to the family, 20
— to the patient, 20

^r ^^^^^^1

^^H 446 ^^^^^^^H

Obserralions of ^mptaoH^^S^^^^H

^^^^H

^H night duty of, responsiUlity of, 19

-llie Madder, 50 ^^H

^^^H persoual bearing, iS

— Ihe boweU, So ^^^H

^^H care, iS

—the tirenth, 48 ^^^1

^^H in contagious diseases, 236

— Ibe facial expressioo, 47 ^^^1

-the menslmalion, 52 ^H

-the mouih, 46 ^^^H

^^M sympathy uid kindness of ihe,

—the 49 ^^^H

^^H tuward llie palieiil, 282

— Ihe taking of foiid, 46 ^^^^^|

^^H Nurse's equinmciit, 25
^^H for anoislelriccaK, lai

—the tongue, 46 ^^^H

of vilriol. 347 ^^B

Oils, admintslerine, 75 ,^^H

^^M meals, xt.

7S-S0 ^^H

^^B iccords. (See FfcerJ)

Olive-oil enema, 61 ^^^^H

^^H Nursing. h(>s]iila!, eliquelle in, 23

Omentum. Ilie, 308 ^^^^H

^^H ivrjuj private, 23

Ope rail ng- room, uuree's dutin ^^^^H

^^H In accidenu and eioer^ncies.

156 ^^H

^H 17^193

^^^^H in common emergency casc^, iqJ"

^^^1

selection of, 145 ^^^^^|

^H in general sureical cases, l44-«7a

the kitchen as an, 141, 151 ^^^^|

^^H in gynecoloipc cas«, 137-144

^^H in obstetric caKes, 115-137

gicol cases, 145, 146 ^^^H

^^B in special medical diseases, 213-

Operation ! ^^^H

gynecologic, ufker-cire of p>lie<^^^^^H

^H of sick children, 262-283

■43 ^^^H

^^1 private, eliquelle in. 24.

examination for. ptqaratlDit ^^^H

^F (See Patienl.)

patient, 137 ^^H

^~ Nursing of inlani liy the mother, 265
Nutritive enema, administration of.

patitnnsror. 137 ^^^H

preparation for, 140 ^^^^^^H

surgical, after-care of |Bitienl, M^^^^^l

formula: fT, 64

arranging the palienl for. ISS^^^H

frequency and aniounl of, 64

cleansing Ihe pari for, I49 ^^^^1

rclenlion of. 64

diet before, 149 ^^H

dressing the patient for, 1 jO ]^^^^l

emc^cncy, duties of (he noi^^^H

USSCKVATIONS in medical cases, 39-

152 -^^^H

food More, giving, 150 ^^^^H

— body-tcmpcratuie, 41-44

prepamlion for the, atticlca l^^^^H

— Ihe pulse, 39^1

quired. 146. 147 ^^^H

—the respiration, 44

of patient. 151 ^^^^H

— collapse. 161 ^^^^H

—chills 49

— hcmorrhaee, 161 ^^^H

— cough and eipedoralion, 47

-6hock.lS9 . „ ^^^H

^H -delirium. 4S

^^ —hiccough. 51

■ 63. 164 ^^H

^^B —pain, 47

catheteriialion aficT, 164 ^^^^H

INDEX,

447

Operations, surgical, 144-172

antiseptic cleanliness of nurse

in, 122, 247
emergency, duties of the nurse
in, 151
Ophthalmia neonatorum, 275
Opisthotonos, 190
Opium, antidotes, 21 1

-poisoning, diagnosis of, from
apoplexy, 253
Orbits, eye, 303
Organs, circulatory, 285, 300
digestive, 290, 305
of generation, fenoale, 308
respiratory, 305
sensory, 301
urinary, 293, 308
function of, 293
Os uteri, the, 308
Ovaries, the, 309
Oxalic acid, antidotes, 209
Oxygen, deficient, effect of, 290
Oysters, recipes, 322

Pack, cold, 88

hot, 89

partial, 90
" Packed feces," 50
Pads, obstetric, antiseptic, 121
Pain from burns, 198

inflammatory, cause of, 91

reporting the, of the patient, 47
Pancreas, the, 307
Pancreatic juice, 292

digestive action of, 292
Paracentesis in pleurisy, 243
Paralysis, 254

changing the patient's clothing in
case of, method, 53

hysterical, 257

of infancy, 276

treatment of, 254
Paraplegia, 254
Paregoric, 363
Paresis, 254

Paris green, antidotes, 210
Patella, the, 299
Patient, the, 39-114

administration of medicines, 70-80
— by the mouth, 74
— by the rectum, 76
— ^hypodermatic, 76

Patient, the, administration of med-
icines:— by inhalation, 80
— ^inunction, 78
after-care of, in gynecologic opera-
tions, 143
in suigical operation, 159
after-treatment of, in amputations,

•63

in abdominal operations, 163
in surgical operation, 163
arranging the, for surgical opera-
tion, 158
bathing the, 55
bodily care of, 52-59
body-temperature of the, 41
lx)we1s of the, condition of, 50
breath of, character of, 48
breathing of the, character of, 49
changing the bed-clothing of, 30^

3'
the body-clothing of, 52

chills of the, reporting of, 49
convalescent, wrap for, 36
cough of, reporting the, 47
delirium of the, character of, 48
dressing the, for surgical opera-
tion, 150
expectoration of the, 47
expression of, facial, 47
external applications to, general

and local, 81 -1 15
feeding of the, 56

rectal, 64
food taken by, record of, 46
functional disturbances ojf, relief

of. 59-70
— catheterization, 68

— douches, 65

— enemata, 59

— rectal feeding, 64

— washing out the bladder, 69

— washing out the stomach, 70

gynecologic, after-care of, 143

— the diet, 143

— vaginal dressings, 144

— vaginal tampons, 143

positions of, for examination,

preparation of, for examination,

137
for operation, 140

helpless, carrying the, 59

448 /AV

Koicut, helpless, lifting of ihe, 57,
S8
hiccough of ihe. character of, 51
menstniatlon of the, 51
inuulb of ihe, state of, 46
moving of the. 57

with fractured iitn'i 'i

ohservjition of symp
obsteUic, preporiboi
pain of the, reportii
posilioTi of, symplcHi
in gjiving vaginal .
in peritonitis, 146
prepamion of, for si
lioiM49. 15;
the mqmmg of Hu
150
pulse of the, 39
resfaralion'i of tht, 44
serving the foiKt to the, 3:
— leverages, 314
— necessity for cleanliness,
3'3.

J14

— taking the n1e.1l. 313
— varying Ihe bill of fare,
3", 3'J
serving liquids 10 the, 312
skin. etc. uf ihe, cniidiiion of, 49
syni|>alhy and kindness of the

nurse toward the, zKz
toilet of the, 53

unconscious, ndministering med-
icine to, 73
rectal feetling of. 57
urine of the, condilioii of, 50
vital (xiweis of, lowest ebli, 36
Patients, lied-, a(>)>tiances Tor the re-
lirf or, 33. 34
delirious, caution observed with,
48
Pelvis, the, 2g8

female, contents of, 298
Pep]>er, cayenne, 357
Peppermint cnmplioi, 362
Peptoniied U'ef-lea, 310
milk, 327

toast. 328
oysters, 322

Pertonition, bowel, in typhoid (ever,

compIicaiinE typh«d fever, 120

Pericardium, 300
Periosteum, 396

;. 307

iiilis, 245

»es of, 245

ition of patient in, 46, 247

tic, 165-167

iptoras of, 245

.sis. (See meefiimg.rtuxi.)

ian bark, 352

cetin. danger in use of, 239

c acid. 346

■I. 346

«iiie,348
.^^.n&sia dolens, 135
Phosphoric acid. antidijLc, 310
Fliosphonis, antidotes, 3 to
Phthisis, 236
acute, symptoms, 237

chro:

;. y?

dai^er of contagion by contact
with patient, 136

forms of, 137

nursing of patients with, 237
Physiology, 2S5-196

of blood -circulation, 3S5

of digestion, 390

of respiration, 389

of urinary function, 293
Pi a mater, 301
Picrotoxin, 353
Pillows, bed, changing the, 31
Pith, administering, 75
Pinna, the, 304

Placenta, fetal and matenial, ) 17
Plants in the sick-room, removal of,

290
Plasma, blood, 90
Plaster, canlharidat, Io6

mustard, 106

removing a, method of, 178
Plaster of Paris, 350
Pleura. inHammation of. (See

Pln,ri,,.)
Pleurisy, 243

|>osilion of patient in, 46

symptoms of, Z43

INDEX.

449

Pleurisy, treatment, 243
Pneumonia, croupous, 240

symptoms, favorable and unfa-
vorable, 240
treatment, 240
" double," defined, 240
Poison defined, 208
Poisoning, accidental, 208-212
what to do in case of, 208
by tainted meats or fish, antidotes,

212
carbolic-acid, from absoiption,

symptoms, 169
from ivy, treatment, 210
induction of vomiting in, 209
iodofoim, from absorption, symp-
toms, 170
mercurial, by inunction, symptoms

of, 79. 169
septic, from catheterization, 68
Poisons, classification and action of,
208
irritant, 209

action of, 208
narcotic, 211
action of, 208
Polyarthritis, 259

Position, change of, by patient, favor-
able sign, 46
for gynecologic examination, 137
— dorsal, 137
— knee-chest, 139
— Sims, 138
— upright, 140
for surgical operation, 148
Trendelenburg, 148, 149
Potash, antidotes, 210
Potassium carbonate, antidotes, 210
Poultice, the, action of, 91
boric-acid, 100
carbolic-acid, loo
corrosive-sublimate, 100
creolin, 100
green soap, in surgical operations,

150
renewal of, on sleeping patient, 97
Poultices, 95-101

— antiseptic, 100
— bread, 98
— bran -jacket, 98
—charcoal, 98
— flaxseed, 95

Poultices : — green-soap, 100

— hop, 100

— ice, 100

— ^jacket, 97

— mustard, 98

— slippery-elm, 100

— spice, 99

— starch, 99

— yeast, 99
method of applying, proper, 96
renewal of, frequency, 96
Powder, apj)lying, to the throat,

method of. III
Powders, administering 74
Pregnancy :

— abdominal enlargement,
rate of, 116

— conception, 116

— date of confinement, 116

— disorders of, 119

—duration of, 1 16

— fetal movements, 118

— fetus, the, 117

— nurse's preparations for the
confinement, 120

— signs and sym|)toms of, 115

— termination of, 120
disorders of, 1 19
extra-uterine, 136
Presentations in labor, 122, 123
Prostration, nervous, 257
Protrusion, Iwwel, of infancy, 275
«* IVoud flesh," 189
lassie acid, 346
antidotes, 209
Puddings, recipes for, 323
Puerperium, management of the, 129

— breast-bandage, 132

— care of the breasts, 1 31

— catheterization, 129

— lactation, 131

— the after-pains, 131

— the diet, 130

— the lochia, 130

— the napkins, 130

— the temperature and pulse,
130
j>athology of the, 1 33 -1 36

—eclampsia, 135

— hemorrhages, 133

—insanity, 135

— phlegmasia dolens, 135

Puerperium, palhology of the; — sepli-
cemia, l^
— [hrumbosia, 136
Pulse, the, 39-41

"dicrolic wave" nf, 40
duiiTi); ilie pueriierium, 1 jo
frequetiiry uf, 40

in htniorrhage (ol
opera iton, 1
in septicemia, 166
in shock, 160
in Aniall'pox, 336
in typhoid ftvct, 311
in lyphiis fever, 315
in uremia, 250
of infancy, l^]^
tailing of the. 40

— C(im|.iressib1e, 40
— Jierotic, 40
— ^frequent, 40

— highJenaion, 40
-—incompressible, 40
— inlemiillent, 40
— irregular, 40

— rapid, 40
— regular, 40
—running, 40
I'ulse-rale, 39-41
at puberly, 41

conditions influencing the, 39
influence of body-tempeialure on,

42.43
in sepdcemia, 166
normal, 41
of infant at Urth, 41, 269, 377

rate of decease. 277
of infants and children, 41
of the aged, 41
Purgative enemata, admjnislraljon of,
61,63
formula for, 63
Purgalives, administering, 75
Pyemia, symptoms. 190
treatment, 190

Quicksilver. 362

Quinia, antidotes, i

Radius. Hi e, 399
Rash. (See £/w/Vm«.)

beef-leas and extracts :
—beef-essence, 319

— tKef-extraci, totllcr

— liecf tea, 319, jit)
— l>ei;f-lea. iie^itunicei
— licef-tea with oaliii
venues :

— cliocolate, 333
—cocoa, 333
— coffee, 333
—coffee, crust. 333
— coDec, nutritious. 3
— coffee, riie, 334
—egg-nog. J

'«i.\ '

334

nade. egg, 335

— milk, steriliied, 335
— ^m ilk- punch, 335
— orangeade, 336
— sherbert, lemon, 334
— sherbert, orange, 336

—lea, flaxseed, 336
— water, albumen', 336
—water, apple-, 336
—water, larley-. 336
— water, gum-arabic, 337
—water, rice-, 337
— wuer, tamarind-, 337
—matt, toast., 337
— wine, mulled, 335
broths:

— chicken, 331
— H:lain, 311
—mutton, 331
—oyster, 333

— apples, baked, 339
— cream. Bavarian, 329

—cream, tapioca, 330
— cream, whi|^>ed, 333

— Irish moss, blanc-mange,

331
— jeUy. cairi fool, 330
— jelly, lemon, 330
—jelly, orange, 330

Record, nune's, of food taken bf

milk, 331

palieni, 46

_irlly.wii.e.33.

of pulse, leminrralnre, and rea-

-junket, 331

of, 45

—rice blancmange. 3*9

of symptoms, 4S-S»

— snoweEEs. J3J

Records, nune's, keeping the

2S-»«

—soft cuslnrO, 319

Rectal doiicbe. 67

-wliey, wine, 33*

Keclum, Ibc. 308

gas. jHssagc of, 50

— anowroot, 317

mcdidnc'S .vlminisLcred by Ibe, 76

—corn -March. 318

temperature in, takii^ the.

— ttuel. h'ulecIHuur. 318

Keflex action, 303

—gruel, oalme.ll, 318

Relapse in typhoid fever, 216

— gniel, tice-ttour, 318

Reports, noTse's, essentials of the.

—oatmeal, 318

milk:

method of makinp, 26, 27

-k..iTmv^., ^i^

Respiration, 45, 46, 2S9

— l)g]Hiim/.-il, JI7

— sago. 3»7

drowned, 201, 202

in shock, 161

—chicken panada, 316

of ilie now botn. 127

— eK*. poached. 325

Cheyne-Sl.,kes 45

condilions influencing the,

— ccip, soft-boiled. 316

mechanism of, 389

-infaiil's food, 326

normal, 44

— mncaruni, 325

of infancy, 45, 377

— omeler. 335

of the new-bom, first, 125

—potatoes, creamed, 325

lakine the, 44

oysters:

Rest for iiitlammiiion. loj

—broth, 323

in after Ireatmeni of s

urgictl

Rest-cure, 257

—stewed, 31a

Retention of urine of Ihc ne»

bom.

p.KldL„RS:

264

treatment of. 203

— com-flour, 323

Khciiniali.ni. 258

— custaiil, 323

ntlkul.17 iicute, 258

—rice. 323

cumpliMliiinsof. 259

-sago. 323

—snow, 324

muscular acute, 259

soups:

tinisin^in,2^1%

-chicken, 324

ircnlment. medidnnl, 259

-mullon. 324

Kil«. Ihc. agy ,

— polain, 324

— while-celery, 324

toaits:

reatmcnt of. i J3

Rincworm, 260

-cream loasl. 328

Rntlielk hnit, 364

—Iry loa«. 328

enema r)f, 62

—tf.fi, toast. 328

Rcller-handages. I78-183

-milk loa.t, 328

-milk .O.S., «p.oni«d. 328

Room <lisinrcclion by conosi
limate solution, 235

e-sub-

45S

Room Icmperalure

lalicnlE, 25s
TegulatioD of, 37

Room-venlilaiion, 37

in Bcarlel-fcver cases, 333
Rubcracieuts, 104

Sachum, xgS

Si. Vitus' danec. (S(
Saliva, digeslive ndiui
Sail enema, 63

-solution, 1 6a
Sand-Uijrs, how made,
Sartcjrius, 399
St^Jies. 359
ScaltJs. (See Siirmi at
Scapula, the, 39S
Scarlalina. (See Seartti
Scarlel ferer, na-ss;

CompIicMions of:
— dropsy, 224
—nephritis, 214
— uremia, 224

convalescence of, 325

delirium of, 115

depression in, 225

disinfection in, 323

malignant, 232

room- vent ilalioD in, 223

syiii|)(oTns of, 22z

treatment of, 222

uremic convulsions of, Ireatnient,
224
Scarlet-fever tongue, 47
Screen, l>ed-. improvised, 34
Sea-bathing, 82
Secretions, body, 292
Se<laiives, action of, 73
Sejeis after childbirth, symptoms, 131

death from, resjxinsibilily for, 166
Be|iticemia, 165

puerpeml. 134

symptoms, 166

trenlment, 166, 167
Ser|)cnt-I>ites, treatment, 212
Sheet-bath (dripsheet), 87
Sheets, bed-, changing of, without
removing the patient, 30, 31
Shingles, 260
Shock, botly-

IMDEX

theumalic j Shuck, from bums, 19S

from surgical opemtiott, I
respiration, artiBeial, in, I

syniptani->i. 160
133 I trealmcnt, 160

Sliudder-blade, 39S
■■ Show," f

3ii-J"7
crving the food in, 3? i
oom, the, 19-38
of the, 37
Doling the, 37
ring of the nurse in, 18--33
, pK]iaratiaD of, 39
: of the, 36

ss of the nune in the, 25
[uelle of the, 14
ligation of the, aOer Contagious

kcfping the ri- cords, mtlhods of,

25-27
plants ill the, removal of, 290
pre|iaralion of. 29
removal of excreta from, 38
selection of, 20
temperature of, 36
regulation of, 37
venlilalion of, 37, 38, 223

ptutectioii of palieni during, 38
Sigmoid flcKure, 307
Sign of labor, tiisl, 123
Sigtis of pregnancy, |xisilive, llC
probable, 115
"vital," the three, 39
Sinus, 192

Sitz-lialh, action of, 82
Skin, anatomy of the, 296
color of, canse of, 296

— eciema, 239

— herpes losier, 260
— ringworm, 260
— scaliies, 259

of the patient, color of, 49

redness of, inflammatory, cause of.

icing.

160

INDEX.

453

Sleep, taking of, by the nurse, 21
Sleeplessness, treatment of, 206
Small-pox, 226-228

confluent, 227

malignant, 227

nursing-treatment, 227, 228

pitting of, prevention, 228

symptoms, 226
Smoke, escaping through, how to
prevent suffocation in, 203
SnufHes of infancy, 276
Soda, antidotes, 210
Sodium carbonate, antidotes, 210
Solutions, antiseptic, 341
Soups, recipes for, 324
Spanish flies, 351
Spanish-fly blister, 106-108
Spinal column, 298

cord, 301
Spleen, the, 307
Splint, coaptation, 186

improvised, in fracture, 173

pliler-of- Paris, 186
how to remove, 187
Splints, 186, 187
Sponge-hath, 55
Sponges, gauze, 147

sterilizing the, 172

surgical, attention required of the
nurse in handling, 157,

158

Sprains, treatment, 176

S|)rays, no

Sputum, disposition of, in infectious

diseases, 48
Sputum-cup, 48, 236, 241
Stages of normal labor, 1 23-1 25
— first stage, 123
— second stage, 124
— third stage, 125
Stapedius, 299
Stapes, 297

Starch-and-laudanum enema, 62
Steam-bath, acid, action of, 86
Sterilization by l)oiling water, 152
for surgical operations, 147
milk, 266

of foods. (See Recipes.)
of gauze sponges, 172
of nurse's hands, importance of,

156, 221.
of suture-materials, 171

Sterilization of utensils, etc. used for
surgical operations, 157,
171, 172
personal, of nurse, for surgical
operation, 156, 157

surgical, I47» I5>. 'S^
Sterilized milk, 335
Sternum, 298
Stimulants, action of, 72

alcoholic, in treatment of hemor-
rhage, 194

per rectum, effect of, 64
Stimulating enemata, 63
Stomach, the, 290, 305

bleeding from the, 196

food-changes in the, 292

inflammation of. (See Gastritis.)

washing out the, 70
" Strawberry-tongue," 47, 222
Stretcher, improvised bed-room, 59
Strychnia, antidotes, 21 1

as a heart -stimulant, 161
Stupes. (See Fomentations.)
Subinvolution of womb, 126
Suffocation from drowning, treat-
ment, 201
Sugar in the urine, Trommers' test

for, 295
Sugar-water, 267
Sulphuric acid, antidotes, 210
Sunburn, treatment, 206
Sunstroke, 200

Ixxly-temperature in, 42, 200

symptoms, 200

treatment, 200
Suppositories, introduction of, 76
Suppuration, 189
Suture, button, 171

continuous, 171

interrupted, 171
Sutures, materials of, 17 1

sterilizing of, 1 7 1
Suturing, 171

Swallowing, involuntary, how to in-
duce, 252
Sweeping and dusting the sick-room.

Sweetbreads, cooking of, 321
Sweet oil, 363

spirits of nitre, 355
Sweliinij, inflammatory, cause of, 91
Symptoms, observation of, 45-5^

^^v h^^^^^^^^l

^^1^ ^^^^I^^^^^H^^^^^^I^^^^^^I

^M 4S4 ^^1

^H Syncmnl flui.l. 197

Tepid balh, action of, 83 ^^^^|

^M Syringe, founlain. uses of, 3$

Telaniis, I90 ^^^^1

^^M hard-rublier, lo |«evenE lEak]^e of,

^H hypodcimic. care of the. 7S

treoiment, 190 ^^^H

^^1 inelhoil of using Ihe, 77

Thermonieier, batb-, 81 ^^^H

^^H Syringing ihc eyes of infants, method

clinit^l, Ihe, 43 ^^^H

^H 275

Thigh-bone. (Sec^.^H>-.) ^^^H

ThiTsi in hcmorrhaee, 196 ^^^|

^^B TAKi-ii, eyDccotogic. 141

relief of, by bathing. Si ^^^1

^H Tal>le sail. 366

after apeiation. 163 ^^^^|

in typhoid fever, relief of, 218 ^^^H

^m Tan<|>oii. kite-tail, 144

Thorax, 197 ^^H

^H Tampons, vaginal, 143

Throat, gargling and spraying iM^^^I

^^H Tartar emetic, 348

no. Ill ^^^H

^^M Tanoric add, aniidoles, 109

precaution; III ^^^^H

^^1 TeirsaeeffheninranlRnt sheds, 26S

□bslrudion in (he, removal d^^^^l

^^H

^H Teelh, age when erowth of ibe, 1>e-

sore, hot-water gaiglii^ in, 1 11 ^^H

H gins. 368

^H developmenl of Ihc. zGS

^H Teething of infancy, 274

Tibia, the, 299 ^^^1

^^1 Temjieralure, body-, 41-44

Toasts, recipes for, 318 ^^^^1

Toilet of the palieni, 53-56 ^^^H

-b»h!The.S5 ^H

-bed-pan, Ihe, 56 ^^M

^^1 daring the pucrperiom, 131

-care of the body. 54 ^^M

-clKuising Ihe inoalh, 53 l^^^M

^^m incerebro-spinal meningilis.zSl

-dressing Ihe hair, S3 _^^M

223 ^^^H

^^™ in faemonhige, 160, 161

coated, in fevers^ 40* 47 ^^^^^^^|

in meaEles. 218

infant's, how to see the, 276 ^^^^1

in peritonitU, a4S

" sirawbcny." 47. 312 ^^^H

Ton^-ue-tic. 276 ^^H

in scarlet fever. 213

in septicemia. 166

Tonics, action of. 72 ^^^^B

in shock, 160

in smail-pox, 22G. 237

Tourniquet. 195 ^^H

in sunstroke. *oo

Trachea, Ihe. 305 ^^^H

in tetanus. 42

Tracheolomy, after care in, 232 ^^^^

in typhoid fever. 215

in typhus fever, laj

duties of the nurse, 131

of infant at binh. 269

in scalds of Ihe glottis. 198

of infantG, how tu take Ihe, 276

Tracheotomy-tube, care of the. atfc 1

>33 ^^IH

taking at the, 43

reflation of. 37

Tulvbath,ss.S3 ^^H

^_ Tendo Achillis, 300

Tuhes. (.ronchial, 305 ^^^H

^L Tendons, 300

Fallopian, 309 ^^H

^M Tents (surgical), 177

Turi^nline enem*. 62 ^^H

INDEX.

455

Tympanites in typhoid, cases, relief

of, 221
Tympanum, the, 304
Typhoid fever, 215

bed-sores in, prevention of, 221

body-temperature of, 215

excreta of, disinfection of, 216

coating of, tongue in, 46, 47

complications of, 219

— hemorrhage, 219, 220
— perforation, 220

convalescence, management of,
221

diet in, 217, 218

nursing in, 216

of children, 278
treatment, 278

period of inculcation, 215

relapse in, 216

symptoms, 215

synonyms of, 215

tepid baths in, 219

the eruptions in, 216

thirst in, relief of, 218

treatment of, 217-222

tympanites of, relief of, 221

walking, 221
Typhas fever, 225

complications of, 226

symptoms, 225

treatment, 226

Ulcer, 192

Ulna, the, 299

Union of broken bones, process of,

173
Uremia, 250

complicating scarlet fever, 224

symptoms, 250

treatment, 250
Ureters, the, 308
Urethra, the, 308
Urinalysis, 295
Urination of infant, 264
Urine, the, 293

abnormalities of the, 51

albumin in the, 294
test for, 295

amount of, conditions affecting the,
293, 294
in diabetes mellitus, 293

color of, 293, 294

Urine, color of, conditions affecting,
294
composition of, 293
excretion of, in pleurisy, 243
incontinence of, 50, 119

in children, 279
in diabetes, 258
odor of, 293, 294
of the patient, condition of, 50
of the pregnant, attention to, 119
passage of, 50, 51

points to be noted, 51
quantity of, normal, 293
reaction of, 293

method of determining, 294
retention of, by the new-bom, re-
lief of, 265
danger of, 308
in typhoid fever, 217
treatment of, 203
specific gravity, 293

method of ascertaining, 294
sugar or urea in, 294

test for, 295
suppression of, from cantharidism,

107
testing the, 295
Urinometer, 294
Uterus, the, 308

Vaginal douche, administration of,66
apparatus for, 65
purpose and effect of, 66, 67
Valve, mitral, 287

tricuspid, 287
Valves, heart, 287

semilunar, 287
Vapor-baths, action of, 81,83
Varioloid, 227
Vein, jugular, 300
Veins, the, 286

hepatic, 289

pulmonary, 287
•« Vena portoc," 288
Ventilation, sick-room, 37, 223
Ventilator, window, 38
Ventricles, heart, 287
Vermiform ap})endix, 307
Vermin, head, extermination of, 53
Vemix caseosa, 262
Vertebrae, 298

cervical, 298

456

INDEX.

Vertebrae, dorsal, 298

lumbar, 298
Vesication, 105
Vestibule (ear), 305
" Vital signs,'* the three, 39
Vomiting, induction of, in poisoning,
209

in ether anesthesia, 154

in septicemia, 166
treatment of, 167

of infancy, 272

of patient, symptoms of, 46

repetition of dose after, 76

treatment of, 206

Wafers, medicine, 74

Warm bath, action of, 81, 82

Water-bed, 33

Water-dressing (surgical), 176, 177

Waters, mineral, alkaline, 337

carbonic acid, 338

chalyl)catc, 338

purgative, 338

saline, 339

sulphuretted, 339
Weaning infant, time for, 268
Weights and measures, 340

Wharton's jdly, 118
Whispering in the sick-ioom* 34
Whoqping-cough, 238

complications af, 239

symptoms, 238

treatment, 239
Witch-hazel, 358
Womb, the, jc^

involution and subinvoliitioii ol^
125, 126
Wood-oil, 349
Worms of infancy, 274
Wound, contused, VS^

defined, 188

punshot, 188

incised, 188

lacerated, 188

nuise^s prepanuion of a, for the
surgeon, 177

poisoned, 188

punctured, 188
Wounds, 188-191

ase|itic and se|)tic, 188

dangerous sequels of, 1 89-191

healing of, 1 88

su]Y|)uratiun of, 189

varieties of, 188

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MANUAL OP MATERIA MBDICA AND THERAPEUTICS.

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NOTES ON THE NEWER REMEDIES: their Therapeutic Ap
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DISEASES OF WOMEN. By Henry J. Garsicues, AM., M.D.,
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FfBU.lt Grnit»l«.-Aoalomy of (hi Pemile F
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A SYLLABUS OF GYNECOLOGY, arranged in conformity with
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SYLLABUS OF OBSTETRICAL LECTURES in the Medical
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MUHHIS, M, [),

5. 9. ESSENTIALS OF PRACTICE OF MEDICINE.

MoRKis, M. D. An A^'cnilii on UmsE ExAMlNATlor

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VENEREAL DISEASES. 2d edition, revised and enluged. 76
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13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY. AND

HYGIENE. 130 diiutiations- By C. E. Armand SEMfLK. M. D.

14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND

THROAT. 1J4 illustrations. 2d edition, revi-ed. By Edwam)

Iackson, M. 1).. and E. Baldwin Gleasiin. M. D.
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18. ESSENTIALS OF PRACTICE OF PHARMACY. By L. E,

SaVkE, 2d edition, revised.

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11. ESSENTIALS OF NERVOUS DISEASES AND INSANITY.

48 illu.slraiiuns. 2d edition, revi.sed. By Joits C. Shaw, M. D.
32. ESSENTIALS OF MEDICAL PHYSICS. 155 illui^tratiotis. id

edition, revised. By Frkii J. Brockv-AY, M. D. (Price, Jl.oo n«.)
23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illuslT^ions.

By LlAVlii |) SrtWARr, M. n., and EuwARD S. Lawrance, M. D.
^4. ESSENTIALS OF DISEASES OP THE BAR. By E, B. GLaA>
M. U. S9 illuslratioiii.

JUST PUBLISHED.

OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA- I

TIONS. liy L, Cll. [tiilM.iMKRl'^ M. D., Kmerims Professor of Ohstel- ■

rid in tht St, I-ouis Medical College, elc. limo. Hnndsomely illuslrued. fl

Price, $3.00 net

" For ihe use of Ihe practitioner who, when away from home, has n

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guiding nnd uaiBling him in emergencies."

FORTHCOMING PUBLICATIONS.

AN AMERICAN TEXT-BOOKOF APPLIED THERAPEUTICS. 1

Edited by J. C. WiisoN. M. D.. Trofcssor or lli.j I'inciict of Meilieii
of Clinical Medicine, Jeffen-'.n College, I'ljiladclphia.

AN AMERICAN TEXT-BOOK OK PHYSIOLOGV. Edited bfM
William H. Howelu I'h. L»,. M-D., Prufeisor of Physiology i
Johns Hopkins Univcreity, Balliniorc, Md.

SURGICAL DIAGNOSIS AND TREATMENT. Ry J. W. MAofl

DoNAtj), M. D., (liailuale of Medicine of the Uiiivi^i^ity of Edinbu^; ff
Licentiate of the Royal Coli^ of Surgeotis i>( Edinhurgli ; Professor of
■he E^actice of Surgery and of Clinical Surgery in Minneapolis College of
Physicians and Surgeons; Surgcott lo Wisconsin Central Railway, etc.

TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, AND J
PHARMACOLOGY, liy Uti.RCR K. Huii.uk. Pli. <;„ M. D,. Piw-I
fr^s-wof Miiieriii Medici and of Oinital Medicine, t^ollcee of Pliysiciam j
and Surgeons, Chicago, 111.

TEXT-BOOK OF EMBRYOLOGY. By }i

ProBcclot to ihe ProfesBot of Analom)', Mcdi
veisity of Pennsylvania,

ESSENTIALS OF EMBRYOLOGY. Py J. P, Tit

I)cmon*lr.ilor of Anntoiny, L'niverwty of P«nn>-ylvi

MANUAL OF DISEASES OF CHILDREN. By W. .S. Cliltl»
i, M. D., Professor of Diseases of Children, Chicago Pclyclini

LANGUAGE OF DISEASE. Hy S.

LAXn MEDICAL LIBRARY

To avoid fine, this book should he rctnnied on
itr before the date last stamped below.

V41 Stoney, S,X.A, 46912
|S8e Practical points is
1896 nursing.

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